What side effects to expect from your hormonal contraception?

Posted on February 6, 2012 by drlesliegreenberg

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Hormonal contraceptives are medicines (with hormones in it)that decrease your risk of getting pregnant.  This can be in the many forms: a pill, a patch, a ring inside the vagina, implants under the skin, or an intrauterine device.

Most women do not have serious side effects.  If symptoms are mild, I suggest hanging-in-there for the first three months–as most will go away.  You may feel

  • Acne,
  • nausea,
  • sore breasts,
  • decreased sex drive,
  • irregular periods,
  • headaches,
  • or weight gain.

The best way to decrease the side effects is to take  your medicine as prescribed: if it is a pill, take it every day at the same time or day.  If you are using a patch or a ring, be sure to follow the doctor’s schedule.  This will help decrease the hormonal variations in the body which should decrease your adverse symptoms.

And, as always, a condom helps decrease risk of infection and an unplanned pregnancy.

Hope this helps.

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Do your child’s toes point inward when walking? What should you do?

Posted on February 2, 2012 by drlesliegreenberg

flickr.com/photos/ simonvanmaele/ 4042622726

Intoeing is a term describing toes pointing to each other while walking.  This can be concerning for parents.  An accurate diagnosis can be made with a history and exam.

As a physician, I want to know

  • when it started
  • associated symptoms like limping, tripping or pain
  • how does your child sit
  • any concerns (from the patient or parent)
  • birth complications
  • how has development been
  • any injuries
  • family history of similar conditions?

The toes can look like they turn inward due to turning at three points in the lower leg: the thigh (increased femoral anteversion), the lower leg (internal tibial torsion), or the foot (metatarsus adductus).

  1. Increased femoral anteversion  (the thigh) usually resolves by late childhood in more than 80% of patients.  Bracing or shoe modifications are usually not helpful.
  2. Internal tibial torsion (lower leg)  may be seen first after a child starts to walk and resolves in 95% of patients by age 8.
  3. Metatarsus adductus (the inturning foot) is one in 1,000 live births.  If mild, observation is suggested.  If it is more severe, then serial casting may be done for six weeks.

Watchful waiting or what others call “benign neglect” may be most helpful as most of these conditions soften or go away with age.  And, sports skill/speed has not been found to be lessened with intoeing.

Seek help, answer questions, and be patient–if need be.

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How to keep your sleeping baby well.

Posted on January 27, 2012 by drlesliegreenberg

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SIDS cases have decreased in the US by 50% since the “Back to Sleep” campaign  in 1992 was started.  But, we can do more.

The ways to decrease the risk of SIDS in your baby is to. . .

  • Place baby on the back for every sleep.
  • Use a firm sleep surface designed for infants.
  • No soft objects in the bed.
  • No wedges to help position baby.
  • No bumpers, crib drapes or bumper pads.
  • No blanket on baby.
  • No co-sleeping (like with a parent or sibling)—as a draped arm over baby or soft covers may suffocate baby.
  • Do not expose baby to cigarette smoke.
  • Keep current with vaccinations.

Back sleeping is best.  Parents worry that the baby will choke on secretions/vomit while asleep.  The baby has built-in protective guards against choking.  There is NO evidence that sleeping on their side helps drain secretions from their lungs.

Pacifiers protect the infant against SIDS.  This may be due to the baby being in a lighter sleep/sucking frequently and therefore being more aroused.  Do not attach pacifier to clothing or around the baby’s neck as this string/ribbon could suffocate baby.

Sleep tight.  Hope this helps.

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Medicare to pay for obesity counseling: Nice feature.

Posted on January 23, 2012 by drlesliegreenberg

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Medicare patients can now get obesity screening and dietary counseling without paying a co-pay.  The Centers of Medicare and Medicaid Services (CMS) announced that effective immediately these services will be offered without “cost sharing,” meaning co-pays from the patient.

The benefit includes screening for obesity (measuring body mass index), conducting a dietary assessment and for providing counseling therapy to promote sustained weight loss.  CMS even regulates a frequency of these visits:  once a week for the first month, one face-to-face visit every other week for months 2 through 6.  Then at the 6 month visit the provider must assess whether the effort is resulting in weight loss.  If 6.6 pounds have been lost in the first 6 months, then additional 6 months of visits may be performed without co-pays.

