Considering a tattoo?

Posted on June 16, 2011 by drlesliegreenberg

Here’s a riddle: What is expensive and painful to get; even more expensive and painful to get rid of; a common source of infection and allergies; and something that you will probably want to have removed some day? Answer: a tattoo.

I value free speech and the freedom to apply body art.  But, buyer beware. . .A study at the University of North Carolina at Chapel Hill School of Medicine revealed about 50 percent of people with tattoos seek medical attention to have them removed. Technology is trying to meet this demand with laser ablation, dermabrasion (scraping the top layer of skin with a wire-like brush) and excision of the tattooed area of the skin. While all methods of tattoo removal leave scar tissue, researchers point out that some results are worse than others.

If you think you might change your mind about your tattoo, don’t get it or at least consider not having  red or  yellow –they’re the hardest to remove.

More about tattoos to come. . .

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MRSA. Do you have it? How to avoid it? How to treat it!

Posted on June 9, 2011 by drlesliegreenberg

Yesterday, I had the opportunity to incise and drain this spectacularly large,  red abscess.  Culture is not back yet, but I suspect (and treated for) MRSA, methicillin-resistant staph aureus.  Here are the nuts and bolts about diagnosis and treatment of MRSA.

1/3 of us carry staph on our skin.  Usually it does not infect us, unless we are immune compromised OR we have scratches on our skin allowing the staph in–like chinks in our armor.

You are at increased risk for MRSA  if. . .

  • Recently hospitalized (any care provider needs to wash their hands upon entering your room)
  • Child care workers
  • Contact sports participants
  • Residents of long-term care facilities ( nursing homes, prisons, military, college students)

MRSA symptoms?  You may think you were bitten by a spider.  But, consider MRSA if you have a red, raised lump that hurts or is increasing in size.  NEVER drain it yourself.  If sterile technique is not used (or used improperly), the infection can get worse  spreading deeper  into tissues.

Treatment may require incision and drainage, placement of sterile gauze packing (inside the wound cavity to help lead the infection out and to keep the wound from re-sealing over) or hospitalization.  Wound cultures may be taken and antibiotics will be started.  Methicillin-RESISTANT staph is resistant to the penicillin family, so other more sensitive antibiotics will be started.

To decrease your risk  of MRSA  use good hygiene.

  • Wash hands or use hand sanitizer
  • Clean cuts or scrapes well.  Cover with bandage until healed
  • Don’t share towels or razors
  • Don’t touch another person’s wounds or bandages
  • At the gym, clean equipment before and after usage, keep hands away from your face, and shower after workout.

Hope this helps.

Posted in Dermatology, Dermatology, General Medicine- Adults, infections, infections, Pediatrics | Tagged , , , , , , , , , , , , | Comments Off on MRSA. Do you have it? How to avoid it? How to treat it!

Drowning. The silent, public death. What to watch for. . .

Posted on June 3, 2011 by drlesliegreenberg

This is a macabre subject, I know.  But, one that needs to be considered.  Summertime means more time around water.  Drowning is a real danger.  It is the second leading cause of accidental death of children aged 15 years and younger.  Here’s what to watch out for. . .

  • mouths alternately sinking below the surface of the water and then resurfacing.
  • no call for help (there is not enough air or time above water to vocalize)
  • no wave for help (the arms are pressing down on the surface of the water in an attempt to propel head above water).

This water surface struggle usually occurs for 20 to 60 seconds before submersion occurs.

Be aware of swimmers with their head low in the water (or mouth at water level), those with eyes closed or glassy, hyperventilation or gasping,  or if they appear to be climbing an invisible ladder.  This is the person who needs your help to ward off disaster.

One other trick, ask the swimmer if he/she is okay.  If they answer you, they are more successful with underwater kicking and treading water.   A life-preserver may be needed instead of you physically jumping  in to rescue them.

Stay vigilant.  Of the 750 children who will drown in the next year, about 375 of them will be within 25 yards of a parent or other adult.  The CDC notes that 10% of drownings the adults watch and are unaware of what is happening.

Water safety is so important.  Be a poolside lifeguard yourself.  Insist on children’s swimming lessons. Consider taking them for yourself to hone your skills or take a lifeguarding course!

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Infantile hemangiomas. Get your cameras out!

