I’m back! Well. . . I am back to blogging. . .

Posted on October 5, 2015 by drlesliegreenberg

IMG_4185After a 2 month hiatus,  of  moving across the country and settling my family of 5 into our new community, I have returned to doctoring and blogging.

I have recently joined the teaching faculty at the University of Nevada School of Medicine Family Medicine Residency Program.  I have learned (my 8th) a new electronic medical record and have seen my first day of patients.  Whew!  These days medicine is made more difficult with the cumbersome recording system.  And, I am determined to master this EMR as well.

Expect to “hear” more from my blog to come.

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When should you go to the Emergency Room?

Posted on May 12, 2015 by drlesliegreenberg
flickr.com/photos/ atmtx/ 3989504360

flickr.com/photos/ atmtx/ 3989504360

Certainly if you have a major trauma or accident, you should visit the emergency room.

But, there are other reasons to go to the ER such as any symptoms that interrupt your life or your ability to function–

  • severe chest pain,
  • shortness of breath,
  • stroke-like symptoms (including numbness),
  • suicidal thoughts.

If you have a primary care doctor, here are some reasons to be seen by your doctor (assuming it is during office hours) on an emergent basis

  • abdominal pain,
  • back pain, bites (animal or human),
  • bleeding,
  • coughs and sore throats,
  • cramping or bleeding while pregnant,
  • dizziness or other balance problems,
  • fevers (especially in the very young or old),
  • headaches/migraines,
  • mood changes,
  • rashes or allergic reactions,
  • weakness.

Your emergency room experience (or wait time) goes depends on your level of acuity– meaning how urgent is your medical issue.  The more urgent (like chest pain or possible stroke) are frequently taken straight back to a room in the ER for physician evaluation.  Lower acuity problems like back pain or sore throat may mean a longer waiting room time.

Also, consider HOW you are getting to the emergency room.  At times, driving yourself or a loved one to the emergency room won’t get you care fast enough.  In those instances, call 911.  The paramedics can deliver life-saving care on the way to the ER.

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Can red-yeast rice be taken instead of a statin drug?

Posted on May 4, 2015 by drlesliegreenberg
flickr.com/ photos/ cobalt220/ 4343621338/

flickr.com/ photos/ cobalt220/ 4343621338/

Not really.  Here in the United States, the red-yeast rice extract that contains naturally-occurring lovastatin (a statin drug) is not FDA approved.

In contrast, in China red-yeast rice is a common dietary and medicinal product.  Their red-yeast rice contains a wide range of biologically active compounds… including lovastatin. (Lovastatin is a statin drug that in the US is sold at the pharmacy with a prescription.)   Studies in China using their red-yeast rice have shown significant reductions in coronary heart disease (up to 30%!) and a 60% reduction in myocardial infarctions.

The products that are purchased online from America may contain variable amounts of lovastatin and therefore therapeutic effects aren’t predictable.  I would suggest letting the FDA do their job and regulate the medication and their strength.  Get a statin prescription from your doctor.

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What do some doctors do on their day off?

Posted on May 1, 2015 by drlesliegreenberg

What do some doctors do on their day off?…teach 6th graders about the heart!  

 Man, do I LOVE my profession.

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Prescription gel helps with knee pain

Posted on April 28, 2015 by drlesliegreenberg
flickr.com/photos/ jaypoct/ 2429061604/

flickr.com/photos/ jaypoct/ 2429061604/

Diclofenac gel (the only topical nonsteroidal anti-inflammatory available in the United States) was shown to help decrease pain and improve function scores for as long as 12 weeks in patient with osteoarthritis of the knee.  The drawbacks are the cost of the diclofenac gel (reportedly $260- 330 per 150 mL bottle),  minor skin dryness and irritation.

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I’m moving west…. Way west!

Posted on April 22, 2015 by drlesliegreenberg

 Dear patients,

After caring for (and doctoring) Wichitans for nearly 20 years, my family is moving to our hometown–Reno, Nevada.

I will be practicing at Andover Family Medicine until July 21, 2015.

Please call my office to schedule a visit before then so… we can do a check-up, review your medical care, and can seamlessly coordinate your care.

