Should we be facebook friends?

Posted on April 24, 2011 by drlesliegreenberg

Social networking and doctoring.  Interesting concepts.  USA Today’s opinion editorial from a physician backs up the idea that doctors should not be “friending” their patients.    Her reasons were two-fold. . .

Professional judgment may be impaired when a physician has another relationship (financial, social or professional) in addition to the therapeutic relationship.  As a family doctor in a tight-knit community, I am friends with many of my patients.   I try to keep these relationships separate and distinct. 

There is also the issue that in a public platform, such as facebook, there’s threat to patient privacy.  The American Medical Association adopted a social media use policy November 2010.  It states that physicians “should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online.”  I appreciate that.   I once replied to a patient’s facebook question regarding morning sickness and “outed” her pregnancy to her extended family.

My patients know how to reach me during the day and  after hours.  I am accessible.  Online is not a good  forum.  I liken online correspondence  to a “curbside consult.”  When I’m at a BBQ and a patient asks me about an issue  (hip pain, vaginal discharge—you’d be surprised. . .) I do not have access to past medical history, allergies, surgeries, test results nor can I do an adequate physical exam.  That is subpar health advice.  An office visit is the best way to conscientiously and thoroughly address health problems. 

Hope this helps.

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What to do if you think you have shingles. . .

Posted on April 21, 2011 by drlesliegreenberg

If you’ve had chicken pox, the herpesvirus is hibernating in your body.  It can reactivate anytime and cause shingles.   Shingles is a painful , itchy, burning, bugs-under-your-skin-feeling rash on one side of the body.  See your doctor for confirmation.

The goals of antiviral therapy are not to get rid of the virus (as this is impossible) but instead to promote faster healing of skin lesions, lessen the severity and duration of pain, and to decrease the incidence or severity of postherpetic neuralgia (which means post-herpes-nerve-pain at the same site of the rash).

Antiviral medication is recommended for patients >50 years of age with uncomplicated shingles.  The patient needs to see the doctor within 72 hours of clinical symptoms or medication may not help decrease the pain or shorten the course.   Two antiviral choices are Valacyclovir (1000 mg three times daily for seven days)or acyclovir (800 mg five times daily for seven days).  Both are effective, acyclovir is much less expensive but less conveniently dosed.

The benefit of antiviral therapy in younger patients (under 50) is not as clear, as younger patients are less likely to have post herpetic neuralgia.   But, because antivirals are relatively safe, they CAN be given if the patients are diagnosed within 72 hours of clinical symptoms.

In short. . .

  • Anyone who has had the chicken pox can get shingles.  Be aware of feelings of skin tingling, burning and then a rash developing.  See your doctor.
  • Shingles nerve pain hurts.  Your doctor can prescribe pain medication.
  • Early antiviral treatment for shingles reduces the duration and incidence of postherpetic neuralgia.
  • Steroid therapy once was thought to decrease complications from shingles, but this has not been shown to help and may, instead, decrease the immune system/infection fighting ability of the system and put the patient more at risk.
  •  If older than 60, get herpes shingles vaccine.

Hope this helps!

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Do you need antibiotics before seeing the dentist?

Posted on April 19, 2011 by drlesliegreenberg

My mom recently was told by her dental office that due to orthopedic hardware in her ankle she’d need to take antibiotics before  teeth cleanings.  There are guidelines to specifically address this.  And, no antibiotics are needed.

Every time you brush or floss your teeth you are at risk for bacteria spilling into the bloodstream, but antibiotics are not prescribed for the rest of your life.

The use of antibiotic prophylaxis prior to dental procedures has NOT been shown to reduce the risk of subsequent total hip or knee infection.  (And, there have been fewer than 25 documented cases of late-onset prosthetic joint infection after dental procedures).  There are no experimental observations suggesting a link between bacteria in the blood brought on from a dental source causing a  prosthetic joint infection.

Because of this, the American Academy of Oral Medicine, the American Dental Association, and the American Academy of Orthopedic Surgeons  all do NOT advise that antibiotics be given  before dental procedures (if the goal is solely to prevent  prosthetic joint infections).  This cooperative position statement was published in 2003 per the Journal of  American  Dental  Assoc. 2003;134(7):895.

The issue gets a little hazy regarding TOTAL  joint replacement patients.  Prosthetic joints are considered more problematic if they become infected (as the surgeon may need to take out the joint hardware and replace it) so only in those patients are  antibiotics considered for an orthopedic problem.

Heart conditions are different and may need antibiotics before dental procedures.  This is another discussion altogether.

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New Prostate Cancer Test More Accurate : Northwestern University Newscenter

Posted on April 15, 2011 by drlesliegreenberg

Northwestern University (ah, hem. . . my alma mater) has seemingly made a better PSA test.  More studies pending.  I’ll stay tuned.  Read on. . .

New Prostate Cancer Test More Accurate : Northwestern University Newscenter.

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“Hot” off the press! Change in teething care.

Posted on April 14, 2011 by drlesliegreenberg

For all of you who care for  young children . . . the FDA has issued a warning to NOT give over  the counter teething medication to children under age 2.  Here is why. . . benzocaine products, such as Anbesol and Orajel, contain benzocaine which can cause (a fancy medical condition) called methemoglobinemia.  That is a rare, but potentially fatal, condition in which the amount of oxygen carried through the bloodstream is greatly reduced.   This condition has been reported with all strengths of benzocaine gels and liquids.