Posted on May 30, 2011 by drlesliegreenberg

This delightful baby’s hemangioma was nearly imperceptible at birth and grew to be this rather impressive lesion.  I advised the parents to take lots of pictures because by preschool it will probably be gone.  Infantile hemangiomas are benign tumors of vascular endothelium, frequently causing angst in the parents. They are the most common tumors of childhood

Even though hemangiomas are benign (non-cancerous) and self-limited (will stop growing on their own), they can cause ulcers or be disfiguring.

The goals of hemangioma management are:

  • Prevention or reversal of life-threatening or function-threatening complications (like inability to swallow or breathe)
  • Prevention or minimization of disfigurement from residual skin changes (common for lesions on the lip, nose and ear)
  • Minimization of psychological distress for the patient (and family)
  • Treat any ulceration to minimize scarring, bleeding, infection, and pain

Individualized care is based upon size of the lesion(s), what it looks like, location, presence or possibility of complications, potential for scarring or disfigurement, the age of the patient, and the rate of growth or involution (shrinking) at the time of evaluation

“Active nonintervention” is the mainstay of therapy for most uncomplicated hemangiomas because hemangiomas involute spontaneously.  This means to intervene only when necessary.

I refer to a dermatologist, vascular anomalies team or other subspecialist if the family would like further information or hemangioma involves

  • Lesions in the airway, liver, or gastrointestinal tract
  • Lesions in the periorbital region
  • Very large, rapidly growing cutaneous hemangioma

Steroids are the first-line treatment option.  Propranolol may be second-line.  Vincristine (a cancer medication) and interferon alpha (an immune-modulator medication) may be considered for aggressive hemangiomas otherwise not responsive to the first two therapies.

Hope this helps.

(Consent, of course, obtained from the parents)

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Blood clots, a villainous term

Posted on May 26, 2011 by drlesliegreenberg

Blood clots  in the large deep veins can be deadly.  Avoid triggers and watch for symptoms  to decrease your chance of getting them.  Here are some tips. . .

Suspicious symptoms for venous thromboembolism  (VTE) are swelling in the leg with pain and redness.  It is especially dangerous if a part of the blood clot in the leg breaks free and travels to the lung.  A large blood clot to your lung can be fatal.  This is called a pulmonary embolism.

Coughing up  bloody sputum may be a sign of (non-fatal) pulmonary emboli.  But, sometimes there is no difficulty breathing or warning  before a big blood clot goes to the lung and the patient falls over dead.  Scary, huh?

Let’s prevent VTE.

    • Quit nicotine.  It damages  blood vessels and increases your risk of forming a blood clot.
    • Walk every 2 hours.  Contract your calf muscles by pointing your toes to the ceiling and then the floor.  This will mobilize blood in the calf blood vessels so that it won’t make a clot.
    • Beware.  When sedentary, like after surgery or a long car trip, blood can pool and make a clot.
    • Tell your doctor if you have a history of a blood clot as you may have a blood disorder that makes it easier to make clots.  Blood tests may be ordered.  In this case, medicines like hormones and birth control pills may be avoided as these can increase your blood clot risk further.

 

      Want more information?  Try

http://www.nlm.nih.gov/medlineplus/deepveinthrombosis.html

Posted in contraception, General Medicine- Adults, menopause, nicotine, Uncategorized, Women's Health | Tagged , , , , , , , , , , , , | Comments Off on Blood clots, a villainous term

New York Times. What does your current health tell about YOUR future?

Posted on May 24, 2011 by drlesliegreenberg

Interesting study showing how exercise capacity and speed foretells level of health 40 years later.  As for me. . . I’m ditching this keyboard, running, and starting a log of my running times!

Running Time as a Measure of Heart Health – NYTimes.com.

Make the most of your body and your time.  Get out there!

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Need help returning to work as a breastfeeding mom?

Posted on May 22, 2011 by drlesliegreenberg

Know the benefits! Several studies show that breastfeeding helps individual families as well as employers– improved productivity and employee loyalty, enhanced public image of the employer, AND decreased absenteeism, health care costs, and employee turnover.

Employers must provide “reasonable break time for an employee to express breast milk for her nursing child for one year after the child’s birth each time such employee has need to express milk” per the Patient Protection and Affordable Care Act (PPACA), signed into effect March 2010.

A few caveats,

    • this time expressing milk is unpaid time
    • employers with fewer than 50 employees are not required to comply if it would cause the company financial strain
    • there is no other legislation to require an employer to give additional breaks outside of time needed to express milk.

 

      Your doctor can give you a letter for your employer to help facilitate “pump time.”

http://www.womenshealth.gov/faq/letter-from-employees-physician.pdf

A great governmental resource to help with details of returning to work is http://www.womenshealth.gov/breastfeeding/government-programs/business-case-for-breastfeeding/employees-guide.pdf

Hope this helps.

