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.

Posted in breast, Obstetrics, Pediatrics, Uncategorized, Women's Health | Tagged , , , , , , , , , , , | Comments Off on Need help returning to work as a breastfeeding mom?

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!

Posted in General Medicine- Adults, heart, Uncategorized | Tagged , , , , , , , , , | Comments Off on Atrial fibrillation may be PREVENTABLE!

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.

Posted in General Medicine- Adults, Pediatrics, Uncategorized | Tagged , , , , , , , , , | Comments Off on Head lice (Is your skin crawling?). Two new treatments.

Teens birthing babies tumbles to a record low.

Posted on May 12, 2011 by drlesliegreenberg

This is something to celebrate!  As a mother, I know that once you have a child your life (and your life’s pathway) are forever altered.  And, you are forever tied to their father (hi, honey!).   My teen patients and I discuss what is happening to their bodies and decisions they will be making.  Dating?  Boundaries?  Sex?  Contraception?  STDs?  Pregnancy?  I have rarely had a parent that did not want me to be a professional sounding board for their changing teen.

The CDC released data that the teen birth rate has fallen 37% over the last 20 years.  However, our rate of teen pregnancy (ages 15-19) is still NINE times higher than in many other developed countries.   The numbers of teens having sex decreased in white, black and Hispanic races for both boys and girls, but black and Hispanic girls remain twice as likely (as white girls) to become teenage mothers.

A CDC fact sheet states that health care providers can help reduce the teen birth rate.  My role is to listen, counsel, and help anyway that I can.  Use your family physician to help educate your children about the adult decisions they will face.

Hope this helps.

Posted in contraception, infections, Obstetrics, Pediatrics, safety, Uncategorized, Women's Health | Tagged , , , , , , , , , | Comments Off on Teens birthing babies tumbles to a record low.

Happy Mother’s Day to all the mothers and those WITH mothers. . .

Posted on May 8, 2011 by drlesliegreenberg

What a special day!  A time for us to  thank our mothers, reflect on our childhoods, and for those of us who are mothers. . . to savor our children.  I am blessed with three children and am amazed by their unique constellation of personality traits, quirks and talents. 

I chose  the career of “family medicine with obstetrics” because it is energizing, engrossing, emotional and truly amazing.  I considered obstetrics during medical school, but I wanted to keep following  the mother and baby.  I counsel  couples  through their pregnancy and am present to help with the birth of  their baby and becoming a family.  Those first few weeks of a newborn’s life are so challenging to the new parents.  I love to hold their hands, answer the lists of questions.  It is a delight and an honor. 

Rajneesh says “The moment a child is born, the mother is also born.  She never existed before.  The woman existed, but the mother, never.  A mother is something absolutely new.”  Well said.

How fantastic.  Enjoy what you have.  Revel in your life.

Happy Mother’s Day to all.

Posted in Uncategorized | Tagged , , , , , , , , , , | Comments Off on Happy Mother’s Day to all the mothers and those WITH mothers. . .

Should I insist my doctor order an MRI?

Posted on May 7, 2011 by drlesliegreenberg

There are lots of magazine articles telling patients that if they want better care to speak up for themselves!  This brings up . . . are MRIs done too often? 

Magnetic Resonance Imaging has become a routine test in the evaluation of musculoskeletal conditions.   Most patients with neck, back, knee or shoulder pain will improve with conservative management.  MRI often shows pathology (aka that something is wrong)  that may have no relationship to the patient’s symptoms.  Tests have shown that young and middle-aged people with NO symptoms 30-40% of the time have changes in their disks.    The MRI can give confusing information that may not identify the source of pain. 

To optimize healing, I do a thorough history and physical exam.  Certainly, if there are “red alarms” like infection or acute disc herniation or cauda equina syndrome, then an MRI is warranted.   If conservative therapy does not help resolve the problem in 4 to 6 weeks, then an MRI may help also.  We physicians are trained to not obtain tests that won’t help the diagnosis or plan of care.  MRI is not indicated if the result will not alter treatment.  Muscle stretching and strengthening are the cornerstones of rehabilitation.  That requires the patient be motivated and engaged in therapy. 

cervical spine MRI

Hope this helps.

Posted in bone health, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , | Comments Off on Should I insist my doctor order an MRI?

Are you considering NOT immunizing your child?

