Life Space
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.
Physical Therapy for Shoulders
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.
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.
Episode 38 - All About Asthma
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.
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.
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
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
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
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
Mental Health During the Pandemic
Child and Adolescent Psychiatrist Dr. Stefanie Hanisch joins us to discuss mental health, especially that of youth, during the current pandemic.
Dr. Hanisch was born and raised in South Africa. She attended medical school at the University of Pretoria, South Africa, before obtaining her fellowship in Child and Adolescent Psychiatry at Baylor College of Medicine in Houston, TX. She served as Chief Resident before moving to Fargo, ND. She has been in her current practice since 2007 and currently serves as her Department Chair in addition to having faculty appointment at the UND School of Medicine. Dr. Hanisch is married and has two sons. She enjoys traveling with her family and is an accomplished runner.
In this episode, we talk about mental health (with a focus on youth) during the pandemic. We discuss the following points:
How kids might respond differently based on their age and developmental level
How to talk with kids about their feelings and fears.
Validation of feelings
Spend time with the fear, and then transition to constructive thinking (what you can do about the situation)
The value of parental role modeling
How to maintain health for all during the pandemic
When to seek help: WHEN NEEDS OUTWEIGH RESOURCES
Available resources include:
Your primary care provider
Emergency department
Health Pearl: take time to relax and destress. There are many great resources for this, including the following:
Headspace app
Ahway Island Podcast (for youth)
Calm app
Youtube Meditation
Peloton app - meditation, yoga, family work outs