Hello Reno Families!

2021 Leslie Greenberg headshot croppedHello, I am  Leslie Greenberg.  I am a family physician in Reno, Nevada.  I attended Northwestern University in Chicago, then University of Nevada School of Medicine.  I 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 400 + family medicine residents (and countless medical students), over nearly 25 years.  I currently teach at the family medicine residency program in Reno and also see private patients.  I care for newborns through elderly patients in both the hospital and office.  I love to do procedures: skin biopsies, circumcisions, IUD insertion/removals, paps, colposocopies, and toenail removals. I invite you to read my blog.  If you would like to become a patient, please call 775-982-1000.

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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How concerned should you be about a diagnosis of “pre-diabetes?”

How concerned should you be about a diagnosis of “pre-diabetes?”  Research estimated the likelihood of older adults converting from prediabetes to diabetes over a 6 ½ year study…. as very low.  More than 90% of older adults will NOT progress to diabetes.  They routinely stayed at the same hemoglobin A1c level or it even normalized.  In fact, if you are in your mid-70s without a diagnosis of diabetes, the chance that you will convert is low. 

Certainly, cleaning up your diet (stop drinking sugar-sweetened beverages and eating fried foods) and exercising regularly are good for everyone… at every age. 

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Should you read your spine MRI report?

Should you read your spine MRI report?  I would suggest against it. 

In the era of transparency and patient access to their entire electronic medical record, you CAN look at your spine MRI report.  And, yet, do you know what you are looking at?  Do you know what pathology is significant?  Do you know the LEVEL in your spine that your symptoms originate from? There are many radiologic findings on MRI that are actually asymptomatic. 

Research showed that patients with low back pain who read their MRI results without interpretation by a clinician had lower function and more pain even after 6 weeks of conservative treatment. 

The patients who received a call from their physician and were told “their MRI results were normal with age-related findings” did better than those who read their report.

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What intervention gives sustained improvement in chronic back pain?

What intervention gives sustained improvement in long-standing back pain?  The intervention that showed a greater than 30% reduction in back pain was exercise. 

Patients may have trialed opioids or non-steroidal anti-inflammatory pills, but those are routinely not given for long.  A 2020 systematic review of 25 randomized controlled trials (with over 2,400 patients!) found that if you have low back pain for 12 months or more, epidural steroid injections do not give long-term meaningful improvement. Yes, epidural injections may be more effective than placebo in the short-term, but not in the long term.

Other interventions that help are osteopathic manipulation and topical capsaicin cream. Physical therapists are a great resource for initiating back exercises and confirming that your technique is correct.  Then, you can continue the therapist’s exercises as your “homework.”

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Which OTC medications are best for treating chronic constipation?

Which OTC medications are effective at treating chronic constipation?  Lots of products are effective at treating chronic constipation.  First-line therapy to treat chronic constipation is polyethylene glycol (Miralax) or senna. Other good products are stimulant laxatives, fiber supplementation or magnesium-based products.  Psyllium fiber tends to cause bloating and gas.

I, personally, suggest that patients fiddle with the dose of Miralax and take it (daily) if needed.  Miralax never leaves the GI tract meaning that it does not tax the liver or kidneys and it helps draw water into the intestines to keep the stool soft.  The drawback about titrating the dose of Miralax is that if you take too much (for you) when you pass gas, you can pass stool. 

Live and learn, right?!

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Should you take full-dose aspirin or a baby dose?

Should you take full-dose aspirin (325mg) or a baby aspirin dose (81 mg)?  Recent research has showed that there is no advantage to taking a full dose for patients with established cardiovascular disease compared to the lower dose.  Of course, ask your physician for their input. 

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Do eating eggs cause increased risk of cardiovascular disease?

Do eating eggs cause increased risk of cardiovascular disease?  No.  A meta-analysis (a combination of many research studies) has shown that over an average of 12 years, egg consumption is not associated with an increase number in cardiovascular events (heart attack or stroke). In fact, eating more than one egg a day (on average) is associated with an 11% less chance of coronary artery disease. The researchers are unsure if those who eat eggs dail have other healthful habits (more likely to exercise? less likely to smoke?)

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Should you take Vitamin C to help iron supplementation work better?

Should you take Vitamin C to help iron supplementation work better?  No. Research has shown that those taking iron WITH Vitamin C for 3 months had no incremental increase in hemoglobin (or in serum ferritin level) after 3 months compared to those who took iron alone. 

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Should you increase your antidepressant after beginning on a starting dose?

Should you increase your antidepressant after beginning on a starting dose?  Not necessarily.  Research has shown that new-generation antidepressants like SSRIs may not need to be increased from the starting dose.  This means that your first dose, may be all that you need to ease your mood. Patients are urged to see their physician at 6 to 8 weeks after starting medication to assess clinical improvement.  Before increasing the dose or changing the medication, talk to your physician.  In short, research showed no benefit to automatically increase the dose. 

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Does a short course of antibiotics work?

Does a short course of antibiotics work to fight infection? It depends.  The American College of Physicians recommends FIVE days of antibiotics for pneumonia (when it’s community acquired—not hospital or nursing home acquired).  Five days is also recommended for COPD exacerbation when a bacterial component is suspected.  Those with uncomplicated kidney infection need 5 to 7 days of antibiotics. Although, those with an uncomplicated bladder infection may be completely treated with only THREE days! We, physicians, used to prescribe longer courses of antibiotics. But, we know more now!

Of course, if there is no clinical improvement additional (or different) antibiotics may be needed.

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How to prevent delirium:

How to prevent delirium:

Delirium is an acute confusional state.  There’s an alteration of consciousness with decreased ability to focus, sustain or shift attention.  Delirium usually develops over hours to days and may fluctuate during the course of the day. 

To prevent delirium:

  1. Stay hydrated
  2. Get good nutrition
  3. Maintain oxygenation
  4. Avoid constipation
  5. If in the hospital, avoid tubes (monitors, foley catheters, intravenous lines)
  6. Keep mobile.  Walk.
  7. Keep senses aware: Use eyeglasses, hearing aids, mobility devices).
  8. Prevent infections
  9. Limit medications that are psychoactive (sleep or anxiety medications)
  10. Manage pain with nonsedating medications like ibuprofen or acetaminophen
  11. Have familiar people around (family and caregivers)
  12. Visualize clocks and calendars.
  13. Get reoriented by family and staff to location and time, as needed.
  14. Avoid nighttime disturbances
  15. Reduce noise at night.

I hope this helps…

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