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

Do you have chronic sinusitis?

Do you have chronic sinusitis?  Does your nose drip all the time?  Do you have

  • Facial pain/pressure,
  • decreased or inability to smell,
  • nasal drainage, and
  • nasal obstruction?

When 2 or 4 symptoms are present, chronic rhinosinusitis is present. chronic part means that symptoms have occurred for more than 12 weeks.

Treatment is directed at helping the clearance of secretions in the nose, improving sinus drainage, and decreasing local infection and inflammation.

  1. First-line treatment is nasal saline irrigation (found at pharmacies and called a Neti-Pot) and
  2. intranasal corticosteroid sprays (of which fluticasone is now available over the counter).
  3. Antibiotics may help if there is evidence of an active, superimposed acute sinus infection.
  4. If treatment does not help, then a consult with an ear,nose,throat doctor may help.4343716879_a89038810f_o

They may perform endoscopy (a small tube put in the nose to look at the structures inside the nose, sinuses, and the back of the throat). For patients who have other conditions such as inflammation of the blood vessels, cystic fibrosis, or immunodeficiencies, an allergist or pulmonologist may also be of help.

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Worth the read: What it’s like being a doctor.

Worth the read: What it’s like being a doctor. One key point Malcolm Gladwell addresses are the motivations of physicians to dedicate their (my!) life to doctoring and the increasing need to be an insurance claim expert. Read on… it’s a really good piece. Enjoy!

https://www.forbes.com/sites/robertpearl/2014/03/13/malcolm-gladwell-tell-people-what-its-really-like-to-be-a-doctor/#178fa03b4420

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

Want a synopsis of a Pulitzer-prize-winning oncologist/author with FASCINATING ideas?

Want a synopsis of a Pulitzer-prize-winning oncologist/author with FASCINATING ideas?  Siddhartha Mukherjee MD, PhD this week came to University of Nevada Reno and spoke to a packed crowd.

Dr. Mukherjee has written two books: The Emperor of all Maladies: A Biography of Cancer and his new book, The Gene: An Intimate History.

I took notes and here were some of his most interesting thoughts during this recent lecture…

  • Genetics in medicine is going to be impacted by three important concepts and their relation to each other: genetic prediction, deep learning (artificial intelligence) and precision medicine.
  • Consider our genes are like pixels on a screen.
  • In the 1940s and 50s eugenics was the study of manipulating genes to promote selective breeding.  I think of the Nazis with their “perfect race” but that this concept of altering future genes in humans is still present– with sophisticated researchers with deep-pocketed investors.
  • Each of us has DNA which is 3 BILLION different protein components (A,C, T or G) strung together in a unique array.  He says to imagine that these protein components are like words in an encyclopedia.
  • Every cell has the SAME 3 billion DNA, but different “pages” are read to make different parts of the body.  Like the DNA in the cells of the skin are the same as the hair, but they choose to “read” different.
  • Every cancer has a unique fingerprint and unique gene abnormalities.  It could be ONE gene is abnormal, or it could be that cancer only surfaces when there are multiple (maybe even tens to hundreds) or genetic abnormalities.  Some gene abnormalities will remain dormant until there is an environmental trigger (like smoking).
  • Treatment, in the future, may be depending on matching the genetic abnormalities.

He admits that we are on the “eve before the bomb” referring to the night before the Atomic Bomb was dropped.  We are on a precipice with genetic research wherein afterwards we can manipulate genes of future generations (genetic selection of fetal characteristics?!).

My friend who attended this lecture with me leaned over and said “You can’t put the genie back in the bottle…”  Oh, so true, my friend.

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What is a family doctor?

What is a family doctor?  Why do you need (deserve?!) one?

I am NOT a generalist.

I am NOT a provider

I am NOT a practitioner.

I am a medical professional who cares for complex and healthy patients regardless of age.  I am best understood as an integrationist.  I integrate the mental, spiritual, and physical well-being of my patients, in the context of their families and community, to help them become whole, to maximize their life.  I integrate the sometimes disparate recommendations of medical specialists to insure that treatments that benefit one organ system does not damage another.  I integrate and apply complex medical research on populations to the unique biology, needs, and goals of my patient.

I am the “pluripotent stem cell” of the medical community.  I start with a broad education and then adapt to the needs of my community to fill the voids in healthcare.

I am the “Marine of medicine“.  I get the job done, often under harsh conditions.

I truly have a fantastic job and I feel blessed that I can work as a family physician.

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

Is there a link between weight and cancer?

Is there a link between weight and cancer?  We think yes!  Last month the Centers for Disease Control and Prevention (“The CDC”) published a report that being overweight or obese significantly increased the risk of developing at least 13 (!) types of cancer.

  • What is the definition of overweight versus obese?  Overweight is considered a BMI of 25-29.9.  Obesity is a BMI of 30 and over.  Plug your height and weight into this easy-to-use calculator  www.smartbmicalculator.com
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    flickr.com/ photos/ lynnfriedman/ 8703242835
  • Who is most at risk?  The effect is more pronounced in older people (at least 50 years old) compared with younger people  AND women are much more likely to have overweight- and obesity-related cancers than men.  (218 cancers per 100,000 women versus 115 cancers per 100,000 men). This is thought to be that female-specific cancers like postmenopausal breast cancers and endometrial and ovarian cancer only exist in women and constitute 42% of the overweight- and obesity-related cancers.
  • What can you do?  Be aware that weight-reduction and maintaining a healthy BMI (between 20 and 25) can play a role in your cancer prevention!

 

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

There is a new shingles vaccine in town… and it’s great!

Theres a new shingles vaccine in town… and it’s great!  The Advisory Committee on Immunization Practices (ACIP)– the guru organization

regarding immunizations– has just voted to recommend preferential use of a NEW shingles vaccine (Shingrix) instead of the currently available shingles vaccine (Zostavax).

This is BIG news. This new vaccine is approved by the FDA for prevention of shingles in adults 50 and older (instead of 60 for Zostavax). Other changes from Zostavax are that Shingrix is 2 vaccines dosed between 2 to 6 months after the first dose. Shingrix is also a non-live vaccine.

What should you do?

  • Wait for Shingrix to be released (expected to be released early 2018).
  • Be patient as it may be in great demand and the manufacturers may have difficulty keeping up with demand at first.
  • If you have had the Zostavax it is suggested that you get the two-shot regimen of Shingrix to help boost immunity against shingles. (I am unsure the patient-cost of 2 doses of Shingrix and administration of those two doses.)
  • It is unknown if Medicare will pay for the two-shot regimen.

Interesting…  Stay posted.

shingles day 2

herpes zoster day 3

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

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.

 

 

 

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