Hello Reno Families!

This is Leslie Greenberg.  I am a family medicine doctor in Reno, Nevada.  I attended University of Nevada School of Medicine and have recently relocated back in my hometown.  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 family medicine residents for 18 years.  I currently teach at the family medicine residency program in Reno and also see private patients.  I invite you to read my blog.  If you would like to become a patient, please call 775-682-8200.

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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Posted in Uncategorized

More myth-busting! This time let’s tackle preventive care!

More myth-busting! This time let’s tackle preventive care!  I am a myth-buster of preventive care ideas.

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Are you a woman (at routine risk and) concerned about getting ovarian cancer?  No screening tests are suggested for women at routine risk of ovarian cancer as you probably will not  live longer (medical phraseology is “unlikely to experience any mortality benefit”).

Do you have a first-degree relative who had colon cancer, what are your risks of colon cancer?  Research has showed that if you have only one first-degree relative with colorectal cancer, and YOU have not developed colorectal cancer by 55 years of age, your risk of having colorectal cancer is similar to the risk in the general population.

If you are an older woman wanting to reduce your urinary tract infections, cranberry capsules (taken daily) do not help.

 

 

 

Posted in colon, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , ,

Do you have toenail fungus? What can you do about it?

Do you have toenail fungus? What can you do about it?

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Who gets this?  8% of adults have onychomycosis (toenail fungus).  The prevalence increases with age with more than 50% of those over 70 year of age having it.  It is NOT a sign of poor hygiene or an underlying medical condition, it is largely a cosmetic problem.

There are three types of fungus that can cause onychomycosis: dermatophytes, yeasts and nondermatophyte molds.

How do you know if you have this?  Toenails are characterized by thickened nails and thickened skin beneath the nail.  This thickened skin debris under the nail can cause tenderness and pain when it accumulates over time.  Nails may also become discolored and deformed.

What are your risk factors for getting onychomycosis?  Cigarette smoking, older age, any medical condition that can decrease blood flow to the extremities (like peripheral vascular disease), wearing occlusive footwear, using shared bathrooms, trauma to a toenail.

What is a cure?  Some research consider the nail cured if no fungus can be found on nail culture.  Most people would consider a “cure” when the nail improvement appears normalized.

How can this be treated?  This can be done either by taking oral pills or by putting a medicine on top of the affected nails.  Terbinafine is a pill that has the highest “complete cure rate” of 38%.  Terbinafine is given everyday for 12 weeks for toenails. Checking liver enzymes is suggested by a blood test.  Of the topical medications, they are all known to be expensive and the cure rates are low with complete cure rates at 15% or less.

It is not suggested that the affected nails be surgically removed as this will require a very extended healing time and poor healing rate.

Laser therapy is approved by the FDA, but the clinical cure rates are no better than oral or topical antifungal treatment.

Posted in Dermatology, foot health, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , ,

Myth-busting heart and lung thoughts

Yes, I am a myth-buster and this time it is about heart and lung medical care.

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If you have heart failure BUT you also have a preserved ejection fraction (as seen on heart cath or echo), consider NOT taking a long-acting nitrate pill as this may decrease your level of activity and increase adverse events.

If you have community acquired pneumonia, your doctor may discontinue antibiotics (if deemed clinically stable) after five days.  Make sure your doctor thinks you are medically stable, do not stop medication without their okay.

We, doctors, are decreasing our prescribing of antibiotics during acute asthma attacks.    Oral (or a shot of) steroids may help you and antibiotics may not improve your outcome.

 

Posted in General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , , , ,

Wow! Stop the presses. Pap scheduling change.

Wow! Stop the presses. Pap scheduling change.  I know…every woman loves to go in to her doctor for a pap.  (Just kidding.)  Years ago we performed paps every year on every woman and that’s how the “annual visit” became synonymous with the pap.  Well…no more!

The USPSTF which is a conservative organization (US Preventive Services Task Force) tells us that we can space out the paps AND even decrease our number of tests.