Why is this being done?  Because more than 30% of people over 65 are obese.  Obesity counseling adds to a list of preventive services covered by Medicare.

Hope this helps.

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Does it burn when you pee?

Posted on January 19, 2012 by drlesliegreenberg

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Burning is one sign of bladder infection (and sexually transmitted diseases–another topic altogether).  Bladder infections are common and uncomfortable.  It is caused by a bacterial infection in the bladder.  Symptoms are

  • pain and/or urgency with urination,
  • a sense of incomplete emptying of the bladder and
  • increased frequency of urination (you may notice this most at nighttime).

Bladder infections are caused by bacteria getting into the urethra.  You may ask “where are the bacteria?”  There are bacteria that live near the urethra (where the urine comes out).  Bacteria are also in the GI tract.   If women wipe from back to front (think about it…) bacteria near the bottom can be moved into the vaginal/urethral area.  You can also get a bladder infection if you hold your urine (instead of urinating when you feel the urge), have sex often, or are pregnant.

When should you see your doctor?  Right away.  You need to give a urine sample.  The urine may need to be cultured to show which bacteria are present and what antibiotic it is sensitive to (which antibiotic will kill the bacteria).  It takes 3 to 5 days to get a urine culture result because they need to grow out the bacteria from your sample in the lab.

Antibiotics treat bladder infections.  7 days of antibiotics used to be commonplace, now we know that 3 to 5 days of antibiotics should get rid of the infection in most cases.  Drink more water to help push the urine through the kidneys.  Call your doctor if pain not better in 36 hours, if you get worse, have a fever more than 100.4 degrees F.   Rarely, patients need to go to the hospital for urinary tract infections or if the infection has traveled from the bladder up to the kidneys.

How to prevent?  Drink plenty of fluids.  Wipe from front to back (from urethra to rectum) anytime you use of the bathroom.  Pee after intercourse (to flush any bacteria near the urethra out of it).  Pee when you need to; don’t hold your urine.  Wear cotton-lined panties.  Don’t wear thong underwear if you get frequent bladder infections.

Want more information?  http://familydoctor.org/497.xml

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Vaccine suggested earlier. Hmmm. . . another shot?

Posted on January 17, 2012 by drlesliegreenberg

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An FDA advisory panel is supporting an earlier administration of the pneumonia vaccine. Prevnar 13 is to prevent pneumococcal disease–which is a bacteria causing pneumonia and other invasive disease.

The advisory panel is poised to suggest the Prevnar 13 be given to adults older than 50.

This vaccine is routinely suggested for those under age 65 with risk factors (like diabetes, asthma or chronic lung disease), but until now has not been suggested for the routine population until age 65.  There is a study with more than 85,000 adults being held now to confirm the results.

I’ll keep you posted.

Posted in General Medicine- Adults, infections, lung conditions, Uncategorized, Vaccines | Tagged , , , , , , , , , , , | Comments Off on Vaccine suggested earlier. Hmmm. . . another shot?

Did you know that DEATHS from hepatitis C are now more common in the US than HIV?

Posted on January 13, 2012 by drlesliegreenberg

As a result of this finding, the Centers for Diseases Control (CDC ) is launching a “No More Hepatitis” campaign with screening recommendations.  Currently, the CDC  suggests hepatitis labs for patient who

  • ever injected illegal drugs,
  • received clotting factors made before 1987,
  • received blood/organs before July 1992,
  • were ever on chronic hemodialysis,
  • have evidence of liver disease (elevated alanine aminotransferase [ALT] blood level), or
  • are infected with HIV.

We now know that ¾ of those who die with hepatitis C infections are baby boomers–most without risk factors as above.  So, a new initiative is starting to test all people born between 1945 and 1965 for hepatitis C.

We know that it takes years for hepatitis C to make the liver cells fibrotic or into cancer.  And, there was an approval in May 2011 of two new medicines to help fight hepatitis C.  So, with the increase in incidence of the infection and improved treatment, we may be able to save and lengthen lives.

I think that is a pretty good combination!

flickr.com/photos/ 37613229@N00/ 4674844

Posted in Cancer, General Medicine- Adults, infections, Uncategorized | Tagged , , , , , , , , , , , , , , | Comments Off on Did you know that DEATHS from hepatitis C are now more common in the US than HIV?

