Exercise-induced asthma. . what are our goals?

Posted on August 11, 2011 by drlesliegreenberg

I saw a young asthmatic having a rare (and mild) wheezing episode this week.  Her mother wanted a note to excuse her from P.E.   Nope!  That’s the opposite from the desired outcome.   My goal is to give medications so she IS a normal, active kid.

Asthma causes symptoms like coughing, shortness of breath, and wheezing.  Commonly exercise  brings on these symptoms.  Studies show only 23% of kids routinely took their albuterol inhaler before exercise.    Adolescents are most likely to avoid activities because of exercise-related respiratory symptoms.

Asthma treatment can be used in a stair-stepped approach, adding medication as the patient’s symptoms require.  If an albuterol “rescue” inhaler is used twice a week or less, no other medication is needed.  A life-preserver at the pool is like an albuterol inhaler.  If it’s needed more than twice a week, you need to learn to swim (or help your lungs in a different way).  An inhaler with different properties should be added daily, not just when needed.    In addition, if environmental  allergies are a trigger, then a daily antihistamine should be used.

You and your physician can make up an asthma action plan.  A peak flow meter (breathing into a special tube at home) used daily gives you a lung volume number.  This helps gauge lung capacity, before wheezing or other symptoms start.   Check out an action plan.  http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf

Hope this helps.

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Cigarette packaging is getting a dose of reality. . .

Posted on August 9, 2011 by drlesliegreenberg

Eye-catching cigarette packaging, isn't it?

Cigarette packaging will be more graphic, starting September 2012.  Manufacturers will be required to devote 1/2 of the front and back of every cigarette package to photos and written warnings about the dangers of tobacco.  There are nine photos showing some risks of tobacco use (like lung cancer and death).

This is the first major change to cigarette warnings in 25 years.  It is hoped that these changes will increase the awareness of specific health risks from smoking, encouraging smoking cessation, and empowering people not to start smoking.

Want to see more?

http://www.aafp.org/news-now/health-of-the-public/20110622cigarettegraphics.html

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Got an itch? Your doctor should be asking some of the following questions. . .

Posted on August 5, 2011 by drlesliegreenberg

If you are itching, there is more to the story.  There are other parts to the history and physical to investigate.

Any new cosmetics or creams? They can cause allergic contact dermatitis, hives or even sensitivity to the sun.

New animal exposures?  Did they give you fleas? or an allergic reaction?

New medications, supplements or illegal drugs?  Hives can occur– or something called fixed drug eruptions.

Contact with sick people?  Let’s hope your vaccines are up to date.  You could have mumps, chicken pox, scarlet fever, fifths disease (the virus that causes cheeks to look slapped), rubeola, or folliculitis (an infection around the hair follicle shaft).

Unexplained weight changes, feeling hot/cold when others are not, changes in menstrual period?  This could be thyroid related and blood work will reveal it.

Unexplained weight loss with night sweats/fever and fatigue?   You also need blood work to rule out a cancer.

Nausea, “bone tired,” less urine output?  Blood work will show if you have kidney failure.

Recent travel?  A good skin exam may reveal lice, scabies, or hives.

A thorough history and physical is the detective work needed to help diagnose (and then cure) itching.

Hope this helps.

Posted in allergies, allergies, Dermatology, Dermatology, food, General Medicine- Adults, medication issues, medication issues, Pediatrics, Uncategorized | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , | Comments Off on Got an itch? Your doctor should be asking some of the following questions. . .

Interesting political/medical turn of events.

Posted on August 2, 2011 by drlesliegreenberg

Birth control pills and breast pumps without copays?  New rules start January 1, 2013.  Read on. . .

Insurers must cover birth control with no copays – Yahoo! News.

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Which smoking cessation interventions work best?

Posted on July 31, 2011 by drlesliegreenberg

There are many options. Here are your effective options to stop smoking:

  • Nicotine Replacement therapy (like gum and patches): All forms of nicotine replacement therapy increased abstinence rates after 6 months. No one type of nicotine replacement can be suggested over another, as all were equally effective.
  • Buproprion. Average quit rate was 17% versus 6% for placebo at 6 months. Either 150 mg or 300 mg therapy worked well.
  • Nortriptyline. This antidepressant-type medication helped boost quit rate.

Of note, no evidence of improved quit rate with silver acetate, Nicobrevin (a nicotine-free smoking cessation aid), lobeline, or naltrexone.  Also, no high-quality studies showed effectiveness of hypnotherapy, acupressure or acupuncture for smoking cessation.

There are known benefits to counseling—individual, group, telephone session, online sessions. This increases quit rates and decreases relapse (starting smoking again) rates.

1-800-QUIT-NOW

Hope this helps.

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Do you feel like you gush like a geyser when on your period? New medical help. . .

Posted on July 28, 2011 by drlesliegreenberg

Heavy menstrual bleeding (menorrhagia) is common enough to cause 10 to 30% of women to seek a physician’s help.  Often the bleeding is severe enough to affect social and emotional well-being.  The current treatment options have been non-steroidal anti-inflammatory pills like ibuprofen, hormonal medications like “The Pill,” progesterone-only intrauterine device, and surgical procedures.

