Thursday, April 26, 2012

Why Don't Teens Date Anymore?

By Guest Blogger, Barbara Greenberg, Ph.D.

Dear Dr. G,

Call me old-fashioned if you must. I just don't understand why my teenage children ages 17 and 18 just don't seem to go on dates. When I ask them about this, they look at me like I have two-heads, roll their eyes, and tell me that dating is not what teens do anymore. It seems like the word dating is foreign to them. I don't even know what the new vocabulary is for teens spending time together. I do hear about hook-ups and break-ups but am unfamiliar with what "hook-ups" refer to and if they are healthy for our kids.

Please explain what is happening with teen relationships these days.

An Old -Fashioned Mom

Dear Old-Fashioned Mom,

Take heart in knowing that you are not alone in wondering what is going on with teens and relationships these days. The answer may or may not make you feel any better depending on how you look at things but at least you'll be in the know.

The current generation of teens has, as you are aware, moved away from dating and is often referred to as the "hook-up" generation. Hook-ups, I am told by the teens, refer to no-strings attached physical meetings of the body ranging from kissing to intercourse. They tend to be most likely to occur when teens are at parties and under the influence of alcohol.
These "hook-ups" also seem to be replacing dating. It seems that males and females are equally aggressive these days and have embraced a culture of "friends with benefits" the benefits being physical encounters without the strings of relationships attached.

It is both possible and likely that since many teen girls are making themselves available in two roles-that of the "aggressor" and "available" there is less motivation for the boys to ask them to date. The old expression 'Why buy the cow when you can get the milk for free?' seems to apply here. And, believe me I am not a fan of either referring to females as cows or of this expression. It simply seems to apply to the current teen scene.

My concern is that there has been a move away from relationship-based sex to recreational sex. I am concerned as well that disconnnected sex may be too much for our teens to handle emotionally. Sexual intimacy often leaves teens emotionally vulnerable and at risk for disappointment, embarrassment, and sadness. Perhaps, we have failed to teach our children about the relationship between the heart, the body, and the mind when it comes to physical intimacy. The sorry state of affairs (no pun intended) is that teens are more distressed than they let on to when their Saturday night "hook-up" doesn't remember their name or even the "hook-up" itself on Monday morning in English class.

With the hope of reversing this trend perhaps we should teach our kids about not only what sex is, about contraception, safe sex, and stds, but also about the strong connection between sex and their tender feelings.

Good luck and I hope that I have answered your question without confusing the issue further.

Good luck.
Dr. G.

BOTTOM LINE: This "Dr.G" highly recommends you check out Dr. Barbara Greenberg & her website: as well as her book:"Teenage as a Second Language: A Parent's Guide to Becoming Bilingual".

Friday, April 20, 2012

To Pap or NOT to Pap?

Choosing Wisely is a wonderful campaign aimed at increasing discussions between doctors and patients about tests and procedures, and what is expected versus what has been shown to be effective. I am starting my focus on this campaign with highlighting the recommendations of my academy- the AAFP (American Academy of Family Physicians.) So far, I've discussed back x-rays, sinusitis treatment, bone density tests and EKGs, and today I would like to address Pap tests.

Pap tests do a wonderful job in helping us detect cervical cancer in early, very treatable stages. With our increased understanding of this disease being caused by HPV (the Human Papilloma Virus) as well as improving technology that allows us to detect the specific strains of HPV that are high risk for cancer, we are changing the recommendations for Pap tests on what seems like an annual basis. This recommendation focuses on two parts: Girls under the age of 21 and women who have had hysterectomies for reasons other than cancer (such as fibroids or heavy bleeding) do NOT need Pap tests. Evidence has shown that the vast majority of teens who are infected with HPV will not progress to cancer, but instead effectively "clear" the infection within a few years (meaning the HPV lowers to an undetectable level, though it still may be present.) Likewise, the incidence of cancer in women who have had their uterus removed for non-cancerous reasons is so small that there is little evidence for improved outcomes.

As a major proponent of sexually transmitted disease awareness, however, I want to be crystal clear that women under the age of 21 STILL NEED TESTING for STDs if they are having sex! No Pap does NOT equal no testing or no exam.

