Everything Your Doc Wants You To Know

Lindsey Dahl & Kirsten Juhl
Everything Your Doc Wants You To Know Podcast

The mission of this podcast is to educate and inform about health matters affecting adults, from latest research updates to tips on navigating the health system and everything in between.

  1. 29/03/2021

    Dizziness

    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.  Follow us on Facebook and Twitter

    32 min
  2. 05/10/2020

    4M's To Discuss With Your Physician

    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: https://www.nia.nih.gov/health/exercise-physical-activity Deprescribing: http://www.deprescribing.org https://www.cdc.gov/aging/pdf/acp-resources-public.pdf https://polst.org/ Health pearl: Get your influenza vaccines! They’re very important this year.

    35 min

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The mission of this podcast is to educate and inform about health matters affecting adults, from latest research updates to tips on navigating the health system and everything in between.

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