SIDS. Sudden Infant Death Syndrome

Posted on November 1, 2011 by drlesliegreenberg

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An obstetrical patient of mine asked me to post a blog about newborns.  Here’s an important subject.  SIDS death risk has decreased in recent years . . .but treatment of SIDS has caused other problems with infants to increase.  The “back-to-sleep” campaign to prevent SIDS has encouraged parents to place the infant on their back for sleeping, instead of on their stomach.   There are 3 problems that have occurred due to too little “tummy time.”

  • Gross motor movement delay.  Parents are placing their children on their back when they are asleep (this is good!) but also when awake (which can hurt their development).  This delay, which can manifest as early as 2-3 months of age, can be seen as an inability to raise his/her head when on their stomach.  Prevention/Treatment:  one hour a day of tummy time.
  • Flattening or widening of the skull (plagiocephaly or brachycephaly).  Babies are more likely to get this in the first 4 months of life in male infants, first-born,  those who don’t move their head much, bottle feeding and in a child whose head is routinely placed to the same-side during feedings.   Prevention/Treatment:   varying head position when laying the child down for sleep or molding therapy with a helmet.
  • Head tilt to one side (torticollis).  1 of 6 newborns is born with torticollis, a head tilt, due to the head being stuck in one position inside the mom’s uterus.   Prevention/Treatment: neck motion exercises, awake tummy-time and changing head-position during sleep.

Hope this helps.

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(Irritating) irritable bowel syndrome. What is it? What to do about it?

Posted on October 30, 2011 by drlesliegreenberg

flickr.com/photos/ maigh/ 3296330012

Irritable bowel syndrome is a common intestinal problem.  We are unsure why it occurs.  It may signal intestinal hypersensitivity to pain or nerves–or a change in bowel bacteria.  A “textbook case” involves a 20-year-old woman with symptoms as below.

  • Bloating and gas
  • Constipation
  • Diarrhea, especially after eating or after morning awakening
  • Feeling that after a bowel movement, you are not completely
    emptied
  • Stomach pain and cramping that may go away after a bowel
    movement.

What makes it worse?  Changes may make it worse: schedule changes, traveling, stress, change in diet, the beginning of a menstrual period.

Irritable bowel is a “diagnosis of exclusion.”  That means that we, physicians, rule out more concerning diagnoses like inflammatory bowel (like ulcerative colitis) and cancer.

Treatment is avoiding triggers (keep a journal so you know which foods aggravate your bowels), eating a healthy diet, and finding ways to cope with symptoms.

Fiber is a great treatment option.  Soluble fiber helps make stools soft, formed, and more controllable.  Foods high in soluble fiber are apples (WITH peels) and beans.  Psyllium is an over the counter fiber supplement.  Fiber is available many forms.  OOOOOOOh. . . the choices. . . .Pick your favorite!  Powder.  Tablet.  Capsule.  Wafer.  Increase dietary fiber slowly—so your gut can get used to it.

What can your doctor do?  A good history and physical may help diagnose this (and rule out the other bad stuff).  A colonoscopy may be needed to see the bowel walls and take biopsies.  Prescription medication may decrease colon spasms.  Heating pads and hot baths can also help with symptoms.

What else can you do?  Learn ways to cope with stress, avoid laxative use as they may make your condition harder to control over time, drink plenty of water, eat a small,
frequent meals of healthy food, and avoid dietary triggers.

irritable bowel will look normal on colonoscopy

I perform colonoscopies.  This is what irritable bowel may look like on colonoscopy–normal and healthy!
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Read on. . . if you want less (or to get rid of) canker sores

Posted on October 27, 2011 by drlesliegreenberg

ouch!

What are canker sores?  Round, small painful ulcers that usually heal in 10-14 days without a scar.

What causes canker sores?  We do not know.  It may be a reaction to stress, hormones, infection, food hypersensitivity, immune problems or hereditary (run in families).

