Wound care 101–cub scout badge time

Posted on November 16, 2010 by drlesliegreenberg

I assisted at my son’s Cub Scout meeting and helped dispel some wound care myths.  Lots of questions need answers. . . here is how I address wounds.

  • Allergies? to latex, antibiotics or anesthetics (the medicine to numb a wound)?    I don’t want to make the situation worse.
  • Tetanus status?  Tetanus vaccine is due every 10 years.
  • How did the injury occur?
  • Is there a foreign body (wood, glass, asphalt) in the wound?  (An x-ray may show me a solid object in the wound, but glass is hard to see).
  • Are the nerves, tendons, joints, and blood vessels intact and working?
  • Cosmetically, how and should I close the wound?
  • Does the wound need a specialist?
  • Is there another reason to NOT close (stitch) the wound?

Time.  It is important.  19 hours seems to be the magic number. Studies show wounds stitched UP to 19 hours after the injury heal significantly better than those closed later. So, as a physician, I do not sew wounds that come to me more than 19 hours of age.

What can YOU  do with a “fresh” wound?

  • First, stop the bleeding. Apply direct pressure to the wound. Most wounds stop bleeding in 10-15 minutes.
  • Wash out the wound. Studies found tap water works as well as saline.
  • (If it needs to be sewn, it’s done at this step).
  • Clean petrolatum (NOT your used lip chapstick) can be put on top of the wound so that the dressing or bandage does not stick to the wound. I do not use neomycin as it is one of the top 10 allergens (that cause wounds to LOOK red and infected).
  • Keep the dressing on for 48 hours, then leave open to the air.
  • Wash with gentle soap and water and pat dry twice daily.

Call the doctor with any fever, redness, streaking, or any concerns.   Antibiotics are not suggested with most patients.  Exceptions are a  grossly contaminated wound (with dirt or saliva), immune compromised patients or the wound that extends into a joint.

Last question. . .did you earn a scout achievement badge?

Posted in General Medicine- Adults, Uncategorized, wound care | Tagged , , , , , , , , , , , | Comments Off on Wound care 101–cub scout badge time

Menopause

Posted on November 10, 2010 by drlesliegreenberg

I went to a ‘Menopause The Musical’  a few years ago: utterly hysterical. It may only be funny onstage. I have seen two patients this week in their 40s who have all the symptoms. . . including a little denial.

Menopause usually occurs between ages 45 and 55, with the “textbook age” being 51. It is when the ovaries stop producing eggs and menstrual periods end. Before menstrual periods come a complete stop, there are years of

  • irregular menstrual periods (more or less blood loss at differing intervals),
  • hot flashes which last for 2-4 minutes (frequently causing sweating followed by chills and shivering),
  • sleep disturbances,
  • mood changes, and
  • dry vaginal tissues (read this: pain with wiping or with intercourse).

Menopause is a diagnosis made clinically, meaning lab work not needed. If a woman is older than age 45 with the above symptoms, she is in the peri-menopausal period until no menstrual period for 12 months.  Then the word “menopause” fits. If she is under age 45 she may benefit from some blood work to make sure she isn’t pregnant or has a thyroid problem.

There are lots of treatments to help with the symptoms of menopause. Your doctor can discuss these with you. Alcohol is not suggested. Studies have shown that alcohol increases the frequency of hot flashes and night sweats compared to patients who only drink once a month.

Hope this helps.

Posted in menopause, Uncategorized, Women's Health | Tagged , , , , , , , , , , , | Comments Off on Menopause

When should women have their first pap?

Posted on November 5, 2010 by drlesliegreenberg

Common question. New guidelines. Let me share. . .ACOG (The American College of Obstetricians and Gynecology)  released a position statement delaying pap screening in adolescents. A pap is now suggested at age 21 unless the patient has HIV or a weak immune system from another disease. And, HPV testing should not be done until age 21, either.

The reason for the change is that HPV is a common virus spread from sexual contact. And, adolescents get rid of their HPV virus (without extra help from physicians) 90% of the time. We now know that adolescents have been over-treated in the past which may lead to unnecessary treatments that compromise the cervix and increase a teen’s risk of having a preterm birth later in life.

I believe we-can’t-know-what-we-know-until-we-know-it. Research is continually coming out and redirecting us to better, more effective care. My job is to stay current. . . and to help educate.

Sexually active teens still need sexually transmitted disease screening yearly, but a pap can wait until age 21.

Happy birthday!

Posted in pap test, Pediatrics, Women's Health | Tagged , , , , , , | Comments Off on When should women have their first pap?

The sore-throat-should-I see-my-doctor quandary. . .

Posted on November 1, 2010 by drlesliegreenberg

I saw a patient this morning who I diagnosed with viral pharyngitis, not (bacterial) strep throat. She said she felt embarrassed that she came in to see me. I reassured her the importance of coming in to figure out  if she has strep throat, otherwise known as Group A streptococcal tonsillopharyngitis.

The symptoms of strep throat are

  • abrupt onset of intense sore throat (most patients would rather drool than swallow),
  • pus on the tonsils,
  • tender lymph nodes in the neck and
  • fever.

