Decrease YOUR chance of breast cancer. . .

Posted on February 18, 2012 by drlesliegreenberg

http://www.vhct.org breast cancer

There are many things in life that we cannot change: our age, our gender, our family history. But, there are (what we physicians call) modifiable risk factors.

To decrease your risk of breast cancer, follow these. . . .

  • avoid unnecessary medical radiation throughout your life,
  • avoid the use of combined estrogen-progesterone hormone therapy after menopause,
  • avoid smoking,
  • limit alcohol intake, and
  •  curb excess weight after menopause.

The Susan G. Komen asked for this data to be amassed and the Institute of Medicine’s Committee on Breast Cancer and the Environment delivered.  In addition to the risks found above, there were other factors that were less clear.  There is conflicting evidence regarding the risk/benefit of physical activity, use of hair dyes, and exposure to non-ionizing radiation (like microwaves). Other risk factors being investigated are second-hand smoke exposure, nighttime shift work, exposure to chemicals like benzene and ethylene oxide.

Change what you can.

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2 Tylenol changes: Packages recalled AND Change in medication strength.

Posted on February 15, 2012 by drlesliegreenberg

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Recall: 

Tylenol has recalled nearly 600,000 infant Tylenol packages.  Click onto the Tylenol website below to see if your bottle needs to be returned.

http://www.tylenol.com/page2.jhtml?id=tylenol/news/subp_tylenol_recall_8.inc

Strength change:

Liquid acetaminophen for infants has always been available in one dose.  That dose has changed.   Parents need to look at the strength of their acetaminophen: the old infant dropper 80mg/0.8 ml OR new 160 mg/5ml formula.

It’s important to follow the packaging directions.  The new formula may also be packaged with an oral syringe, instead of the dropper parents are accustomed to.  FDA warns “do not mix and match dosing devices” as you may give TOO much acetaminophen.  Too much acetaminophen is toxic.

At my kids’ childcare center, there was a posted sign with the “5 Rs”: Right Patient, Right Route, Right Frequency, Right Dose, and Right Medicine.

Check.  Double check.

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Wart treatment

Posted on February 11, 2012 by drlesliegreenberg

flickr.com /photos/ sea-turtle/6061032366

If you are patient, there is a good chance that your (nongenital) wart will go away with no treatment.  In fact, 48% of warts resolve in 12 weeks.

If you are NOT that patient, then two other suggestions are topical salicylic acid, cryotherapy (freezing therapy) or topical fluorouracil.   Topical fluorouracil is a distant third suggestion as it is 15 times more expensive than salicylic acid and can produce pain and blisters.

The combination of salicylic acid and cryotherapy is thought to be better than either treatment alone.  The physician can confirm the lesion is a wart and discuss treatment options with you.  I prefer to pare the wart down with a scalpel (don’t worry, you won’t feel it), then two freeze (then thaw) cycles.  This helps make the wart more susceptible to daily treatment with salicylic acid, which you can place on the wart at home.

The effectiveness of duct tape on clearing warts is now unclear.  Two similar studies had differing results: one helped, one found no difference.  And, studies have also found insufficient evidence to support bleomycin or interferon for wart treatment.

It may take weeks to months to get rid of warts.  But, be patient.

Doctors can help. . . and you can help, too.

Posted in Dermatology, Dermatology, General Medicine- Adults, Pediatrics, Uncategorized | Tagged , , , , , , , , , , , , | Comments Off on Wart treatment

The HPV vaccine is effective!

Posted on February 9, 2012 by drlesliegreenberg

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A study recently showed that HPV vaccine helped protect women against several types of cervical cancer for up to 7 years.   Seven years.  Pretty good.

2650 young women were vaccinated with quadrivalent HPV vaccine and there were no cases of severe cervical dysplasia or of cervical cancer in the next 7 years.

The HPV vaccine is a series of 3 vaccines which can be given between ages 9 to 26 regardless if the patient has already begun sexual encounters or if she has a history of HPV (as the vaccine can help protect her from other high-risk HPV types).

Hope this helps.

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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.

Posted in contraception, General Medicine- Adults, menstrual issues, Sexually Transmitted Infections, Uncategorized, Women's Health | Tagged , , , , , , , , , , , , , , | Comments Off on What side effects to expect from your hormonal contraception?

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

flickr.com/photos/ axelsrose/ 2657883341

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

flickr.com/ photos/ miqul/ 227467257

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

flickr.com/photos/ atmtx/ 3989504360

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.

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