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

Reno: Free Family Estate Planning Series

Reno: Free Family Estate Planning Series

 

2018 Family Estate Planning Series

Posted in Uncategorized

Marijuana and adolescents…

Marijuana and adolescents…  I live in Nevada and it is now legal to use marijuana for both recreational and medical use.

How prevalent is marijuana use? 5.4% of 8th graders, 14% of 10th graders and 22% of 12th graders have used marijuana at least once in the past month.  Marijuana is second most-used substance after alcohol for adolescents.

Adults may view marijuana use as benign or not harmful, but there are major concerns about use in adolescents.  Regular or heavy or daily use of marijuana can lead to adverse medial, mental, psychosocial and cognitive outcomes.  Brain maturation is not complete until the mid-20s.  Negative outcomes can include

  • delayed reaction time,
  • impaired motor coordination,
  • higher rates of serious or fatal motor vehicle crashes,
  • poor work and school performance,
  • increased school dropout rates,
  • and anxiety.
  • Those with a predisposition to schizophrenia can have their first episode of hallucination associated with marijuana-use.

What is the risk of chronic marijuana use?  It increases the younger that marijuana is started.  Those adolescents who use marijuana daily, the risk of long-term use is 25-50%.  Whereas there is a 9% regular use in those who experiment with it.

There is a lack of regulation by the US Food and Drug Administration regarding marijuana…  so purity, THC (tetrahydrocannabinol) concentration and CBD (cannabidiol) concentrations are different with each batch.  Also, the method for which it is ingested changes its effect: eaten, drank, topical administration, vaped or smoked.  The concentration of THC (the psychoactive substance in marijuana plant) has increased greatly over the years: 4% in 1995 to 12% in 2014.

Talk with your children about the dangers of marijuana use.  Consider stopping yourself.   Ask your physician for help.

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

Should you as an ex-smoker have a CT scan to rule out lung cancer?

Should you as an ex-smoker have a CT scan to rule out lung cancer?  This is a great question.

A few years ago the National Lung Screening Trial found a reduction in disease-specific and all-cause mortality with lung cancer screening.  THEN the Canadian Task Force on Preventive Health Care AND the U.S Preventive Services Task Force voted in favor of a low-dose lung CT scan in those aged 55-80 who have a 30-pack/year smoking history (like one pack a day for 30 years) and currently smoke or have quit within the past 15 years.  So, we physicians, have been ordering low-dose lung CT scans on appropriate patients.

What were the results?  In a small group of Veterans Health Administration patients, it was found that 97.5% of patients who were told they had an abnormal lung CT DID NOT have lung cancer.

Where does this leave us?  The patient and physician should have a discussion about the risks of a false-positive result (a concerning lung CT with subsequent negative work up) and other harms such as radiation exposure, over-

Big C

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diagnosis and incidental non-lung-cancer findings.

Talk to your doctor.  Make a plan.

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

Pregnant women, should you ask for skin staples or stitches with a C-section?

Pregnant women, should you ask for skin staples or stitches with a C-section?  A meta-analysis (combined multiple studies) with 2300 patients looked at complication rate or infection, separation, hematomas (blood collections under the skin surface) and cosmetic result.

All 10 studies included showed that the staples group had an increased risk of wound complications compared with the sutures group.  Otherwise, the cosmetic result between the two groups was comparable at 8 weeks postpartum, but at 12 months postpartum the suture group had a better looking scar per observer scores (and similar-resulting scar per the patient themselves).

Want more information?  Journal of Maternal and  Fetal Neonatal Medicine 2016:29 (22) 3.   pages 3705-3711.

Posted in Obstetrics, Uncategorized, Women's Health | Tagged , , , , , , , , , , , ,

Getting squeezed by health insurance premiums?

Getting squeezed by health insurance premiums? Is your insurance covering less? Charging more premiums? More in copays?

You have options!

Consider direct primary care! Here’s a fascinating Bloomberg article. Cobble together coverage that works for you.

https://www.bloomberg.com/news/features/2018-08-22/priced-out-of-health-insurance-americans-rig-their-own-safety-nets

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Men, do you know your cholesterol level?

Men, do you know your cholesterol level?  There was a recent lipid (cholesterol) guideline released by the American College of Cardiology/American Heart Association which showed that men with a low-density lipoprotein (LDL) component of cholesterol of at least 190 benefit from starting a statin drug.  The study showed a clinically and statistically significant reduction (!!) in cardiovascular events (meaning heart attack and stroke) in those who took a statin daily.  Additionally, it is also thought that all-cause mortality is decreased in these men after starting on a statin drug.

Want more specifics?  This study enrolled men 45 to 64 years of age with an LDL level of at least 155.  They randomized them to either receive pravastatin 40 mg or a sugar pill (placebo).  There was a 20 year follow-up.  There was a consistent  25% relative reduction in cardiac events with the use of statins for those with an initial LDL of 190 or more.  This study excluded men with a known vascular disease, meaning this study was studying how well did statins work for primary prevention of cardiovascular disease.

Want even more information?  Look up Analyses from the WOSCOPS (West of Scotland Coronary Prevention Study).

Posted in Cholesterol, General Medicine- Adults, Male issues, Uncategorized | Tagged , , , , , , , , , ,

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.

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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 , , , , , , , , , , , ,