Hello Reno Families!

Posted on July 1, 2010 by drlesliegreenberg

 

Hello, 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 450 + family medicine residents (and countless medical students), over nearly 30 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 women’s health (contraception and menopause care) and procedures: skin biopsies, circumcisions, IUD insertion/removals, paps, colposocopies, and toenail removals. I am a Menopause Society certified physician.  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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Should male sex partners of women with bacterial vaginosis get treated?

Posted on August 25, 2026 by drlesliegreenberg
Clinical questionBottom-line answer
Does treatment of the male sex partner reduce the likelihood of recurrent bacterial vaginosis in women?3Oral and topical treatment of male sex partners of female patients with bacterial vaginosis reduces recurrence.

Treating male sex partners of women with bacterial vaginosis with oral metronidazole and topical clindamycin decreased the likelihood of recurrence (number needed to treat = 3). Ensuring adherence to the regimen is key; these results were achieved despite only 47 of 80 male partners being at least 70% adherent to the protocol.

Yes! New research suggests that treating male sexual partners may help reduce the chance of bacterial vaginosis (BV) coming back.

Many women with BV notice a “fishy” odor, especially after sex, although some women have few or no other symptoms.

Recent studies have found that when male partners are treated at the same time—with oral metronidazole and topical clindamycin—the risk of BV recurring may be lower. This is an important shift in how we think about recurrent BV and suggests that treating both partners may help some couples break the cycle of repeat infections.

This new treatment of male-partner treatment stems from a 2025 randomized trial (Vodstrcil et al., NEJM) which found that concurrent treatment of male partners in monogamous heterosexual couples significantly reduced recurrence in women. This new treatment option challenges the longstanding practice of treating women alone. This contrasts with older guidance (and prior negative trials without topical therapy) that partner treatment was not beneficial; the difference is attributed to clearing penile carriage with topical antibiotics. 

I hope this helps!

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The Investment That Helps Nevada Keep More Doctors…

Posted on July 28, 2026 by drlesliegreenberg

Want to learn more? Read on. https://www.2news.com/news/local/nevada-awards-nearly-16-million-to-expand-physician-training-programs/article_42d1831f-1c6a-4431-b4ff-95853d3126dc.html

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Understanding Estradiol Levels for Bone Health

Posted on July 1, 2026 by drlesliegreenberg

As a Menopause Society Certified Provider, I stay current with research and regularly attend webinars and conferences. There are many expert researchers and physicians discussing whether there is any need to check estradiol levels.

This is in response to online forums stating that estradiol levels of 80–100 pg/mL are needed for bone protection. According to hormone researcher Dr. Sue Davis, this is “nonsense and not evidence-based.” This misinformation is based on an older study. The way estradiol is measured today is different, and laboratory assays may be affected by other circulating hormones. Additionally, if a woman is taking oral estrogen, a significant amount is converted to estrone, which is not reflected by a standard estradiol level.

What strength of estradiol patch helps decrease bone loss?
An estradiol patch delivering as little as 14 mcg/day helps decrease bone loss. A 50 mcg/day patch has been shown to stop bone loss in approximately 95% of women.

What is the best dose of estrogen for women?
Truly, the most effective dose of estrogen for peri- or menopausal women is the dose needed to adequately relieve menopausal symptoms.

Will increasing the estrogen dose help more (result in less bone loss) than a lower dose?
Not all bone loss is due to low estrogen levels. Bone loss is multifactorial and may be influenced by genetics, physical activity, nutrition, and adequate protein intake. Estrogen is not a silver bullet for preventing bone loss. Simply increasing a woman’s estrogen dose does not assure additional bone protection.

The online chatter is not supported by the best available scientific evidence.

To sum this up, bone is exquisitely sensitive to even low doses of estradiol. Routine estradiol blood levels are generally not helpful for determining bone protection. As I often say, more does not necessarily mean better.

I hope this helps.