 

 

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The USPSTF recommends that primary care physicians
  • screen women ages 21-29 every THREE years with cervical cytology as long as the results are normal.
  • For women ages 30-65, the task force recommended screening with either cervical cytology alone (meaning a pap smear) every three years OR with high-risk HPV (hrHPV) testing alone (which feels like a pap, but is not) every five years.
  • For both the pap OR the high-risk HPV testing a woman is undressed from the waist down, feet in stirrups, and a speculum placed inside the vagina.  As a patient, you may be unaware of which test your doctor is doing.  Ask!  As a patient, I’d prefer the high-risk HPV test with the ability (if the test is negative/normal) to space out my paps for 5 years.

These are “A” recommendations.  “A” means that they are well researched and supported.  Want more information?   www.uspreventiveservicestaskforce.org

Posted in General Medicine- Adults, pap test, Uncategorized, Women's Health | Tagged , , , , , , , , , , ,

I am a myth-buster! Myth-busting at musculoskeletal issues…

Yes, call me a myth-buster!  In my recent family medicine journal there is a fantastic article (with research to back up their recommendations) that helps with musculoskeletal issues.  Which of these categories do you fit in?!

Are you a middle-aged patient with a meniscal tear (and little to no arthritis in that knee)?  If so, consider NOT having arthroscopic surgery as long-term outcomes with pain or function may be better after conservative management of physical therapy.

Do you have knee pain with degenerative joint disease?  If so, injections of (expensive) hyaluronic acid help only minimally more than placebo injections.

If you have knee osteoarthritis consider buying normal walking shoes, not “specially-designed walking shoes” as they both help with pain and function the same

If you have chronic low back pain, consider physical therapy to help for pain and disability, only have a lumbar fusion surgery as a last resort.

If you have chronic non-cancer pain, avoid long-acting opioids.  Long-acting opioids significantly increase the risk of premature death.

More myth-busting to come…

Posted in General Medicine- Adults, Uncategorized, vitamins and supplements | Tagged , , , , , , , , , ,

To follow is NOT a sexy topic, but very important– how to prevent falls for yourself (…or your parent)

To follow is NOT a sexy topic, but very important– how to prevent falls for yourself (…or your parent.)

Why is this important?  Every 20 minutes an older adult dies from a fall.  Each fall-related hospitalization costs an average of $30,000.  Medicare spends $31 billion on falls annually.   If you fall and break a hip, the chance you will EVER return home is slim.

There’s good news!  There are evidence-based (meaning they’ve been researched and they WORK!) interventions that can prevent falls.

The CDC started the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative.  This has three core elements: screen patients to identify their fall risk, assess their modifiable fall risk factors, and intervene.

This includes stopping medications which can make the patient drowsy or unsteady (like sleeping aides and narcotic pain medicine).  Decreasing other medications if they cannot be stopped entirely.  Pick up throw rugs in the moving.  Move electrical cords to avoid a tripping-hazard.  Add secure grab bars to bathrooms and showers.  Add secure grab bars near stairs.  Using a bedside commode during the night.

If you’d like to learn more, refer to http://www.cdc.gov/steadi

Posted in General Medicine- Adults, medication issues, Uncategorized | Tagged , , , , , , , , , , ,

Top 10 list of allergens…

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The top 10 allergens (and how to avoid exposure) …

  • Tixocortol pivalate (a steroid)
  • Propylene glycol
  • Methylchloroisothiazolinone
  • Formaldehyde
  • Cocamidopropylbetaine
  • Lanolin
  • Benzalkonium chloride
  • Fragrance and balsam of peru
  • Neomycin
  • Nickel

Tixocortol pixilate is a steroid present in creams like hydrocortisone acetate.  Usually this sensitivity comes across as a failure in treating a rash..or the rash gets worse.

Propylene glycol, benzalkonium chloride, and neomycin are frequentlflickr.com/photos/ espelina/ 24831708y found in topical creams.

Lanolin (also known as wool alcohol) is often found in emollients, medications and some personal care products.

Methylchloroisothiazolinone may be found in wet wipes and some sensitive skin products.

If you feel like you get a reaction, check the ingredients of your products.  If you do not have a clinical improvement after 8 weeks, I’d consider testing by a specialist.

 

 

 

 

Posted in Dermatology, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , ,