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

Your prescriptions are being monitored!

img_2545Your prescriptions are being monitored!  For years I have received information from insurance companies to let me know which patients are not compliant with their medications.  How do they know this?  They watch how often you pick up a refill on your chronic medications from the pharmacy.

Now, there is an additional prescription monitoring plan. Nevada Board of Pharmacy how has an “enhancement” to the Nevada Prescription Monitoring Drug Program for controlled substances (think opioids, benzodiazepines, and prescription sleep medicine).  The new support tool is called NarxCare.  NarxCare will “aggregate and analyze” prescription information from providers and pharmacies.  It will give the physician visual, interactive information in addition to advanced analytic insights, machine learning risk scores and other information to help physicians and pharmacists provide better patient safety.

NarxCare will give physicians a NarxScore and an Overdose Risk Score.

I do believe that this information will be helpful to pool the data (meaning add together the controlled prescriptions from different pharmacies and physicians), but it also feels a little big brother-ish.

 

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

Take teething bead necklaces off of children

Take teething bead necklaces or bracelets off of children.

Why?  The FDA reports children have choked on beads that break off and an 18 month-old has died from strangulation from a necklace during a nap.

What are they?  Teething jewelry is often necklaces or bracelets made of amber, wood, marble or silicone.  They are marketed to parents to “help relieve teething pain.”

What is a less dangerous teething treatment?  Massaging the teething child’s gums or giving them a hard rubber teething ring to gnaw on.  Avoid gels, creams, and products containing benzocaine… as benzocaine can also be harmful.

Do no harm.

Want to read more?  https://www.fda.gov/Safety/MedWatch/HowToReport/ucm2007306.htm

Posted in Uncategorized

Should you believe the physician rating sites?

canary

flickr.com/ photos/ taksidia/ 1249605102

Should you believe the physician rating sites? I am very skeptical of them. I urge you to question the sites, also.

Consider the patients who come to a physician with a personal agenda:

  • wanting a prescription for an inappropriate medication (benzodiazepine, opioid, etc),
  • wanting a form filled out (like a patient who has uncontrolled seizures who wants their DMV form signed), or
  • one who is upset about the physician’s bedside manner.

https://news.northwestern.edu/stories/2018/april/cosmetic-surgery-online-reviews/?linkId=51051394

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

Five new changes to medical care…

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Five!

 

Five new changes to medical care… The American Academy of Family Physicians has a “Choosing Wisely” list of changes to medical care (that results from research results).

No routine bimanual exam (two-handed pelvic exam on females that we routinely did after a pap) in asymptomatic non-pregnant women.

Do not screen for genital herpes in asymptomatic patients.

No daily blood sugar monitoring for patients with type 2 diabetes who are NOT using insulin.

Transfuse red blood cells to relieve symptoms of anemia.

Do not screen for testicular cancer in asymptomatic adolescent or adult males.

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

Free radon tests! Why to test? How to test? What’s important?

Radon. Why to test? How to test? What’s important?

**Short-term tests are free to Nevadans until February 28, 2019 in honor of National Radon Action Month. Look at website (at bottom of post) for locations for test pick up!**

Radon is a cancer-causing, radioactive gas.  It is a naturally occurring radioactive gas released in soil, rock and water from the natural decay of uranium  Levels in the outdoors pose a relatively low threat to human health, but radon can accumulate in your home.  Radon is the leading environmental cause of cancer mortality in the US and 8th-leading cause of cancer mortality overall. Radon is the leading cause of lung cancer in nonsmokers.

Radon accounts for 37% of ionizing radiation.  Radon used to compromise more than 50% of ionizing radiation.  CT scans account for more of our ionizing radiation than in past years.

What is radon?

  • Radon is invisible, odorless, colorless.
  • It naturally occurs outside.
  • There’s a long latency period.  This means a cancer may occur 15-20 years later.
  • Cancers occur in a patient one at a time, not in clusters.
  • Difficult to link an individual death to radon exposure.

Where does radon come from?  Radon is from the soil and can migrate through invisible cracks in the concrete or where pipes come into a home.  Any house that has contact with soil can have increased radon concentration.   Radon is naturally drawn into buildings.