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Why Many Doctors are Leaving Medicine…

Posted on June 23, 2026 by drlesliegreenberg

I am celebrating my 31st year as a practicing family physician! I love diagnosing and caring for patients– through both everyday and devastating health issues. Medicine has changed a lot since I started practicing.

A new study published in The Permanente Journal found that many doctors are leaving medicine 9 years earlier than doctors did in 2008. The study looked at almost 1,000 doctors from many different specialties. The biggest reasons doctors gave for leaving were the ‘hassle factor’ (44.7%) and ‘too stressful’ (44.5%) as the leading reasons cited by physicians. Think of all of that brain power choosing to NOT practice medicine. What is the cost of that to patient care and our overall health?!

Today, we spend hours dealing with insurance companies as insurance companies tell doctors what medicines they will cover or what tests patients can get. Doctors are increasingly asked to complete “prior authorizations” or “pre-authorizations” for patient to receive their medication or procedure. This means filling out forms, making phone calls for a peer-to-peer call (often this “peer” is not a physician), and waiting for approval.

It can feel soul-crushing.

We went to medical school with the goal of helping patients, not arguing with insurance companies. These extra tasks take away time from patient care and add stress to the workday.

Patients often struggle with medication costs. Some medicines, like asthma inhalers or blood thinners, can cost hundreds of dollars depending on insurance coverage. To help share the burden of dealing with insurance companies, I now give patients a list of medication choices that would all be appropriate for their condition and ask them to message me with the one that costs the least for them. This has worked much better for both of us. The patient understands the cost before starting treatment and I prescribe their chosen medication once.

I am a fan of Mark Cuban CostPlus Pharmacy and GoodRx and SingleCare as they can markedly decrease prescription prices. These three do NOT use insurance and instead the cash-pay price is often LESS than using insurance.

Technology is changing medicine too. I have started using AI scribes during some patient visits. These programs help create chart notes while I talk with patients and review their chart real-time for vaccinations, lab results, imaging, and specialists notes. I am unsure if this saves time as every note still needs careful review before it becomes part of the medical record. AI scribe notes does help me feel less drained after a day in the office. It is as though my mental workload is less.

One of the most freeing experiences I had as a physician was working in the medical tent at Burning Man. Documentation there was brief and simple. There was no insurance billing. I could focus on caring for people. It reminded me why I became a doctor in the first place. It was definitely a highlight of my doctoring career.

Even with all the challenges, I continue to practice medicine with no timeline for retirement. But the changing landscape of healthcare can feel daunting at times. Thank your physician for continuing to practice medicine. Feeling gratitude from patients may lengthen your physician’s career length.

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Vitamin K injections for newborns. Why get them?

Posted on June 9, 2026 by drlesliegreenberg

Many parents have questions about the vitamin K shot that newborn babies receive after birth. As a faculty physician with the University of Nevada Reno Family Medicine Residency Program, I routinely do newborn hospital rounds. Recently, more parents are refusing to give the vitamin K shot to their newborns. This is concerning because vitamin K helps protect babies from dangerous bleeding. And, the vitamin K is soooo safe!

Vitamin K is not a vaccine. It is a vitamin that helps blood clot normally. Babies are born with very low levels of vitamin K. This is because very little vitamin K passes from the mother to the baby during pregnancy and newborns do not yet have the healthy intestinal bacteria that helps make vitamin K. Breast milk is healthy for babies, but it naturally contains only small amounts of vitamin K and breastmilk often has not even “come in” until the newborn is 3 to 5 days of age. Because of this, all newborns are at risk for vitamin K deficiency.

Without enough vitamin K, babies can develop a serious condition called Vitamin K Deficiency Bleeding, also called VKDB. This can cause bleeding in the stomach, intestines, skin, or brain. Bleeding in the brain can lead to seizures, brain injury, or death. Research shows that babies who do not receive the vitamin K shot are 81 times more likely to develop late VKDB than babies who receive the shot. For parents who refuse giving Vitamin K, I urge them that if their newborn appears groggy, listless, does not feed on schedule they should be alarmed and should bring their newborn into the emergency department urgently for an evaluation of a brain bleed.

