Reasons to be taking hormonal contraception. . . .other than contraception.

Posted on August 25, 2010 by drlesliegreenberg

I had a patient today who has menstrual migraines. . . and has had her tubes tied. We discussed starting her on hormonal contraception for noncontraceptives reasons.

I reviewed the ACOG (American College of Obstetrics and Gynecology) 2010 bulletin on noncontraceptive benefits of hormonal contraception. Beware: lots of numbers ahead. . .

Pain.  Oral contraceptives with estrogen and progesterone (“combination pills”) relieve painful with menses in up to 80% of women (even those with endometriosis). Depot medroxyprogesterone (“Depo shot”) and the levonorgestrel IUD (Mirena) also treat menstrual pain.

Bleeding.  Women with heavy bleeding benefit with up to 50% less blood loss with combination birth control pills or up to 97% less in 12 months with insertion of Mirena IUD.

Cancer.  Combined oral contraceptives may reduce endometrial cancer by 50% with cancer protection lasting up to 20 years after medication discontinuation. There is a 20% decreased risk of ovarian cancer for every 5 years of use. There is an 18% risk reduction for colorectal cancer, but this reduced risk stops when medication stopped.

Other potential noncontraceptive benefits of hormonal contraceptives

  • Menstrual cycle regularity
  • Prevention of menstrual migraines
  • Treatment of acne
  • Treatment of bleeding from fibroids
  • Treatment of painful periods
  • Treatments of unwanted facial hair growth (hirsutism)
  • Treatment of heavy menstrual periods
  • Treatment of “PMS”—premenstrual syndrome.
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Rashes. . . . mysteries I love to solve.

Posted on August 20, 2010 by drlesliegreenberg

My non-medical friends are horrified when they see my delight with rashes.  I have given a dermatology talk to medical students monthly for 10 years: dermatology 101. 

One common rash is contact dermatitis.  There are two kinds: 

1.  irritant–which is caused by non-immune-modulated irritation of the skin by a substance and

2.  allergic–a delayed hypersensitivity reaction (when a foreign substances comes into contact with the skin). 

Most common causes of contact dermatitis include

  • poison ivy (allergic)
  • nickel (14% of all contact dermatitis)
  • fragrances (14% of all contact dermatitis)
  • neomycin (11.6% of all contact dermatitis—I do not recommend Neosporin for this reason)

The rash will look different depending on the length of exposure to the agent.  More recent dermatitis may look red with blisters or more chronic exposure may cause thickened skin with cracks and fissures. 

acute allergic contact dermatitis

Other masquerading causes. . . fungal infection, psoriasis, eczema, scabies or bacterial infection of the skin.

My priority is to identify and avoid the causative substance. Cool compresses can soothe the symptoms while calamine lotion and oatmeal baths may help dry and soothe acute, oozing lesions.  Steroids may work well too–topical lotions work well for a small area or oral steroids if involvement is more than 20% of skin surface area.

 If treatment fails, patch testing by an allergist may be performed.  It is expensive, time-consuming, and prohibits the patient from showering during testing.  Skin prick and radioallergosorbent tests are used for respiratory, latex and food allergies—not contact dermatitis.

Oh, what fun!

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Allergic rhinitis

Posted on August 4, 2010 by drlesliegreenberg

“My nose is running all the time.”  Hmmmmm. . . . . .

This is a common complaint.  This spring and summer in Wichita have been SUPER-allergic—even those who have been well controlled.  There are really four ways to help:  patient education, allergen avoidance, pharmacotherapy and immunotherapy. 

The best symptom relief comes from intranasal steroids (FDA approved down to age 2 years old!).    No long term adverse effects have been found.  Some intranasal sprays make your nose sting or smell like flowers, but it will decrease symptoms. Oral antihistamines also help.  Benadryl is available over the counter—this is great at bedtime, because it can make you so drowsy that you HAVE to go to bed.  Non-sedating second-generation antihistamines Claritin and Allegra are effective.

Immunotherapy is performed by an “allergist”—a specialized area of medicine.  Moderate or severe persistent allergic rhinitis not responsive to usual treatments may be helped when given small amounts of allergen extract given under the tongue or skin over the course of a few years.  Also, DNA technology has allowed for allergen-specific vaccines to be developed!

I do like alternative medicine, WHEN it has been definitively shown to help.  As for nonpharmacologic therapies. . . randomized controlled trials have NOT found that acupuncture or probiotics or herbal preparations  to help. 

Lastly, here is a common sense approach.  Avoid exposure to cigarette smoke, pets, and allergens you  know you are sensitive to.  Nasal irrigation (sinus wash) at home may help flush allergens out.  These are available at any pharmacy OTC.  Neti pot or low-pressure squeeze bottle are superior to saline sprays.  Washing hair at bedtime and changing pillow cases nightly may help keep allergens caught in hair to affect you at nighttime. 

