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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Antibiotic prescribing is rampant at urgent care and retail clinics. Does this surprise anyone?!

Antibiotic prescribing is rampant at urgent care and retail clinics.  Does this surprise anyone?

JAMA Internal Medicine recently published a study including 2.7 million urgent care visits, 48,000 retail clinic visits, 4.8 million emergency department visits and 148.5 million medical office visits. Read this…. there are a sufficient number of patient visits to extrapolate antibiotic prescription habits in different locales.

flickr.com/photos/e n321/55331295/

flickr.com/ photos/en321/55331295/

In the study, antibiotic prescriptions are linked to 39% of urgent care and 36.4 of retail clinics.  This contrasts with 13.8% of emergency department visits and 7.1% of medical offices.

For suspected viral respiratory illnesses which antibiotic use is inappropriate, antibiotic prescriptions were given at 45.7% of urgent care visits whereas emergency departments gave antibiotics 24.5% of the time.  Medical offices gave antibiotics 17% of the time and 14.4% of retail clinic visits.

The risk is that antibiotic over-prescription may cause antibiotic resistance.  This is important when a patient truly has a bacterial infection.  You would like antibiotics to work when INDEED you need it.

Your best care is given by a physician who knows you, who you trust.  Secure a primary care physician and cultivate a relationship.  Your healthcare would be more individualized, with better follow up.

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

Breastfeeding linked with reduction in diabetes…

Breastfeeding linked with reduction in diabetes…

This is not new news, as my children are now teenagers…and this was known then. What is new is the percentage DROP in incidence of diabetes in mothers who breastfed per JAMA Internal Medicine.

The Coronary Artery Risk Development Studying Young Adults (CARDIA) study followed 1,238 women aged 18-30 for 30 years.  Their blood sugar was tested over the course of the study.  Women who had breastfed for at least 12 months had a 47% (!!!) lower relative risk of developing diabetes during the ensuing 30 years compared to those mothers who did not breastfeed.

Did the study take into account other factors?  Yes!  They adjusted for race, number of pregnancies, physical activity, weight change, and gestational diabetes status.

What if you breastfeed for 6-12 months there was a 48% reduction in the risk of diabetes and those who breastfed for 6 months, there was a 25% reduced risk of diabetes.

What if you have gestational diabetes (high blood sugars during the pregnancy that doesn’t occur when not pregnant)?  If the mother did not breastfeed, she has a 2.08% higher risk of diabetes per YEAR compared with women who breastfed for at least 12 months.

Why is this?  It is thought that lactating women have lower circulating glucose both when fasting and after eating.  These women also have lower insulin secretion and 50 grams of glucose per 24 hours is diverted into the breast to help make milk.

How many women breastfeed?  It is estimated that 55% of women breastfeed at 6 months and 33% breastfeed at one year.

What do you need to breastfeed?  You need breasts (any size will work), patience, support, and the desire to breastfeed.  There are some women who do not make milk… but you will never know until you try.  I urge women to dedicatedly breastfeed for the newborn’s first 2 weeks of life with professional lactation support, if needed.  This support is offered through the hospital they delivered at or with outside breastfeeding organizations like La Leche.  Do these steps before deciding that she does not make milk.  The mother can always supplement with formula to help give the newborn the nutrition needed.

Want more information? doi:10.1001/jamainternmed.2017.7978

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Posted in breast, food, General Medicine- Adults, Pediatrics, pregnancy, Uncategorized, Women's Health | Tagged , , , , , , , , , , , ,

One more form of birth control “bites the dust.”

One more form of birth control “bites the dust.”  Which one?  What was its history? Why?

The Bayer company is taking Essure off the market.  Essure was marketed as a nonsurgical alternative to “tying tubes.”  Instead of a surgical tubal ligation, done in the operating room under anesthesia, Essure is a small, flexible metal coil that fits into each fallopian tube.  The insertion requires the Essure to be placed through the cervix, into the endometrial (uterine) cavity, and then a coil is placed into each of the right and left fallopian tubes.  The ensuing inflammation causes permanent scarring within 3 months of insertion…so that the blockade will not let egg and sperm meet.

The device has had a troubled past.  The FDA placed a black box warning on the Essure warning physicians and patients about the risk of device migration, allergic reaction, pain, and implant perforation.  This credible warning caused a sales drop of 70% of Essure.  Not surprising, right?!

So, Bayer has decided to discontinue the sale of Essure.  The FDA has vowed to “remain vigilant” to protect women who have already had the device implanted.  Device removal also has risks.  If you have Essure implanted and have no problems, no further investigation is needed.  If you have Essure implanted and have pain or other problems, see your physician.

I hope this helps.  See anatomy below… pretty cool, huh?!