The American Academy of Pediatrics recommends that every newborn receive a vitamin K shot shortly after birth. This has been used safely for decades. The shot greatly lowers the risk of dangerous spontaneous bleeding.

This issue is also important when families ask about circumcision. Before vitamin K shots became standard, baby boys who did not receive vitamin K had much higher rates of bleeding after circumcision. Studies showed untreated male infants had about a sixfold increase in post-circumcision bleeding. Because of this risk, I do not perform circumcisions on male newborns who have not received vitamin K.

Parents naturally want to make the best choices for their children. Asking questions is important. I encourage families to speak openly with their doctor about vitamin K so they can make informed decisions based on science and safety. The vitamin K shot is a simple step that can help protect newborn babies during the first months of life.

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How to Get Less Sick When Exposed to Viruses?

Posted on June 2, 2026 by drlesliegreenberg

How to Get Less Sick When Exposed to Viruses?

Viruses are everywhere. They spread in schools, stores, homes, and waiting rooms. You cannot avoid every germ, but you can help your body get ready to fight back. Consider wearing a mask if YOU are ill (to decrease spread to others), wearing a mask if you do not want to get exposed to viruses when you are in tight quarters, and wash hands often.

Another one of the best ways to get less sick is to help your immune system practice before it sees the real virus. That is what vaccines do! Vaccines for flu and COVID-19 teach your body what to look for. They help your immune system learn faster. Then, if you are exposed later, your body can react sooner and stronger. This does not always stop every infection, but it often helps make the illness much milder.

That means you may still catch a virus, but you are less likely to get very sick, end up in the hospital, or have serious breathing problems.

This is the biggest benefit of vaccines. They do not just lower your chance of getting sick. They also lower your chance of getting very sick.

Flu shots work well. In healthy adults, flu vaccination lowers the chance of getting confirmed flu and lowers the risk of serious illness. Studies also show flu vaccines help prevent hospital stays, ICU visits, and death, especially in children and older adults.

COVID-19 vaccines do the same. They lower the risk of severe illness, especially the kind that leads to pneumonia, hospitalization, or worse. Protection is strongest in the first several months after vaccination, which is why staying up to date matters.

There may be another bonus too.

Some newer studies suggest that vaccines may give the immune system a short-term “boost” that helps it respond better to other viruses, not just flu or COVID. This is called immune priming. It means the immune system may wake up and become more ready to fight.

For example, some studies found people who got flu shots were less likely to test positive for COVID. Other studies found COVID vaccination may help the body respond better to some common cold viruses.

This idea is interesting, but it is not fully proven yet.

Some of that benefit may come from healthy habits of people who choose to vaccinate themselves. People who get vaccines may also wash hands more, sleep better, and stay home when sick. That can also lower virus spread.

So the main message is simple. The best proven reason to get vaccinated is to lower your risk of flu, COVID, and serious problems from both. The possible extra protection against other viruses is promising, but still being studied.

To get less sick, give your immune system practice. Vaccines help it get ready.

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How to build strong bones? Hint…. start young!

Posted on May 26, 2026 by drlesliegreenberg

I recently attended a sports medicine conference and attended a very interesting talk about bone health. One of the most important lessons was this: strong bones in old age begin with healthy bones in childhood.

Many people think osteoporosis is a problem for older adults. Osteoporosis is when bones become weak and have increased risk of breaking. But the truth is that this problem begins much earlier in life. The bone strength we build as children and teens helps protect us many years later.

Our bones are always growing and changing when we are young. During childhood and the teen years, the body is busy building its “bone bank.” The more bone we build early in life, the stronger we may be later on.

