Which OTC medications are best for treating chronic constipation?

Posted on January 4, 2023 by drlesliegreenberg

Which OTC medications are effective at treating chronic constipation?  Lots of products are effective at treating chronic constipation.  First-line therapy to treat chronic constipation is polyethylene glycol (Miralax) or senna. Other good products are stimulant laxatives, fiber supplementation or magnesium-based products.  Psyllium fiber tends to cause bloating and gas.

I, personally, suggest that patients fiddle with the dose of Miralax and take it (daily) if needed.  Miralax never leaves the GI tract meaning that it does not tax the liver or kidneys and it helps draw water into the intestines to keep the stool soft.  The drawback about titrating the dose of Miralax is that if you take too much (for you) when you pass gas, you can pass stool. 

Live and learn, right?!

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Should you take full-dose aspirin or a baby dose?

Posted on December 21, 2022 by drlesliegreenberg

Should you take full-dose aspirin (325mg) or a baby aspirin dose (81 mg)?  Recent research has showed that there is no advantage to taking a full dose for patients with established cardiovascular disease compared to the lower dose.  Of course, ask your physician for their input. 

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Do eating eggs cause increased risk of cardiovascular disease?

Posted on December 14, 2022 by drlesliegreenberg

Do eating eggs cause increased risk of cardiovascular disease?  No.  A meta-analysis (a combination of many research studies) has shown that over an average of 12 years, egg consumption is not associated with an increase number in cardiovascular events (heart attack or stroke). In fact, eating more than one egg a day (on average) is associated with an 11% less chance of coronary artery disease. The researchers are unsure if those who eat eggs dail have other healthful habits (more likely to exercise? less likely to smoke?)

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Should you take Vitamin C to help iron supplementation work better?

Posted on December 13, 2022 by drlesliegreenberg

Should you take Vitamin C to help iron supplementation work better?  No. Research has shown that those taking iron WITH Vitamin C for 3 months had no incremental increase in hemoglobin (or in serum ferritin level) after 3 months compared to those who took iron alone. 

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Should you increase your antidepressant after beginning on a starting dose?

Posted on November 29, 2022 by drlesliegreenberg

Should you increase your antidepressant after beginning on a starting dose?  Not necessarily.  Research has shown that new-generation antidepressants like SSRIs may not need to be increased from the starting dose.  This means that your first dose, may be all that you need to ease your mood. Patients are urged to see their physician at 6 to 8 weeks after starting medication to assess clinical improvement.  Before increasing the dose or changing the medication, talk to your physician.  In short, research showed no benefit to automatically increase the dose. 

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Does a short course of antibiotics work?

Posted on November 18, 2022 by drlesliegreenberg

Does a short course of antibiotics work to fight infection? It depends.  The American College of Physicians recommends FIVE days of antibiotics for pneumonia (when it’s community acquired—not hospital or nursing home acquired).  Five days is also recommended for COPD exacerbation when a bacterial component is suspected.  Those with uncomplicated kidney infection need 5 to 7 days of antibiotics. Although, those with an uncomplicated bladder infection may be completely treated with only THREE days! We, physicians, used to prescribe longer courses of antibiotics. But, we know more now!

Of course, if there is no clinical improvement additional (or different) antibiotics may be needed.

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How to prevent delirium:

Posted on August 14, 2022 by drlesliegreenberg

How to prevent delirium:

Delirium is an acute confusional state.  There’s an alteration of consciousness with decreased ability to focus, sustain or shift attention.  Delirium usually develops over hours to days and may fluctuate during the course of the day. 

To prevent delirium:

  1. Stay hydrated
  2. Get good nutrition
  3. Maintain oxygenation
  4. Avoid constipation
  5. If in the hospital, avoid tubes (monitors, foley catheters, intravenous lines)
  6. Keep mobile.  Walk.
  7. Keep senses aware: Use eyeglasses, hearing aids, mobility devices).
  8. Prevent infections
  9. Limit medications that are psychoactive (sleep or anxiety medications)
  10. Manage pain with nonsedating medications like ibuprofen or acetaminophen
  11. Have familiar people around (family and caregivers)
  12. Visualize clocks and calendars.
  13. Get reoriented by family and staff to location and time, as needed.
  14. Avoid nighttime disturbances
  15. Reduce noise at night.

I hope this helps…

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What are red flag signs for headache?

Posted on August 9, 2022 by drlesliegreenberg

What are red flag signs for headache?

Red flags are concerning symptoms that need further investigation.  See your physician if you have any red flag signs.

Headache red flags:

Systemic symptoms: fever, chills, immunocompromised condition, infection, muscle aches, night sweats, weight loss, pregnancy, postpartum, cancer

Neurologic symptoms: double vision, impaired consciousness, pulsatile ringing in the ears, seizures, confusion.

Onset: occurs intensely within a few minutes like a “thunderclap” headache.

Older:  Headaches starting after age 50

Progression:  If there is a change in headache features, pattern or severity over time.

Precipitated by bearing down (like with a bowel movement or sit-ups)

Worse with lying down.

Swelling of the optic nerve with headache (seen by eye doctor)

Headaches worsen with exercise

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Toenail fungus. How to treat? How to avoid it?

Posted on July 28, 2022 by drlesliegreenberg

Toenail fungus. How to treat?  How to avoid it?

Onychomycosis is a chronic fungal infection of the fingernail or toenail bed. This leads to brittle, discolored, unsightly, and thickened nails.

Untreated, onychomycosis can cause pain, discomfort and may negatively impact quality of life.

Your doctor can do a test on your nail to confirm that it is indeed a fungal infection so that the correct treatment is started.

What is effective treatment?  Oral terbinafine is markedly more effective than topical therapy than topical therapy.  Let your doctor know what other medications you are on as terbinafine can interfere with other medications. Topical medications include ciclopirox 8%, efinaconazole 10% and tavaborole 5% but all are less effective than oral agents.  Topical agents can be used to treat mild to moderate onychomycosis and it has fewer drug-drug interactions than the oral treatment. 

What else can you do to help?  Trim nails and file the nail to keep the nail thickness less.

How to prevent recurrence?  Avoiding walking barefoot in public places, wearing socks, and disinfecting shoes is thought to decrease relapse rate by 25%.

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Can physical activity decrease depression?

Posted on July 21, 2022 by drlesliegreenberg

Can physical activity decrease depression?

A combined meta-analysis of 49 unique prospective studies with nearly 267,000 patients were followed up for 1,837,794 person-years. 

Results:  Both the high intensity interval training patients and the moderate continuous training program participants showed significantly less depressive symptoms compared to those who did no exercise. 

Take home point: Work in some exercise to your life and feel better physically and mentally.

Want more information? https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.17111194

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