My goals with treatment are to decrease

  •  the duration and severity of pain,
  •  transmission to others,
  •  the consequences if not treated. . . rheumatic heart disease and kidney failure.

A rapid strep screen can be done in most physician offices. It is fast and very sensitive to picking up streptococcal infections.

There is a 35% transmission  rate to nearby contacts of the ill patient. Antibiotics significantly decrease this rate as studies show 80% of patients are not contagious 24 hours after receiving penicillin.

The treatment of choice is penicillin. Yup! Still first line treatment since 1950. I prefer one shot of penicillin in the muscle—one little “pinch” and then it’s done. Or the patient can opt for 10 days of twice daily dosed oral medication.

Sore throats are important.

Posted in General Medicine- Adults, Pediatrics, throat conditions, throat conditions, Uncategorized | Tagged , , , , , , , , , | Comments Off on The sore-throat-should-I see-my-doctor quandary. . .

Skin Cancer

Posted on October 28, 2010 by drlesliegreenberg

What an ugly term.  As we put away the pool gear from summer and enter autumn, we may not think much of sunscreen. But, daily sunscreen use reduces the incidence of one kind of skin cancer, squamous cell carcinoma.

The American Academy of Dermatology recommends year-round application of broad spectrum sunscreen with SPF 30 or higher to all areas of the body exposed to the sun.  In contrast to squamous cell cancer, no evidence shows sunscreen decreases basal cell carcinoma or melanoma.  If you have any new or concerning or changing skin lesions, see your doctor.

I am both a daughter and sister of plastic surgeons so I am well versed in the benefits of daily sunscreen on the face and neck–to ward off  “premature” wrinkles.  Find a sunscreen that you like its feel and smell.  Place the bottle in the pathway of your morning routine. Use it daily and reap the benefits.

I tell my kids that a sunburn is like the skin screaming.   There’s no need for screaming. . .

Posted in Uncategorized | Comments Off on Skin Cancer

Mindless Eating

Posted on October 25, 2010 by drlesliegreenberg

Interesting concept.   In fact. . . .what a great name for a book!  The author of Mindless Eating is a food scientist at Cornell and is speaking free this Thursday 7:30 p.m. at Hughes Metroplex in Wichita.

 Obesity is rampant as 1/3 of the US population has a BMI (body mass index) more than 30.  Hand-in-hand with obesity is high blood pressure, high cholesterol, diabetes, heart disease, osteoarthritis and some cancers. 

Many obese patients would like a quick fix

  •  prescription medications.  Studies have shown prescriptions may help promote “modest” weight loss, meaning an additional 2 to 15 pounds.  One of these prescriptions, Sibutramine (Meridia) was recently voluntarily taken off the market (October 8, 2010)  due to increased adverse heart events like heart attack and stroke.
  • “bariatric surgery” like gastric bypass.  This may result in a loss of greater than 20% of body weight, which may be maintained or the patient can learn to outsmart/outeat their stomach.  This surgery has operative and postoperative complications and, on average, 0.28% of patients die within 30 days of surgery.

Weight loss treatment without the above perils is based on the easy concept of, expend more energy than you eat. 

If you can attend the free lecture above, please do.  If you cannot attend, he has a great easy-to-read book which is truly enjoyable reading.  Dr. Wansink states “the best diet is the one you don’t know you are on.”

I agree.

Posted in obesity, obesity, Uncategorized | Tagged , , , , , , , | Comments Off on Mindless Eating

ADHD

Posted on October 22, 2010 by drlesliegreenberg

Will ADHD stimulant medication cause kids to be short?  I was asked this by a neighbor. Hmmmmm. . . .good question.

ADHD affects 1 to 6% of the general population. It can cause pervasive cognitive, academic, emotional and social problems. Patients have a hard time concentrating and finishing a task. Diagnosis requires these traits to occur in 2 settings: work, home, school. There are ADHD checklists that teachers/co-workers and parents can fill out and bring into the  doctor.

I will send patients to a specialist if

  • under age 6
  • other psychiatric or neurologic conditions, or
  • lack of response to treatment.

Stimulants have been found to work as well as stimulants WITH  behavioral therapy. Certainly, a stable home environment with supportive parents and consistent discipline helps, but studies have shown that stimulants are the mainstay of treatment.

Successful treatment is better relationships between patient and parents/teachers, better academic performance and better rule following.

Back to the question of stunted growth. . . the package insert for one stimulant states “Use of stimulants in children has been associated with growth suppression (monitor growth; treatment interruption may be needed).”  Other stimulants mention to “monitor patient growth parameters.”

This all means that a physician should follow the patient for symptom-control and the weight and height charts. Certainly, if the patient can tolerate a drug holiday (weekends or school breaks) this may confirm the need of the medication and give the child a chance to catch up on growth.

Hope this helps.

Posted in ADHD, ADHD | Tagged , , , , , , , , | Comments Off on ADHD

Got itchy, scaly skin?