What variables are there to the radon concentration?  MANY!

  • strength of the radon source
  • porosity of the soil.
  • the distance between soil and the house (is there a crawl space?)
  • environmental factors like season, temperature, and wind.

This means that you cannot guess if a single home will have an elevated radon level. Testing is the ONLY way to know if your home has a radon problem.  If your neighbor tests, and their home is fine, it does NOT mean that yours is fine.

How to test for radon?  The outside doors and windows must be closed 12 hours before and during the test.  Best season to test is in the wintertime.  Do not put the test kit in the kitchen or bathroom or laundry room as the humidity impairs the testing accuracy.  Normal coming-and-going from the home is okay.  Less than 4pCi/I shows that there is no radon problem in the home.  Retest every 2 years as seismic activity can change the home foundation and the pathway of radon.

What to do if radon is high?  Use a certified mitigator who is also a Nevada State licensed contractor.  Get two estimates.  Radon mitigation systems can be installed in one day.  Retest needed after 24 hours to confirm radon level.

RadonNV.com  or http://www.epa.gov/radon

1-888-RADON10 (1-888-723-6610

http://breathingeasier.info is a well-done 12 minute video

 

Posted in Uncategorized

What are the lung cancer screening recommendations?

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Yosemite National Park

What are the lung cancer screening recommendations?  Recently the ACCP (The American College of Chest Physicians) published their new lung cancer screening guidelines.

Who should get an ANNUAL lung cancer screening?

  • Adults aged 55 to 77 years of age who have smoked at least 30 “pack year history” (like one pack per day for 30 years)
  • both for individuals who continue to smoke OR those who have quit within the past 15 years.

What is the annual lung cancer screening?  “low-dose” CT scan of the lungs.

What if patients have other risks of lung cancer but don’t meet the above criteria?  Then, it is not suggested that an annual low dose lung CT is done.

What else to consider?  Individuals with grave conditions (such as advanced liver disease, chronic obstructive pulmonary disease or a New York Heart Association class IV heart failure) should not receive the low-dose lung CT as the patient may potentially sustain substantial harm from screening or may have limited potential benefit.

There is some discrepancy between different medical groups with regard to lung cancer screening.  The USPSTF recommends low-dose lung CT scan in patients aged 55 to 80 (and otherwise is the same as above) and the American Academy of Family Physicians concluded that the evidence was insufficient to support screening and instead the physician and patient should have “shared decision making”.

Want more information? Chest.  April 2018; 153(4): 954-985 or https://journal.chestnet.org/article/s0012-3692(18)30094-1/fulltext

 

Posted in Cancer, General Medicine- Adults, lung conditions, nicotine, Uncategorized | Tagged , , , , , , , , , , , , , ,

Are aspirin and/or fish oil needed for diabetics?

Are aspirin and/or fish oil helpful for diabetics?  The ASCEND trial results show that low-dose aspirin and fish oil supplements have not resulted in significant clinical benefit.

The ASCEND (A Study of Cardiovascular Events in Diabetes) study included 15,480 diabetic patients with no known cardiovascular disease.  Patients were started on 100 mg/day of enteric-coated aspirin or placebo and 1 gram/day of omega-3 fatty acid or a placebo.  The patients were followed for 7 years.

This study was done as it is known that low-dose aspiring is supported for secondary prevention (those patients who have already had a cardiovascular event like a heart attack or a stroke) but it is NOT known if it helps in diabetics who have never had an event.  In the end, low-dose aspirin decreased the risk of a serious vascular event by 1.1% compared with placebo, BUT it increased the risk of major bleeding by 0.9%.

What about fish oil?  The ASCEND fish oil findings showed that omega-e fatty acid supplementation had no effect on the rate of serious vascular events.

There are two continuing trials, one called the REDUCE-IT trial and the STRENGTH trial, both of these have randomized trials of higher-dose fish oil supplementation to see its effect on secondary prevention.

I am forever reminded the adage that half of the information learned in medical school we later find out is wrong.  The interesting part is waiting to find out WHICH half is wrong.  I’ll keep you posted when new research is known…

 

Posted in Diabetes, General Medicine- Adults, medication issues, Uncategorized | Tagged , , , , , , , , , , ,