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

How to pick a probiotic?

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How to pick a probiotic?

Did you know that in 2012 3.8 million adults and 300,000 children were known to be taking probiotics?!  This is a 400% increase in 5 years.

What does a probiotic do?  It transiently changes the microbiome of the intestine.  It can only be found in the gut microbiome in stool samples for one to two weeks.  This means that the health benefit of a probiotic only lasts for 1-2 weeks after your last ingestion of the probiotic.  This also means that probiotic foods, like yogurt, are as effective as a supplement.

Probiotics are considered a nutritional supplement per the Dietary Supplement Health and Education Act (DSHEA) so they are NOT regulated for clinical application as it is considered food and not a drug.  The DSHEA requires that dietary supplements meet current good manufacturing guidelines, but this does not necessarily mean that the products are effective.

How to buy a probiotic?  Consider buying a probiotic with an expiration date printed on the bottle and one that lists the number of viable colony-forming units at expiration–as this may give some assurance that the probiotic viability continues throughout the lifespan of the product.

The probiotic Saccharomyces boulardii is not eradicated by antibiotics and may help with gut health.  Probiotics have good evidence supporting their benefit in patients with irritable bowel or ulcerative colitis and may prevent antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea.

When buying probiotics, I recommend a probiotic with the National Science Foundation’s certification of good manufacturing practice.  This website can help…   http://www.nsf.org/regulatory/regulator-nsf-certification

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

NEW Cancer Screening Recommendations

 

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NEW Cancer Screening Recommendations.

To help diagnose breast cancer, the American Cancer Society suggests mammography starting at 45 years of age with annual screening until 54 years of age and then every other year after 54.

To prevent cervical cancer in females and oropharyngeal cancer in males, ACS suggests a two-dose vaccine of HPV vaccine beginning with children ages nine to 14 years of age.  Patients who get the first HPV vaccine at age 15 (up to 26 years of age), should continue to follow the three-dose vaccine schedule.

Lung cancer screening with a low-dose CT scan of the lung should be performed in patients 55 through 74 years of age who are current or former smokers.  Medicare covers lung cancer screening with low-dose CT scan of the lung for patients up to 77 years of age.

There is no recommended ovarian cancer screening.

For cervical cancer, the screening depends on the woman’s age.  Women between 21 to 29 should have a pap every 3 years (as long as it’s normal).  Women from 30 to 65 years of age get a Pap test and then that same specimen can also be tested for HPV.  If both negative, this is done every 5 years.  Women 66 or older who have three or more consecutive negative Pap tests or two or more consecutive negative HPV AND Pap tests within the past 10 years should stop cervical cancer screening.  Women who have had a total hysterectomy for noncancerous reasons never need another pap.

I hope this helps.

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

AARP Bulletin with medical tips from yours truly!

AARP Bulletin with medical tips from yours truly!AARP Dr. Greenberg article_1.jpgDisclaimer:  Talk to your doctor about your specific knee pain.  If you are walking around with bone-on-bone arthritis, you may need a total knee replacement (and NOT be a candidate for conservative management).  And, if your knee pain does not get better within 2 months or you have a history of kidney problems, talk to your doctor about appropriate treatment.

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

Kidneys. How important are they?

Kidneys.  How important are they?  REALLY IMPORTANT.  I have told my kids that the organs that I think are most importance… in order of importance is the brain, then heart, then the kidney.

Kidney disease affects 47 million people in the United States and is associated with significant health care costs, morbidity and mortality.  Kidney disease is silent in its early stages.  It is best to initiate interventions early.

How to watch for kidney health?  Some guidelines recommend annual screening with blood work and a urinalysis (but The American College of Physicians and the US Preventive Services Task Force do not suggest yearly labs for those not at increased risk).  These labs are especially important for patients with diabetes, high blood pressure, and those with a history of heart disease.  There are markers of kidney damage: increasing creatinine and albuminuria.  If the serum creatinine is persistently elevated and if there’s albumin in the urine those are concerning findings.

When you should see a nephrologist?  When the glomerular filtration rate (a lab finding) is less than 30 mL per minute, persistent urine albumin/creatinine ratio greater than 300 mg per gram or if there is evidence of rapid loss of kidney function.

