Are you doing what you are passionate about?

Posted on July 12, 2011 by drlesliegreenberg

Today I had the pleasure of teaching.  I routinely help teach my patients at office visits.  But, today, it was teaching physicians, new physicians.  I continue to teach at a local residency program, and a group of 16 interns just started.    All that inquisitive brain power is amazing!  Inquisitive.  Energized.  Motivated.

Today I taught the Advanced Life Support for Obstetrics course like I have for 13 years.  It is an intensive course –like a 16 hour CPR course covering high-risk obstetrics. . . ahhhh!  I appreciate reading new guidelines, learning improved techniques, hearing colleagues lecture, and performing hands-on workshops.

Word is that half of what is taught in medical school is later found to be wrong. . . I hope to replace THAT half of my knowledge.

Enjoy today!  Seek out what YOU are passionate about.

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Does your New Year’s resolution resolve need a booster?

Posted on July 9, 2011 by drlesliegreenberg

Over 13,000 women participated in a study which yielded some interesting information on what habits can increase or decrease  your cancer risk . . . and by how much.

  • In women with a family history of breast cancer, or “other factors”. . .Women who smoke for 35 + years have a 59% higher risk of developing breast cancer compared with those who never smoked.  Smoking 15 – 35 years had a 34% higher risk.
  • Colon cancer is four times higher among women with 35+ year smoking history and 7% higher for those who have smoked 15-35 years.
  • It was noted, and not too surprisingly, that one pack per day of cigarettes for 35 + years has a risk 30 times higher risk of lung cancer than did women who never smoked.
  • Are you a couch potato?  Low level of exercise raises risk of endometrial cancer by 72%.
  • Alcohol consumption was NOT found to increase cancer risk.  (This means moderate alcohol consumption which is up to one drink a day.)   This was shown to decrease risk of colon cancer by 65% compared with those women who did not drink.

Take home message?  Don’t smoke.  Or stop smoking.  Exercise.  Drink in moderation.

Hope this helps.

Posted in Cancer, General Medicine- Adults, Uncategorized, Women's Health | Comments Off on Does your New Year’s resolution resolve need a booster?

2.4 million swimmer’s ear visits a year! How to not get one. . .

Posted on July 7, 2011 by drlesliegreenberg

The Centers for Disease Control forwarded on this astronomical number in a bulletin on external ear infections.  There are simple steps to do before and after swimming (or coming in contact with water), to greatly reduce your risk of this painful infection.

Symptoms of swimmer’s ear are tenderness at the ear or around it, redness, and swelling of the external ear canal.  Cases peak during the summer months and children aged 5-9 years accounted for the most physician visits for this—although it can occur at any age.

Surprisingly, the cost per case was $200 for those not requiring hospitalization.  3% of those visiting an emergency department for this were hospitalized.

To prevent. . .

  • Use ear plugs or bathing caps to reduce exposure of the ears to water
  • Dry the ears after swimming–hopping on one foot, moving the ear lobe, and tapping the other temple with your hand, or gently blow drying your ear.  Some sound silly but these do help.
  • Keep foreign objects (like cotton swabs) out of the ear, as these may break the skin and create an avenue of infection.

Do not remove ear wax.  It is good for the ear and helps protect it from infection.

Swim in maintained pools as proper pH and chlorine levels decrease Pseudomonas aeruginosa and Staphylococcus species which are the usual culprits of external otitis infections.

For more information, visit www.cdc.gov/healthyswimming

Enjoy the water this summer!

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How often do YOU need a pap?

Posted on July 5, 2011 by drlesliegreenberg

The Pap smear used to be done every year. . . guidelines have changed.  Read on. . . We perform paps on women to screen for abnormal cells on the cervix.  Cervical cancer is a disease of sexually active women, related to infection with specific high-risk strains of HPV.  Risk factors are earlier onset of sexual activity, multiple partners, cigarette smoking, and immunosuppression.

Initial screening is not suggested (by most professional groups) until age 21.  We now know that adolescents who have intercourse and contract HPV may have transient cervical changes and most resolve spontaneously, without any treatment.  At age 21 a pap should be offered to all women, regardless if they have ever had sexual intercourse.

