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

Sleep. Are you a good sleeper?

Sleep.  Are you a good sleeper?

Sleep Quality.   It’s a predictor of overall physical and mental health and overall vitality.  The National Sleep Foundation made a consensus statements.  I’ll summarize them…

How long should it take you to fall asleep?  Less than 15 minutes is appropriate.  If it takes you 45 to 60 minutes to fall asleep, it’s taking too long.

How many awakenings are important?  In all age groups one or fewer awakenings per night indicates good sleep quality.  In older adults, 2 awakenings per night is considered good sleep quality.  If you are awake for more than 50 minutes at a time, that is considered a component of poor sleep quality.

What is sleep architecture?   This is measured in terms of sleep cycles and patterns.  The sleep cycle begins with the transition from being awake to non-REM sleep (from stage N1 to N2 to N3) and then to REM sleep.   In adults, when REM sleep is between 21 to 30% of sleep time this indicates good sleep quality.

Should you take naps?   Yes, if you are a child.  Otherwise, 1 or fewer naps per day, lasting 20 minutes or shorter may still constitute good sleep quality.

It is know that a sleep study in a lab may not reflect normal sleep patterns at home.

What else can change sleep patterns and quality?!

  • ingesting or withdrawing from drugs,
  • major depression,
  • obstructive sleep apnea,
  • restless legs.

I hope this helps.

infant car seat

flickr.com/photos /lessel/ 2729066

Posted in Brain, General Medicine- Adults, Pediatrics, sleep disorders, Uncategorized | Tagged , , , , , , , , , , ,

“Pajama time” finishing clinic notes? How does your doctor finish their day?

“Pajama time” finishing clinic notes? How does your doctor finish their day?

The New England Journal of medicine ran an interesting article. Attached is a graph of how doctors finish their day. It’s absurd. I urge my kids (and every medical student I meet) that they should practice typing games online. Its fun, but also may allow you to get-home-on-time AND be mentally present for your family. This is true for ANY field.

I type 110 words a minute so my “pajama time” is usually not spent looking at my work’s electronic health record (EHR). I did have a young patient once remark that I’d have made a great secretary… I agreed with him.

Here’s that short and enlightening article of how much time is spent on EHRs and how the system can be changed. EHRs are causing physician burnout. It’s tedious patient care meant to justify billing to insurance companies. Doctors are retiring or changing fields (away from patient care) in droves. Beware patients… this really does affect you.

https://catalyst.nejm.org/date-night-ehr/

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

Are you un- or underinsured or without a SSN in Northern Nevada? We have free medical clinics!

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Northern Nevadans who are uninsured, underinsured or without a social security number can receive free medical care at upcoming free University of Nevada, Reno School of Medicine Student Outreach Clinics in January and February 2018. UNR Med offers the clinics in a continuing effort to assist the region’s medically uninsured with needed healthcare services.

Click on the following link for more details!

https://med.unr.edu/news/archive/2017/soc-january?utm_source=University+of+Nevada%2C+Reno+School+of+Medicine+Email+List&utm_campaign=91ff0ea5b5-INM-December-2017&utm_medium=email&utm_term=0_044afe96b3-91ff0ea5b5-292964061

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

Pancreatic cancer is an uncommon and deadly cancer

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flickr.com/ photos/ lynnfriedman/ 8703242835

Pancreatic cancer is an uncommon AND deadly cancer.  It is the 12th most common cause of cancer in the US and usually diagnosed at an advanced stage.  Only 3% of stage III patients are alive at 5 years.  Pancreatic cancer rarely affects those less than 45 years of age. There are both non-hereditary risk factors and hereditary (family-linked) risk factors.

  • Nonhereditary risk factors for pancreatic cancer–
    • Occurs more often in men,
    • African Americans,
    • patients with a chronic pancreatitis,
    • diabetes,
    • cigarette smokers,
    • obesity and
    • physical inactivity.
  • Hereditary risk factors
    • Those with a non-O blood type,
    • someone with a first-degree relative with pancreatic cancer, and
    • risk increases with each additional first-degree relative with pancreatic cancer, hereditary breast and ovarian cancer syndromes (like BRCA gene carriers, hereditary nonpolyposis colon cancer, atypical mole and melanoma syndrome, and Peutz-Jeghers).

