Gonorrhea. The G word.

Posted on April 11, 2012 by drlesliegreenberg

flickr.com /photos/ jakefowler/ 34989134Nuts-and-bolts about gonorrhea.

  • Sexually transmitted.
  • Symptoms are different for men and women.  For men, the most common symptom is pain with urination.  In women, less than ½ have symptoms.  When present, symptoms are vaginal discharge and pain with intercourse.
  • 10 to 40% are coinfected with Chlamydia, too.
  • Cure rates are 95% with a single dose of antibiotics.

The natural history of untreated gonorrhea infection is weeks (to  months) of unpleasant symptoms… and then spontaneous resolution and clearance of the bacteria.  This means that you can get rid of the infection without antibiotics, but if left untreated, you are a vector and can pass this infection to others. And, gonorrhea can cause pelvic inflammatory disease (PID) which may lead to pelvic pain, pain with intercourse, and to infertility.

Ways to avoid gonorrhea?   Don’t have oral, anal or vaginal intercourse.  If you are with a new partner,have yourself and a new partner (go as a couple!  have fun with it) tested for sexually transmitted infections.  Use condoms.

Hope this helps.

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Doctors ordering too many tests? Which tests? Read on…

Posted on April 5, 2012 by drlesliegreenberg

Web MD has done a great job simplifying a new statement that discusses the overuse of many medical tests.  It lists tests that are (most commonly) unnecessarily ordered.    I’ve read it and agree wholeheartedly.  Click on the link to see the article and help better manage your own care.

http://www.webmd.com/back-pain/news/20120405/many-medical-tests-procedures-not-always-needed?page=2

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Breast screening guidelines have changed.

Posted on April 3, 2012 by drlesliegreenberg

flickr.com/photos /mbk/ 3624302664/

Breast cancer deaths can be reduced with effective screening.   Screening is based on age and risk factors.

By age:  Women 20 years and older should be taught about breast self-awareness.    A woman should be aware of the normal feel and appearance of her breasts.  She should see her doctor with any concerns.

Age 20 to 39: Breast exams should be done by a doctor every 1 to 3 years.

Age 40 and older: Breast exams by a doctor AND mammograms should be done yearly. “Enhanced screening” should be recommended and risk reduction methods should be discussed in women who test positive for BRCA1 or BRCA2 gene mutations.  This enhanced screening may include every 6 month breast exam, annual mammograms, annual MRI of breast, and guidance in self-examination.

Breast MRI is not recommended in women at average risk of breast cancer.  The American Cancer Society recommends MRI only in high-risk women with a 20% lifetime risk.

The following website reviews risks and the amount of increased risk of breast cancer with each risk factor.  http://ww5.komen.org/BreastCancer/RiskFactorsSummaryTable.html

Posted in breast, Cancer, General Medicine- Adults, Uncategorized, Women's Health | Tagged , , , , , , , , | Comments Off on Breast screening guidelines have changed.

Pruritis ani– the dreaded “itchy butt.”

Posted on March 30, 2012 by drlesliegreenberg

flickr.com/photos /r4vi/ 2316877289/I have a great job.  Every day is different.  One of the conditions I see commonly is perianal itching. This affects 1 to 5% of the population and is the second most common anorectal condition (after hemorrhoids—a topic for another time).

Studies show that most patients self-treat for one year before presenting to a physician.  There are many underlying problems that can lead to anal itching:

  • allergies,
  • dietary irritants (beer, caffeine, citrus, milk, tomatoes, chili peppers),
  • stool on the anal skin (poor hygiene, rectal skin tags),
  • infections (pinworms, STDs, yeast),
  • skin cancer, or
  • topical irritants (detergent, soaps, suppositories, tight clothing, toilet paper dyes or perfumes).

Once the itch-scratch cycle starts it is a difficult cycle to stop …as the scratching causes the anus to be inflamed which causes an irresistible urge to scratch more.

My job is to break that itch-scratch cycle, to diagnose the underlying condition, and to treat.  If after sufficient investigation and treatment, the area still itches a biopsy of the tissue is needed to rule out malignancy.

Hope this helps.

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Do you want to help teach medical students?

Posted on March 28, 2012 by drlesliegreenberg

What a great opportunity!  Right in our fair city, Wichita!  The University of Kansas School of Medicine is opening their doors for you to be a “standardized patient.”

This was a new concept when I was in medical school 20 years ago.  People 18 years or older are needed to portray patients who have a particular medical history, body language, physical examination results, emotion and personality.  And, you get paid!  No medical or acting experience needed.

If you are interested in pretending to be a patient (and helping medical students learn), there is an informational session Thursday, March 29, 2012 at “the School”–1010 North Kansas in Wichita from 5 pm to 6:30 pm.  316 293-2615.

I love teaching. . . and now YOU can get in on “the act.”

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Are you looking for health insurance for your domestic partner?

Posted on March 25, 2012 by drlesliegreenberg

flickr.com/photos/ wheelz24/ 4291783906

Kansan Kathleen Sebelius, the US Department of Health and Human Services Secretary announced that the Health Plan Finder tool on www.healthcare.gov now allows for users to search for insurance plans that include coverage for domestic partners.