At the other end of the age spectrum, Medicare first started reimbursing for Pap smears in 1990 because studies showed 40% of elderly women had NEVER had a pap.  How amazing!  There are no studies to show the effectiveness of screening women older than 65.  Paps may be considered in patients with positive HPV status, current sexual activity, or recent new sexual partners.  Also, older women who have not been screened should have Pap tests annually until they have had three normal tests.  No more paps needed for screening in those with adequate previous testing and no risk factors.

Screening frequency intervals have changed for those 21 to 65.  Most US guideline-issuing organizations recommend screening every two to three years for women older than 30, more frequent for younger women or those with risk factors (HIV infection, immunocompromise, in utero exposure to diethylstilbestrol, prior abnormal paps, or prior cancer).

If you’ve had a hysterectomy for non-cancerous reasons, no more Paps are needed.

For more information the CDC has a great brochure:   http://tinyurl.com/6g8de6v

Hope this helps.

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New measles and whooping cough vaccination guidelines for adults!

Posted on July 1, 2011 by drlesliegreenberg

Changes! Changes! The governing body on immunization practices met last week. Many babies are becoming ill with pertussis and the pregnant mom can help. The pertussis vaccine is considered safe for pregnant women and may give immunity to their young babies before they can make an immune response to their vaccines at the 2,4, and 6 month well child check visits. Measles is coming home as a travel souvenir , so some adults may need a booster of that before international travel.

Read on …

http://www.addthis.com/bookmark.php?v=250&username=aafponline.

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What to do about unwanted hair?

Posted on June 29, 2011 by drlesliegreenberg

A patient of mine recently asked me to blog about female unwanted facial hair.   She has more facial hair than she desires and works with children (who frequently are inquisitive and vocal).  This is not a singular problem, most of post-pubertal persons in the world routinely practice some form of hair removal.  Plucking or shaving are common. . . here are a few others to consider.

The temporary methods are just that, temporary–although sometimes the dermal papilla are damaged by the removal, leading to permanent removal of hair.

  • Plucking is effective, often lasting for 6 to 8 weeks, and often painful.  Plucking is best for selective area with small numbers of unwanted hairs.
  • Waxing involves applying a layer of cold or hot wax to the area and when the wax is pulled off, the trapped hairs are pulled out.  For some, this is less painful than plucking.  This pulls the hair out down to the bulb.
  • Depilation is the use of a chemical to dissolve the hair, which is then wiped off.  Most contain sulfur which produces an unpleasant odor, and the results only last 2 weeks.
  • Shaving is common, only removes hair to just below the surface of the skin, and may need to be repeated every 12 to 24 hours.  Shave bumps are especially common in black men.  Shaving can cause infection of the skin with staph aureus or spread warts or molluscum.
  • Bleaching does not remove hair, but may mask its presence.  The hydrogen peroxide may cause irritation, itching and possible skin discoloration.  Try this on a small area of skin first to make sure you do not make a reaction.
  • Vaniqa (FDA approved only for the face) is a prescription strength cream which can reduce hair growth by inhibiting an enzyme the hair needs to grow.  This is my patient’s favorite (and the reason she asked me to blog on the subject).  Noticeable results in 6-8 weeks.  When treatment stopped, hair returns to pretreatment levels in another 8 weeks.
  •  Lasers are effective, multiple treatments are needed, and it works best on dark hair.  A dermatologists or plastic surgeon can help.
  • Electrolysis permanently removes hair, usually performed at spas and not physician offices.  Technicians are not required to be formally trained.

Hope this helps.

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Risks to consider when getting a tattoo. . .

Posted on June 27, 2011 by drlesliegreenberg

Three risks to consider when getting a tattoo.   Purchase, possession and overt health risks.

Purchase risks include expense and pain.  Adolescents are especially at risk for impulsively obtaining a tattoo and may overpay, choose a tattoo parlor that is unsafe/unclean, or have increased risk of infection due to not appreciating the importance of skin care.  (FYI: Some tattoo artists have temporary locations at flea markets, rock concerts or fraternity parties–convenient . . . and invites impulse “buying”).