Do you want to calculate your risk of progression to

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end-stage renal disease?  Go to http://kidneyfailurerisk.com/

Call your family physician for a well adult visit.

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

Who doesn’t want a do-over? Laser tattoo removal…

 

 

 

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Written by guest blogger: Luke Stovak.  Who doesn’t want a do-over? I often see tattoos decoratively scripted with a loved one’s name or letters over the knuckles spelling “LOVE” or “HATE.”  Would I like that on my body when I’m 80? Will that beautiful sun around my navel look the same as I age? I don’t think so. Because of this, I believe that laser tattoo removal is fantastic. It helps those who want to start over.

If the hip tattoo names a previous loved one and a new lover is visually reminded of the past, how does that help their future?  If an ex-gang member would like to dissociate from the gang or apply for a job, shouldn’t they be able to shake the employer’s hand without seeing “HATE” in the handshake? Or without tear drops inked by their eye?  

Youthful dalliances in the tattoo parlor or vengeful thoughts put onto the skin could forever be displayed. There is a viable option for tattoo removal. Laser tattoo removal has been available for 30 years and can be used to remove names, rings, designs, or even parts of designs. The process may take several sessions, depending on the color and depth of the ink. Consider laser tattoo removal instead of excision of skin as it is less invasive and may cause less scarring.  For more information, one great resource is www.newlookhouston.com

Posted in General Medicine- Adults, Uncategorized | Tagged , , , , , , , | 3 Comments

Palpitations. How to evaluate them?!

Ever have your heart make a weird pitter pat?

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Palpitations.  How to evaluate them?  Palpitations are very common of which the most concerning cause is cardiac.  Other possible causes are adverse effects from both prescription and over-the-counter medications, psychiatric illness and substance use.

Drugs that can cause palpitations are

  • cocaine,
  • methamphetamine,
  • MDMA/ ecstasy,
  • marijuana

 

What are some other non-cardiac causes of palpitations

  • alcohol
  • anemia
  • anxiety
  • beta-blocker withdrawal
  • caffeine
  • cocaine
  • exercise
  • fever
  • medications
  • nicotine
  • pheochromocytoma
  • pregnancy
  • thyroid
  • dysfunction

It is imperative to rule out cardiac causes as this could be deadly.  I was taught in medical residency training that “you need to rule out what can kill the patient first.”  I agree.  First, a thorough history and physical examination should be done.  After that targeted diagnostic testing should be performed.

What are important aspects of the work-up?  Family history of cardiac dysrhythmias or abnormal physical examination or abnormal EKG findings.  Symptoms with exertion of chest pain or difficulty breathing are concerning.

In short, if you have palpitations, see your primary care doctor and,  if needed,  they’ll send you to a cardiologist.

 

 

Posted in Ear, heart, Uncategorized | Tagged , , , , , , ,

Shingles?! Prevention and management.

Shingles?! Prevention and management.    Shingles is also called herpes zoster and it is caused by the reaction of the chickenpox virus (aka varicella zoster virus).  One million cases of shingles occur annually in the US.  We each have an individual lifetime risk of 30% to contract this.  Patients with immunosuppression are more at risk for shingles.

The symptoms that may occur before a rash include malaise, headache, low-grade fever, and abnormal skin sensation starting 2-3 days before the rash becomes evident.

What are the hallmarks of shingles?  It is a unilateral (one side of the body), dermatomal (see the diagram), and typically progresses to clear blisters that become cloudy and then crust over with a scab in 7-10 days.

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How to treat shingles?  Antiviral pills, if started before 72 hours of the onset of the rash, are known to decrease the length of time the rash is present.

What is postherpetic neuralgia?  It is the after-shingles-nerve-pain that is present more than 90 days after the rash resolves.  This occurs in 1 in 5 patients.

What is treatment?  Treatment is aimed to control the symptoms and includes topical creams (lidocaine and capsaicin) and oral pills like gabapentin, pregabalin and tricyclic antidepressants.

What is my opinion of the varicella zoster vaccine?  I think it’s great.  It is approved for adults 50 years and older.  Search my blog on Shingrix vaccine for more information.

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