Do you wheeze?

Posted on December 5, 2010 by drlesliegreenberg

Do you cough without a cold?  Do you get winded easily?  Hmmm. . . asthma comes to mind.

Frequently asthmatics are not adequately controlled.  Symptoms are frequently a wheeze, cough or feeling “tight.”  Some have a cough that they just can’t kick. . . so, a “cold” may actually be asthma.

A full history is needed.  How often are symptoms?  Any triggers?  Nighttime cough?  Any medicine used in the past?  How often was it dosed?  Did it work effectively? There may be triggers like seasonal allergies or exercise.   And, then, of course,  a physical exam.  Maybe a xray.

Next is

  • patient education (do daily peak flows to show lung air volume) ,
  • environmental control (even beloved pets should not sleep in bedrooms), and
  • manage other conditions (like allergies).

Guidelines show a stepwise approach for asthma management is best.  Patients may need daily medication so that rescue inhalers are not used more than twice weekly.  There are long-term medications that work best to control symptoms, and then in another category are rescue medications (like a life-preserver is used when someone is drowning).

I have cared for adult asthmatics in the ICU that the rescue inhalers, taken (inappropriately) 30 times a day, no longer work.  Frightening and, occasionally, deadly.

The goal of asthma therapy is to live like you DON’T have asthma.   That is the goal!

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Kids and bladder infections

Posted on December 1, 2010 by drlesliegreenberg

Can kids get bladder infections?

Yes.  1 in 10 girls get a bladder infection before age 16.  Only 3% of boys do.  Boy babies under 6 months are more likely to get a urinary tract infection (UTI) than girls.  After that age, the penis lengthens and bacteria from the rectum are less likely to make their way up to the bladder.

Symptoms of a UTI are

  • fever or
  • urinary symptoms — pain with urination, urinating more often than normal or having “accidents” after being potty trained.

A urine sample will be obtained. A dipstick test of the urine gives a snapshot, but a culture gives more information.   If there are more than 100,000 colonies of bacteria grown out of the urine in a lab, a UTI will be diagnosed.

40% of kids with a first UTI have some degree of vesicoureteral reflux which means the urine is getting hung up on valves and unable to flow down to the bladder and out.   (Kind of like a lake with stagnant water can get scum on top).  Additional tests may be needed to diagnose reflux which, if severe, may require surgery. Antibiotics treat the infection.

Untreated UTIs put the patient at risk for kidney damage.

My son once asked what are the most important parts of the body.  I answered

1.  Heart (for without that you are indeed dead).

2.  Brain (for without that you are unaware of your surroundings).

3.  The kidneys as they keep everything in balance.

Hope this helps.

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Ooooooh, so much to be thankful for. . .

Posted on November 25, 2010 by drlesliegreenberg

Clean water  (tap water is fine, save your money)

Vaccinations  (please get yours!)

Freedom  (religious, political, personal)

Fresh air

Antibiotics (for bacteria, not viruses)

The promise of a new day (yesterdays mistakes are in the past)

Shelter

Health (not to be taken for granted)

An opportunity to “be” and achieve

Caring nurses (thank you!)

Friends

A progressive medical system  

My family. . . (with a father-in-law who cooks Thanksgiving dinner)!

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Bone health

Posted on November 19, 2010 by drlesliegreenberg

I’ve seen three fractures in the past week.  This makes me think of bone health: how to make (AND  KEEP) strong bones.

Good nutrition is important!

  • Calcium 1000 mg a day for children through adulthood.  Milk with every meal is suggested (chocolate or “strawberry” milk count, too).  Postmenopausal women need 1500 mg a day.  More than 2000 mg a day can cause problems.
  • To best absorb the calcium, the body needs vitamin D.  800 IU a day is sufficient.

Peak bone mass occurs by age 30.  After that, it’s all downhill (bone mass, that is).

Looking for ways to keep your bones dense?

  1. Do weight-bearing exercise
  2. Maintain a normal weight
  3. Do not smoke
  4. Maintain healthy eating habits: no anorexia or radical weight loss

 

Other questions. . .

Carbonated colas?  They may decrease bone mass but experts think this is because the amount of other nutritional foods is decreased.

Caffeine?  There is no evidence that it decreases bone mass

Depo-Provera shot for birth control?  Studies show that it decreases bone density but there is no evidence that it increases the risk of fractures.  Studies also show that the body increases bone mass after the Depo is stopped.  The FDA has a warning on the Depo shot and it is now suggested to be used if other contraceptive methods fail.

I hope this helps.

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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?

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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.

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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!

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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.

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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. . .

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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.

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