Posted on May 5, 2011 by drlesliegreenberg

A new position statement was released revealing that even a small number of unimmunized individuals can greatly increase spread of disease.  For children who do NOT get immunized, their risk of measles is 35 times those who are vaccinated, 23 times for whooping cough and 9 times for chicken pox.  If an unimmunized child contracts an infection, they may infect your incompletely immunized child, too.  Read more. . .

Pediatric Infectious Diseases Society Rejects ‘Personal Belief’ Immunization Exemptions — AAFP News Now — American Academy of Family Physicians.

Posted in infections, Pediatrics, Uncategorized, Vaccines, Vaccines | Tagged , , , , , , , , , , | Comments Off on Are you considering NOT immunizing your child?

Did your pedicure give you an infection?

Posted on May 3, 2011 by drlesliegreenberg

I was teaching physicians the other day and helped take off a pus-filled, red and angry  ingrown toenail.  This is immensely rewarding.  When the toenail digs into the skin folds on the feet and every step causes pain, we physicians can help.

Ingrown toenails occur when the nail grows downward on the sides (especially of the big toe) and inflames the skin around the nail border.  This may happen because of trauma (like a stubbed toe), but it more commonly is caused by trimming the sides of the toenail too much.  If it is only mild, soaking the toes for 15 minutes three times a day for 2 weeks may help. After the soak, gently nudge the skin surrounding the nail away from the nail.  Wedging a toothpick or dental floss under the corner of the nail that is imbedded in the skin may help elevate it and relieve the problem.  Epsom salts can be placed in the water, if desired (your feet will be softer, too!)  Your doctor can prescribe a high potency steroid cream to help decrease the inflammation in the tissue.

If this does not help, or there’s a raging  pain/infection, we can take that part of the toenail off.  Your physician will

  • numb the toe with a digital block which will feel like a pinch on both sides of your toe.  That’ll make your entire toe numb.
  • remove a portion of the toenail so that it may regrow in the correct manner.  This new nail should not be trimmed until it is even with the end part of the nail.
  • An antibiotic ointment may be suggested by your physician on the bare nailbed until the nail has started to grow.
  • Oral antibiotics have not been shown to decrease the recovery time.

Like I tell my kids. . . let’s cut those toenails straight across.  Not angled like the fingernails.

Hope this helps.

Posted in foot health, General Medicine- Adults, infections, Uncategorized | Tagged , , , , , , , , , | Comments Off on Did your pedicure give you an infection?

What to do about molluscum?

Posted on April 29, 2011 by drlesliegreenberg

I had a conscientious mom “up in arms” about her daughter having two molluscum lesions on her neck. I calmed her a bit and then discussed the treatment options with her. . .

Molluscum is a poxvirus causing a chronic localized infection.  The lesions are firm, flesh-colored, and dome-shaped.  It is considered common, with 5% of US children having molluscum.  Those with eczema may get molluscum easier.  Molluscum also affects healthy adolescent and adults, often from sexual contact or contact sports.

The poxvirus transmits from skin-to-skin, although it has been shown to transmit by towels or sponges and, rarely, in pool water. Humans are the only host and takes usually 2 to 6 weeks from contact until first lesion forms. In sexually active adolescents or adults, STD screening should also be performed.

There is a decision to make: to treat or not.  Adolescents and adults should be treated so as to avoid spread.  But for children, we can advise that molluscum is not harmful and will go away on its own (although this will take months.) A systematic review in 2009 showed “insufficient evidence to conclude that any treatment was definitively effective.”

That means that I do not push children to have treatment.

I do offer the following. . .

  • Cryotherapy otherwise known as (“freezing”). Cons: painful to young children, may cause scarring and decreased skin pigmentation where frozen.
  • Curettage (scooping out the dome-shaped lesion). Pros: 80% worked after a single session. Cons: fails more often with more lesions and with a history of eczema, may cause small depressed scar
  • Cantharidin (a liquid blistering agent). Requires skill of physician placing the liquid. Repeat applications every 2 to 4 weeks commonly needed. Can cause scarring.

To avoid spread, cover lesions with clothing or bandages while at sleepovers and during contact sports.

To treat or not to treat? That is the question. . .

Posted in Dermatology, Dermatology, General Medicine- Adults, infections, infections, Pediatrics, Sexually Transmitted Infections, Uncategorized | Tagged , , , , , , , , , , | Comments Off on What to do about molluscum?