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.

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Ladies. . . Next screening guideline: cervical cancer.

Posted on November 2, 2012 by drlesliegreenberg

The American Cancer Society cervical cancer screening guidelines for this are dependent on many factors: age, risk factors, choice of screening test and screening history.  Let’s break it down by age.

21.  Women at average risk should begin screening at 21 years of age (or 3 years after first vaginal intercourse, regardless if they had the HPV vaccines).  Then yearly screening with routine pap or every other year with the liquid-based pap until age 30.  Your doctor will choose either the conventional pap or the liquid-based pap depending on preference.  As the patient you’ll notice no difference in technique–it’s just a different type of specimen for the lab (a slide or a specimen container).

30.  After 30 women who have had three consecutively normal screening paps may choose to be screened every two to three years with conventional or liquid based pap or every 3 years with HPV DNA testing and conventional or liquid based pap.  HPV testing may be done as the human papillomavirus may make the cells on the cervix more likely to change to cancer.   Many women with HPV infection will not develop changes on their cervix.  HPV infection is most common in persons who have had sexual intercourse, so new partners introduce the ability to pick up a new strain of the HPV infection.

70.  Screening can continue in women who still have their cervix until age 70.  (Women with hysterectomies most often have the cervix removed and do not need repeat paps unless the uterus was taken out due to cancer).  Paps can also be stopped if they have been normal in the previous 10 years and 3 consecutive paps have been normal.

I encourage my female patients to come in for an annual preventive health exam.   Some years this will include a pap and some not.   This is a time to review blood pressure, vaccine needs, skin-cancer screening, breast exam and the like. . .

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Cancer screening guidelines: The down-and-dirty on breast cancer screening.

Posted on October 31, 2012 by drlesliegreenberg

flickr.com/photos/ loonyhiker/ 6819318915

The American Cancer Society updated their guidelines on cancer screening.  I’m going to update myself (and you!) with those.  This will be broken up into a few blogs.  In honor of Breast Cancer Awareness month, it’ll be reviewed first.

Breast exam.  Breast cancer screening is guided by age in the average-risk woman.  Between 20 and 39 women should have breast exam by a physician every three years and then annually at age 40.  During this exam, the provider should discuss how to perform a self-breast exam (and the potential benefits, limitations and harms associated with it).  Women should be aware and watch for breast changes.  Discuss with your physician a breast or ovarian cancer family history—most important in first- and second-degree relatives (like a mother and aunt).

Mammograms.  These should begin at 40 and continue yearly.  The benefits of mammograms are the reduction in the risk of dying from breast cancer and, if cancer is detected, less aggressive measures may be needed.  This may translate to taking out a lump of breast tissue instead of the entire breast, less aggressive adjunctive treatment and more treatment options.  Mammograms may not detect all cancers and some cancers will have devastating outcomes.  Biopsies may be performed when possibly the breast cancer would not have been fatal meaning possibly it was an unneeded procedure.  Mammography should be continued as long as the woman would be physically able to endure breast cancer treatment.  There is no upper age at which mammograms need to be discontinued.

Are you in need of a check-up?

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Want to start smoking again after a stroke?

Posted on October 29, 2012 by drlesliegreenberg

flickr.com/ photos/lanier67/ 237055775

Patients who started smoking again after an ischemic (not-enough-blood-getting-to-the-brain) stroke raise their risk of dying by nearly threefold within one year.  The risk of dying increases the sooner the smoking relapse occurs.  Patients who start smoking within 10 days of leaving the hospital are five times more likely to die within a year compared to those who remain smoke-free.

This was a study of 921 active smokers who stopped smoking during their hospital stay after an ischemic stroke.  Their habits were followed after hospital discharge and even five cigarettes per day were linked with increased cardiovascular events (like a heart attack).

You should know that an ischemic stroke is a sign from the body that the brain is having a difficult time consistently getting blood flow.  It’s in your best interest to make it EASY for the brain (and heart and other bodily organs) to get blood.  Stop smoking for good.

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Does your tween have acne?

Posted on October 25, 2012 by drlesliegreenberg

Acne in teens.  Recently,  I saw a tween for a knee injury.  Upon completion of the visit I asked him how his skin was doing.  His mom energetically piped in that his current skin condition was good for him and that she was concerned that his acne would “bloom” like his older sister.  (She had needed Accutane to control her acne.)

Acne is common and seemingly relentless.  Washing with soap and water twice daily helps keep the face clean.  Patting the face dry with a towel (instead of scrubbing) helps to not rough up the skin.    Many over the counter acne compounds contain benzoyl peroxide.  This is first-line therapy for acne.  If acne persists, then other topical agents can be used: retinoids (like Retin A) or antibiotics (erythromycin or clindamycin).  If those do not work,then antibiotics by mouth may be used.  As a last resort Accutane can be used.  Accutane has its own challenges and risks.

I encourage you to ask your doctor to help with skin care.  Being a kid is hard enough without eye-catching acne.

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HPV vaccine was studied and found NOT to increase teenage sexual activity.

Posted on October 22, 2012 by drlesliegreenberg

This LA Times article is informative with an interesting perspective.  Please read on. . . especially if you are a” tween” parent.

http://www.latimes.com/health/boostershots/la-heb-promiscuity-hpv-vaccine-20121015,0,5783319.story

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