How can I treat them?  I recently read an article combining 4 studies.

  •  Amlexanox is the most effective overall.  It is available in a paste and has been shown to increase the chance of being pain-free by day 3 and healing the ulcer by day 3.  It is applied four times a day for a week and costs about $30.
  • Steroids may help. (In fact, in the short-term, there is a long list of things that
    steroids help. . .)  Clobetasol paste also helped with pain by day 3 of treatment and decreased ulcer size by day 5.
  •  A steroid spray may also help decrease pain and ulcer size.
  • A silver nitrate stick touched to the lesion by your doctor showed 70% of patients were pain-free by day 1 but it doesn’t speed up ulcer healing.
  • Two non-prescription aids which have been shown to decrease pain and number of ulcers are Antiseptic mouthwashes with chlorhexidine and the herbal preparation Eupatorium laevigatum (not yet commercially available) and
    Listerine antiseptic containing menthol, thymol, methyl salicylate, and
    eucalyptol.

What can I do to avoid getting more canker sores?  Oral vitamin B12 supplements may help.  Avoid toothpastes containing sodium lauryl sulfate.

Hope this helps.

Posted in Dermatology, General Medicine- Adults, oral health, Pediatrics, Uncategorized | Tagged , , , , , , , , | Comments Off on Read on. . . if you want less (or to get rid of) canker sores

Inhalants, top drug of abuse for 12 year-olds

Posted on October 23, 2011 by drlesliegreenberg

flickr.com/ photos/ streetart- berlin/ 5096767492

Ugh!  My firstborn is nearing 12 and this study sure got my attention!  A new federal study shows that inhalants are the most abused drug among 12-year-olds– exceeding use of marijuana, cocaine, and hallucinogens combined.

Almost 7% of 12-year olds said they had used an inhalant to get high.  Inhalant-use is largely a phenomenon among whites, but large numbers of Hispanic and African Americans also abuse the chemicals according to SAMHSA (Substance Abuse and Mental Health Services Administration).

Inhalants use often precedes a move to other drugs or is used
to enhance the high from other drugs or alcohol.  Inhalants are easy to obtain and can be abused without detection.

Where do you find inhalants? In your house! Frequently used compounds are found in

  • household cleaners,
  • paint thinner,
  • magic markers,
  • glue,
  • hairspray,
  • nail polish remover,
  • dessert topping sprays, and
  • fabric protector.

The inhalant of choice usually is in a pressurized can like the one to force dust out of computer keyboards.

The chemicals can lead to short-term memory loss, problems
with walking and speech, emotional instability and over time can cause
permanent brain and heart problems.

Most teens are in-the-moment-thinkers and need to know about
the issues that are important to them: how to resist peer pressure of inhalants
and risk of “sudden sniffing death” (in which the inhaler dies from cardiac arrest
instantly.)  They may be less interested in the long-term problems, but we parents sure are.

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Hormone Replacement Therapy (And the Alternatives)

Posted on October 18, 2011 by drlesliegreenberg

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When I started med school, estrogen was a panacea—beneficial for nearly every postmenopausal ailment: mood, heart and bone.  Then in 2002 the Women’s Health Initiative clinical trial was published.  This showed that combined estrogen with progesterone increased the risk of coronary artery disease, breast cancer, stroke and venous thromboembolism (blood clots).   Combined therapy, though, did decrease the risk of colorectal cancer, hip fractures, and total fractures.

Subsequent analysis of the data has shown that starting hormone therapy at the beginning of menopause might not increase cardiac risk compared with a start years after menopause (defined as “the stopping of menstrual periods for 6 months”) begins.

What are the options for you if you have hot flashes AND mood swings AND vaginal dryness?First, off, your physician should counsel you about the risks and benefits of hormonal therapy.  It is currently recommended that patients NOT use hormone therapy to prevent or treat cardiac disease. . . only use to decrease menopausal symptoms.

