Real Health Chats

Dr. D and Becky answer listeners questions about both themselves and medical topics.

--- Send in a voice message: https://anchor.fm/realhealthchats/message

Aligning your goals for visiting a doctor with the doctor’s goals for your appointment will help make the most out of every appointment. Know what type of appointment you need. Common appointment types include new patient, annual wellness, follow up, pre operative consultation, and procedure. New patient appointments may take longer as the doctor will take time to learn your history and get to know you. Annual wellness appointments may also be called yearly check ups, health maintenance visits, annual physical, among others. Follow up appointments may include a follow up after an illness, a regular follow up and check for maintenance of diseases, or a follow up from a procedure like stitches or a cast. Often when preparing for surgery it is required to be screened to make sure a patient is healthy enough for the surgery. This is done in a pre op consultation appointment. Procedure appointments are scheduled to focus on specific procedures that can be done in the office. Common examples include wart removal, removal of a toe nail, etc. Appointment types allow the office to schedule the appropriate amount of time, as well as know appropriate coding and billing. When scheduling an appointment, understanding the type of appointment you need can be helpful to make sure you get what you need out of your appointment. Being as specific as possible when scheduling will also help to prepare the office staff and doctor to better serve you in your appointment. If you have issues that arise prior to your appointment that you would like to discuss in addition to what you have already scheduled for, it is sometimes helpful to contact the office to let them know. You can say that the reason for your appointment is private if is of a more personal nature. Understanding your provider’s office procedures for scheduling and communication can be helpful in getting the most out of your experience with that office. Working with your provider and the provider’s office, you can have more positive experiences and maintain a common agenda for your visits. --- Send in a voice message: https://anchor.fm/realhealthchats/message

Dementia is characterized by progressive decline in cognitive function from baseline and causes significant impairment. Types of dementia Alzheimer- most common, up to 80% of cases Vascular Frontal Lewy body Parkinson Many people have a have combination of types of dementia. Most people who think they are having some memory loss are not developing dementia. People with dementia don’t know they are having problems. They are usually brought in to the doctor because of concerns of family. Concerns that arise: Personal memory loss and progression of disease. Who will be caretaker. Don’t want to be a burden. What will be the cost? Family and caretaker concerns include how to deal with the memory loss. Who will care for the patient? Where will they be? Will they be safe? How will we pay for this? Ideas for dealing with the symptoms and issues of memory loss: Family and caretakers should be positive, agreeable and redirect. The person with dementia does not remember what they have done, not done, or said. They will argue that they did not do that thing that they did. They don’t remember. It does no good to argue with them because they won’t remember the argument either. The best plan is to agree, pacify and redirect. Get to the physician early to discuss concerns. There is testing that will be done to rule out treatable cause of cognitive dysfunction like dementia, hypothyroidism, B12 deficiency. There is testing that should be done to determine the cause of dementia and the severity. Have early discussion with family to determine wishes for treatment. Get living will, power of attorney, etc There is no definite treatment but there is hope in current research. There are some medications available that might slow the progression. These have side effects that are sometimes worse that the disease. Enlist the help of your doctor as needed when hard conversations have to happen. Consider what is best for the patient first when making decisions. Seek out community resources for help, including respite care. Caregivers need to take care of themselves as well. https://alz.org/ https://alzfdn.org/ https://www.wvnews.com/fairmontnews/news/historic-breakthrough-wvu-rockefeller-neuroscience-team-first-to-use-ultrasound/article_7b95c0b8-c307-5cda-ab00-51ca0ddfb41f.html --- Send in a voice message: https://anchor.fm/realhealthchats/message

COPD is chronic obstructive pulmonary disease (also called chronic obstructive lung disease) It is the 4th leading cause of death in the US. Anatomy Lungs composed of airways that branch smaller and smaller like a tree and end in tiny air sacks called alveoli where oxygen and carbon dioxide are exchanged. When we breathe, air moves in and out of our lungs, delivering oxygen and giving off carbon dioxide. COPD results in obstruction of this air flow. COPD has 2 categories, chronic bronchitis and emphysema. Chronic bronchitis is caused by inflammation, mucous production and stiffening of the airways. Common symptoms are productive cough, congestion, wheezing and shortness of breath with exertion. Emphysema is caused by destruction of the air sacs where oxygen and carbon dioxide exchange occurs. This leads to shortness of breath, air hunger, weight loss and chronic fatigue. Smoking is the leading cause of COPD although there are some other minor causes. Chronic uncontrolled asthma can lead to COPD and there is a genetic enzyme (alph 1 antitrypsin) deficiency that leads to lung tissue destruction and emphysema. Smoking damage is estimated in “pack years”. 1 pack year is one pack daily for one year. Increased pack years increases the risk of developing COPD. It is very important to diagnose COPD correctly because there are other diseases that can cause similar symptoms and treatments might be different. Testing for COPD might include pulmonary function testing, xrays, CT scans and tests to rule out or diagnose other problems. Treatment for COPD is aimed at managing symptoms. It is very important to stop smoking. Inhaled medications help open airways and decrease inflammation. Once damage has occurred, it cannot be repaired, but lung function can improve. Please stop smoking and don’t start. Help loved ones quit, but they have to be ready. It is important to have end of life discussions if your family is facing issues with COPD.

