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.

Posted in Uncategorized

Considering adding cannabis to your medical prescriptions?

54718660_da9ad3db9c_o

flickr.com/photos/riussi/54718660

Considering adding cannabis to your “medical” prescriptions?  Rethink your choice.  A recent study of TWENTY MILLION patients shows a 26% increased risk of stroke and a 10% increased risk of heart failure.  The study analyzed data of patients aged 18 to 55 and found that even if they control every other factor (“using multivariate regression analysis”), patients who use cannabis are significantly more likely to experience

heart failure, stroke, coronary artery disease (this can lead to heart attacks), sudden cardiac arrest, and atrial fibrillation.  Also, cannabis users are more likely to report high blood pressure, tobacco use, alcohol use, and obesity.

It is postulated that using cannabis may rev up cannabinoid receptor type 1 and may increase atherogenesis (when blood vessels become lined with plaque)

Now that cannabis is legal in 28 states (plus Washington DC), there’s a need to be more knowledgeable of the risks (and benefits?!) of cannabis.  More research is pending…

I hope this helps you make more informed decisions about your healthcare.

Posted in medication issues, Uncategorized | Tagged , , , , , , ,

HPV vaccination is fighting cervical cancer and winning!

the vaccines

flickr.com/photos /lavid/ 01793987

HPV vaccination is fighting cervical cancer and winning!  HPV vaccination has been shown to decrease cervical intraepithelial neoplasia 1 (CIN1)  by 9%.  CIN1 is a precursor to frank, invasive cervical cancer.  So, this vaccine shows great success!

In fact, in the future cervical cancer screening guidelines may change to differentiate between those who have had the HPV vaccine and those who have not.  This may mean beginning to screen for pap smears at a later age or may have pap smears less often than those that do not have the HPV vaccine.

The HPV vaccine was  introduced in 2007. Initially it was a series of 3 vaccines.  Now, if given before the patient’s 15th birthday a 2-vaccine HPV series is given.  If started after the 15th birthday, then it is a three vaccine series given over 6 months.    Both boys and girls should get the HPV vaccine.

Boys’ benefits are decreased risk of head and neck cancers.  And, if the rate of HPV is less in boys, then it is also less in their female partners.  That helps with “herd immunity” where everyone is less at risk for an infection because some vaccinate.  It takes a village, right?!

Posted in infections, Pediatrics, Sexually Transmitted Infections, Uncategorized, Vaccines | Tagged , , , , , ,

IUD insertions are on the rise. Thank President Trump for this…

Here’s an interesting article about the response to the uncertainty of women’s contraception coverage under President Trump.  I can attest to the increase in long-acting reversible contraception (like IUDs and Nexplanons) insertions since the election.

Interested?  Read on…

http://www.mdedge.com/familypracticenews//article/133580/contraception/increased-iud-use-suggests-trump-effect

Posted in Uncategorized

Are you a woman with fibroids?

 

sonohysterogram

Are you a woman with fibroids?  What are they?  Why do you have them?  What can you do about them?

Fibroids are a common benign neoplasm.  They are more common in older women and African American women.  In fact, one study shows that 80% of 50 year-old women have a fibroid.  Most are discovered incidentally.  We affectionally call these findings “incidentalomas” meaning they may be insignificant, but now we know you have them.

What are fibroid symptoms?  You may feel abdominal/pelvic pressure, constipation, increased urinary frequency and urgency (because the fibroid presses on the bladder), urinary retention, abnormal uterine bleeding, and pain with intercourse.

What is the best way to diagnose them?  Ultrasound.

What to do about them?

  • Watchful waiting may be best.   If the patient is mostly asymptomatic, then waiting it out may be all that is needed.  That is because that most fibroids shrink  in size during menopause.
  • If you have symptoms of heavy menstrual bleeding, then hormonal contraceptives, tranexamic acid or NSAIDS like ibuprofen may help decrease menstrual blood flow.  Surgical treatment is done at times which may lead to
  1. hysterectomy (taking out the uterus) or
  2. myomectomy (cutting into the uterine muscle to cut out the fibroid),
  3. uterine artery embolization (an interventional radiologist or vascular surgeon puts a catheter in to your groin and blocks the artery that feeds the fibroid),or
  4. MRI-guided focused ultrasound surgery.
Posted in menstrual issues, Uncategorized, Women's Health | Tagged , , , , , , ,

RSV bronchiolitis. Diagnosis and treatment

RSV bronchiolitis.  I’ve seen lots of bronchiolitis in the hospital recently.

babyDiagnosis and treatment.  Does your infant or young child have a hacking cough?  It may be respiratory syncytial virus or RSV.

Most patients present with two to four days of upper respiratory tract symptoms (like fever, runny nose and head congestion).  Then the symptoms go lower like with a hacking cough, wheezing, and increased work of breathing.

How does your kid get this?  RSV is transmitted through contact with respiratory droplets either from an infected person or they infected themselves by touching contaminated secretions on a surface and then touching their mouth/nose/eyes.

As difficult as this is with all of our fancy equipment, the treatment is supportive.  What does supportive mean? It means we give the patient oxygen if they are hypoxic (have low oxygen) and we give intravenous fluids if the patient is dehydrated.  Our “fancy” stuff like epinephrine, steroids, hypertonic saline, bronchodilators, and antibiotics are often NOT helpful.

Is there a way to avoid this infection?  Yes.   There is a prophylactic medication that is given to 3 types of patients: 1.  infants who were born premature (BEFORE 29 weeks gestation) or 2. infants with chronic lung disease or 3. premature infants and children with significant heart disease.  This medication is called  palivizumad which is a humanized monoclonal antibody, given in up to five monthly doses.

Posted in Pediatrics, Uncategorized | Tagged , , , , , , ,

Brag post: DrLeslieGreenberg.com is one of the top 100 healthcare blogs of 2016 !

IMG_3426Brag post: DrLeslieGreenberg.com is one of the top 100 healthcare blogs of 2016 !

Wow!  How did I miss this?

I have truly enjoyed being a physician and an educator.  My goal is to both educate myself and my patients.  I find that reviewing headlines, articles and research is rewarding.  I distill it down to a readable (?!) blog which also helps me incorporate those concepts into my medical practice.  I hope it also helps you take care of yourselves.

Thanks for the kudos.  I appreciate it.

Want to see other 99 blogs?

blog.evisit.com/top-100-healthcare-blogs-2016-edition

Posted in Uncategorized

What can the elderly do to decrease their number of falls?

What can the elderly do to decrease their number of falls?

Lots of things!  Lifestyle modifications are best: structured exercise programs and home safety interventions (like get rid of throw rugs and electrical cords across walkways).  Multifactorial assessment and inv=tervention programs reduce the rate of falls, but not the risk of falling.

What has NOT been found to work?  Vitamin D supplementation AND education about fall prevention has not been shown to decrease the rate or risk of falls.

Why is this so important?  1/3 of people older than 65 years old fall each year.  Falling once doubles a person’s chance of falling again.  One out of every five falls causes a serious injury like a head injury or a broken bone.  If an elderly person falls and requires hospitalization, their average bill is usually over $17,000.  Wow!

So, exercise and keeping the home free and clear of clutter underfoot are key!

I hope this helps.

elderly people walking

flickr.com/ photos/ tokaris/ 207335658

Posted in end-of-life issues, General Medicine- Adults, Uncategorized | Tagged , , , , , ,