Everything Your Doc Wants You To Know

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

First Link (211)

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

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Episode 30 COVID-19: A Marathon, Not a Sprint

Recorded Sunday April 5, 2020

Today we are joined by Infectious Disease expert Dr. Dubert Guerrero to discuss COVID-19. Dr. Guerrero is a practicing Infectious Disease Physician at Sanford Health. He graduated from the University of the Philippines and completed his training in Internal Medicine at Akron General Medical Center. He went on to complete an Infectious Disease fellowship at Case Western Reserve University in Cleveland, Ohio. Dr. Guerrero is married and has three children.

In this episode, we discuss common questions related to the current coronavirus pandemic, including

- What is social distancing?

- Is social distancing effective?

- Is it important to sanitize groceries and other items coming into one’s home?

- What can we expect to see over the next several months regarding COVID-19 cases?

- When can we expect to see vaccines and/or treatments for the virus?

Health pearl: take care of your mental health. You can do this by taking time for yourself every day, including exercise and mindfulness/meditation in your daily life.

Resources:

Center for Disease Control and Prevention

World Health Organization

Your state health department

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Your Questions Answered

This week we spend a few minutes summarizing key information about COVID 19.

The remainder of the episode is devoted to your questions, including topics ranging from which diet is best to how can you tell if your doctor is a good one.

Resources
COVID 19: https://www.cdc.gov/coronavirus/2019-nCoV/index.html

https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Your state health department

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Episode 28 Pharmacogenomics with Dr. Natasha Petry, PharmD, BCACP

Natasha has a bachelor’s degree in Microbiology and graduated with a Doctor of Pharmacy in 2012 from North Dakota State University in Fargo, ND. She completed a post graduate Pharmacy Practice Residency at Trinity Health in Minot, ND and joined the faculty at NDSU as an Assistant Professor with a clinical appointment at Sanford Health. She is a board-certified Ambulatory Care Pharmacist and began working in the area of Pharmacogenomics in 2014. She is an affiliate member of the NIH funded Implementing GeNomics In practice (IGNITE) network. She currently works as a Pharmacogenetics Clinical Pharmacist for Sanford Imagenetics. In addition, she is pursuing a Master of Public Health degree. Natasha is a wife, mother to 2 beautiful girls, and enjoys attending sporting events.

Pharmacogenomics: The genetics of how people metabolize (break down) medications. Genetic information can help guide the use of medication dosing and medication choice. Genetics looks at the enzymes that break down medications. Can help determine efficacy or utility, safety and/or dosing

Still limited but growing rapidly- another “tool in the toolbox”

Genetics does not change in a lifetime

Cost can be limiting

Currently useful in prescribing antidepressants, some pain medications, cholesterol medications (statins), clopidogrel (Plavix), warfarin

Limitations:

No standardization in lab testing regarding which allele variants are tested

Cost

Limited actionable results that impact a finite number of medications

Genetic testing collected through blood, saliva, cells from the cheeks depending on lab used

Variable insurance coverage: preemptive testing not likely covered, reactive is being covered more often

Direct to consumer testing vs. laboratory (health system) derived testing

Need Medical Geneticists and Pharmacists to help interpret information

Health Pearl: Try out meal delivery kits for improved health

Resource list: https://imaginetics.sandordhealth.org

https://www.genome.gov/FAQ/Pharmacogenomics

https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics

https://www.yourgenome.org/facts/what-is-pharmacogenomics

https://nigms.nih.gov/education/pages/factsheet-pharmacogenomics.aspx

https://www.cdc.gov/genomics/disease/pharma.htm

https://pharmgkb.org/page/pharmacogenomics

https://www.pharmkb/page/iAmACitizen

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Episode 27: Sugar and Metabolic Syndrome

In this episode we discuss the impact of sugar on metabolism and the adverse effects of sugar loads on various organ systems.

Metabolic syndrome: dysregulation of normal metabolism. It can lead to damage of many organs. Increases risk of diabetes, high blood pressure, excess body fat (especially central obesity), abnormal cholesterol. This increases risk for heart attack and stroke. Can also lead to fatty liver disease.

High fructose loads cause cellular inflammation. Fructose loads trigger a metabolic pathway that stimulates increased consumption of food and storage of energy. This is beneficial for animals that hibernate or don’t have access to as much food during winter, but not for humans. Fructose also depletes energy on a cellular level.

The more concentrated the sugar load, the more it stimulates increased food consumption and storage. Because of this, sugary beverages such as soda, sports drinks, and juice should be avoided.