. . . I’m reminded of that kid-joke ending in . . . It’s SNOT funny.

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Swimmer’s ear, nothing that a swimmer wants.

Posted on July 25, 2010 by drlesliegreenberg

“Ow!  My ear hurts.”  I heard that four times last week.  It is swimming season here in Wichita and swimmers ear and pools go hand-in-hand.   The story is usually. . . one-sided ear pain, tender-to-touch ear, hurts to chew AND recent exposure to water.

 

When water gets inside the ear canal and can’t get out it’s like when you were a kid and had your cast cut off.  The skin under the cast that got wet STAYED wet.  That skin becomes macerated and weeps (just like swimmer’s ear stays wet).  Ick! Uniquely, the dermis comes into contact with the periosteum (bone) –thus, minimal inflammation in the ear causes significant pain.

Some people are more prone to otitis externa with frequent water exposure, inability to clear the water from their ears, or mishapen/tortuous ear canals.  (One example of misshapen ears are  “cauliflower ears” of wrestlers who bruise their ear after having it mashed into the mat.)  Protectively, ear wax helps create an acidic environment in the ear which fights bacteria and fungal growth.

Your doctor may perform an  ”aural toilet” (ear wash) to help clear out bacterial overgrowth or place an ear wick.  Antibiotic drops with steroid help the ear canal tissue be less inflamed, hurt less, and fight the infection.

To decrease your risk of swimmer’s ear. . .

  • Stop scratching the inside of your ear
  • Do not excessively clean wax out of ears
  • Beware of devices that block the ear: hearing aids, headphones or diving caps.
  • Instill rubbing alcohol and vinegar in the ears or gently blow dry ears after swimming

The ears are self-cleaning (kinda like my oven).  The old adage “Don’t put anything smaller than your elbow in your ear” is right!

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Family medicine. My career choice.

Posted on July 25, 2010 by drlesliegreenberg

I love stories.  I always have.  My parents instilled in me a desire to do my personal best, be self-sufficient (read that: financially independent) and to explore my passions.    I chose Northwestern University in Chicago (2000 miles from my hometown) to make my own way.  I challenged myself educationally and honed my skills.  Psychology was a great major as I love human behavior.  I enjoyed art history, architecture, and women’s studies – an advantage of a great liberal arts school.

 When I entered medical school I considered psychiatry and found the mental pathology was more than I desired.  I was primed to be an obstetrician until I realized that I’d  hand over the newborns to another physician at birth.  Family medicine allows me the breadth of medicine—to care for everyone– with the interrelationships and connections that I enjoy.

 I taught medical resident physicians for 12 years but recently I yearned for more patient contact.  During my new patient visit, I get to know them by discussing their past medical and social history so that  I truly know who my patient is and how I can help. 

This is the life I was to lead.  What a privilege and a joy it is to have passion for the entirely of my job.

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shingles aren’t just for houses

Posted on July 5, 2010 by drlesliegreenberg

Are these chicken pox?
 
My neighborhood has been in an uproar recently about the contagiousness of chicken pox and shingles.  It is time for a little general knowledge dissemination.
 
Varicella zoster virus is the culprit.  It is one of 8 herpesviruses known to cause human infection.  There are 2 distinct forms:  varicella (“chicken pox”) and herpes zoster (“shingles”).  The primary or first infection of the virus results in chicken pox.  After that the virus lives in the body but is hibernating.  If or when it resurfaces, it causes shingles. 

shingles

 
The vaccine was created in 1995.  My three children have been vaccinated, and I recommend the vaccine to my patients.  The first dose is given at 12 months and then a booster at the “kindergarten physical”—between ages 4 and 6. 
 
Chicken pox is wildly contagious!  90% of household contacts get the infection if not vaccinated.  It is spread by nasopharyngeal secretions (spit) or by touching the pox lesions (ew!).  The vector (patient) is contagious to others 48 hours BEFORE they get a rash and stay contagious until all the pox are scabbed over which may take about 2 weeks.  The incubation time from contracting the virus to the beginning of a rash is 14 – 16 days.  Chicken pox is usually not harmful in children (except for those itchy pox lesions), but can be severe in adolescents, adults, and immunocompromised people.  Initial symptoms are fever, fatigue, and sore throat, followed by the beginning of the rash.
 
If I get a varicella vaccine can I still get the chicken pox?  Yes.  20% of those who get the vaccine get a breakthrough infection.  This is usually mild.                        

chicken pox

         
 
There are also criteria for vaccinating those people who think they never had chicken pox.  Vaccination is important for

  •  people older than 13 years old without immunity(which can be tested by a bloodtest). 
  • healthcare workers
  • those who have immunocompromised houseguests
  • childbearing-age females. 
     