There was a multicenter, randomized, double-blind placebo-controlled study (oooh, aren’t those exciting words for you researchers and physicians out there) which compared tranexamic acid with placebo.  Tranexamic acid caused a reduction in blood loss per cycle over 6 cycles of 40%.  Maybe, better yet, the women in the tranexamic acid group improved their quality of life with fewer changes in social and physical activity due to menstrual flow.

The tranexamic acid is only given during the menstrual cycle and does not interfere with ovulation.  So, women who want to conceive can take this.  One caveat, the study was sponsored by the pharmaceutical company that makes the drug (no surprise).

The medication, brand name is Lysteda, is expensive, costing about $170 for 30 tablets.   Of note,  I do not own any stock in this product.

Hope this helps.

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To mouth-to-mouth or to not mouth-to-mouth? That is the question. . .

Posted on July 26, 2011 by drlesliegreenberg

Hopefully, you know I am referring to cardiopumonary resuscitation (CPR).   I have kept a mask to use for CPR in my car since medical school for exactly this task. There has been interest in whether CPR using chest compressions alone is comparable to outcomes of compressions plus rescue breathing.  Here is the newest answer. . .

There was a study published in New England Journal of Medicine with 1,941 patients which showed that there was no difference in survival to hospital discharge in those given rescue breaths in addition to compressions.  There was also no significant difference in having a “favorable neurologic status” (good brain functioning) with the addition of rescue breathing.   And, to go further, there was a better outcome in those receiving only chest compressions in those patients who had a cardiac cause of their cardiac arrest (instead of  choking or aneurysm rupture, etc).

So, if you are a bystander and see someone down, please do CPR.  It may save their life, a life with “favorable neurologic status.”   Consider taking CPR training.  The Red Cross offers classes nationwide.

Hope this helps.

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Want more information on hepatitis C?

Posted on July 25, 2011 by drlesliegreenberg

Hepatitis C  is a virus that may cause long-standing liver disease.  It is spread through the blood of a person with hepatitis C.  You can’t get it through casual contact—hugging, sharing utensils/drinking glasses, kissing, using public restrooms, sneezing, coughing or shaking hands.

 How will you feel if you have hepatitis C?  Most have no symptoms.  Some have flu-like symptoms like fatigue, nausea, body aches, weight loss, weakness, decreased appetite.  The virus may stay in your body for the rest of your life, even if you have no symptoms.  It can cause liver damage/scarring called cirrhosis. 

To decrease your risk, do not share needles or use illegal drugs.  If you have done either, you are at risk for Hepatitis C.  Ask your doctor about testing.  Do not share items that may have blood on them: toothbrushes, razors, combs, brushes, or nail clippers.  Sexual transmission is low, but latex condoms and limiting number of sexual partners helps decrease risk.

Is there a vaccine for hepatitis C?  No.  But, there are vaccines for hepatitis A and B.  If you have hepatitis C, the other two vaccines are suggested to decrease the risk of other infections affecting the liver.

Is there treatment for hepatitis C?  Yes.  There are medications  like interferon and ribavirin that may need to be taken for a year to help clear the infection.

What should I do if I have hepatitis C?  No medications should be taken that tax the liver (like acetaminophen) and no drinking alcohol. 

Will I infect others?  Hopefully not.  Wear a latex condom with intercourse.  Do not donate blood and don’t share personal items as above.

Want more information?  http://familydoctor.org/071.xml

Hope this helps.

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Tai chi, one pathway to a better life.

Posted on July 21, 2011 by drlesliegreenberg

I have seen groups of people performing tai chi in the park and wondered what was the draw to (what seemed to me)… arm waving.  I know, I am unenlightened.  A recent internal medicine journal cites a study showing tai chi significantly improves heart failure patients’ quality of life.

Tai chi is actually a gentle, meditative exercise of flowing circular movements, weight and balance shifting, visualization, breathing techniques and focused internal awareness.   In one study, patient’s performed tai chi for one hour twice a week with an instructor and were encouraged to practice three times a week.

After 12 weeks the tai chi patients had

  • better mood scores,
  • less depression and
  • better exercise tolerance than those in a heart health education program only.

These studies spurn me to learn about complementary practices that I know little about.

Hope this helps.

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Frogs do not cause warts.

Posted on July 19, 2011 by drlesliegreenberg

I see warts commonly, today in fact. They are caused by the human papillomavirus (HPV). There are more than 100 types of HPV.  HPV infects the skin where there are nicks in the skin and causes cells to proliferate and make a thickened, warty bump. Risk factors include using communal showers or changing rooms, being a meat handler for a job (interesting, huh?), and having a weak immune system.  The HPV vaccine given to adolescents is targeted against genital warts, not to the HPV types that cause common warts.

Do not pick or scratch the wart.  You may spread the virus and get more warts.  Warts are harmless and usually resolve spontaneously within months to years. There are very few, large, high-quality studies to show effective treatments for warts. In those few studies, topical salicylic acid and cryotherapy (freezing with liquid nitrogen) have been found to be most effective.  There are countless home remedies, but none have showed much promise in good studies.

What should you do if you or your child has nongenital warts? You can be patient– as natural immunity will help clear the warts over time in most patients. Or try a tried-and-true method as above.

Your doctor can help.

Posted in Dermatology, Dermatology, General Medicine- Adults, infections, infections, Pediatrics, Uncategorized | Tagged , , , , , , , , , , , , , , | Comments Off on Frogs do not cause warts.