Foods to limit/avoid to help improve metabolism:

Juice and soda, sports drinks, or other beverages with added sugar.

Potatoes

Bread

Chips

Rice

Dried fruit

Fruits (limit, don’t avoid) - some have more sugar than others (grapes are high in sugar, low in fiber)

Beer and wine

Foods/beverages that promote healthy metabolism:

Water

Vegetables

For fruit consumption, eating berries, kiwi, other low sugar fruits is better

Resources:

Peter Attia, MD episode 87: Rick Johnson, MD: Fructose - the common link in high blood pressure, insulin resistance, T2D, & obesity? https://peterattiamd.com/rickjohnson/

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Warning Signs of Heart Attack and Stroke

Heart Attack: Occurs with decreased blood supply to the heart muscle.

Symptoms:

Chest pressure, like elephant sitting on chest

Jaw Pain

Pain into left arm

Nausea/indigestion

Breaking into a sweat

Shortness of breath

Other warning signs: change or decrease in exercise tolerance

Stroke: Decreased blood supply to area of the brain

Symptoms:

Facial drooping/drooling

Arm or leg weakness/numbness

Speech difficulty

Acute imbalance or change in/lack of coordination

These symptoms are concerning enough to warrant evaluation in an EMERGENCY DEPARTMENT!

Health Pearl: Read book Being Mortal by Atul Gawande or watch PBS documentary of the same name https://www.pbs.org/video/frontline-being-mortal/

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A Pain in the Back

80% of the population will present to primary care with low back pain. Most of the time low back pain isn’t a signal of a worrisome underlying condition/ dangerous, though it can affect quality of life and become chronic.

Definitions:

Acute back pain: new back pain that has been present less than 4 weeks

Subacute back pain: back pain present for more than 4 and less than 12 weeks

Chronic back pain: back pain present for more than 12 weeks

Most of the time it will improve.

Symptoms:

Pain across the low back, may shoot down the leg or to other locations

Muscle spasm with stiffness

Difficulty urinating or moving bowels*

Weakness, foot drop*

Numbness, tingling

Tenderness over the spine

*More concerning symptoms

Causes:

Nonspecific - a definitive diagnosis is not obtained or needed

Injury/twisting/pulling

Osteoarthritis / degenerative disc disease

“Slipped disc” or disc herniation

Compression fractures

Radiculopathy (inflammation of the nerves)

Spinal stenosis (narrowing around the spinal cord)

Ankylosing spondylitis (auto-immune condition)

Scoliosis

Depression can increase pain sensations

Foot issues - flat feet, poor arch support can contribute

Kidney stones

Shingles

Intra-abdominal conditions (pancreatitis, gall bladder disease)

Less common, more worrisome causes: cauda equina syndrome, spinal infection, malignancy

Evaluation:

Office visit for history and exam, usually no X-rays or other imaging at the first appointment unless trauma occurred. Clinician can rule out worrisome symptoms

Management:

Physical therapy

Heat, ice

Acetaminophen, NSAIDs (ibuprofen, naproxen, etc) if approved by your clinician, muscle relaxants

Stretching, massage, rest

Exercise, strengthening supporting muscles - needs to be ongoing

Weight loss when indicated

Injections from pain clinic or spine clinic

Topical products (Biofreeze), lidocaine patches

Narcotic pain medications are not usually indicated. If they are, it would be for 3 days or less. Narcotics have no role in management of chronic pain.

Medications to help with nerve pain: duloxetine, gabapentin, pregabalin

Health pearl: book recommendation - Mayo Clinic Guide to Stress Free Living by Amit Sood.

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Episode 7: Living Well with Dementia

Dementia - changes in memory and thinking that are beyond what is normal for age. It is progressive (worsens over time).

Treatment can slow progression of dementia, but there is no cure. It is felt that regular exercise, following a healthy diet such as the Mediterranean diet, and staying socially and cognitively engaged can help prevent dementia. Controlling chronic diseases such as high blood pressure, high cholesterol, and diabetes can also help with prevention.

Today we are joined by Deb Kaul, the owner of geriatric consulting service “Dignity Care” and one of the Co-founders of “Memory Café of the Red River Valley.” Deb has a bachelors degree in Business Administration from UND and a BSN from the University of Mary. She also has a Master’s certificate in Geriatric Care Management from the University of Florida. Deb considers the lessons she learned while caring for her parents - both of whom lived with dementia, the most valuable education she has ever received.