Second risk is possession risks, meaning the risk of a negative response from others.  The tattoo may have significant meaning to the person, but the parents, teachers and co-workers may express dislike.   Consider the placement of the tattoo–how public would you like the tattoo?  (on your neck?  or only to be seen by those you are intimate with?)  Consider the content of the tattoo  (will you always like a spider? or current loves name?) Consider your profession.  Artistic jobs may be more approving of visible tattoos versus . . . say, your dentist.   This may cause low self-esteem, possibly difficult job placement, and eventual removal of the tattoo.

Third risk is localized infection.  Of note, tattoo artists are not required to complete formal training.  Staphylococcus aureus infection may occur.  To decrease this risk,  have tattoists adhere to infection-control measures

  • change gloves between clients
  • wash hands
  • use alcohol and iodine on the skin before tattoing begins
  • disinfect tattoo equipment before application of dye
  • wash skin with soap and water twice daily after tattoo applied.

Hepatitis B may be transmitted during tattooing with reused or inadequately sterilized instruments.  State regulations also do not require hepatitis B vaccination be given to tattoo artists.  No known cases of HIV have been caused by tattooing.

Be aware of the ink used, as ink is not FDA approved.  Some artists use automobile paint or printer ink.  These can contain metals like cadmium (yellow dye), mercury (red), cobalt (blue), and chromium (green) which can cause allergic reactions in the skin.  Consider using bioabsorbable ink (like “Freedom-2 inc”) which when exposed to laser energy is resorbed by the body.  Long-term studies on safety of Freedom-2 ink are unknown.

Please do not tattoo over a dark mole.  It makes watching that mole for cancerous changes more difficult.

Hope this helps.

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Are you on a statin? Will it give you diabetes?

Posted on June 22, 2011 by drlesliegreenberg

We now know that a high-dosed statin can increase your risk of getting diabetes.  What are the risks?  New study shows increased risk of diabetes with high-dose statin medication albeit only 2 per 1000 patient-years.  Studies, though, showed that there is less risk of vascular disease, decreasing incidents by 6 per 1000 patient-years.  This shows that benefit may outweigh the risks.

To check for diabetes, fasting blood sugar (under 100 is normal) should be checked yearly.  A comprehensive metabolic panel (which has a blood sugar in it) is obtained yearly anyway to make sure that your body can effectively break down the statin.

Here is the study. . .

Risk of Incident Diabetes With Intensive-Dose Compared With Moderate-Dose Statin Therapy, June 22/29, 2011, Preiss et al. 305 24: 2556 — JAMA.

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Exercise and help colon health. What does that mean?

Posted on June 21, 2011 by drlesliegreenberg

Would you like another reason to exercise? How does reduced risk of colon polyps and thereby possibly less often colonoscopies sound?!  An interesting study from Memorial Sloan-Kettering Cancer Center in New York of nearly 1000 patient showed that one hour of exercise a week are less likely to have colon polyps.

In overweight and obese patients who exercise at least one hour per week, they are 40% less likely to have colonic polyp adenomas and 63% less likely to have advanced adenomas compared to their overweight/obese counterparts who exercise less.

This could have a substantial public health impact as this suggests that even a moderate amount of exercise can have far reaching benefits.  Research is planned to identify which specific activities and level of intensity help protect most.

I’ll keep you updated. . .

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Happy Father’s Day!

Posted on June 19, 2011 by drlesliegreenberg

My father died too young.  I miss him daily.  One of my jobs as a physician is to guard my patient’s health.  I want to screen them for diseases, vaccinate to avoid preventable infections, and counsel about healthy living.  I try to involve their families.

Happy Father’s Day to all you fathers out there.  May you and your families encourage healthy behaviors so that you may experience MORE (and often unexpected moments) of life’s joy: giving your daughter away at her wedding, meeting a first grandchild, growing old with your wife.

Consider that those that you leave behind may grieve your passing.  Let your loved ones help support you in stopping smoking, encouraging exercise, changing to a healthy diet, assisting with preventive care measures.  For you family members. . . bribe, cajole, harass all the while letting your dad know that you love him. 

“A truly rich man is one whose children run into his arms when his hands are empty.”—Unknown.

Enjoy.  Take care of each other.  Plan for your future.

Happy Father’s Day!

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