The race is on!

Posted on December 4, 2012 by drlesliegreenberg
flickr.com/ photos/cups/ 4339100355

flickr.com/ photos/cups/ 4339100355

It’s off with a start!  Quickest start in 10 years!… I wish I were talking about the Kentucky Derby, but I am talking about the flu.  There is still time to get vaccinated.

Who should be vaccinated?  Anyone older than 6 months.  That includes pregnant women, children, asthmatics, those with chronic health conditions, and everyone else!

You CANNOT get the flu from the flu vaccine.  CANNOT.  Avoid a week of muscle aches, inability to get out of bed, high fever and a cough.

See your doctor today for a vaccine.

Posted in General Medicine- Adults, Obstetrics, Pediatrics, Uncategorized, Vaccines, Vaccines, vaccines | Tagged , , , , , , , , , | Comments Off on The race is on!

Carpal tunnel. Who? What? Why?

Posted on December 3, 2012 by drlesliegreenberg

Who?  Anyone can suffer from carpal tunnel syndrome.  It is often associated with repetitive motion at work or play but also frequently occurs in people with diabetes, thyroid disease, or in pregnant patients.

What?  Carpal tunnel syndrome occurs when the median nerve gets squished in the wrist.

Why?  Think about all the structures that need to help our fingers move: arteries, veins, nerves, tendons. It’s amazing there’s enough room for all that–so any swelling within the carpal tunnel tips the scale . . . and the hand has symptoms.

Common symptoms are

  • numbness,
  • tingling or pain in thumb, index or middle fingers,
  • swelling and tightness in the hand,
  • pain that shoots from your hand up through your arm,
  • numbness in the entire hand.

Associated symptoms include

  • difficulty holding (or dropping) objects,
  • numbness that’s worse at night or in the morning,
  • weakness in the hands or arms in the morning,
  • trouble opening a lid on a jar or using a screwdriver.

Treatment depends on the severity and frequency of symptoms.  Early diagnosis is important to successful treatment.  Options may include stretching, wrist braces or splints, physical therapy, anti-inflammatory medicines, strengthening exercises, cortisone injections, or surgery.

… I’m having an Abbott and Costello flashback.  Who is on first? What is on second?  I don’t know is on third?!

Posted in General Medicine- Adults, Obstetrics, Uncategorized | Tagged , , , , , , , , , | Comments Off on Carpal tunnel. Who? What? Why?

Sleeping too much or too little has risk.

Posted on November 27, 2012 by drlesliegreenberg

flickr.com /photos/mart3ll/ 255289520

Heart health is tied to how much sleep you get.  There is an optimal amount of sleep: 6-8 hours per night.

Those who slept less than 6 hours per night had twice the risk of heart attack or stroke compared to those who slept 6 to 8 hours per night.  Studies have linked insufficient sleep with

  • hyperactivation of the sympathetic nervous system,
  • glucose intolerance,
  • an increase in cortisol,
  • increase in blood pressure,
  • decreased variability in heart rate,
  • disruption of hypothalamic axis, and
  • increase in inflammatory markers.                               Wow!  All bad things!

Those who slept more than 8 hours per night had a twofold increased risk of heart pain (angina) and an increased risk of coronary artery disease (which may lead to heart attack). It is postulated that patients who sleep more than 8 hours per night may do so because of an underlying condition like lung disease, diabetes, or low socioeconomic status which all could contribute to cardiovascular risk.

Hope this helps.

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Reducing waste in healthcare

Posted on November 23, 2012 by drlesliegreenberg

flickr.com/ photos/ nickhumphries/ 2215306696

Choosing wisely?  Choosing Wisely campaign is a coalition of medical societies and physician groups that wants to reduce waste in healthcare.  Here are a few examples of wasteful use of healthcare dollars (because treatment frequency is not justified by the medical literature)

  1. EKGs and exercise stress tests for heart disease
  2. Imaging tests for lower-back pain
  3. CT scans and MRIs for headaches
  4. Bone-density scans (DEXA scans) for low-risk women
  5. Antibiotics for sinusitis

Want to see more?  Visit http://choosingwisely.org/

Posted in Uncategorized | Comments Off on Reducing waste in healthcare

70 is the new 100!

Posted on November 19, 2012 by drlesliegreenberg

flickr.com /66109304 @N00/ 486082775/

What?  There are new guidelines on lowering cholesterol.  We have, for years, targeted  LDL (the bad cholesterol) to be under 100 in at-risk patients.  Now, the LDL target number is under 70!

An LDL below 70 mg/dL should be the goal for all patients with coronary artery disease, or those with diabetes plus at least one additional risk factor (smoker, high blood pressure, history of stroke, chronic kidney disease).

Be aware of your risk factors. And, get to goal!

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Falls among the elderly can be decreased.

Posted on November 15, 2012 by drlesliegreenberg

There are many treatments to decrease falls in the elderly that’ve been not helpful.   Home-based and group exercise intervention programs help the most (for elderly living in their own home)!    A second factor to reduce falls is “home safety interventions” when done by occupational therapists.