Screening for pancreatic cancer.  Bad news…. There’s no effective screening for asymptomatic people or those at normal risk.  The US Preventive Services Task Force recommends against routine screening.  The International Cancer of the Pancreas Screening Consortium recommends that patients at increased risk of pancreatic cancer may have an endoscopic ultrasound or magnetic resonance cholangiopancreatography.  Although there is no consensus on when or how often this screening should be done.

What may bring you in to the doctor if you have pancreatic cancer?

  • Nonspecific abdominal pain,
  • weight loss, and/or
  • jaundice.

There may also be enlargement of the liver, anorexia (meaning loss of appeteite), nausea, vomiting and diarrhea.

Presenting signs and symptoms relate to the tumor location.

  • 70% of pancreatic cancers are at the head of the pancreas.  The symptoms that are associated with this location are weight loss, dark-colored urine and jaundice.
  • 30% of pancreatic cancers are in the body or the tail of the pancreas and this may cause abdominal pain, weight loss, and loss of appetite.

How is pancreatic cancer diagnosed?

First off, your doctor should do a thorough medical history and physical exam.  There are no blood markers to reveal pancreatic cancer.  Imaging studies are depending on patient presentation and may include an abdominal ultrasound or CT scan.

Treatment.  First the cancer needs to be “staged.”  This is to decide if the cancer is resectable as the only curative strategy is surgical removal of the cancer.  Tumor markers are not useful from a diagnostic perspective, but cancer antigen 19-9 (CA 19-9) is useful in determining the prognosis.

If the tumor is unresectable, palliative care is the only option.  If the patient has chemotherapy, a clinical trial should be affiliated with the treatment.  Some chemotherapy regimens have been shown to prolong life by several months.

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

Wear condoms! 2016 was an all-time-high year for sexually transmitted diseases.

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flickr.com/photos/starzrpurple/4438702579

Wear condoms! 2016 was an all-time-high year for sexually transmitted diseases.  Did you know that more than 2 million cases of chlamydia, gonorrhea and syphilis were reported in the US in 2016.  Chlamydia was the biggest offender, with 1.6 million cases diagnosed.  Oftentimes there are spikes in infection in certain areas.  The best treatment is prevention.

Show yourself some love, have your partner wear a condom.

Posted in General Medicine- Adults, infections, Sexually Transmitted Infections, Uncategorized | Tagged , , , , , , , ,

Preconception counseling

Preconception counseling.  Often preconception counseling is not done, as half of pregnancies are unplanned. But, when I have a woman come to the office to discuss what she should do in anticipation of pregnancy or I see a woman of childbearing age who is not using contraception… here are some points to follow.

  • Folic acid supplementation. Prenatal vitamins are available cheaply and over the counter.  Take one daily until a woman is done childbearing.3737405848_8a0ff61814_o
  • Chronic disease management. Hypertension, diabetes, depression and anxiety.
  • Teratogenic medications should be stopped.
  • Discuss family and genetic history (like sickle cell, hemophilia, Down’s syndrome).
  • Update vaccines as needed.
  • Assess for physical, sexual, and emotional abuse.
  • Sexually transmitted infection counseling and testing.
  • Weight should be maintained in a healthy BMI (between 20 and 25)
  • Advise to stop smoking, as this is linked with miscarriage and small for gestation age infants.
Posted in General Medicine- Adults, Obstetrics, pregnancy, Sexually Transmitted Infections, Uncategorized | Tagged , , , , , , , ,

Bladder cancer is the sixth most prevalent cancer in the US. It causes more than 16,000 deaths yearly. This often presents with painless blood in the urine.

The risk factors for bladder cancer include

  • male sex,
  • older age,
  • white race,
  • occupational exposure to chemicals,
  • history of pelvic radiation,
  • chronic bladder infection or irritation, and
  • cigarette smoking.

If you have painless blood in urine, then see your family doctor. If it is confirmed, then you may need a urologist who will perform a cystoscopy. (a small scope is placed through the urethra to see the inside lining of the bladder).

Should you be screened for bladder cancer?  No.  No major organization recommends screening for bladder cancer due to insufficient evidence that the benefits outweigh the harms of screening.

restroom2

flickr.com/photos/hygienematters /6034747101

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