Abuse.

Posted on September 5, 2011 by drlesliegreenberg

The Wichita Eagle newspaper ran recent stories regarding horrific domestic abuse.   As a family doctor, my focus is to keep my patients well, both emotionally and physically.  I routinely screen (meaning I ask everyone) at periodic visits like annual exams, prenatal or postpartum visits about abuse.  I also look for signs or symptoms of abuse.

Abuse is pervasive and comes in many forms– all harmful.

  • Sexual abuse (rape or forced sexual activity)
  • Emotional/verbal abuse (threats, repeated name-calling, or
    insults)
  • Controlling behavior (limited ability to move about or
    access to money)
  • Physical abuse (kicking, punching, or hitting).

Partner violence is a crime. During a lifetime, it is a common crime: 1 in 4 women and 1 in 9 men.  It can occur among any type of couple—dating, married, heterosexual or same-sex.   People of any age, income or education level, or ethnicity can be in an abusive relationship.

What can you do?  Tell someone you trust: clergy, friend, physician.
Get organized: have your bank records, birth certificates, social security cards in a place that you can take if you leave in a hurry.  These documents give you access to money and social services.  Make a plan to go to a safe house, shelter or friend’s house.

If you feel you are in immediate danger, call 911.  A restraining order may help the abuser stay away from you.

flickr.com/photos/vectorportal/5888281079

The National Domestic Violence Hotline has more information  1-800-799-SAFE or http://www.thehotline.org/get-help-in-your-area/

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Does exercise make you wheeze?

Posted on September 3, 2011 by drlesliegreenberg

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Exercise-induced wheezing, also called bronchoconstriction,
happens when the airway passage shrinks during or after exercise.  You may feel short of breath, start coughing or wheezing.  There are triggers to avoid and some easy treatments. . .

It can be caused by

  • cold weather,
  • dry air,
  • dust or pollen,
  • chemicals in the air (like at hockey rinks or swimming pools)

You can wear a mask to help warm and humidify the air.  Several inhaled medicines help with the symptoms.  There are short-acting inhalers (either bronchodilators or mast-cell stabilizers) that help when taken 15 minutes before exercise and last for 3 to 4 hours.   Leukotriene modifiers are another type of medication which when taken daily helps ward off symptoms and are taken regardless of anticipated exercise.  Steroid inhalers are also indicated for long-term control of asthma symptoms.

If allergens are your trigger antihistamines like Benadryl, Allegra, Claritin, or Zyrtec may be helpful also.

See your doctor for a history and exam.  Consider wearing a medical-alert bracelet (which will help greatly in case of emergency).  With the correct diagnosis, you should breathe easily, AND without thinking about it.

The goal is to be active and symptom-free.

For more information  http://www.uptodate.com/contents/patient-information-exercise-induced-asthma?source=search_result&search=exercise+induced&selectedTitle=1%7E10

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An ATM to dispense medicine?

Posted on August 31, 2011 by drlesliegreenberg

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Wichita hasn’t seen this kind of ATM yet, but I imagine it is on its way.  It dispenses medicine.  InstyMeds is the company and there is controversy over its benefit and safety.  Read on… An ATM for what ails you | StarTribune.com.

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Painful bladder syndrome

Posted on August 29, 2011 by drlesliegreenberg

flickr.com/photos/hygienematters/ 6034747101

Interstitial cystitis (IC) affects more than 1 million people in the U.S.  The cause is unknown, but there are things we can do to help.

We know the urothelium (the cells that line the inside of the bladder) in IC patients is damaged and can inadequately serve as a barrier against noxious components of the urine.

What are the symptoms?

  • Genital area pain,
  • pain with intercourse,
  • urinary urgency and frequent urination, and
  • needing to urinate during the night.

Who does it affect?  Mostly women.

What tests are used to diagnose interstitial cystitis?  First, a physical exam, bimanual exam for females/rectal exam for males, and a urine specimen are tested.  This is needed to assess if there is a genital or bladder infection, stone, or obstruction.  If those tests are normal, a urology consult may be needed.  There is a link to a questionnaire below which may help diagnose IC.  The urologist may help with the potassium sensitivity test, the anesthetic bladder challenge, and perform a cystoscope.  (A cystoscope is a lit camera placed into the urethra and up to the bladder which allows visual examination of bladder walls).  During this exam the urologist may fill the bladder to distend the walls to see if this elicits pain.

Treatment options are oral medication (pentosan polysulfate sodium) , medications placed directly into the bladder (dimethyl sulfoxide)  and dietary changes with supplements.   The FDA has only approved the two above medications for IC.  Antidepressants and allergy medicines have also been found to help decrease symptoms.

The O’Leary-Sant Symptoms and Problem Index is a
questionnaire that is available at http://www.ichelp.org/Page.aspx?pid=444

Hope this helps.

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New mothers choose “tied tubes” over IUDs: study – chicagotribune.com

Posted on August 27, 2011 by drlesliegreenberg

flickr.com/photos/summerbl4ck/3093533735/

Are you pregnant?  or done having children? This is a timely and thoughtful article.  It compares “tube tying” to intrauterine devices.  Read on…

 New mothers choose “tied tubes” over IUDs: study – chicagotribune.com.

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Want fewer wrinkles and avoid skin cancer?

Posted on August 25, 2011 by drlesliegreenberg

flickr.com/photos/jremsikjr/80676497/

Summer is in full swing  (107 degrees here yesterday in Wichita–ugh!).  There are new labeling rules from the FDA to help consumers select effective sunscreen against wrinkles and skin cancer.    If you read the phrase “Broad Spectrum protection” on the label, it means the sunblock has been tested to protect you from both UVA and UVB radiation.