If you use hormonal therapy, consider stopping after three to five years.  Use the lowest effective dose to stop symptoms of menopause.  When you stop hormone therapy, you can taper or stop “cold turkey.”

What alternatives are there?   Numerous studies have shown the following
treatments are no better than placebo for hot flashes  acupuncture, dong quai, herbal formulations, red clover extract, kava, black cohosh, dietary soy, Chinese herbal
formulations or phytoestrogens.

What about bioidentical hormones?  Online marketing and word-of-mouth about compounded hormone formulations has increased recently.  These are unregulated formulations with unproven effectiveness or safety.  They may cause endometrial
hyperplasia (overgrowth of uterine lining tissue) which can lead to other
problems.  Patient’s should take these formulations knowing the risks and benefits.

What else is there? A few antidepressant medications decrease hot flashes by 61%.  Some specifics about this are… paroxetine is the only SSRI that has an FDA-indication for hot flashes.  But, venlafaxine, desvenlafaxine, citalopram, and escitalopram are also known to help.  Avoid sertraline or fluoxetine as these two medications within the SSRI family are not known to help.  If your hot flashes are mostly at night, gabapentin may be most helpful.

What should you do about vaginal dryness?  Estrogen cream helps with vaginal dryness and the effects have not been found to cause heart or blood clot problems.  Replens, an over-the-counter vaginal moisturizer is non-hormonal and has been shown to be as effective as vaginal estrogen for symptom relief.

Hope this helps.

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Speech delay in children

Posted on October 13, 2011 by drlesliegreenberg

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Well child checks are just that most of the time.  One of my goals is to assess for children meeting “developmental milestones.” At my new office we screen for this by reviewing the DDST, Denver Developmental Screening Test, with the parent.

There is a different DDST for every age because as the child ages, different skills should be mastered. The DDST reveals if your child is developmentally on track in four components: gross motor (like leg functioning), fine motor movement (finger functioning), personal/social (like eye contact), and speech.

Speech delay may cause your child to have problems saying words and phrases, putting feelings/thoughts into words, or have difficulty understanding what is said.

Some milestones by age are

  • 15 months of age: use at least three words
  • 18 months of age: follow one-step directions
  • 2 years of age: point to pictures of body parts when they are named
  • 2 ½ years of age: use original two-word phrases
  • 3 years of age: follow two-step directions.

Speech delay can be caused from hearing loss, intellectual disability, slow development, autism or cerebral palsy.

I encourage my two-language-households-families to speak BOTH languages. This is the time to introduce it! The parents (and their physician) should expect the child to mix up the two languages, but this should resolve by age 5.

If your child has a speech delay, your physician may opt to watch, perform a hearing screen, or send to speech therapy.

“Words, words, mere words, no matter from the heart.”  — William Shakespeare

 

 

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Breathe. . . . . .. . . . gasp! snort! .. . .Sleep apnea

Posted on October 11, 2011 by drlesliegreenberg

Sleep apnea is disruption of sleep (to both the patient and their bed-partner) and is harmful to the body.  Here are some nuts and bolts  about it. . .

What are the symptoms?

  • Snoring.
  • Frequent awakenings during sleep.
  • Daytime sleepiness.
  • Slower reaction time.
  • Reduced quality of life.

Why does it happen?  There is upper airway obstruction near the mouth or throat: at the tongue, soft palate or epiglottis.  Factors that make this more common are conditions that narrow the upper airway like

  1. obesity,
  2. enlarged tonsils,
  3. enlarged tongue or
  4. bony abnormalities of the head/neck.

Other associated risk factors are

  1. increasing age,
  2. men (two times more common than women),
  3. menopause,
  4. family history of sleep apnea,
  5. smoking, and
  6. nighttime nasal congestion.

flickr.com/photos/randar/ 185791934

How is it diagnosed?  Sleep study.  You sleep at a sleep
lab with an oxygen saturation monitor on your finger, with a chest monitor to show chest rise, monitors on feet to show leg movements—nothing invasive, but lots of equipment.  After a night’s sleep the patient goes home (or work) and the tests results are evaluated.