BOTTOM LINE: Pap testing recommendations are changing frequently- please talk with your doctor about the most current recommendations and do not be surprised if you do NOT need one this year!

Thursday, April 19, 2012

Choose Wisely: An EKG?

Should an EKG (electrocardiogram- the heart tracing) be a ROUTINE part of your annual physical? NO- not unless you have risk factors that suggest otherwise! I am blogging this month about the American Academy of Family Physician's recommendations for tests and procedures that patients and doctors should question. The Choosing Wisely campaign is focusing attention across specialties to look at evidence-based recommendations that should be discussed to help make better decisions for patient health & health dollars.

So what about the heart tracing? Well, it turns out that there is little evidence that pure screening EKGs in healthy, low-risk people will pick up silent coronary heart disease and subsequently prevent heart attacks. Instead, what we see is a moderate number of false-positive tests that lead to additional unnecessary and often invasive procedures.

Who SHOULD get EKG's? Risk factors for coronary disease include high blood pressure, high "bad" (LDL) cholesterol or low "good" (HDL) cholesterol, smoking, family history of heart disease, diabetes, males over age 45 & women over 55, and obesity. The more risk factors you have, the higher your risk, and the more likely it is that your doctor will indeed recommend an EKG at your office visit.

Check out the other AAFP Recommendations: Bone Density Test, Sinus Infection treatment, and Back X-rays

BOTTOM LINE: ROUTINE EKGs in healthy, low risk patients are unnecessary and possibly harmful- skip this test unless you & your doctor determine you are at risk for heart disease!

Wednesday, April 18, 2012

Bone Densities- Really Necessary?

As part of the Choosing Wisely campaign, the American Academy of Family Physicians has released our top five recommendations for tests and procedures that patients and doctors should question. Today, I am focusing on the third issue: bone densities. The recommendation is this:

Do not use dual-emission X-ray absorptiometry (DEXA) in women younger than age 65 or men younger than 70 with no risk factors.

We now know that using these bone density scans are not cost-effective in younger, low risk patients. This simply means we do not need to ROUTINELY do bone densities as part of the well woman exam each year. Please note that I did NOT say NEVER to use this test! In patients with risk factors for thinning bones, bone densities can give us excellent information.
What are risk factors?
--Family history of osteoporosis (Do you have tiny, hunched over, little old ladies for grandparents?)
--Thyroid disease (especially people who have been over-replaced for under active thyroid disease)
--Excessive alcohol intake (>2/day)
--History of a fracture without having trauma
--Age over 65 and Female, or 70 & Male
--Caucasian or Asian
If you have one, or especially, several of these risk factors, your doctor may indeed suggest getting a bone density test, and she should!

BOTTOM LINE: Bone density testing should not be a ROUTINE screen for everyone, but reserved for those with risk factors.

Tuesday, April 10, 2012

Does Your Sinus Infection Need Antibiotics?

Item number two on the Choosing Wisely” campaign to educate doctors and patients on unnecessary tests is the toughest one of all- “Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.”

For years doctors have known that the majority of sinusitis infections are caused by viruses. We know that antibiotics do NOT cure viral infections, only bacterial ones. Why, then, do many doctors continue to prescribe antibiotics for this problem? Why do patients ask for an antibiotic even when the doctor takes the time to explain that an antibiotic is unlikely to help? Americans spend over $5.8 BILLION health care dollars on this common diagnosis via 16 MILLION office visits and medication costs.

Have I ever prescribed antibiotics for this? You bet- especially on a Friday, or when a patient is headed out of town! BUT…let me explain why and how. As a busy mom, I understand the exasperation of a lingering runny, stuffy nose and headache, and the desire for a simple cure to “fix it”- whether those symptoms are mine or my husband’s or kid’s. If I take the time to schedule an appointment, show up, and wait because the doctor is running late, I want to get my money and time’s worth and be handed a cure. The doctor wants to be able to give you this cure. Both parties can feel like they are “doing something” when the doctor prescribes the antibiotics. And sometimes it seems that once we take that antibiotic, then, indeed the symptoms go right away. However, from good research, we know this is the exception, and not the rule.