Are you young with high blood pressure?

Posted on January 10, 2012 by drlesliegreenberg

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A common belief is that high blood pressure is only important to people as they get older.  We each have an age in our head that we think that we are young (!) … and do not need medicine like “old people” do.  Well, this is false.

A recent Harvard Alumni Health Study shows that blood pressure should be lowered (when elevated) in early adulthood to decrease risk of coronary heart and cardiovascular disease (like heart failure and heart attacks) and death due to heart problems.  The study also showed that increased blood pressure increased all-cause mortality later in life.

The Journal of the American College of Cardiology recently published a study showing that the risk for cardiovascular disease mortality was greater in those who had high blood pressure at age 18 even when age, body mass index (measure of obesity), smoking and physical activity were taken into account.  The study followed nearly 19,000 male students who started at age 18 and were followed up at 46 years of age.   Younger patients with hypertension tend to remain unaware of their high blood pressure, are less likely to be on treatment, and less likely to have their blood pressure in a good range.

Have you had your blood pressure checked lately?  (Psssssttt…goal is under 120/80!)

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Crohn’s disease of the bowel

Posted on January 7, 2012 by drlesliegreenberg

I see many patients with GI complaints.  Some have Crohn’s disease which is inflammation of the digestive tract—it can affect anywhere between the mouth and the anus.

Symptoms are stomach pain, weight loss, bleeding from the rectum, stomach pain and diarrhea.  With these symptoms, a colonoscopy should be performed.  I have done over 2000 colonoscopies in 16 years.  (I love that I can give my patients this service!)   During the colonoscopy biopsies (little pinches of tissue) will be obtained of the walls in the large bowel.  The pathologists (the doctors who look at cells all day under a microscope) tell me if colitis, or inflammation, is present in the cells.  Other tests may be needed to evaluate the symptoms:  CT scan, MRI, dye studies, or ultrasound.

There are medicines that can help the symptoms, but Crohn’s cannot be cured.  Aminosalicylates can be taken by mouth or by enema (in the rectum) to help control inflammation.  Steroids can be used for short times to help with flares.  Antibiotics may be needed also.  Immune system modulators (changers) decrease the activity of the immune system and are used if symptoms are not controlled by other medications.  Newer medications like biologic therapies reduce inflammation.  A tuberculosis test is needed before starting on this medication.

The Crohn’s and Colitis Foundation has a good website  http://www.ccfa.org

normal colonic mucosa

 

crohn's colitis. See the ulcerations?

 

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Face pain? Sinuses acting up?

Posted on January 5, 2012 by drlesliegreenberg

The sinuses are four pairs of hollow spaces in the bones of your face.   The hollow spaces are lined with tissue that makes thin, watery mucus.  The sinuses connect to each other and drain through the nose.  Can you tell there are many problems that can cause this system to not work as intended?

“Sinusitis” is swelling of the sinus lining.  It can last for a week or for months.  Chronic sinusitis lasts for more than 12 weeks.

Cause of sinus infections? Most common is a virus.  When the virus makes sinus mucus thick and sticky, the sinuses don’t drain well.  Bacteria then can grow in the mucus.

Who gets sinus infections?  Anyone.  More common in those with nasal allergies, hay fever, asthma, cigarette smokers, deviated septum or changes in pressure (like when flying or scuba diving).

Symptoms may include headache, fever, nasal congestion and runny nose, sore throat, bad breath, less sense of smell or taste, pain/pressure in forehead, nose or between the eyes.

Treatment?  Most people clear sinusitis on their own over a week.  Drink fluids (to keep mucus thin).  Sleep with your head propped up and sit in a steamy shower (to help the sinuses drain).  Take over the counter pain medication to help with facial pain and headaches.

See the doctor when symptoms last more than 7 days, the headache does not get better with over-the-counter pain medicine, vision changes or swelling around the eyes, fever above 100.4 F, or symptoms not better after a course of antibiotics.

Want to know more?  http://www.entnet.org/healthinformation/sinusitis.cfm

Posted in allergies, allergies, General Medicine- Adults, infections, infections, Pediatrics, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Face pain? Sinuses acting up?