Treatments which have not been shown to help are

  • walking programs,
  • hormone replacement therapy, and
  • adjustment of medication regimens,
  • cognitive behavioral therapy,
  • vision improvement interventions, and
  • withdrawal of psychotropic drugs,
  • vitamin D supplementation, and
  • nutritional therapy.

The above information was collected by the 2012 Cochrane Database.  These combined studies performed in 21 countries and included 79,193 patients.  Other specifics include the fact that vitamin D supplementation only helped decrease falls they were vitamin D deficient.

The most successful exercise programs included more than one of the following techniques gait training, balance training, functional training, muscle strength/resistance training, tai chi, walking and 3-D training which is constant, repetitive movements through all three special planes.

If you (or a loved one) need help, please get it.

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What should I bring when going to the doctor?

Posted on November 12, 2012 by drlesliegreenberg

The well-heeled patient comes to the office with information about themselves, their family, and some paperwork!  All of these allow me to care for you more fully at that visit, while we are face-to-face.

  • Immunization status.  This is important for children for their overall health (and because the school system will require them for school entry and sports clearance) AND it is important for all adults.  Usually, the last time adults think of their own vaccines is when they go off to college.
  • Drug allergies.  It’s important to know what medications you are allergic to AND the exact reaction you had.  Did you have to go to the emergency room?  or was it an intolerance to a drug (like stomach upset).  The more specific you can be, the better.
  • Names and dosages of current medicines.  This includes everything: over the counter medicines, supplements, herbal remedies, and prescription medicines.
  • Prior surgeries and conditions.  Did you have your appendix out?  This will alter the physicians care of you with abdominal pain in the future.
  • Family history.  Keep track of your parents’ and siblings’ medical problems especially if there were premature deaths (meaning men before age 55 and women before age 65).

Bring your best, most complete self to the doctor’s visit.  You’ll get more complete care.

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To circumcise or not?

Posted on November 9, 2012 by drlesliegreenberg

flickr.com/photos/ bain/ 731005089
Were you expecting a different picture?

Did you know that US circumcision rates have decreased from 79% to 55% in the past 20 years?  This has resulted in an estimated $2 Billion (Yes, billion with a “B”) in additional healthcare expenditures.

The benefits of circumcision are prevention of urinary tract infections, penile cancer and transmission of some sexually transmitted infections to other sexual partners.

The decision to have a child circumcised rests with the parents–who should consider the medical evidence in context of their own religious, ethical, and cultural beliefs.

Interesting statistics.

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Endometrial, lung, and ovarian cancers: How, when, and DO we screen?

Posted on November 7, 2012 by drlesliegreenberg

American Cancer Society Screening guidelines were just released.

Endometrial cancer.  This is cancer of the lining of the uterus.  No routine screening test should be performed.  Women should have testing if they have symptoms: irregular or unexpected vaginal bleeding, especially after menopause (when they should have stopped menstrual bleeding–forever!).

Lung cancer.  No screening tests are suggested.  There are multiple organizations reviewing evidence to determine the potential benefits (and harms) of screening for lung cancer as low-dose CT scans contain radiation.

Ovarian cancer.  There is insufficient evidence that the following have been shown to detect early ovarian cancer:

  • pelvic examination,
  • tumor marker CA-125,
  • transvaginal ultrasound, or
  • multimarker panels and bioinformatics analysis or proteomic patterns.

Screening guidelines help us benefit the patient population as a whole–decrease the poking and prodding–when screening may do more harm than good.  Talk to your doctor about your concerns, family history, risk factors, and any symptoms you have.  If you have symptoms, then it is not considered “screening” and a work-up may be warranted.

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Prostate cancer screening guideslines. New! from American Cancer Society

Posted on November 5, 2012 by drlesliegreenberg

To screen or not to screen… that is a thoughtful decision.  Screening for prostate cancer should not be performed without an informed decision-making process.   Most elderly men die with prostate cancer, not from it.  The risk of screening is that prostate cancer (that may not impact quality of life or life expectancy) may be treated with painful and invasive procedures that may cause urinary incontinence and impotence for the rest of a man’s life.

Who? And when to screen? Men to screen have at least a 10-year life expectancy.  Beginning at age 50 men with average risk should be informed about their screening options.  Men with higher risk including blacks or men with a family history of prostate cancer before age 65 should be informed screening to begin at age 45.  Men with multiple family members diagnosed with prostate cancer before age 65 should be informed beginning at age 40.

The test of choice?  Prostate-specific antigen (PSA).  This blood test can be performed with or without a rectal examination.  Men with PSA less than 2.5mcg/L may be screened every 2 years, whereas those with 2.5-4.0 mcg/L should have annual testing.  A PSA level above 4.0mcg/L should be offered referral to an urologist for further testing.

Hope this helps.

Posted in Cancer, General Medicine- Adults, prostate cancer, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Prostate cancer screening guideslines. New! from American Cancer Society