Everything Your Doc Wants You To Know

Physicians Lindsey and Kirsten are back with a new topic. They discuss the concept of life space, the area in which one conducts life activities. Studies have demonstrated that larger life space positively affects health. Lindsey and Kirsten discuss the benefits of a larger life space and explore how to obtain these benefits even when life space is limited.

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In this episode we discuss shoulder pathology including impingement, adhesive capsulitis, arthritis of the shoulder, and rotator cuff injuries with physical therapist Lindsey Sandbeck. We review what to expect from a PT evaluation, as well as non-operative and post-operative physical therapy. Lindsey provides insight into strategies to optimize recovery from shoulder injuries and surgery.

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Dizziness

Dizziness can come in different forms: vertigo, lightheadedness, disequilibrium.

Vertigo:  False movement, room spinning.  Feels as if you are moving when you are not.  

Benign Paroxysmal Positional Vertigo:  acute, occurs with certain movements, lasts seconds to minutes

Dix-Hallpike to diagnose 

Vestibular rehab/physical therapy to treat - Epley Maneuver

Meniere’s Disease: vertigo, with hearing loss and ringing in ears

Labyrinthitis

Central vertigo: can be more worrisome, exam looks for signs of stroke or other pathology. May need brain imaging. 

Lightheadedness: feeling like one could pass out, pre-syncope

Cardiac causes: arrhythmias, valve disease

Orthostatic hypotension

Disequilibrium: sense of imbalance

Changes in nerve sensation can contribute: peripheral neuropathy, knee replacements

Vision and auditory impairment can also contribute

Diagnosis: monofilament testing, vibration sensory testing, gait speed, get up and go test, Romberg test all help evaluate

Treatable causes: B12 deficiency, thyroid disease, uncontrolled diabetes, medications that can be stopped (older anti-histamines)

Treatment: Adaptations (change in glasses, hearing aids), practice balance - physical therapy, strengthening

Persistent Postural Perceptual Dizziness (PPPD): persistent dizziness that worsens with motion or upright position, present > 3 months

Often follows BPPV or labyrinthitis

Anxiety, depression often present concomitantly

Treatment: Evaluate medications, consider medication to help with anxiety, depression

Health Pearl: For people who have been fully vaccinated for COVID-19, we discuss CDC guidelines and ways to safely expand activities. 

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In this episode we discuss asthma. We review symptoms, diagnosis, and treatment. We also discuss triggers and how to minimize them. We talk about creating a home management plant, or asthma action plan, with your doctor. Finally, we talk about symptoms that indicate an asthma exacerbation and symptoms that might indicate a need for prompt evaluation.

Health pearl: try a low calorie Shrub for a refreshing alcohol free drink. 

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Episode 37 - COVID-19 Vaccine Q & A

In this episode, we answer questions about the COVID-19 vaccine, including how it works, common side effects and who should get the vaccine.

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Episode 36 - Gut Health

In this episode we discuss a problem commonly encountered in our clinics, chronic diarrhea. We review various causes, and discuss how patients can help us determine the cause. We provide a basic overview of treatment of some types of chronic diarrhea.

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Common Aches and Pains

Tendonitis: Inflammation of the tendons (attachment of muscle to bone). Elbow, ankles, wrist, overuse.

Treatment: rest, ice, NSAIDS. Physical Therapy can be necessary and helpful

Bursitis: fluid filled sacs in areas of friction that can become inflamed.

Common: Trochanteric Bursitis (hip), Anserine bursitis (medial knee), Olecranon Bursitis (elbow)

Treatment: Physical therapy, Steroid injections, Ice, NSAIDS, stretching

Arthritis: Pain in the joints

Osteoarthritis: wear and tear or degenerative joint disease. Knees, hips, Spine, hands, shoulders

Risks: age, obesity, family history, prior injury, occupation

Pain worsens with use

Treatment: scheduled Tylenol, NSAIDS if able, injections ultimate joint replacement

Topicals always worth a try

Inflammatory Arthritis: most common Rheumatoid Arthritis (autoimmune- immune system fighting itself at the joints)

AM stiffness lasts hours, red, warm swollen joints, symmetric- hands wrists, feet, knees

Treatment: prescription medication to avoid destruction/deformity in the future

Future: Gut microbiome and diets role in joint inflammation and pain?

