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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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. . .

Posted in Dermatology, Dermatology, General Medicine- Adults, Pediatrics, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Considering a tattoo?

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

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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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