Boys often build more bone than girls because testosterone helps increase bone strength. Girls build strong bones too, but after menopause, women lose bone faster because estrogen drops. That is one reason women are at higher risk for osteoporosis later in life.

This is why the teen years are such an important time for bone health. There is a short window when the body is especially good at building strong bones. For girls, this important window is usually between ages 11 and 14. For boys, it is often between ages 12 and 15. In girls, the years around the first menstrual period are especially important for building peak bone strength. In fact, most girls reach their highest bone mass by about age 18.

Bone strength is not just about bone size. It also depends on bone density, shape, and inner structure. The good news is that healthy habits can help improve all of these.

To build strong bones, children and teens need enough calcium, vitamin D, and protein. These nutrients help bones grow strong and stay healthy. Calcium and vitamin D is available together in tablets, capsules, and gummies. Keep calcium and protein-rich foods at the house within arms-reach.

Exercise is also one of the best ways to build strong bones. Activities that make the body push, pull, jump, or land help bones grow stronger. These include basketball, soccer, gymnastics, tennis, and strength training. Even simple resistance bands or light weights can help.

The best time to start is before puberty and continue through the teen growth spurt. Just 10 to 20 minutes a day can help. School gym class in middle school has been shown to improve lifelong bone health! If you are a parent of a child or teen, add activity to your family time: light weights, yoga, basketball dribbling, and strength bands. Make it fun!

The takeaway is simple: childhood and adolescence are the most important years to build strong bones for life. Take advantage of this time.

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How to stay healthy when you fly

Posted on May 12, 2026 by drlesliegreenberg

I recently attended a very interesting, research-based lecture about air travel and how to avoid getting sick on a plane. As a family physician, I thought the advice was simple, smart, and worth sharing—especially if you travel and don’t want to get sick.

Many people catch a cold after flying. That is not your imagination. Air travel (especially if you are traveling more than 5 time-zones) raise your risk of upper respiratory infections by 300%, especially because you are in close contact with many people for hours. Be aware that jet lag, poor sleep, and stress weaken your immune system. The good news is that a few small steps can make a big difference.

First, think about where you sit. On a plane, the people most likely to affect you are usually in the two rows in front of you and the two rows behind you. That means your “bubble” is bigger than you may think. A window seat is the best choice because you have less contact with people walking by in the aisle. Try to choose a seat near the front or back of the plane and stay in your seat as much as possible.

Second, wear a mask—and keep it on. This is one of the easiest and best ways to lower your chance of getting sick. Airports and planes are full of shared air and close spaces. A mask adds a strong layer of protection.

Third, clean what you touch. Plane surfaces can be dirtier than most people realize. Tray tables are one of the germiest spots on a plane (10 times more germs than on a toilet flush button). In one study, tray tables had more germs than seatbelt buckles, bathroom locks, and even the flush button in the airplane bathroom. Use a disinfecting wipe with at least 70% alcohol to wipe down your tray table, armrest, and seatbelt buckle. Then use hand sanitizer often, especially before eating.

Next, support your immune system before you even leave home. Get good sleep the night before your trip. Try to lower stress. Stay hydrated. Some travelers also use a layered approach with vitamin D, vitamin C, zinc, and probiotics to help support immune health.

Finally, be extra careful in busy travel areas like gate lines, boarding lanes, and airport bathrooms. These are high-contact spaces where germs spread easily.

Flying can be hard on the body. But with a few smart habits, you can lower your risk and arrive healthier.

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Advice about marijuana use in teens

Posted on April 27, 2026 by drlesliegreenberg

As a family physician, I often talk with patients and their families about cannabis and how it may affect growing brains. Many teenagers see the prevalence of use and may hear that marijuana is “natural.” They may assume that this means it is safe. But newer research suggests cannabis use during the teen years may negatively affect how the brain grows and works.

The teenage brain is forming. It keeps growing and changing well into the mid-20s. During this time, the brain is building important skills like memory, attention, learning, planning, and self-control. These are the same skills teens need to do well in school, make safe choices, and manage emotions.