Deb provides recommendations for living with and caring for people living with dementia:

Keeping the diagnosis of dementia a secret from the person with dementia robs the individual of their autonomy. It also perpetuates the stigma related to dementia.

It is possible to live well with dementia.

Our responses to the diagnosis impact how a person responds to the disease. If they are diminished and de-humanized, they lose hope.

How to engage with a person living with memory loss: Greet them with a compliment or information that reminds them about their life. Tell them their story (“That is a beautiful/handsome sweater.” or “You did such a great job raising your children.”) Avoid quizzing them (“Did ___ come to visit you this morning?”)

For caregivers: Communicate about what’s occurring. Allow the person with memory loss to set goals for themselves. Avoid arguments with people living with dementia. They lose the ability to rationalize and reason, and it’s our job as caregivers to think creatively to solve problems. Caregivers can apologize, redirect, distract to work around conflicts or disagreements “Live their truth.” People with dementia are living in the present moment, so living with them in their truth/reality can help them and reduce conflicts. Engage trustworthy friends to build a village of support around them. People living with dementia should continue to have opportunities to make friends and maintain some independence. Communicate goals with physicians and other medical providers. Continue to pursue joy in life (both caregiver and person living with dementia).

Available resources:

“What the Hell Happened to my Brain?” by Kate Swaffer. The author’s diagnosis resulted in “prescribed disengagement” by her physician. She was told to “get her affairs in order” when diagnosed at age 49. She challenged these ideas and has achieved incredible things while living with dementia.

The Dementia Alliance International (DAI) - https://www.dementiaallianceinternational.org/

Alzheimer’s Association - https://www.alz.org/

Memory Cafe- free socialization and support for people with mild to moderate memory loss and their caregivers

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Episode 23: Resolve to do your Advance Care Plan

We are joined by guest Gail Christopher to discuss Advance Care Planning. Gail is a nurse with over 40 years of experience in clinical nursing, surgery, utilization management, wellness coordination, and long term care among other things. In 2003 she obtained an MSN from UND with a focus on Nursing Administration. She works for Sanford Health in Fargo as the lead with the Advance Care Planning Team. In April 2019 she became a Certified Sacred Passage End of Life Doula through the Conscious Dying Institute in Boulder, CO. She has worked much of her career with the geriatric population and has a special interest in this area. She is a lifelong North Dakota native, and has 3 children and 5 grandchildren.

Advance care planning definition: formerly known as healthcare directive. Process of defining your goals and wishes for healthcare, especially if you’re unable to make those wishes known at some time in the future.

Barriers include

- Good health (feeling it doesn’t apply)

- Feeling their families already know wishes

- Misconception that it’s only for elderly

- Fear of facing mortality

- Mistrust of others’ ability to follow directive

Steps of completing an advance care directive
- Who do you want as an agent to speak on your behalf?

- Document your wishes

- Communicate with your family about your wishes so they can advocate for you

- Communicate with your PCP about your wishes. Your PCP can help maintain perspective and advocate for you

It’s important and can be helpful to think about how you want the end of your life to look.

Questions in advance care planning can include:

Where you want to die and how you would want that to look

What matters most to you? What makes life worth living?

Specific medical treatments that you would or would not want (including cost of certain treatments) - CPR, artificial nutrition, respiration, etc

Burial vs cremation vs donation

Organ donation

Autopsy

Once completed, advance care plans should be updated every 10 years or sooner if there are other major changes in health (new diagnoses, decline in health, death or change in the agent)

End of life can be a beautiful experience rather than something to fear.

Consults can be arranged with an advance care planning team. Local Sanford phone number: (701) 234-6980 to schedule an appointment or obtain advance care planning documents.

Resources:

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

https://polst.org/

Health Pearl: Butternut Squash Wild Rice Stew

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Winter Colds

Most of the time caused by viral infections (no benefit from antibiotics) as opposed to bacterial infections. Symptoms include nasal congestion, headache, sinus pressure, face pain.

Control symptoms with humidifier, nasal washes/rinses, steroid nasal sprays, guaifenesin for thinning of mucous, Tylenol, and time. Often more than 2 weeks to see resolution of symptoms and can be up to 4-6 weeks.

Health Pearl: Try to begin active traditions like a Turkey trot during the holidays. Okay to indulge for 1 day. Be sure to drink water as this helps keep you full. ***Additional information: Prevention is key! Remember to wash your hands often during cold and flu season. Cover your mouth with the bend of your elbow when coughing or sneezing. Stay home from work or school when sick.

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