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

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 , , , , , , , , , , ,

Perimenopause may trigger the first episode of depression.

Perimenopause may trigger the first episode of depression.  Women in their late 40s are often in this hormonal stage called “perimenopause.” This is when the body may still have a menstrual period, but that the menstrual cycles are irregular because their estrogen is waning.  Perimenopause can cause nearly a decade of hormonal instability.

Women are at increased risk of developing depression during this perimenopausal transition.  In fact, studies have shown that 45 – 68% of perimenopausal women have elevated depression symptoms.

Other risk factors that increase the risk of perimenopausal depression include

  • psychosocial changes like adverse life events,
  • anxiety,
  • low social support,
  • interrupted sleep,
  • black race, and
  • financial difficulties.

Perimenopause is often a time of great transition: caring for aging parents, launching their adult children into life, or facing changes in marital status.  Your physician may perform a Patient Health Questionnaire-9 (PHQ-9) to help diagnose a mood disorder or may perform a test to show life scales with mood items like the Menopause Rating Scale and the Menopause-Specific Quality of Life Scale.

Some suggestions are psychotherapy, exercise, medication to help with mood changes (like SSRIs).  Botanical and or complementary/alternative approaches for treating menopausal depression have not statistically been shown to help.  Whatever treatment works for you is the best treatment.  See your physician for help.

https://www.mdcalc.com/phq-9-patient-health-questionnaire-9

 

 

 

 

Posted in Emotional health, General Medicine- Adults, menopause, Uncategorized, Women's Health | Tagged , , , , , , , , , , , , ,

What are some things a doctor should know about the elderly LGBTQ community?

What are some things a doctor should know about the elderly LGBTQ community?  I recently attended a panel discussion about medically related LGBTQ issues.  Here are some of the take-home messages

  • 50% of nursing home staff thought “their colleagues” would be uncomfortable with taking care of LGBTQ patients.
  • 2/3 of gay, lesbian, bisexual or transgender people live alone.  Many do not have children, are not in contact with their families of origin further isolating themselves as they age.

As LGBTQ individuals age, they often “go back into the closet” as this may “feel safer”  Is there a nearby nursing home that will care for LGBTQ patients? Can you age in place (alter your home to accommodate you as you age)?

LGBTQ individuals live 3-7 years less than cis-gender heterosexual individuals.  This may be due to the marginalization of a patient’s health care issues over their lifetime.

What can physicians do?

  1. Treat our patients as we would treat our families.
  2. Address patients as the gender and name that they would like to be called.
  3. Address loneliness. Who is important to the individual? Who are their current or future caregivers?

This highlights the need for accepting, open, honest, caring primary care physicians.

 

 

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

Incidentalomas? What’s the chance….?

Incidentalomas? (Incidental findings found on imaging tests)  What’s the chance…?  Recently 20 systematic reviews of observational studies were combined to show which imaging test/region reports the greatest number of incidental findings?  And, of these findings, what are the chances that the incidental findings were cancer.

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flickr.com/ photos/ lynnfriedman/ 8703242835

We, physicians, are often concerned about going on a “fishing expedition” which may not show what we are looking for and instead may show a result which leads to patient anxiety, further testing and possibly overtreatment.

Here are the results of the % of incidental findings found with a specific test

  • CT chest 45%
  • CT colonoscopy 38%
  • cardiac MRI 34%

The rate of the incidentalomas being a cancer was dependent on the part of the body the incidental finding was found

  • breast 42%
  • ovary 28%
  • prostate and colon 10-20%,
  • brain < 5%,
  • parotid gland < 5%,
  • adrenal gland (a small gland found on the top part of each kidney) < 5%.

We all know of people who found malignant “incidentalomas” that are still alive due to the serendipitous finding and prompt treatment.  I also imagine that we know many others who had a scare only to find out after additional testing (or procedures) that it was benign.  We, physicians, are trying to find the important things and not the unimportant ones.  Do no harm, right?!

I hope this helps.

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

Record number of Sexually Transmitted Infections diagnosed in 2017

Record number of Sexually Transmitted Infections diagnosed in 2017.

Not a great statistic, I know.  The Centers for Disease Control and Prevention released the 2017 data showing that nearly 2.3 million cases of chlamydia, gonorrhea and syphilis were diagnosed in the US last year.  This marks the fourth consecutive year of increases in these sexually transmitted infections.

Chlamydia is the most common condition, with more than 1.7 million cases last year.  Gonorrhea increased 67% and syphilis increased 76% in the past four years.

The best treatment is prevention.  Abstain or get tested before intercourse AND wear a condom.img_2339

Want more information?  cdc.gov/media/releases/2018/p0828-increases-in-stds.html

 

Posted in General Medicine- Adults, infections, Male issues, Uncategorized | Tagged , , , , , , , , , , , , , ,

Half of urine drug screens revealed improper medication use!

Half of urine drug screens revealed improper medication use!  Wow.  A study of over 4,000,000 (!) urine drug screens showed that 52% of patients were taking inappropriate medication.  The most common combination of medications misused were opioids (pain medicines) and benzodiazepines (anxiety/insomnia) which accounted for 21% of the discordant samples.  In 64% of the above cases, either the opioid or the benzodiazepine were not prescribed by a physician.

Urine drug screens are standard of care when a physician prescribes a controlled substance as it is the only objective way to know what the patients are really taking.  This study of four million patients reveals that if we ask our patients half the time, they won’t tell the whole story.  In another study of over 450,000 urine drug screens

45% were positive for nonprescribed or illicit drugs (in addition to the prescribed medications)

34% did not show all the drugs the patient had been prescribed

22% did not show all the drugs the patient had been prescribed BUT were positive for other illicit or nonprescribed drugs

Men and women were equally likely to misuse medications.  Misuse peaked in young adults.

Opioid use was down by 12% between the years of 2012 to 2016.

So, if you are on a controlled substance, expect a urine drug screen as it is standard of care… and know that if you are taking nonprescribed illicit drugs, that it may alter your physician’s prescribing habits for you.

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flickr.com/ photos/masterslate/ 3003880273

 

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