When should a patient with low back pain get an xray/MRI?

Posted on January 17, 2013 by drlesliegreenberg

I love this question.  The research-tested answer is that routine imaging for patients with low pain is not warranted.  In fact, routine x-rays are associated with increased cost, poorer health in recipients, increased risk of surgery, and no reduction in patient anxiety.

Imaging is needed if there are “red flags.” If cancer is a possibility, inability to control bowel or bladder functioning, fever, or severe neurological deficits.

X-rays should be performed if trial of therapy hasn’t worked, ankylosing spondylitis (an inflammatory problem) is suspected,or older patients with risk factors for a spinal fracture.

MRI imaging should be limited to patients with nerve pain or symptoms of spinal stenosis–when symptoms do not respond to therapy.

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How many blood pressure readings are needed to accurately diagnose high blood pressure?

Posted on January 14, 2013 by drlesliegreenberg

Answer:  Several.  The blood pressure measurements should be taken over time.  Your doctor will want the individual blood pressures, but may also average them to get your “true” blood pressure.  Use of a single blood pressure to determine whether blood pressure is controlled will yield a false result more than 20% of the time.

Take home thought: Between physician visits take your blood pressure at differing times of the day (most pharmacies have a self-starting blood pressure cuff), record all the blood pressures, and bring that list to your next office visit.

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Want weight loss?

Posted on January 10, 2013 by drlesliegreenberg

“Success travels in the company of very hard work. There is no trick, no easy way.” John Wooden (former long-time successful UCLA basketball coach)

Food is for fuel. Eat when hungry, not by the clock. Resist advertising. Be aware of portion size.

Need encouragement? Nearly 45% of adults have pre-diabetes or diabetes. 90% of type 2 diabetes can be prevented with lifestyle changes and weight loss.

How to start…

  • Consider the first month eating ½ of the amount you used to eat.
  • Don’t drink your calories.
  • Then second month continue eating ½, but exchange sugary/fried foods for healthful foods.
  • And, start exercising 30-45 minutes 4 times a week.

This is a start. Your mindset (with regard to your diet and exercise AND health) must change for long-lasting health results.

Start today!

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Is stopping smoking on your New Years resolution list?

Posted on January 7, 2013 by drlesliegreenberg

20% of US population smokes, 100% know that smoking is bad.

Smokers use 18% more healthcare costs.

The number of times smokers tried to quit before they were habit-free:

  • 1 time: 40%,
  • 2-3 times 38%,
  • 4+ times 22%.

Stay in there!  Be persistent! Have a plan.

Nicotine replacement may cost $40/month, some pills to help stopping cost $100/month (the same cost as a one ppd habit).

Consider environmental changes  (get rid of cigarettes, ashtrays, lighters), Perform routine changes, Consider substitutes (gum, candy, straws) to keep your mouth and hands busy.  List rewards (financial, health, family).

Sources of help.  1-866-KANSTOP, 1-800-QUITNOW, http://www.familydoctor.org

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Hypnosis for hot flashes? Hooray for complementary medicine.

Posted on January 2, 2013 by drlesliegreenberg

Hypnosis may ease severe postmenopausal hot flashes. Five sessions reduced severity of postmenopausal hot flashes by 80%. Wow! This study had 184 women with moderate to severe hot flashes. Hot flash frequency and severity fell by 70% at 5 weeks and even further to 80% at 12 weeks (which was 7 weeks after the intervention ended).

This intervention entailed hypnotic induction with relaxation and direct and indirect suggestions, dissociation, and mental imagery evoking coolness (such as visualizing yourself walking down a mountain path on a cool day). Emphasis was placed on teaching patients self-hypnosis and patient empowerment.

I love it!

“Give a man a fish; you have fed him for today. Teach a man to fish; and you have fed him for a lifetime”—Author unknown

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Constipation

Posted on December 30, 2012 by drlesliegreenberg

Constipation is a common digestive problem. Your stools may be very hard or you may have a sense of fullness even after a bowel movement. It’s not true that you must have a daily bowel movement to be “regular.” The normal frequency range is three times a day to three times a week.

What can you do to avoid constipation?

Eat more fiber
Drink eight 8-ounce glasses of fluid a day (nonalcoholic)
Exercise often as it helps the bowel move the stool along
Limit high-fat and high-sugar foods
Eat more fiber (at least 2 cups of fruits and 2 1/2 cups of vegetables per day are recommended)
Don’t use laxatives too often (it can damage the bowel and make constipation worse).
Don’t resist or ignore the urge to have a bowel movement.

Hope this helps.

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Multivitamins do not cut cardiovascular events

Posted on December 27, 2012 by drlesliegreenberg

What does this mean? Behavioral interventions such as exercise and medications for cholesterol-lowering therapist CAN lower cardiovascular disease risk. Multivitamins daily did not provide any cardiovascular benefits.
There was a study of nearly 15,000 male physicians and rate of cardiovascular events (heart attack or stroke) who took daily vitamins for 11 years was 11.0/1,000 person-years compared with 10.8 events/1,000 person-years in those taking placebo (fake pills).

The message from this study: Eating healthy foods, exercising regularly, avoiding tobacco products and taking proven medications to decrease cardiovascular events DOES help, multivitamins do not.

Source: JAMA 2012; 308: 1751-60.

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Wanting to avoid holiday weight gain?

Posted on December 12, 2012 by drlesliegreenberg
flickr.com/ photos/ reallyboring/ 2860775800

flickr.com/ photos/ reallyboring/ 2860775800

Follow your bodies “satiety signals”– your body’s ability to gauge that you have eaten an appropriate amount.

1.  Mindless or distracted eating (like standing/talking/AND eating or eating while driving) can make food-intake-memory fuzzy.  This seems to override the effects of the body’s satiety signals.

2.  In a 2006 study, when people ate what was named a “meal” they consumed less at the next meal than when the same amount of food was named a “snack.”

Take home points: Pay attention to your food during mealtime and consider it a “meal”, not a snack.

Enjoy the holidays!

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Circumcision may lower prostate cancer risk

Posted on December 11, 2012 by drlesliegreenberg
flickr.com/ photos/ blmiers2/ 6904758951

flickr.com/ photos/ blmiers2/ 6904758951

Interesting study involving 3,399 men. It was found that men who are circumcised before their first sexual intercourse have significantly lower risk for prostate cancer than do uncircumcised men (or men who are circumcised after their first sexual encounter).

The scientists found a 15% reduction in relative risk. They postulated that infectious or inflammatory pathways may be involved in the changing of the prostate cells to cancer. A 1987 study also linked circumcision to reduced prostate cancer risk.

Hmmmm.

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Breast cancer pill rethought

Posted on December 7, 2012 by drlesliegreenberg
flickr.com/ photos/masterslate/ 3003880273

flickr.com/ photos/masterslate/ 3003880273

Tamoxifen is used in the hopes of stopping a  breast cancer recurrence.  For 15 years the standard has been to take a tamoxifen pill once a day for 5 years.  And then stop.

There is new research that women who take tamoxifen for 10 years may have significantly less chance of breast cancer recurrence.  Read on…

http://www.nytimes.com/2012/12/06/health/extended-use-of-breast-cancer-drug-suggested.html

Hope this helps.

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