A large recent study followed more than 11,000 children from ages 9 to 10 into their later teen years. Researchers tracked both brain development and substance use over time. They found that teens who used cannabis showed less growth in important thinking skills, including memory, attention, language, and processing speed. Some of these teens started out doing just as well as other children when they were younger. But over time, their progress slowed, while other teens kept improving.

Researchers also found that THC, the main chemical in cannabis that causes a “high,” was linked to worse memory over time. CBD did not show the same effect. This matters because many newer cannabis products contain much higher levels of THC than in the past. Do you think most users know what components are in their cannabis?

Brain scans in another long-term study showed that teens who used cannabis had faster thinning in parts of the brain that help with decision-making, attention, and impulse control. These changes were seen most in the prefrontal cortex, an area that is still developing during adolescence. The more cannabis a teen used, the stronger these brain changes appeared to be.

Even teens who did not have a cannabis addiction were more likely to struggle with depression, trouble focusing, school problems, and thoughts of self-harm compared with teens who did not use cannabis.

This does not mean every teen who uses cannabis will have lasting harm. Some may be more sensitive than others. But the evidence is clear enough to guide caution. Teens who start younger, use more often, or use high-THC products appear to be at greater risk.

The bottom line is simple: adolescence is a critical time for brain growth, and cannabis use during these years has risk. Patients and families should know that today’s cannabis products may carry real risks for learning, mental health, and healthy brain development. User beware.

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Why to consider seeing a family medicine resident as your primary care physician

Posted on March 11, 2026 by drlesliegreenberg

I recently attended a Residency Leadership Summit for the American Academy of Family Physicians (AAFP). The meeting was full of workshops and discussions focused on improving family medicine training so that physicians are EVEN BETTER prepared to care for patients.

Across the United States there are 1,234 family medicine residency programs. I teach at University of Nevada Reno Family Medicine Residency Program. I am passionate about my job educating the next generation of family physicians. This is my 28th year of being both a physician and a teacher of physicians. This, truly, is my life’s work… in addition to raising my 3 “children.” As of February 2024, the AAFP reports about 15,300 family medicine resident members currently in training. About 1 in 7 physicians in the United States are trainees.

This matters because many experienced physicians are aging out of practice or leaving medicine. The doctors currently in residency will play an important role in the future of health care.

Family medicine residency programs work hard to train these physicians as lifelong learners while they care for patients in supervised clinics. When patients are seen at a residency clinic, they are usually seen by a resident physician who has completed medical school and is now receiving 3 years of advanced training. The resident works under the supervision of an experienced attending faculty physician (like me!).

This means two physicians are reviewing the patient’s care. The resident evaluates the patient and develops a plan, and the supervising physician oversees to helps guide the final decisions. In many ways, this provides an extra layer of thought and oversight. Two brains are better than one, right?!

Residency programs also emphasize continuity of care. When possible, patients are scheduled with the same resident physician over time so the doctor can get to know the patient’s health history, concerns, and goals. We call this continuity. In primary care, continuity matters. Details do not get lost. Whole-person care is given. Because these are teaching environments, visits are often more detailed and less rushed than another office. Residents often spend extra time asking questions and reviewing cases with supervising physicians.

Family physicians are trained to provide comprehensive care across the lifespan. Residency clinics often provide preventive care, chronic disease management, women’s health, pediatric care, geriatric care, and minor procedures.

Residency programs also have strong oversight. In the past year alone, about 250 site visits were conducted to review family medicine residency programs and ensure high standards of training and patient care.

For patients, residency clinics offer a unique benefit. You are usually cared for by an energetic new physician while also having your care reviewed by a seasoned faculty physician.

For many patients, this combination of supervision, teamwork, and continuity makes a family medicine residency clinic an excellent place to receive care while also supporting the training of the next generation of physicians.

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