In addition, the SPF needs to be 15 or greater to help decrease skin cancer, the major sign of aging.  I urge patients to find a sunscreen with SPF > 15 that feels and smells good.  That way you will incorporate it into your routine every morning.

For more information:  www.fda.gov/sunscreen

Hope this helps.

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Hemorrhoids

Posted on August 23, 2011 by drlesliegreenberg

A common condition when the veins in the anal canal are dilated is called hemorrhoids.  If mild, patients can treat themselves with nonprescription cream and warm baths.

Better yet. . . to prevent hemorrhoids eat high fiber foods, take fiber supplements if needed, and drink at least eight glasses of water daily.   If symptoms do not get better, then make an appointment with a physician.  The doctor will consider other conditions including cancer, warts, tears in the anal sphincter, infections, or skin tags that could be the problem.

Hemorrhoids can be internal (inside the anal sphincter) or external (outside the anal sphincter).  Pregnant women and patients with chronic constipation are at risk for hemorrhoids.  Stool softeners can help with symptoms as well as other local therapy–to relieve swelling, pain and fullness.  At times, the hemorrhoid needs to be incised and drained.  Amazingly, this is not very painful to the patient and relief occurs momentarily.  A colonoscopy may be warranted in patients older than age 50 or those at risk for colon cancer.

If hemorrhoids are diagnosed and do not resolve, surgical options are available.  Ask your surgeon about an in-office procedure called rubber band ligation or infrared coagulation (using a special light) or operations requiring anesthesia like excisional hemorrhoidectomy or stapling.

As a medical student, I scrubbed in to help with a hemorrhoid surgery.  The surgeon advised me he eats fiber to avoid hemorrhoids, so that he doesn’t have the kind of surgery that he performs.  How honest!

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Are you due for a pertussis vaccine? Read on and find out. . .

Posted on August 21, 2011 by drlesliegreenberg

I am a family physician who also performs obstetrics.  And, as such, I keep up with  pregnancy-related updates, too.  There is a new indication for the TdaP (Tetanus with pertussis) vaccine.

  • Pregnant women in their third trimester.  The Centers for Disease Control (CDC) and Advisory Committee on Immunization Practices (the two organizations who review vaccine practices) suggest the TdaP vaccine to be given during pregnancy instead of afterwards.  This TdaP vaccine is intended to prevent tetanus AND pertussis (whooping-cough) in the mothers and their newborns.  The TdaP vaccine should replace one dose of Td (tetanus) and preferably be given in the late second or third trimester (meaning after 20 weeks into the pregnancy).
  • Adolescents and adults in contact with infants younger than one year.  This is in response to a recent pertussis outbreak with hospitalizations and deaths in young children.
  • For adults who are due for their every-ten-year tetanus vaccine.  Once as an adult a TdaP (tetanus with pertussis) vaccine should be given instead of the Td (tetanus alone).

And, yes, the vaccination of pregnant women for Tdap is thought to be safe for
both mother and fetus.

So, consider getting a vaccine while pregnant or if you have contact with a child under the age of one–to keep you both safe and healthy.

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Dr. Greenberg is on the move!

Posted on August 16, 2011 by drlesliegreenberg

I am moving my medical practice 8 minutes EAST!

As of October 1, 2011 I’ll be practicing (the same) family medicine with obstetrics at 105 South Andover Road. I am excited for this opportunity to practice medicine at Andover Family Medicine in an intimate, progressive office.

I invite you to move with me! The office is clean, well run, with a great support staff. I will be seeing patients at my current office at 8020 East Central until the end of September. Starting October 1st I will work Mondays, Wednesdays and every other Thursdays in Andover. There will be acute care coverage for my patients on days that I am not in the office–just as there has been in the past.

To facilitate the move, you can fill out medical record transfer forms at http://www.lakepointfp.com/index.cfm?pageId=16&Page=Documents&getDoc=16#.pdf ) and submit to Lakepoint (fax number 316 636 2644) or my new office can do that.

I look forward to continuing to serve
you and I am accepting new patients.

Fondly,

Leslie Greenberg MD

www.drlesliegreenberg.com

Andover Family Medicine 105 South Andover Road, Suite D, Andover, KS 67002

w (316) 778 0919 fax (316) 733-1280

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Dr. Greenberg is on the move!

Posted on August 16, 2011 by drlesliegreenberg

I am moving my medical practice 8 minutes EAST!

As of October 1, 2011 I’ll be practicing (the same) family medicine with obstetrics at 105 South Andover Road.  I am excited for this opportunity to practice medicine at Andover Family Medicine in an intimate, progressive office.

I invite you to move with me!  The office is clean, well run, with a great support staff.  I will be seeing patients at my current office at 8020 East Central until the end of September. Starting October 1st  I will work Mondays, Wednesdays and every other Thursdays in Andover.  There will be acute care coverage for my patients on days that I am not in the office–just as there has been in the past.

To facilitate the move, you can fill out medical record transfer forms at  http://www.lakepointfp.com/index.cfm?pageId=16&Page=Documents&getDoc=16#.pdf  ) and submit to Lakepoint (fax number 316 636 2644) or my new office can do that.

I look forward to continuing to serve
you and  I am accepting new patients.

Fondly,

Leslie Greenberg MD

www.drlesliegreenberg.com

Andover Family Medicine  105 South Andover Road,  Suite D,   Andover, KS  67002

w (316)  778  0919                          fax  (316)  733-1280

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