--- Send in a voice message: https://anchor.fm/realhealthchats/message

In this episode, we discuss some basics of cardiovascular anatomy, physiology, disease states, testing and treatment. This is meant to provide basic information that will help in discussing cardiovascular health with your physician or your family. Anatomy and physiology. (Remember this is basic) The heart is a muscular organ that is the pump of the circulatory system. Blood comes into the heart from the lungs where it is resupplied with oxygen that is needed by all of our cells. The blood then goes back to the heart where this freshly oxygenated blood is pumped to the rest of the body. Arteries are the blood vessels that carry the fresh blood to the body and veins are the blood vessels that carry the blood that is now out of oxygen back to the heart. The heart, just like the other organs of the body, needs fresh blood to maintain health and function. The first arteries that leave the heart are called coronary arteries and these supply fresh oxygenated blood to the heart. Disease states (there are many others, remember this is very basic) When arteries of the circulatory system become diseased (narrowed and blocked due to plaque build up) the organs that are fed by these arteries suffer from poor circulation and are unable to function normally. Coronary artery disease (CAD), also called heart disease occurs when the coronary arteries become narrowed or blocked by plaque buildup. This leads to chest pain with activity, myocardial infarction (heart attack), and heart failure. Cerebrovascular disease is this process in the brain and leads to strokes. Peripheral arterial disease (PAD) is the same process in the legs and leads to pain with activity that improves with rest, poor wound healing, and amputations. Heart failure occurs when the heart cannot pump enough blood to keep up with the needs of the body. Testing EKG or ECG- electrocardiogram. This is a test and measure of electrical activity as it goes through the heart. It gives information about heart rate, heart rhythm, heart size, and blood supply. ECHO- echocardiogram. This is an ultrasound of the heart. It uses sound waves to evaluate how well the heart pumps and how well the valves work. It can also give indirect information about the pressures in the heart. Heart cath. This test is used to evaluate the blood supply to the heart, how well the heart is pumping and can measure the pressures in the heart. A catheter is placed in an artery in the groin and is threaded up to the heart. When in the right place, dye is injected and xrays are used to take images. Treatments Angioplasty or stent placement. This is used to treat coronary arteries that have decreased blood supply. Angioplasty is used to stretch area of narrowing and a stent is used to permanently open it. This is done through the heart cath procedure. Coronary artery bypass graft surgery, also called CABG. When a blockage of a coronary is too severe or there are multiple arteries affected a bypass surgery is performed. This is done by using blood vessels that are harvested from a different part of the body (usually the leg) and then surgically placing that piece of vessel above and below the blockage to go around or bypass it. Heart transplant. This is done to treat severe heart failure. --- Send in a voice message: https://anchor.fm/realhealthchats/message

Vitamin supplements are not necessary for the general population if eating a well balanced diet.  Most health issues associated with vitamin deficiency can be solved with a well balanced diet.

Some conditions such as Crohn's and Celiac disease can cause problems with the absorption of vitamins.  Restrictive diets, including vegan, may limit intake of some essential vitamins, especially B12.  Advancing age may also be a factor in limiting vitamin absorption.  Talk to your personal physician if you are concerned about the need for vitamin supplementation. 

Liver is a prime source of multiple vitamins.

There are several causes of vitamin D deficiency, including decreased intake from vitamin D rich sources like milk, decreased absorption, and reduced sun exposure. 

Individuals at risk for vitamin B12 deficiency include those on a restrictive diet like vegan and those post gastric or bariatric surgery.  They should receive oral vitamin B12 supplements. 

Folic acid supplementation is recommended in pregnancy, but not for the general population unless at risk.  Risk factors for folate deficiency include malnutrition, chronic alcohol use, chronic hemolytic anemia.  Those individuals should receive folic acid supplementation.

Most infants should have an iron supplement while breastfeeding.  Children will also get the proper nutrients from a well balanced diet.  

Calcium and vitamin D supplements can be helpful in reducing the risk of osteoporosis.  Talk to you personal physician for specific recommendations to meet your needs.

https://www.fda.gov/consumers/consumer-updates/fortify-your-knowledge-about-vitamins