Health Pearl: Anti-inflammatory diet limit processed food, sugar, simple carbohydrates

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Episode 34: the 4M’s

4M’s to discuss with your physician: Medications, Mobility, Mentation, Matters Most (what Matters Most)

Help shape patient-centered care

Reduce hospitalizations, decrease the need for care

Mobility - evaluate yearly

Measures:

Gait speed is one measure (slower than 1 m/s increased risk of falling, increased risk of hospitalization)

Timed get up and go

Balance evaluation by physical therapy

Getting up from chair without using arms

Next step:

Home exercise program (NIH healthy aging)

Physical therapy

Multi-disciplinary falls and stability clinic

Driving

- Multiple falls indicate increased risk for driving safety issues

Everyday movement is important to maintain mobility

Home exercises, Youtube exercises

Medications

Beer’s list - potentially inappropriate medications for older adults due to risk of side effects

Examples include benadryl, benzodiazepines, narcotic pain medications, some seizure medications

Need to look at benefits versus side effects

Evaluate for “prescribing cascades” - one medication is used to treat a side effect of another medication, and then another medication is used to treat side effects of that medication.

Polypharmacy - more than 6 medications is polypharmacy. More medications = more side effects and medication interactions. Deprescribing can help with this.

Goals of care can help determine which medications are adding value

Matters Most

It’s important to discuss what’s important and what makes life worth living, then delve deeper.

“What could you live without and still feel you have good quality of life?” Focuses on quality of life rather than just quantity

Patients can bring this topic up by bringing in an Advance Care Directive or Polst form, or mentioning this as a goal of the visit

Evolves depending on stage of life

Mentation

Assessment of memory and cognition, as well as mood

Generally we evaluate cognition when family brings up a concern or clinician notices a change

Can be done as part of Medicare Wellness Exam

Depression and anxiety can look like physical symptoms and cognitive changes in older population

Next steps if a concern is present:

Evaluate medications, which can impact cognition and mood

Obtain more information from screening tests, family members

Consider referral for further testing; this isn’t required to make a diagnosis

Neuropsych testing can distinguish between depression, anxiety, dementia

References

NIH National Institute on Aging

Deprescribing

Advance Care Planning

https://www.cdc.gov/aging/pdf/acp-resources-public.pdf

POLST: Portable Medical Orders

Health pearl: Get your influenza vaccines! They’re very important this year.

Everything Doc Show Notes: Genetic Counseling

Special guest: Allison Hutchinson a certified genetic counselor. Has worked at Sanford Imaginetics for the last 2 years. Her focus is working with teams to offer genomic and pharmacogenomics education to providers, patients, and the public. She is part of a research collaborative investigating whether these education interventions have been successful and how to continuously improve. Prior to this Allison was a high school science teacher for over a decade. She enjoys listening to podcasts in her spare time!

Quote: “Teaching should always start the discussion and never end it.”

Genetic Counselor: Advanced healthcare providers with training in genetics and counseling.

Education includes semester in classroom, year in clinic, research throughout

Certified

Who should see a genetic counselor?

Those with rare genetic diseases in family

Family history of related cancers in 2 or more people on same side, often earlier onset

Help interpreting consumer driven testing

Cardiovascular diseases: arrhythmias with sudden cardiac death, familial hypercholesterolemia

Pretest counseling is important! Think about all possible outcomes of genetic testing and what you might do with range of results.

How to prepare?

Come with information about family members: cause of death, age of death, chronic diseases, so pedigree can be developed.

Help write letters to family

Most insurances cover but varies check with your insurance

For more information about Genetic Counseling visit:

https://imagenetics.sanfordhealth.org/

https://www.aboutgeneticcounselors.org/

https://www.augie.edu/academics/graduatepeducation/master-science-genetic-counseling

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The Dark Side of Isolation During COVID-19

In this episode, we discuss the unintended isolation that results from social distancing and quarantine measures, especially in the elderly. We review complications of isolation, including frailty, sarcopenia, depression, cognitive changes, and increased suicidality. We also review measures to help mitigate these adverse consequences, and discuss how everyone can help.

We explain which outings are safe and whether gathering during the summer can be safe. We review precautions that should be taken when out.

Health pearl: Find someone who could benefit from a safe, social distancing outing and do something fun together!

Resources:

Search “Adopt a Grandparent” to find a program near you.

Nacional Suicide Prevention Lifeline: (800) 273-8255, https://suicidepreventionlifeline.org