Hello Reno Families!

This is Leslie Greenberg.  I am a family physician in Reno, Nevada.  I attended University of Nevada School of Medicine and relocated back to my hometown in 2015.  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 20 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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Colorectal Cancer Screening.

2020 Colorectal Cancer Screening Recommendations, per the American College of Physicians consensus statement

Why is this so important? Colorectal cancer (CRC) is the second leading cause of cancer death in the US. There is a 65% overall five-year survival. Removal of adenomas can prevent cancer.

What does screening mean? Screening are baseline tests. This means that the CRC patient is asymptomatic (no rectal bleeding, no change in bowel habits, and no abdominal pain) AND has no increased risk (no history of polyps or no family history of colon cancer). These consensus statements are NOT generalized to people at elevated CRC risk.

Who to screen? The BMJ/MAGIC Group recommends calculating a patient’s CRC risk. https://qcancer.org/15yr/colorectal/ If the 15 year risk of CRC is less than 3% no screening for CRC is recommended. Routine recommendations are to perform CRC screening to average-risk asymptomatic adults from aged 50 to 79 with at least 15 years of life expectancy.

Methods of screening? Colonoscopy reduces incidence of premalignant adenomas by 34% because the GI doctor can remove polyps during a colonoscopy. Patients who have noninvasive tests like FIT tests of guaiac fecal occult blood testing cannot remove polyps with the testing.

Guidelines/Timelines for screening for CRC by method…

-Colonoscopy. Every 10 years. Benefits: may be fully paid by your insurance as it is a considered a screening test. Physician can remove polyps at the time of scope. Drawbacks: need to do a bowel prep.

-FIT. Every 2 years. Benefits: no bowel prep needed. Submit a single stool sample to the lab. No dietary restrictions. Drawbacks: If positive, you need a colonoscopy. Insurance, then, may code your colonoscopy as a diagnostic test and you may have a big insurance bill.

When to stop screening? CRC screening is not recommended after 75 years of age or when life expectancy is less than 10 years.

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What can doctors do to decrease hospital admissions for dehydrated kids?

A recent systematic review shows that oral ondansetron medication can decrease hospitalization rates in children who are vomiting.

It is important for these children to still be evaluated by a physician as they need an exam to rule out treatable infections. They also may need blood work or intravenous fluids.

Ondansetron can also help the child hold down more fluids. It is a win-win situation.

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Heavy menstruating female? What to do…

Heavy menstruating female?  What to do….

Heavy menstrual bleeding is considered more than 80 ml or more of menstrual blood loss per period.  Truly, heavy menstrual bleeding (the diagnosis name is menorrhagia) is more often diagnosed on patient report of an amount of frequency of blood loss that interferes with psychosocial or physical well-being. 

flickr.com/ photos/ tweedledeedesigns/ 6994535294

Menorrhagia affects 30% of reproductive age females.

How to treat this?  Nonsteroidal anti-inflammatory drugs (like Aleve and Ibuprofen) DO reduce heavy menstrual bleeding in premenopausal women when compared to placebo.  But, NSAIDs are less effective than tranexamic acid and less effective than the levonorgestrel-releasing intrauterine device (Mirena IUD).

How expensive is tranexamic acid?  Per the GoodRx app, I show that 30 pills of tranexamic acid 650 mg cost $26 near my zipcode.  Not bad. 

If you have life-altering menstrual periods, ask your family physician how she can help.

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Nevada Voter registration details below…

What to do for Nevada voter registration… for the Nov. 3 election

flickr.com/photos/bjmccray/5730624609

Is there a deadline to register to vote? Yes. In Nevada, online voter registration closes Oct. 29. You can also register and vote in person (!) at a polling location up through Election Day, Nov. 3.

Do you need to confirm that you are registered to vote? You can view your voter registration to confirm that your information is correct.

Are there voting changes due to the pandemic. Yes. Nevada is automatically mailing ballots to all active voters.

What is the deadline for voting? November 3. Mail-in ballots must be postmarked (or dropped off in person) by Nov. 3 AND received by Nov. 10. Considering giving the post office more time than one week AND/OR attach a USPS first-class (55 cent) stamp to the mail-in ballot.

What are the Washoe county polling locations? For in person voting during early-voting or on Election Day, a variety of Washoe County polling locations are available.

What should you do if you are a full-time college student? You can choose to vote in Washoe County, or in your home county if it’s outside of Washoe County. You  must be registered in the county where you plan to cast your vote.

Visit the Nevada Secretary of State or Washoe County Registrar of Voters for more information, including the offices up for election on Nov. 3 and candidate profiles.

Do your civic duty. Review the candidate profiles and vote. Democracy is not a spectator sport.

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My thanks to Ruth Bader Ginsburg (RBG)!

My thanks to Ruth Bader Ginsburg (RBG)!

How have I benefited from RBG?  The opportunities that I have had in my 50-year life are because of RBG.  The benefits are innumerable and occur daily.

I chose with whom, when and how many children I had.

I am my spouse’s peer and equal partner, both at work and at home.

I can be pregnant and work.

I can be a mother and return to work.

I can have a credit card in my name only.

I can consent for my own medical procedures.

As a woman I am NOW paid 82 cents to the male dollar, compared to 60 cents to the male dollar before the 2009 Lilly Ledbetter Supreme Court Case.

“Whatever you choose to do, leave tracks (and that means do not do just for yourself as this will not be fully satisfying).  You will want to leave the world a little better for your having lived.”   I have dedicated my work life to teach new physicians how to be physicians AND to care for my own patients.