--- Send in a voice message: https://anchor.fm/realhealthchats/message

This show we discussed thyroid disease. The thyroid is a gland that is located in the front of the neck that produces thyroid hormone. Thyroid hormone is important for metabolism in all of our cells. There are 2 main classes of thyroid disease other than thyroid cancer (we did not talk about thyroid cancer). Hyperthyroid means that the thyroid gland is overproducing thyroid hormone. Hypothyroid means that the thyroid gland is underproducing thyroid hormone. Most common cause of hyperthyroid is Graves disease. This is caused when the body makes antibodies that falsely stimulate the thyroid to produce hormone. Symptoms include weight loss, palpitations, fast heart rate, heat intolerance, fatigue, protruding of the eyes. Hypothyroid has a few causes but the most common is Hashimotos thyroiditis. This is occurs when the body makes antibodies that destroy the cells that make thyroid hormone. Symptoms of hypothyroid include fatigue, weight gain or difficulty losing weight, dry skin or hair, hair loss, depression, memory and cognition decline, among others. Thyroid hormone is produced in two forms, T3 and T4. The thyroid gland produces mostly T3 and less T4. The hormones are released into the circulation and go to all the cells of the body. Inside the cells, T3 is converted to T4, which is the active form. Thyroid hormone production is regulated by other hormones. TSH (thyroid stimulating hormone) is produced in the pituitary gland and stimulates the thyroid to make thyroid hormone. This process is regulated by a negative feedback loop which means when thyroid hormone is low, TSH production is increased which stimulates the thyroid gland to produce more thyroid hormone, as the levels normalize, TSH levels go back down. Because of this feedback loop, we monitor TSH levels for adequate thyroid hormone production or when people are treated with thyroid hormone replacement. Hypothyroidism is treated with thyroid hormone replacement. It is usually treated with levothyroxine (T4) which is a synthetic bioequivalent form. It is converted to T3 in the cells where it is needed. --- Send in a voice message: https://anchor.fm/realhealthchats/message

Dr. D and Becky share personal colonoscopy experiences.  

--- Send in a voice message: https://anchor.fm/realhealthchats/message

Diabetes is the 7th leading cause of death

1.5 million new cases diagnosed every year

30 million people with diabetes, about 7.5 million don’t know they have it

84 million with pre diabetes

327 billion dollars in diabetes care in 2017

Diabetes is a chronic disease whose hallmark is elevated blood glucose (sugar) above normal.

Normal fasting blood glucose values for diabetes are 70-100

Pre diabetes 101-125

Diabetes greater than 126

Type I diabetes is usually early or childhood onset, we did not talk about this, we will save it for a later episode.

Type II diabetes is also called late or adult onset because it usually is diagnosed in middle age

It is associated with insulin resistance. Insulin is a hormone made in and secreted from the pancreas and is responsible for keeping blood glucose in a normal range. Insulin resistance is a state in which the cells of the body become resistant to the effects of insulin, making it harder for the glucose to get from the blood to the inside of the cells of the body where it is needed. This results in higher blood glucose levels which leads to all of the complications of diabetes.

Risk factors for Type II diabetes include obesity, family history, hispanic or African American decent. There are others, these are most common.

Symptoms of diabetes are not common early in the disease.  As it progresses and blood sugar gets higher symptoms can include excessive urination and thirst, recurrent urinary tract infections (UTI), recurrent yeast infections, fatigue, weight loss. Interesting note, when these symptoms occur, the urine has excess sugar and before lab testing was available, doctors would taste urine to see if it was sweet.

Consequences of untreated or poorly controlled diabetes include cardiovascular disease, heart attack, strokes, peripheral arterial disease which can lead to poor wound healing and amputation, blindness, kidney disease, neuropathy. These consequences are related to the damage that long term high glucose levels cause in small blood vessels which then leads to end organ failure.

There is no cure for diabetes so management is very important to prevent the above problems. Management strategies include lifestyle changes like healthy diet that includes low sugar intake and adequate exercise. Dietitians and diabetic educators play a vital role here. Medications are very important. It is important to check blood sugar regularly and keep follow up appointments with your doctor. Please follow doctors advice.

Very useful resources can be found at www.diabetes.org

--- Send in a voice message: https://anchor.fm/realhealthchats/message

Cold and upper respiratory infection mean the same thing. It is caused by different respiratory viruses that cause sore throat, cough, nasal drainage and congestion, low fever and mild body aches. It will usually last about a week and gradually gets better after 3-4 days. This does not require antibiotics for treatment.  A slight cough may persist for two or three weeks with a cold.

Flu is caused by influenza virus and has similar symptoms to a cold, but the symptoms start more suddenly and is associated with high fevers, severe body aches and fatigue. You feel awful, worst cold ever. Antibiotics don’t treat this but there is treatment available that might shorten the length of illness and decrease symptoms. There are some people who need to be treated, but it must start within the first one to two days.

Sore throats are usually caused by viruses and don’t require antibiotics unless it is strep throat. This needs to be treated with antibiotics to prevent certain complications.

Sinus infections and ear infections are usually caused by viruses. If a bacterial source is suspected based on length of illness or symptoms, antibiotics are needed.

If symptoms last 7-10 days, get worse or there is a second illness that presents (getting better then suddenly get worse) this might be an indication for further evaluation and treatment.

See your doctor if:

You are worried it is worse than a cold (it is still probably a cold and does not need antibiotics)

Early, if you think you have the flu and would need to be treated.

If you were getting better, then got sicker

Fever more than 3 days

Very young or old are more susceptible to serious infection

Inappropriate use of antibiotics leads to antibacterial resistance strains of bacteria, possible serious adverse reactions, c.diff infections, and the perception that antibiotics are necessary when they are not.

To help prevent and stop the spread of colds and flu:  wash your hands, stay home if you have the flu, cover your cough and sneeze, and wash your hands again.  Also, get your flu shot.

--- Send in a voice message: https://anchor.fm/realhealthchats/message