Given all these factors, here is my approach. If I examine a patient and believe they have a mild to moderate sinus infection that has lasted only a few days, I frequently offer them two prescriptions: one for something to help with the symptoms (such as a drying antihistamine, if a runny nose is a major complaint, or a decongestant and something to break up mucus if they are stuffy with thick nasal discharge); and the second one a prescription for an antibiotic. BUT- I ask them not to fill the antibiotic prescription for a couple days, explaining why it is unlikely to help unless their symptoms drag on or they get signs of a secondary infection such as fevers or local pain in their teeth or forehead. I encourage them to hydrate till they float, and to use old -fashioned topical vapor rubs or sip spicy soups to open nasal passages. I have found that the vast majority of the time, when we follow up with our patient, they report they never needed to fill that second prescription (for the antibiotic) and we all feel as though we’ve done something productive.

BOTTOM LINE: Most sinus infections will resolve without antibiotics- talk with your doctor about treatment options that will help your symptoms, but don’t insist on an antibiotic.

An Xray for Your Aching Back?

Last week, the “Choosing Wisely” campaign was unveiled to physicians and patients alike. The concept was for each major specialty to identify five interventions that traditionally, physicians have ordered (and patients have expected) yet now evidenced-based medicine is telling us that these are simply unnecessary, not truly beneficial, and/or costly in dollars or health. For the next week, I would like to add my two cents worth for each of the five interventions highlighted by my academy- the American Academy of Family Physicians.

The first recommendation is to AVOID IMAGING (x-rays, CT or MRI scans) for LOW BACK PAIN that has been present less than six weeks
Did you know that low back pain is the 5th most common reason that people head to their doctor? We “throw out” our backs at an amazing rate, and it’s usually just from bending over or vacuuming more than moving baby grand pianos. The vast majority of low back pain is muscular, and a combination of anti-inflammatory medications (like ibuprofen), topical modalities (heat & massage) and judicious use of muscle relaxants-plus TIME measured in days, not hours- will take care of the problem. Ergonomic evaluations and physical therapy can also do wonders for low back pain, especially if it is recurrent. Insisting on an x-ray or fancy scan will certainly reduce the thickness of your wallet, but is unlikely to reduce your pain.

BOTTOM LINE: Hold off on x-rays or other scans for low back pain unless your pain has persisted more than six weeks, or your doctor sees “red flags” that suggest less common, more serious underlying issues.

Sunday, April 1, 2012

Gluten-Free Calamari: April Fools?

One of my biggest challenges of eating gluten-free (GF) can be dining out, especially at my favorite seafood or Italian restaurant. (What's Gluten? Click here.) My stomach moans and mouth waters when the waiter presents the loaded basket of heavenly scented fresh bread or crispy rings of fried calamari, and I inwardly pout (okay, perhaps I outwardly whine) as I am left to sip my water, which is often the only GF item at my place setting. This week, however, while in Boston, I had a delightful surprise on the waterfront at the famous Legal Sea Foods.

A large group had dashed over for lunch during our full conference day. I asked if they had GF labels on their dishes, and the waiter immediately swapped out my menu for one that highlighted the GF choices. To be honest, I was skeptical when I saw fried fish as part of the choices, but happily, the waiter clearly was educated about special diets, and I had my pick of numerous dishes. He took our orders, then came back with drinks and the infamous bread basket. As he set it down, however, he smiled at me and said- unsolicited- "no worries, your gluten-free rolls are in the oven and I'll be back with them in a few minutes"! I squealed with delight, much to the amusement of my new friends and colleagues, I might add...

Ultimately, I ended up eating at Legal's not once or twice but literally four times in three days (a definite first for me for ANY restaurant) and the icing on the proverbial GF cake was that last night I discovered FRIED CALAMARI on the list! This was the best calamari I have ever had, GF or "regular". Yum!

BOTTOM LINE: More and more restaurants are offering GF options- be sure to ask your waiter! AND...if you're in Boston (or anywhere there is a Legal Sea Food), you've gotta go to Legal's and have the GF Calamari!

PS. First of the month, so change those AIR FILTERS (especially here in Austin- the oak is out of control!)