“There is no satisfaction… equal from knowing that you have made another’s life, your community a little better for your effort.”  I have taught countless medical students and 400+ medical resident physicians in my career and put them out into the world to care for their communities. 

“Men and women have one principal role… that of being people.”  This notion of sex-equality was an organizing principle for RBG.  I cannot agree more.

Thank you, RBG.  Now, let’s get on with the act of living and exacting change.

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Covid and sports, a local NCAA physician’s perspective…

Covid and sports, a local NCAA physician’s perspective…

http://nevadasportsnet.com/news/reporters/what-will-it-take-for-mountain-west-to-play-football-ncaa-expert-weighs-in

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2020 Flu vaccines!

2020 Flu vaccines! Drive-through flu shots available at the Reno-Sparks Livestock Events Center.

When is the flu season? The first week of October is considered the start of flu season. In the past, most offices have given flu vaccines inside… but, with the spread of COVID-19 in our community, the Washoe County Health District is offering drive-through flu shots. This starts tomorrow, Saturday, Sept. 19.
 
“Since flu and COVID-19 symptoms are similar, avoiding the flu can also help to preserve adequate testing capacity for COVID-19. A flu shot can prevent you from getting the flu, as well as help decrease the severity of the symptoms,” said Washoe County’s District Health Officer.
 
How to get flu vaccines at the Reno-Sparks Livestock Event Center? The drive-through flu clinics will be held on a first come, first serve basis. No appointment is required.

Where? Use the entrance at N. Wells Avenue and Sadlier Way

When? Saturday, Sept. 19, 9 a.m. to noon
Tuesday, Sept. 22, 4 p.m. to 7 p.m.
Wednesday, Sept. 23, 4 p.m. to 7 p.m

Who should get the flu vaccines? A yearly flu shot is recommended for everyone over 6 months of age, especially those with certain medical conditions, pregnant women and people over age 65. Flu shots are free with most insurance plans (remember to bring your insurance card). Patients without insurance will be vaccinated at no cost.

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Is anxiety getting in the way of your mask wearing?

Is anxiety getting in the way of your mask wearing? Masks help contain the coronavirus and it is each of our responsibilities to support our community.

Here’s a desensitization program which should help you wear one more comfortably.

Of note… N95 masks with valves spew the wearer’s respiratory viruses out the valve and do not protect others. I urge cotton masks, surgical masks, or N95s without valves.

This is me on hospital rounds—N95 with cotton mask on top ( with eye glasses and scrub hat for extra protection)…not glamorous, but necessary.
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Want a Covid test performed?

Want a Covid test performed in Washoe County?

Washoe county residents can now get Coronavirus testing even if asymptomatic.  They must still complete the questionnaire, then go to the site as directed to schedule an appointment.

https://aca.accela.com/WASHOE-COVID19/Welcome.aspx

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What does it mean if a medical resident doctor is caring for you?

What does it mean if a medical resident doctor is caring for you?

Medical school graduates are starting and they are awesome! I’ve been a physician, educating physicians for 22 years. It has been a pleasure to teach and me turnover 350 physicians. And, I’m not done yet…

For those who love Grey’s Anatomy, ER and Scrubs these terms may sound familiar but are great for review since a lot of us are more aware of healthcare resources right now during COVID!

𝐌𝐞𝐝𝐢𝐜𝐚𝐥 𝐒𝐜𝐡𝐨𝐨𝐥
Getting into medical school requires a college degree and taking a rigorous medical school admission test (MCAT). It is really difficult to get into medical school. So much so that many decide to have “back up plans” in case they don’t get (usually it is still a career in medicine in another healthcare discipline such as PA, NP and Nursing which are all amazing as well… but require far less schooling and training than physicians).

Medical School is tough. It is full of class/instruction all day with hours and hours of studying for the first two years. Then you have to take a standardized test (Step I Boards) to make it on to the last two years. That board exam is tough and can dictate your career path!

The last two years of medical school are just as rigorous but the hospitals and clinics are the classroom. And, yes, there’s still a lot of studying when you’re “off”. Right before you finish medical school you take ANOTHER board exam (Step II) to make sure you are ready to graduate!

𝗥𝗲𝘀𝗶𝗱𝗲𝗻𝗰𝘆
After you graduate from medical school you’re still not done! You have to study for a minimum of 3 years to specialize in training called residency. Some residencies are up to 7 years depending on the field of practice (like Neurosurgery!).

I still remember my first day of internship! So much excitement and nervousness and it flew by! I’m so thankful for my senior residents, attending physicians, nurses and all the hospital staff that helped me along the way.

Interns are so full of knowledge and should be applauded for their accomplishments! So many people don’t even make it to internship! They are some smart and dedicated physicians!

𝗔𝗳𝘁𝗲𝗿 𝗥𝗲𝘀𝗶𝗱𝗲𝗻𝗰𝘆…
And just so the public knows – the studying and tests never end! There still is Step III Board Exam during your residency, Specialty Boards after you’re done with residency. Then, recertification exams every 10 years afterwards! So, seeing a board-certified physician means your doctor is keeping up with new medical knowledge.

To all the interns, congrats! You are starting your career in historic times. We THANK YOU for dedicating your life to medicine and I am invested in helping in your education as you will be MY doctor someday in the future!

Photo Graphic Credit: Christin Giordano McAuliffe

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