• Episode 41 - Life Space
    Jan 10 2022

    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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    25 mins
  • Episode 40 - Physical Therapy for Shoulders
    Jun 16 2021

    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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    1 hr and 2 mins
  • Episode 39 - Dizziness
    Mar 29 2021

    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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    32 mins
  • Episode 38 - All About Asthma
    Mar 11 2021

    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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    33 mins
  • Episode 37 - COVID-19 Vaccine Q & A
    Jan 22 2021

    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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    28 mins
  • Episode 36 - Gut Health
    Dec 19 2020

    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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    30 mins
  • Episode 35 - Common Aches and Pains
    Oct 17 2020

    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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    33 mins
  • Episode 34 - 4M's To Discuss With Your Physician
    Oct 5 2020

    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.

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    35 mins