Hello Reno Families!

Posted on July 1, 2010 by drlesliegreenberg

2021 Leslie Greenberg headshot croppedHello, 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 400 + family medicine residents (and countless medical students), over nearly 25 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 procedures: skin biopsies, circumcisions, IUD insertion/removals, paps, colposocopies, and toenail removals. 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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Canker sores. What are they? How to treat them?

Posted on March 15, 2023 by drlesliegreenberg

Canker sores.  What are they? How to treat them?

Canker Sore

Ugh.  Canker sores are the most common ulcerative condition in the mouth.

  • Peak age is in the teen years.  
  • There’s a genetic predisposition to getting canker sores. 
  • It is unknown why some people get them. 

Most ulcers are considered mild with lesions less than 1 cm in diameter.  These lesions are usually present for 1-2 weeks and heal without scarring. 

Ulcers more than 1 cm in diameter represent less than 10% of cases.  They may persist for 6 weeks and heal with mucosal scarring. Major ulcers are associated with HIV infection.

Treatment: Topical corticosteroid gels or rinses are the most common therapy but most heal without any treatment. Major ulcers may require oral steroids.  Peridex rinse may decrease pain and severity, but may stain teeth. Avoidance of toothpaste with sodium lauryn sulfate may decrease recurrences of canker sores.

I hope this helps.

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What contraception is right for you?

Posted on March 7, 2023 by drlesliegreenberg

What contraception is right for you?  There are sooooo many choices.

  • condoms,
  • contraceptive pills,
  • patches,
  • vaginal ring,
  • implants in your arm,
  • implants in your uterus,
  • injectables (either in the muscle or subcutaneous),
  • natural family planning,
  • OR you can decide you want a baby in 9 months,
  • OR you can decide you do not want any more children in which case sterilization of the woman in the form of a tubal ligation (or her partner which is a vasectomy). 

Consider how often you want to think of contraception:

  • Do you want to take pills daily?
  • Place patches on the skin weekly? 
  • Put in a vaginal ring monthly?
  • Have a physician implant in your arm once in 3 years?
  • Implant in your uterus once in 7-10 years? 
  • Do you want to NEVER think about it again?

Choose what is right for you right now.  You can be seen at a local clinic, FQHC or Planned Parenthood.  You can obtain your contraception online (www.pandiahealth.com). 

Choose what is right for you… right now.

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Toenail fungus

Posted on February 21, 2023 by drlesliegreenberg

What is the prognosis of onychomycosis (fungal infection of your toenails)? And, how to prevent recurrence?  There is effective treatment to rid the majority of patients of onychomycosis.  But the relapse rate is nearly 25% within 2 years (even AFTER successful treatment). 

Who is most at risk to have a relapse (or a recurrence) of their onychomycosis?

  • Patients older than 70 years,
  • those with a history of nail trauma, and
  • diabetics. 

How to prevent recurrence? 

  • Avoid walking barefoot in public places. 
  • Disinfect shoes and socks. 
  • Keep feet dry and cool. 
  • See your physician if a nail seems to be getting infected again. 
  • Twice weekly application of topical antifungal on the toes can help decrease the chance your skin will be infected and serve as a reservoir of infection. 
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Does exercise during pregnancy decrease high blood pressure?

Posted on February 14, 2023 by drlesliegreenberg

Does exercise during pregnancy decrease maternal risk of developing high blood pressure during pregnancy?  Yes, and here is how to do it. 

If you are already an exerciser, continue!… although modifications may be needed.   If you are new to exercising, initiate an exercise regimen early in pregnancy. 

Aerobic exercise performed for at least 30 minutes 3-4 times per week decreases maternal risk of high blood pressure during pregnancy (including gestational hypertension and preeclampsia). The American College of Obstetricians and Gynecologists recommended in their 2020 updated committee opinion that “physical activity and exercise in pregnancy are associated with minimal risks and have been shown to benefit most women, although some modification to exercise routines may be necessary because of normal anatomic and physiologic changes and fetal requirements.”

Photo by Pixabay on Pexels.com
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How tight of control over diabetes should older patients have?

Posted on February 7, 2023 by drlesliegreenberg

How tight of control over diabetes should older patients have?  Not that tight. 

The risks of treating type 2 diabetic patients over the age of 70 with insulin or sulfonylurea drugs AND having the patient maintain a hemoglobin A1c less than 7 INCREASES the risk of unnecessary hospitalization.  So, be sure you know your hemoglobin A1c level and know your hemoglobin A1c goal for your age. 

Have a hypoglycemia plan. Stash appropriate snacks nearby. Have a working glucometer with lancets and test strips if you are on insulin or sulfonylureas to check your blood sugar if you feel low.

I tell my patients that I have many goals for them. One of them is to find joy every day.  And, then I joke let’s find that joy outside of the hospital. 

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How concerned should you be about a diagnosis of “pre-diabetes?”

Posted on January 25, 2023 by drlesliegreenberg

How concerned should you be about a diagnosis of “pre-diabetes?”  Research estimated the likelihood of older adults converting from prediabetes to diabetes over a 6 ½ year study…. as very low.  More than 90% of older adults will NOT progress to diabetes.  They routinely stayed at the same hemoglobin A1c level or it even normalized.  In fact, if you are in your mid-70s without a diagnosis of diabetes, the chance that you will convert is low. 

Certainly, cleaning up your diet (stop drinking sugar-sweetened beverages and eating fried foods) and exercising regularly are good for everyone… at every age. 

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Should you read your spine MRI report?

Posted on January 18, 2023 by drlesliegreenberg

Should you read your spine MRI report?  I would suggest against it. 

In the era of transparency and patient access to their entire electronic medical record, you CAN look at your spine MRI report.  And, yet, do you know what you are looking at?  Do you know what pathology is significant?  Do you know the LEVEL in your spine that your symptoms originate from? There are many radiologic findings on MRI that are actually asymptomatic. 

Research showed that patients with low back pain who read their MRI results without interpretation by a clinician had lower function and more pain even after 6 weeks of conservative treatment. 

The patients who received a call from their physician and were told “their MRI results were normal with age-related findings” did better than those who read their report.

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What intervention gives sustained improvement in chronic back pain?

Posted on January 11, 2023 by drlesliegreenberg

What intervention gives sustained improvement in long-standing back pain?  The intervention that showed a greater than 30% reduction in back pain was exercise. 

Patients may have trialed opioids or non-steroidal anti-inflammatory pills, but those are routinely not given for long.  A 2020 systematic review of 25 randomized controlled trials (with over 2,400 patients!) found that if you have low back pain for 12 months or more, epidural steroid injections do not give long-term meaningful improvement. Yes, epidural injections may be more effective than placebo in the short-term, but not in the long term.

Other interventions that help are osteopathic manipulation and topical capsaicin cream. Physical therapists are a great resource for initiating back exercises and confirming that your technique is correct.  Then, you can continue the therapist’s exercises as your “homework.”

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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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