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flickr.com/photos/sharynmorrow/205306264

Posted in contraception, vaccines, Women's Health | Tagged , , , , , , , , , , , , ,

Why does your doctor NOT look you in the eye?

IMG_3631Why does your doctor NOT look you in the eye?  Please click to watch this brilliant and entertaining video from a fellow physician Dr. Zubin Damania, better known as rapper ZDoggMD.

Entitled “EMRs killed medicine”

 

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

Medicare’s proposed fee payment changes are NOT in your best interest…

Medicare’s proposed fee payment changes are NOT in your best interest…

Medicare would like to “streamline” physician documentation.  And, in exchange for this, they are decreasing the reimbursement for many office visits.  Most Medicare patients are complex, as there is a lifetime of medical conditions to consider.  Many Medicare patients have multiple medical conditions and, as a physician, I aim to address them all at each visit.  This means the patient can spend more time living OUTSIDE of my office and not seeing me for one medical condition per office visit.

What Medicare is proposing is like…. if I am a restaurant owner, every customer can order a filet mignon, but be charged for a kids meal.  This is unsustainable.

The New York Times recently had a good article https://www.nytimes.com/2018/07/22/us/politics/medicare-payments-trump.html.

In my town, many physicians do not accept Medicare as the reimbursement schedule AS IS barely covers the overhead costs (rent, utilities, office staff, medical malpractice insurance, etc).  With this proposed change, if it passes, I am certain that fewer physicians will accept Medicare.

If you would like to speak up for yourself, please email the IRS directly.  They will accept comments until September 2018.  Input regulations.gov and search for CMS 1693.15721269254_39d2144a7a_k.jpg

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

At what age should you really (!) start a screening colonoscopy? 45 or 50?

At what age should you really (!) start a screening colonoscopy? 45 or 50?  The American Cancer Society (ACS) recently released an updated guideline that colorectal cancer (CRC) screening begin at age 45 for patients at average risk.

Researchers have demonstrated a favorable benefit-to-burden balance of screening beginning at age 45.  The new guideline differs from the latest recommendation by the U.S. Preventive Services Task Force released June 2016.

ACS has acknowledged that this recommendation is considered a “qualified recommendation” in that this conclusion relies on the use of modeling without evidence from clinical trials.  Most published studies clinical studies regarding screening for colorectal cancer are in those 50 and older.

Did you know that there has been a steady decline of colorectal cancer during the past twenty years in patients 55 and older due to screening that results in removal of polyps.  Conversely, there has been a 51% INCREASE in colorectal cancer in those younger than 50.  It is thought that this increase in colorectal cancer is that screening begins at 50.

What is the harm of starting screening at age 45?  It may be that the number of lifetime colonoscopies will increase and with every procedure there are potential harms.

When the screening age for colonoscopies was first decided to be at age 50, the rate of colorectal cancer was the same as it is now for 45 year olds.  It is suggested that recommendations are constantly revisited.

If you are considering your first colonoscopy before age 50, confirm with your individual insurer that this will be a covered benefit.

Want more information?  http://www.pressroom.cancer.org/releases?item=770

 

 

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New medical interns start specialization training today!

It’s July 1, and new interns have already earned both an undergraduate degree and completed 4 years of medical school. What else do they need to do before “hanging their shingle” and seeing patients as an attending physician? Read on…

July 1 traditionally marks the start of residency and fellowship for new doctors and doctors who have completed residency.

On this momentous day, I am so excited to welcome the new interns into one of the most noble professions. It is the continuation of a crazy ride but an incredibly awesome and humbling one.

For those who don’t know what an intern, resident or fellow is:

-A resident team means you have a team of committed physicians, all looking over you and your chart, all under the supervision of an attending physician (like me!).

-Even new interns have already had at least 5000 hours of hands-on clinical training before arriving on July 1.

-New interns have already passed 2 of the 3 “steps” required to be licensed in the US: 3 days of testing, nearly 600 multiple choice questions, and 12 standardized patient encounters including assessment of history taking, physical exam skills, communication skills, and ability to form a plan of action based on findings.

-Intern year ( with an estimated 4000 hours of work!) is just the beginning of post medical school training.

-After those 4000 hours, your average pediatrician, family medicine physician and internist (all primary care physicians) will complete an additional 7000-8000 hours of training before taking their respective board exams (an additional 8-10 hours of testing).

Your average general surgeon will complete an additional 16,000 hours.

So, when you see your primary care physician, specialist, or surgeon, know that they’ve spent more than 10,000 hours of training to help you stay healthy.

#july1 #5000hoursandcounting #trainingtobeanexpert #seetheexpert #trainingmatters #knowyourdoctor #iwasajuly1intern #trainingtothetop

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