Over-the-counter hearing aids

Posted on September 16, 2024 by drlesliegreenberg

Hearing loss is associated with depression, disability, social isolation, unmet medical needs and geriatric frailty. Most patients are aware of 10 years of hearing loss before hearing aids are used.  If you are having symptoms, let your physician know so that they can help you get the care you need.

When can hearing loss be suspected?

  • Asking others to speak louder/ slower/ more clearly/ repeat what was said
  • Feeling fatigued with prolonged listening
  • Difficulty hearing in a group/noisy area/on the phone
  • Difficulty hearing loud sounds or difficulty hearing speech in quiet places

What are warning symptoms that require additional evaluation?

  • Asymmetric hearing loss
  • Feeling of blockage of the ear canal
  • History of excessive ear wax
  • New onset of ringing
  • New sensation of dizziness or vertigo
  • Pain or discomfort in the ear
  • Sudden hearing loss or acute worsening of chronic hearing loss

There are prescription and over-the-counter hearing aids.  Audiologists are the specialists who advise the choice of hearing aid type and style. Prescription hearing aids are an expensive option and may cost $1,000 to $6000 out of pocket.

Over the counter hearing aids include preset and self-fitting and assorted styles.  There are in-the-ear aids and behind-the-ear styles. The behind-the ear style often has a better sound quality and filters background noise more effectively. There is also a self-fitting OTC device. 

I hope this helps.

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FREE Skin Cancer Screening in Reno

Posted on April 26, 2024 by drlesliegreenberg
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What is the best way to use telehealth?

Posted on April 24, 2024 by drlesliegreenberg
Photo by Edward Jenner on Pexels.com

Historically, telehealth was rarely used before Covid.  Insurances often did not allow telehealth to be performed and it was not an option that patients knew of.Covid caused a HUGE increase in telemedicine. There was a 766% increase in telehealth from 2019 to 2020!  

What changes happened? There were major alterations to Medicare in March 2020 which allowed the increase in telehealth to occur.  The CARES Act allowed for patients to see a new physician by telehealth (where in the past the patient needed to be an established patient with that physician). Telehealth can originate from any site (before they needed to be in a physician office like the patient was in their rural primary care physician’s office and having a telehealth visit with a specialist located elsewhere) and even outside of the state the physician was in (before the patient had to be in the same state as the physician). 

Who uses telehealth most? Research has shown that those who use telehealth often have Medicaid or Medicare insurance, black and those earning less than $25,000/year.  Surveys have found that audio-only in contrast to audio-visual) telehealth is often used by Hispanic and black patients.  The primary issue expanding telehealth is the inability for underserved to have computers able to have audiovisual equipment.

Telehealth is still more common than before 2020, but has decreased greatly since its peak in 2020.

What do physicians think of telehealth? An AMA study shows that physicians find that virtual care is difficult due to patient’s limited access to technology, limited patient digital literacy, and patient’s limited access to broadband WiFi (so that video visits are difficult). One benefit is that telemedicine effectively reduced patient no-show visits by half.

Patients most liked telehealth for these reasons: medication refills, reviewing medication options, and discussing test results.

So, if you want to be seen by telehealth, ask your primary care physician if this is an option for you. Telehealth is especially good for visits that do not need an exam: medication refills, reviewing test results, and a dialogue about a patient question.

I hope this helps.

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Need help with insomnia?

Posted on March 19, 2024 by drlesliegreenberg


Insomnia affects 30% of Americans. Poor quality or too little sleep can negatively impact quality of life. It can also decrease productivity, increase drowsiness and fatigue and can worsen other health issues.


Initial treatment focuses on lifestyle modification. This includes cognitive behavior therapy to decrease negative thought patterns that disrupt sleep. There are five elements to cognitive behavior therapy for insomnia: cognitive restructuring, stimulus control, sleep hygiene (no naps or caffeine or alcohol), relaxation therapy (progressive muscle relaxation and reducing mental activity and physician tension before bed), and sleep restriction (so that the patient has a consistent wake-up time for getting out of bed consistent with total time spent in bed—- don’t linger in bed). This restructuring can help reduce anxiety about inadequate sleep and its consequences. Expectations are for patients to sleep for 5-6 hours per night. Decreased stimuli near bedtime (blue lights, TV, exercise). Use relaxation techniques and mindfulness exercises.

If these are ineffective, medications can be used. Most physicians avoid benzodiazepines and “Z-drugs” (like Zolpidem, Zaleplon, or Eszopiclone) because there are short-and long-term risks associated with use of these medications. Z drugs are considered nonbenzodiazepine hypnotic medications. Some patients perform complex sleep-related behaviors like sleepwalking and sleep eating. The US Drug Enforcement Administration has classified both drug classes as schedule IV drugs requiring medication monitoring with periodic urine drug screening and tracking prescriptions of controlled substances.
Melatonin receptor agonists are safer and well-tolerated, but some patients find that they are not very effective. Ramelteon is a melatonin-receptor agonist that helps with sleep onset. Melatonin 1-3 mg is available over the counter.


Orexin receptor antagonists can help with sleep onset and sleep maintenance. You may have seen advertisements for these: Daridorexant, Lemborexant, or suvorexant (Quivivq, Dayvigo, or Belsomra). These medications can cost $300-500 per month. The most common side effect of this class of medication is daytime sleepiness.


I hope this helps.

Photo by Pixabay on Pexels.com
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Do you have old medication you need to (safely) dispose of?

