This is Leslie Greenberg. I am a family physician in Reno, Nevada. I attended University of Nevada School of Medicine and 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 family medicine residents for 20 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.
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.
Do you suspect dementia in your loved one? There are many ways to investigate if dementia is present.
Your physician may give a screening test like the Mini Cog, the General Practitional Assessment of Cognition, or the Ascertain Dementia 8-item informant questionnaire. These will help determine if further investigation is needed.
Blood work may also be needed to rule out other causes of mental confusion. A blood count to rule out anemia, Vitamin B deficiency, hypothyroidism, vitamin B12 deficiency, diabetes, and liver and kidney insufficiency/failure. To view the brain, magnetic resonance imaging (MRI) without contrast is the preferred test to exclude other intracranial abnormalities such as stroke, normal-pressure hydrocephalus, subdural hematoma (blood pooling in the brain) or a mass.
Thyroid cancer. Should we screen for this? There are organizations who look over all the known data and update us, physicians, on what screening tests are beneficial to the population as a whole. The U.S. Preventive Services Task Force (USPSTF) does this.
The USPSTF recently delineated the guidelines for thyroid cancer screening in asymptomatic adults. There is not enough evidence to show that screening for thyroid cancer is helpful in those without symptoms. Thyroid cancer is rare and observational evidence shows no change in mortality over time even after introduction of a mass screening program for thyroid cancer. There are also harms in overdiagnosing possible thyroid cancer. These patients undergo additional tests or biopsies or surgeries which can cause laryngeal nerve damage or vocal cord paralysis.
Saline irrigation of your nose decreases the severity of allergy symptoms. You buy the nasal irrigation (like a Neti Pot) once and then it washes away allergens in your sinuses.
Allergic rhinitis is the nose reacting to allergens with an immunoglobulin E-mediated hypersensitivity reaction. You may feel this as nose running, nasal itching or sneezing. Allergic rhinitis can also impair sleep quality and social interactions.
Nasal irrigation may be similarly effective as when oral antihistamines or intransal steroid spray are used. But, with nasal irrigation, it is essentially non-pharmacologic and you buy the irrigator once and then it’s free.
We have begun using progetogens to reduce the risk of miscarriage. This significantly decreases the rate of miscarriage compared to placebo.
How common are miscarriages? Miscarriages occur in 15 to 20% of pregnancies. A “threatened” miscarriage is defined as any vaginal bleeding (with or without pain) in a pregnant woman with a closed cervix and an otherwise viable fetus inside the uterus.
What is NOT found to help? Bed rest, pelvic rest (nothing in the vagina meaning no sex, douching or tampons), vitamins, uterine relaxants, and administration of beta HCG. Progestogens (medications that mimic progesterones) may help. A meta-analysis of 7 research studies with nearly 700 women showedthat oral administration of progestogens had a lower risk of miscarriage compared to those receiving placebo.
The National Institute for Health and Care Excellence is currently developing a guideline with regard to progestogens and miscarriage. More research is definitely needed.
Do omega-3 fatty acids prevent cancer or cardiovascular disease? A study of nearly 25,000 patients found no benefit as primary prevention (someone who does not already have the problem) of cardiovascular disease or cancer.
Want more information: New England Journal of Medicine 2019: 380 (1) 23-32.
I was teaching at the residency program this week and had an interesting nail finding in a child. The girl had a rash 2 months before on her hands and feet and then all of her fingernails started peeling. She otherwise was in good health and felt fine.
What was it? It is called onychomadesis. It can happen 1-2 months after hand-foot-mouth viral illness caused by the Coxsackie virus. The nail plate separates from the nail bed. This makes it look like the nails are peeling. Normal nail growth occurs within 1-4 months and will resolve without any assistance.
I’m glad we could put the patient and the parent’s mind to rest. Reassuring them that this was a normal process was all that was needed.