If sleep apnea is untreated, the patient may have poor quality of life, high blood pressure, possible heart disease, and increased chance of a motor vehicle accident.

Mainstay treatment are continuous positive airway pressure (CPAP–see picture below) , oral appliances, and weight loss (which may make the sleep apnea
better).

flickr.com/photos/ safoocat/ 1384527532

Posted in General Medicine- Adults, Male issues, sleep disorders, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Breathe. . . . . .. . . . gasp! snort! .. . .Sleep apnea

What a great journey this LIFE is. . .

Posted on October 9, 2011 by drlesliegreenberg

flickr.com/photos/ naroh091/ 4980382154

L’Shana Tova!  That means Happy New Year in Hebrew.   The Jewish New Year and my new job coincided.  And, boy, do I feel great!  I am
thankful for my supportive family, fantastic patients,  and the welcoming group that I have joined.  It is amazing when you are OPEN to change that change nearly finds YOU!

Many patients remarked last week how happy I look.  I am surprised by how much human nature is visible to others.  I thanked them for caring (and for appreciating my mood) when I know they were in to see me for their ailments.

What an interesting time this is.  I appreciate that we are all on a different
journey, intersecting at times, supporting one another and moving on.

I am one thankful woman.

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Flu vaccines are in at my office!

Posted on October 4, 2011 by drlesliegreenberg

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I frequently hear from my patients “I don’t get the flu” or  “The flu shot gave me the flu.”  I am armed with some CDC updates which, hopefully, will debunk some myths.

The “flu” is a respiratory virus which causes incessant cough, muscle (can’t-get-out-of-bed)-aches and high fever.  It is not a GI virus.  If you have ever had the flu, you know you do not want it again.

The seasonal flu infection occurs highest in children; whereas, the highest rates of serious illness and death are highest in those older than 65 years of age, children less than 2 years, and those with chronic medical conditions.

Who should get the flu vaccine?  All people 6 months and older.  The first time a 6 month old to 8-year-old is vaccinated, two doses of vaccine, spaced one month apart, are required to help you make a strong response.

Should I get the flu shot or the “mist”?  You can get the mist if you between the ages of 2 – 49 years old, not pregnant, without a history of asthma, or high risk patients (with COPD, cardiovascular disease, diabetes, renal, hepatic, neurologic, or HIV).  The mist is a “live attenuated” virus.   Some patients opt for the injection.  Both are effective and safe in the population as above.

Can I get the mist if I LIVE WITH someone who is immune compromised?  Yes, if the immunosuppressed person doesn’t require a protected environment.

Can I get the flu vaccine (either one) with other vaccines?  Yes.  Consider, if you are receiving another live attenuated vaccine (MMR or chicken pox vaccine) at the same time, to space them 4 weeks apart.  If the patient is 12-15 months of age, then it is well-studied and okay.

Can you cure the flu infection?  There are antiviral medications with activity against influenza viruses.  These are useful adjuncts and are effective ONLY when used early in the illness.  The antivirals decrease the length and severity of symptoms, but you are guaranteed to feel bad for a few days.

My office is giving flu vaccines now.  Come in and enjoy flu season. . .comfortably.

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Doctor and Patient: Is a Well-Rested Doctor a Better Doctor? – NYTimes.com

Posted on September 30, 2011 by drlesliegreenberg

NY Times article

I have been a physician for 16 years and have seen this monumental change in resident work hours.  Once grueling and life-altering, it has become more humane.  There is more life-balance (I can attest to that blessing as I became a community attending after training) but also there are patient continuity and depth of training issues to consider of the learning physician.    Here the NY Times reports on this issue. . .

Doctor and Patient: Is a Well-Rested Doctor a Better Doctor? – NYTimes.com.

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