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Atrial fibrillation may be PREVENTABLE!

Posted on May 19, 2011 by drlesliegreenberg

Atrial fibrillation does not need to be your “destiny.”  AF is an irregular heart rhythm that increases your risk of stroke.  Be aware of the risk factors and change your future!  A study of 15,000+ adults revealed modifiable (changeable) risk factors for atrial fibrillation

  • Elevated blood pressure
  • Smoking
  • Obesity (patients with BMI more than 30)
  • Overweight patients (patients with BMI between 25-30)
  • Diabetes (fasting blood sugars more than 126)
  • Impaired glucose tolerance (fasting blood sugars 100-126)

ONE or more risk factors (above) explained 50% of new atrial fibrillation cases over the 17 year follow-up.

This confirms results of an earlier study.   In a 1994 study,  smoking, hypertension, diabetes and coronary artery disease were atrial fibrillation risk factors. 

If you have ANY  of the risk factors above. . . stop smoking AND get your numbers within normal.  It is in your best interest.   If you have atrial fibrillation you may need to take a blood thinner, watch Vitamin K dietary consumption, and have weekly or monthly blood work for years to come.

atrial fibrillation EKG

Watch your numbers and stay healthy!

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Embarrassed about your pale pasty skin? Get over it.

Posted on May 16, 2011 by drlesliegreenberg

Wanting a rich, deep tan?  Frequenting a tanning salon?. . . Please don’t.  May has been designated Melanoma/Skin Cancer Detection and Prevention Month.  So, let’s celebrate our natural skin color, whatever color it is.

American Academy of Dermatology did an online study of 3800 (adolescent through mid 20s)  females.  The results are shocking!

81% of respondents had tanned outdoors “frequently or occasionally” in the past year.  32% used a tanning bed in the past year, while 25% reported using a tanning bed at least weekly. 

The SAFE alternative to UV-exposure, a “spray tan,” was NOT used by  86% of said respondents in the past year.  The 18- to 22 year-old female crowd is nearly twice as likely (40%)  to use indoor tanning beds as compared to 14- to 17- year olds (22%).   Cost?  Transportation issues?

There are more tanning salons than Starbucks or McDonalds.  In a recent survey in 116 U. S. cities, on average there are 42 tanning salons per city. 

Teens and early adults may not appreciate the consequences of the cumulative sun exposure.  Nearly 75% of skin cancer deaths are from melanoma with rates rising for the last 30 years.

The World Health Organization declared UV radiation from the sun and artificial light sources a known carcinogen (cancer-causing agent) and called for prohibiting minors from indoor tanning. 30 + states either prohibit or require parental consent for minors who want to use indoor tanning devices.

So, consider stopping the “fake bake,”  instead buy sunscreen, embrace your natural skin color, and see your doctor for  a skin check.

Hope this helps.

Posted in Dermatology, Dermatology, General Medicine- Adults, Pediatrics, safety, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Embarrassed about your pale pasty skin? Get over it.

Head lice (Is your skin crawling?). Two new treatments.

Posted on May 13, 2011 by drlesliegreenberg

Good people get head lice.  It is especially rampant in schools where coats may hang next to each other (and the lice essentially jump from one household to another).  Head lice are becoming more resistant to over-the-counter rinses.  There are two reasonably effective therapies to kill the head lice.  Both are non-pesticide and non-neurotoxic therapies that asphyxiate the Pediculosis humanis capitis.  Ick!

  • Ulesfia lotion.  It’s a benzyl alcohol/mineral oil product that stuns the lice spiracles (breathing holes) so the lice drown in the mineral oil vehicle.  (Too much information?)  It can be used in patients older than 6 months.  It needs to be used in a quantity to fully saturate the hair.  Rinse after 10 minutes.  It may not kill the eggs, so repeat one week later.
  • Cetaphil gentle skin cleanser.  Cetaphil is applied to hair and scalp.  2 minutes later comb (not wash) out.  Eight hours later the hair is washed with regular shampoo.  This treatment is repeated once weekly for 3 weeks.

Cure rates for either treatment is 85-97%.  Clothes and bedding should be heated in a hot dryer for 10 minutes and combs washed in isopropyl alcohol for 10 minutes.

Other home remedies like mayonnaise, olive oil, butter, Vaseline, and vinegar were not found to be nearly as effective.

Hope this helps.

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