    Well. . . there are the nuts and bolts!
Posted in General Medicine- Adults, infections, infections, Pediatrics, Uncategorized | Tagged , , , , , | 1 Comment

Back to school. Summertime IS the time for physicals

Posted on July 5, 2010 by drlesliegreenberg

Ahhhhh. . . it’s summer.  So, do I need to take my child for their school physical now? Yes!  Annually preschoolers and older children need to be assessed for school readiness, developmental delay and physical ailments.  There are specific criterion for children to achieve at each age.  It is divided into four categories:  personal/social, speech, fine motor movement (fingers) and gross motor movement (limbs).  The screening tests for this should be performed at every well child check and school physical so we can get kids caught up.

It is the perfect time for parents’ to voice their concerns. . .(Why does my kid eat ice?  Dirt?   When will he be potty trained?  Why does my child need this vaccine?)  or child’s questions to be answered (What is this rash?  How do I stop picking my nails?)  . . . or for a tw/teen to get puberty advice from an expert (I’ve been experimenting with . . . .What is happening to me?  What happens when I. . . )

Shots.  The ACIP updates the immunization schedule every 6 months.  Many of the vaccines are required for school entrance every fall.  There are also new vaccines such as for meningococcal meningitis and for HPV.  The human papilloma virus vaccine is suggested for 9 – 26 year olds.  This decreases the risk of genital warts and cervical dysplasia  (I’ll save that for another blog. . . )

So. . .take one hour out of your summer schedule—between sno cones and the pool—for a check up!  It’ll do your mind some good.

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Vitamin D: Is it the new magical pill?

Posted on July 3, 2010 by drlesliegreenberg

Vitamin D.  Is it a panacea?
 
We now know how important Vitamin D is to the body and how hard it is to get the recommended daily allowance when it is raining here in Wichita.  New guidelines show infants, children and adolescents need 400 IU of vitamin D daily.  So, children who consume less than one LITER of vitamin D-fortified milk per day will need supplementation. 
 
What does vitamin D do? 

  • It is essential for calcium metabolism and mineralization of bone.
  • Adequate levels of vitamin D may help decrease the risk of autoimmune  conditions, infection, and type 2 diabetes. 
  • Observational studies suggest vitamin D may reduce the risk of type 1 diabetes in infants and children. 
  • Subclinical vitamin D deficiency may contribute to the development of osteoporosis and increased risk of fractures and falls in the elderly, decreased immune function, bone pain, and possibly colon cancer and cardiovascular health. 
  • Many other benefits are suggested, but a study of 36,000 patients (Journal of National Cancer Institute 2008) did NOT find a protective effect against breast cancer.
     
    Breastmilk is best for newborns, but it does not supply enough vitamin D.  So, breastfed infants should receive 400 IU vitamin D daily (like Poly – Vi-Sol 1 ml daily) .  Formula fed infants will most likely have an adequate level of vitamin D and require no vitamin D supplementation.  Older children can get their 400 IU daily with Flintstone or gummy vitamins (check the serving size per age on the side of the bottle).
     
    Don’t I get Vitamin D from sunlight?  Yes, but most likely not an adequate amount.  Darker skin pigmentation, latitude, and amount of skin exposed make it difficult to assess how much sun the skin is getting.  Excessive sun exposure may increase the risk of skin cancer.
     
    For adults the suggested Vitamin D dosage is 600 IU a day.  A toxic dose of Vitamin D is over 2000 IU a day.  So, if you want to take anywhere between 600 to 2000 IU a day, that should be safe and effective.  While you are at it, Calcium 500 mg three times a day would be good for bone health, too!
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Hello Reno Families!

Posted on July 1, 2010 by drlesliegreenberg

 

Hello, I am  Leslie Greenberg.  I am a family physician in Reno, Nevada.  I attended Northwestern University in Chicago, then University of Nevada School of Medicine.  I relocated back to my hometown in 2015.  I trained and practiced medicine in the Midwest (Indiana and Kansas) for 20 years before moving back West.  I consider myself a teacher and educator.  I  have taught 450 + family medicine residents (and countless medical students), over nearly 30 years.  I currently teach at the family medicine residency program in Reno and also see private patients.  I care for newborns through elderly patients in both the hospital and office.  I love to do women’s health (contraception and menopause care) and procedures: skin biopsies, circumcisions, IUD insertion/removals, paps, colposocopies, and toenail removals. I am a Menopause Society certified physician.  I invite you to read my blog.  If you would like to become a patient, please call 775-982-1000.

Medical Disclaimer

Please remember that medical information provided by myself, in the absence of a visit with a health care professional, must be considered an educational service only.  This blog should not be relied upon as a medical judgement and does not replace a physician’s independent judgement about the appropriateness or risks of a procedure or condition for a given patient.  I will do my best to provide you with information that may help you make your own health care decisions.

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