In Reno I will work as family physician/teacher at my alma mater medical school.
It’s been an honor caring for you and your families. My move away is bittersweet as I will truly miss being your family physician.   I hope you can understand my need to be near family.  I will greatly miss taking care of you.

 

Wishing you the best,

Leslie Greenberg MD

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Do obese children get more joint injuries?

Posted on April 21, 2015 by drlesliegreenberg

flickr.com/photos /r4vi/ 2316877289/Do we need a study to evaluate this?   Apparently so.  And, yes!  Overweight children are 18% more likely to have lower extremity injuries compared to normal weight children.  The risk increases to 24% in obese children and 34% more likely in extremely obese children.   Good news is that obese children are not at increased risk of upper extremity injuries.

The recommendations should be to discourage obesity in children.  Good diets.  Healthy snacks.  Exercise daily.

Hope this helps.

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I am now a “Fellow”!

Posted on April 17, 2015 by drlesliegreenberg

IMG_3602I have been recognized by the American Academy of Family Physicians for my years of community activism and scholarly activity.  Thanks, AAFP!

Signed,

Leslie Greenberg MD FAAFP (Woo hoo!)

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Do YOU want to apply for disability?

Posted on April 13, 2015 by drlesliegreenberg
flickr.com/ photos /sicilianitaliano/3281602519

flickr.com/ photos /sicilianitaliano/3281602519

Disability evaluations are more than completing a form… I would first ask if there is an alternate job/function/work schedule that you can change to that may fit your needs.

Did you know that according to the World Health Organization, more than 1 billion people worldwide have a disability? In the United States more than 56 million American workers have some form of disability. Of these, more than 38 million have a severe disability. The conditions that most often lead to disability include back or spine problems, heart conditions and arthritis.

Disability impacts family members and caregivers. There are differentiations between disability, impairment and handicap.  These need to be delineated to best evaluate patients and make appropriate recommendations. The two largest disability programs in the United States are Social Security Disability and workers’ compensation.   For veterans, the U.S. Department of Veterans Affairs provides disability benefits.

There are many family physicians performing this initial evaluation of disability. I do not perform disability evaluations; I rely on subspecialists and occupational health physicians. If you are interested in disability, look for physicians who have received specialized medical education by American College of Occupational and Environmental Medicine, the American Academy of Disability Evaluating Physicians, or the American Board of Independent Medical Examiners.

My hope is that even with deficits each of our lives is a meaningful and productive one.

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Wound care (part 2 of 2)

Posted on April 9, 2015 by drlesliegreenberg

Can stitches get wet?

flickr.com/photos /ouistitis/ 6052645034

flickr.com/photos /ouistitis/ 6052645034

Yes. Stitches can get wet anytime. We often suggest that stitches stay dry for the first 24 hours, but studies have shown that there’s no increased risk of infection or wound breaking down if it gets wet in the first 24 hours.

When should you take prophylactic (a medicine used to prevent infection) antibiotics?

Prophylactic antibiotics have little benefit in healthy patients with clean wounds. Topical antibiotic ointments may decrease infection in minor contaminated wounds. Prophylactic antibiotics are often started after human bite wounds, or deep puncture wounds.

Do I need a tetanus vaccine?

Maybe. If you have never received a tetanus vaccine, a tetanus toxoid vaccine should be given as soon as possible. If you have not completed a primary series of tetanus immunizations (at least 3 vaccines) if your last tetanus booster was 10 or more years ago, then a booster is warranted.

How are wound infections diagnosed and treated?

If you have any of the following symptoms, your wound may be infected—

  • redness,
  • warmth,
  • pain,
  • enlarged lymph nodes near the wound,
  • swelling,
  • fever (temperature more than 100.4), or
  • pus.  The treatment of wound infections depends on the severity of the infection, type of wound and the suspected bacteria in the wound.   Antibiotics will be started based on the potentially causative organism. If a culture of the wound can easily be obtained, this will be send to the lab so that the bacteria can be grown out.

When does a wound require hospitalization of referral to a wound care specialist?

Most wounds can be managed by your family physician in the office. However, there are several reasons for hospitalization or referral. Severe wound infections. If wound may need surgical exploration, incision and drainage,  imaging or plastic surgery.

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