As an alternative, parents can gently massage the gum line or give the child a firm rubber teething ring.  Some are intended to go in the freezer; my kids especially enjoyed those.   A homemade version of that is a wet washcloth wrung out, twisted like a rope and frozen.

Weight-appropriate doses of acetaminophen (Tylenol) are also helpful.  Be sure to give appropriate doses and follow the per-day dosing limits as overdosing acetaminophen can cause liver damage.   Some homeopathic remedies like amber teething necklaces can pose choking hazards and belladonna-containing teething tablets are poisonous.

Sometimes simply holding your child may soothe them. . . that’s free, bonding and without side effects.

Also, know that this is just a phase, a season, and soon shall pass.

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Should you (or your man) get a PSA test?

Posted on April 11, 2011 by drlesliegreenberg

This issue has been looked at extensively.  The results are not as you may  expect. . .and  backed by  studies with 341,351 patients!  Prostate cancer is detectable in ½ of men at age 50 and nearly 80% at age 80.  Only 3% of all men die FROM prostate cancer.  The goal of cancer screening is to detect tumors in people who have no symptoms.

The meta-analysis of those 340,000+ men showed that PSA screening conferred no benefit in prostate cancer mortality.  Based on the evidence, PSA testing should not be used for prostate cancer screening in low-risk men.

Those men at high risk have

  • first-degree relatives with prostate cancer (the more first-degree relatives, the more risk)  or
  • are African-American (as the prostate cancer may be more aggressive).

The harm of PSA testing includes worrying over falsely positive results and problems from those interventions include  infection, bleeding, long-term urinary incontinence or impotence.   Current guidelines from the American Urological Association and the American Cancer Society recommend that physicians “discuss” PSA screening with the patients.  The United Kingdom goes as far as disallowing PSA screening.

The Centers for Disease Control and Prevention has a booklet about prostate cancer screening.  Find it at http://www.cdc.gov/cancer/prostate/pdf/prosguide.pdf.

Hope this helps!

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AAP Updates Recommendation on Car Seats

Posted on April 9, 2011 by drlesliegreenberg

Well, parents. . . just when you thought you could turn your 1-year-old forward-facing  in the car seat.  New studies show overwhelming evidence to help your children, infant through 13 stay safe in the car.   Read on. . .

AAP Updates Recommendation on Car Seats.

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Sandal weather is almost here!

Posted on April 4, 2011 by drlesliegreenberg

Time to get those feet sandal-ready!  Warts?  Corns?  Bunions? Hammertoes?  Those are pretty ugly words. . . but there are things I can do to help.

Plantar warts are warts (from a virus) that infect the feet.  They are common, especially in children to young adults.  I am frequently asked, and every time I say,” No, I do not cut them out.”  Cutting can cause scar tissue to form on the bottom of the foot which may lead to long-term pain with walking.  Salicylic acid is effective, as is (surprisingly enough) duct tape!  Before starting have your doctor pare down the wart so the therapy is more effective.

Corns are areas of thickening of the skin where the feet rub against a shoe.  Above all else, avoid shoe pressure.  Pads or shoes with large toe-boxes work well.

Hammer toes are when the toes curl up at the joint and rub against the top of shoes.  Depth shoes are available to give extra height to let the hammer toes not rub.

Stress fractures may seem to happen after an injury, but may be due to overuse (like too much marching in the military or too  much time on the treadmill).  An xray may help diagnose this.  Protect the stress fracture with a specially made shoe or stiff-soled shoe.

“Pump bumps” also known as Hagland’s deformity are from rubbing of the heel on a hard shoe.  Sandals may help, or elastic socks and occasionally an injection near (not on) the tendon.

Plantar fascitis is a common condition when the first step of the day is the worst.  An xray may show a heel spur.  This is treated with specific stretches, custom orthotics (shoe inserts), daytime Cam Walker, night splint and occasionally an injection.

Hope this helps.

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9 Physician Blogs Worth Checking Out – Cancer Network

Posted on April 2, 2011 by drlesliegreenberg

Well, I have thoroughly enjoyed blogging medical issues (as I have loved teaching physicians and patients for 16 years) and I’ve gotten a nod from a “fellow” writer. . . Please pass my site on to friends and family!

9 Physician Blogs Worth Checking Out – Cancer Network.

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Doctor shopping?

Posted on April 1, 2011 by drlesliegreenberg

I frequently hear from friends or patients that they are changing physicians due to discontent.  I encourage that.  It’s important to feel comfortable with your  physician.   Here are some things to consider. . .

Distrust.  No faith.  Not feeling heard.  Poor communication.  Inattentive office staff.   For any reason you do not trust your physician’s  judgment or won’t take their advice, you are seeing the wrong physician.  There are many reasons to change physicians, some are not related to the physician’s skills and others aren’t.  All are important.

You can stack the deck, to find a good match.  Get a referral: ask trusted friends who is their physician.  Research office hours and location as this may help address your expectations and convenience.  You can look on websites www.vitals.com or www.healthgrades.com  for patient reviews of physicians.   Be sure to check if the physician is board certified.   Board certification means the physician  has completed an approved residency program and passed a detailed written exam in at least one of 24 specialty areas, such as family practice, internal medicine, or obstetrics and gynecology.  A free site to check is  the American Board of Medical Specialties at  www.abms.org.  Choose a physician who accepts your insurance.  Make an appointment.  Meet the physician.  Ask questions.

Establish your physician-patient relationship before you are ill or need admission to the hospital.    You are in control.  Do some legwork, shake some hands. . . so that you choose a physician you both like and trust.

Hope this helps.

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