Posted on March 6, 2024 by drlesliegreenberg

The DEA has announced its next National Prescription Drug Take Back Day. On Saturday, April 27, 2024, communities across the country can drop off unneeded, unwanted, and old medications at locations in their area. Stay tuned for the latest information on https://www.dea.gov/takebackday on locations near you and ways you can make a difference to prevent drug misuse before it starts.

flickr.com /photos /essjay/ 5134563753
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Be mindful of reflux symptoms…

Posted on March 1, 2024 by drlesliegreenberg

Gastroesophageal reflux disease (GERD) is very common.  Heartburn? Brash taste in your mouth? Some patients who have long-standing reflux have changes of their cell types in the esophagus due to acid from the stomach causing metaplasia of squamous cells to columnar cells.  This change in cell type is called Barrett’s esophagus.  This affects up to 6 million people in the United States with chronic GERD.  These cellular changes can progress to esophageal adenocarcinoma at an annual rate of around 0.15%.  More than 12,000 new cases are diagnosed annually of esophageal adenocarcinoma. 

Esophageal adenocarcinoma is often diagnosed in advanced stages and because of this there is a five-year survival rate of 16%.

The patients at high risk for developing Barrett’s esophagus or esophageal adenocarcinoma include men with five or more years of weekly GERD symptoms and two additional risk factors (including age > 50, white race, central obesity current or past smoker, and a family history of Barrett’s esophagus or esophageal adenocarcinoma).;

To help decrease this transition to esophageal adenocarcinoma, weight loss, smoking cessation and taking a proton pump inhibitor medication. Lifestyle modifications are always helpful: Avoid foods that are triggers for reflux symptoms (mint, alcohol, nicotine, fatty or fried foods, acidic or spicy foods). Sleep with the head of the bed raised 30 degrees. Avoid eating within 3 hours of bedtime.

If you have reflux symptoms for 5 years or more or worsening symptoms of reflux despite medication, you are urged to see a gastroenterologist.

Photo by Robin Stickel on Pexels.com
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Will pap smears be a test of the past?

Posted on February 15, 2024 by drlesliegreenberg

Researchers are considering screening average-risk asymptomatic women for cervical cancer with only HPV testing. We now know that HPV, human papillomavirus is the virus that causes cells on the cervix to change from normal cells to cancer. 

We used to perform pap smears every year in sexually active women starting after their first sexual encounter.  We have changed our screening practices to take into account HPV and the time-frame it takes for those cells to change.  In the 1990s we changed screening for cervical cancer from only doing pap smears to doing pap smears and testing for HPV.

In the past 15 years there have been 13 population-based randomized controlled trials which have found that primary HPV screening is as effective at detecting CIN3+ (abnormal cervical cells near cancer) as contesting with both pap and HPV testing.

Currently, an HPV specimen is obtained much like a pap smear is obtained.  In the future there may be vaginal self-sampling.  One self-sample method is like a tampon that the patient inserts into the vagina, turns a few times, places it in a transport tube and returns it to the lab.  Another approach is collecting a urine sample which will contain desquamated cells from the cervix and vagina.  This is not standard-of-care yet.  Stay tuned.

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Need to safely dispose of prescription medication?

Posted on February 1, 2024 by drlesliegreenberg

Do you need to dispose of prescription medication? If you have medication around your house you do not use, it is helpful to get rid of this safely. Oftentimes there is extra pain medicine left over from a procedure and leaving this around the house can be tempting for others and may lead to substance abuse.

https://www.dea.gov/everyday-takeback-day is one website to guide you where to go. Or, better yet, you can put in your zip code and find local pharmacies to accept extra medications at this site.

I hope this helps.

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Transgender resources

Posted on April 26, 2023 by drlesliegreenberg

Transgender resources

I recently attended a transgender medical lecture. Excellent resources abounded.  Here are the ones I thought may be most helpful.

https://Jackturban.com Dr. Turban is a UCSF child and adolescent psychiatrist. He has a fabulous website regarding adolescent care.  He reviews media articles on transgender issues. He has copious research showing benefit of offering adolescents gender-affirming care.

When transgender issues occur in adolescents, your primary care may do your primary care AND you will often be referred to pediatric endocrinology.  Pediatric endocrinology physicians can help with medication management and watch their growth. This portion of their care can be done by telehealth if needed.

Real Mama Bears is a fabulous website to help families address transgender issues.

TrevorLifeline 1-866-488-7386 is a hotline 24/7 to help decrease suicide in transgender youth.

Want to know about how to bind? Which bras to buy? Look at Fenway Health.

Transcare.ucsf.edu has guidelines for the primary care and gender-affirming care of transgender and gender nonbinary people. This done by Dr. Deutsch.

WPATH World Professional Association for Transgender Health website has excellent resources and a link to their society guidelines

I hope this helps…

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Teaching family medicine residents!

Posted on April 19, 2023 by drlesliegreenberg

I am in Kansas City learning with 1000 other family medicine academic physicians how to LEAD family medicine residency programs.  It is refreshing to hear new educational curriculum: how family physicians can meet the needs of our current patients.  Because I have taught at three medical schools over 25 years this meeting allows for reconnecting with cherished friends at this meeting.

University of Nevada Reno Family Medicine Residency Program has existed for over 30 years.  We currently mentor 28 family medicine residents over three years and have two one-year fellowships:  one wilderness medicine fellow and 2 sports medicine fellows.

In the US, there are 745 family medicine residency programs who graduate 5,000 family physicians a year.

On average, resident physicians learn over 3 years on HOW to be a family physician. Each resident physician sees over 1600 physicians (both in the hospital and the office) and do 150 telehealth visits before graduation.  There are also requirements for residents to see nursing home patients and do home visits.

Family physicians are diverse with the goal being that the physicians look like the patients:

47% white

28% Asian

10% Hispanic

9 % Black

6% Others

The personal care of patients is our core goal.  Family physicians want to care for patients longitudinally, over time.  My friend has a license plate holder that reads “Everyone deserves a family physician.”  I could not agree more.

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