On this site, consumers can compare health plans and employers of a small business can also search for employee coverage.  The website breaks it into categories to help you choose the best option based on enrollment, out-of-pocket expenses, and specific benefits.

Some states have passed same-sex marriage laws and insurance companies are just a few steps behind.

Hope this helps.

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FDA links reflux medicine to severe diarrhea

Posted on March 22, 2012 by drlesliegreenberg

flickr.com/photos /ouistitis/ 6052645034

The U.S. Food and Drug Administration recently issued a drug safety warning  discussing the link between an anti-reflux medication and watery stools.  The warning suggests that medicines in the proton pump inhibitor family (like omeprazole and nexium) may increase the risk of Clostridium difficile-associated diarrhea.

“C. diff” diarrhea is characterized by

  • watery stool
  • abdominal pain and
  •  fever.

Ways to reduce the risk of developing this diarrhea may be to limit the dosage and the amount of time that a PPI is used.    Notify your doctor if you experience the above symptoms that do not resolve.

For more information visit http://www.aafp.org/news-now/health-of-the-public/20120214cdad-ppis.html

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Have you had a gastric bypass? Feeling tired? Here is one consideration…

Posted on March 19, 2012 by drlesliegreenberg

Obesity is an epidemic in America.  Gastric bypass is becoming a mainstream treatment for obesity.  Gastric bypass makes the stomach smaller, making the patient feel fuller with less food, and thereby helping the patient curb caloric intake.  After gastric bypass surgery, the patient is at risk for iron deficiency anemia.

Anemia means that the red blood cell (the cells that carry oxygen and make you feel more energized) count is low.  Iron-deficiency anemia means the reason for the anemia is that the body does not have enough iron in it to make those red blood cells properly.

One study of 300 patients sent to a hematology office showed that ¼ of the iron deficiency anemia patients were due to gastric bypass (with heavy menstrual bleeding as reason #1).

flickr.com/photos/ 46145831@N00/ 53229035

One symptom of iron-deficiency anemia is “pica.”  This is a desire to eat non-nutritive things: leaves, ice, and toilet paper.  So, be aware of your post-surgical risks and let your doctor know of your cravings.

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Do you need an advanced directive? Do you know what this is?

Posted on March 15, 2012 by drlesliegreenberg

flickr.com/photos/ dave77459/ 6876989843

Two answers:  Yes, you do need one.  And, read on… to find out what’s an advanced directive.

An advanced directive is a legal document that spells out how YOU want to be cared for if you are unable to make those decisions.  Some examples of advanced directives are a

  • living will (a list of treatments you’d like if needed) and
  • durable power of attorney (WHO you designate to make those medical decisions for you).

Here in Wichita, Kansas, Health Ethics leads seminars discussing the intricacies of each of the documents free of charge.  You can also get information at www.caringinfo.org  or http://familydoctor.org/003.xml .

I tell my patients when I turned 30 (and was expecting our first child), my husband and I had “the talk.”  We discussed what we each want done– if we were unable to make those decisions ourselves.  It made it easier, I think, because we’re in good health.  This was just one piece of the puzzle in becoming parents for us.

Be specific with your wishes.  Do you want CPR?  Do you want to be on a ventilator?  If so, for how long?  If your heart stops, would you like medication in your vein to try to jump-start your heart?  If you are mentally incapacitated indefinitely, would you like to live in a nursing home where others care for your daily needs?

Try to emphasize to your durable power of attorney what is most important to you in a variety of situations.  You need ONE durable power of attorney.  If you have more than one, they may disagree with your wishes. . . and, in those cases, usually the patient has more treatment (more invasive, more long-term care) done which may leave you in a situation you planned to NOT have.

Once the advanced directive is completed and signed, it can be changed or canceled at any time.  Please discuss your wishes with your doctor and family.

Start the conversation.

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Eczema: “asthma of the skin”

Posted on March 11, 2012 by drlesliegreenberg

flickr.com/photos/ soberch/ 2829893479

I recently heard a dermatologist describe eczema as “asthma of the skin.” Great analogy. The importance of this is that eczema is a long-term problem. Our goal should be to control this scaly, itchy skin so that the patient and their family lead a life with normal activities. When eczema is not well controlled, the patient itches which can disrupt (patient and parent’s) sleep, increased time spent on skin care and physician/hospital visits.

Eczema, like asthma, has symptoms that will wax and wane, triggers that worsen eczema, and may be passed down from the parents. Some suggestions are to use nondetergent cleansers instead of soap: Cetaphil or Dove. Pat skin dry after bathing so as to not rough up the skin. Put a rich cream on the skin twice a day: once after bathing and one other time during the day. Lather them up with lotion and let it soak in. A dilute bleach bath once a week can help decrease bacterial load on the skin and thereby decrease skin infections. 1/8 cup to a full bath is all that’s needed: more bleach won’t be helpful.

Hope this helps.

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