Posted on October 19, 2010 by drlesliegreenberg

Eczema is a very common condition.  It can occur from infancy through old age.  Nearly 40% of children with eczema will clear  by adulthood.

Textbook lesions are red, scaly and crusted—sometimes with scratch marks.  Diaper area is usually clear.  Places that the body bends are usually the worst: the crease of the elbows and behind the knees.  No blood tests are needed to confirm it.

Treatment is aimed at eliminating triggers, restoring the skin’s normal barrier and hydrating the skin.  Sound easy?

  • Avoid excessive bathing
  • Avoid dry humidity areas (not difficult here in humid Wichita),
  • Avoid overheating of skin and exposure to solvents/detergents.

With an eczema flare, the skin’s barrier is decreased and is at risk for skin infections like staph and herpes (ick!) .

Treatment:

  • Antihistamines, like Benadryl, are used to control itching and to sedate.
  • Thick creams like Vaseline or Cetaphil help the skin not lose water content.  These are best applied immediately after bathing.
  • Wet dressings help soothe the skin, reduce itching and redness.
  • Prescription creams.  Steroid are the mainstay of therapy.  If this fails, there is another type of cream that is FDA approved above age 2 (calcineurin inhibitors).  However, concerns have been raised by the FDA about a possible link to cancers.

Alternative treatments:

  • UV light therapy has also been shown to help.
  • Probiotic therapy, oral essential fatty-acid supplementation and Chinese herbal medicines have been used, but have not been adequately studied or found to be helpful.

In short, bathe less and lube up more.

Posted in Dermatology, Dermatology, General Medicine- Adults, Pediatrics, Uncategorized | Tagged , , , , , , , , | Comments Off on Got itchy, scaly skin?

Hoarseness

Posted on October 14, 2010 by drlesliegreenberg

Hoarse voice

Today, I am hoarse.  I whispered to my family yesterday and now I can talk to my patients.  I was given the advice that I “should start on something” to bring my voice back.  Hmmmmm. . . there are guidelines for the diagnosis and management of hoarseness.

I’ll break it down for you.  A full history and physical by your physician will reveal many hints.

Look for a cause of hoarseness.

  • Medications may cause hoarseness due to cough, dry mucous membranes or chemical laryngitis.
  • Underlying conditions like reflux can cause gastric acid to inflame the vocal cords. If reflux is symptomatic,  reflux medication may help.

When should medication be given for hoarseness?  The answer is rarely.   Steroids should not commonly be prescribed unless a specific diagnosis like recurrent croup is present.  Antibiotics should not routinely be prescribed either as the condition is usually not from a bacterial infection.

There isn’t much to DO about a hoarse voice.

  • Laryngoscopy  (a look-see with a scope down the throat)should be done if hoarseness does not resolve within 3 months or if a serious underlying cause is suspected and before voice/speech therapy is initiated.
  • Surgery should only be done on suspected laryngeal cancers or if other measures for soft tissues lesions do not help.
  • Botulinum toxin  (yes, botox!) is injected for those with spasmodic dysphonia.

Some red flags of hoarseness which may suggest a serious underlying cause of hoarseness are coughing up blood, neck mass, history of tobacco or alcohol use, symptoms occurring after trauma, unexplained weight loss, or worsening symptoms.

Preventive measures are staying hydrated, avoidance of irritants (like smoke and chemicals), voice training and amplification when needed.

Hope this helps.

Posted in Pediatrics, throat conditions, throat conditions | Tagged , , , , , , , , | Comments Off on Hoarseness

Roll up your sleeves or smell the. . . .flu vaccine!

Posted on October 5, 2010 by drlesliegreenberg

Who should get the influenza vaccine?

  • Everyone older than 6 months. It is especially important that high risk individuals get the flu vaccine

Who is “high risk?”

  • Pregnant women
  • Children younger than 5, but especially children younger than 2 years old
  • People 50 years of age and older
  • People with chronic medical conditions
  • Those who live in nursing homes or other long-term care facilities
  • Those who live WITH high-risk individuals

How is the flu vaccine given?

  • The first year kids under age 10 receive the vaccine, they need two doses one month apart.
  • two routes: injected in the muscle of your arm or breathed in your nose

Can I get the flu from the vaccine?

  • It is an Inactivated vaccine.  You CANNOT get the flu from the flu vaccine.  It contains three seasonal influenza viruses.  This years’ vaccine protects against 2009 H1N1, and two other influenza viruses.  Most common reaction is soreness at the site of intramuscular injection.

Can I get the nasal spray flu vaccine?

  • Yes, if you are between the ages of 2 and 49, not pregnant and not an asthmatic

 

Talk to your doctor before getting a flu shot if you have a severe allergy to eggs, or to a previous flu shot or if you’ve had a history of Guillain-Barre Syndrome (nervous system disorder) after a previous flu vaccine.

Get more information at the www.cdc.gov .

Roll up those sleeves, Wichita.

Posted in Vaccines, Vaccines | Tagged , , , , , , , , | Comments Off on Roll up your sleeves or smell the. . . .flu vaccine!