- Coming up on WTVP's "Docs on Call," as we age, our brains and nervous system go through changes.

We're going to look at the differences between normal slowing down and serious problems.

(bright music) (bright music continues) Good evening, and thanks for joining us for WTVP's "Docs on Call."

I'm Mark Welp.

Tonight we're talking about things neurosurgeons deal with, including falls, brain injuries, and degenerative conditions in our older population.

Dr.

Megan Finneran is a neurological surgeon with Carle BroMenn Medical Center in Normal.

Thanks for joining us tonight.

We appreciate it.

- Thanks for having me.

- So, as a neurosurgeon, tell us some of the things that you deal with on a daily basis.

Tell us about your job.

- So we deal with the brain and the spine, and, of course, surgical fixes for pathologies involving the brain and the spine.

Things that we see a lot of, as you kind of already mentioned, especially in the elderly population, as we get older, people fall.

And even when... You don't have to be elderly to fall.

I mean, I have a huge scar on my wrist from when I fell running.

People fall all the time.

But falls result in compression fractures.

They result in traumatic brain injuries, which is bleeding on the brain, bleeding in the brain.

Falls result in herniated discs.

Rolling over in bed can result in a herniated disc or a compression fracture.

We deal with brain tumors.

We deal with degenerative changes of the spine, kind of deal with the whole nervous system and how to help people get their quality of life back.

- Well, let's talk about the aging process a little bit, and let's focus on the brain at first.

You know, when we age, we could feel it in our bones.

We could see our skin changing.

But the brain obviously is not something you can just look at and see what's going on from looking at a person.

So what is going on with our brain as we get older?

- Well, the biggest thing that happens as we get older, our brain is a muscle like any other muscle.

So you can imagine the muscles, if you're looking at a bicep of a 30-year-old versus a 90-year-old, the 90 year old's biceps are a little bit smaller.

So we call that muscle atrophy.

The same thing happens in the brain.

The brain actually atrophies and shrinks a little bit.

And as that muscle, the brain itself, shrinks, there's more space around it, and there's more opportunity for blood to accumulate when you fall, bonk your head.

And then, of course, that's confounded by, a lot of people, as they get older, have heart problems or other clots, problems in the body that require you to be on blood thinners.

So it's kind of, can become a worst-case scenario.

You're elderly with a shrunken brain.

You're on a blood thinner, maybe for atrial fibrillation with your heart or something like that.

These can be aspirin, Plavix, Eliquis, Coumadin, all of these names of medications.

So this is a lot of what we see.

And then you fall, you bonk your head.

That extra space around the shrunken brain is waiting for blood to accumulate in it.

So then we're taking care of those people in the hospital.

- Well, we can't do much about aging, but in terms of, you know, outside factors that may have an effect on your brain, I mean, I don't know, smoking, drinking, pollution, things like that- - Definitely.

- What else would have an effect on your brain?

- So there are big things that, there's a big push now for social engagement and how this helps.

Of course, it can't totally reverse aging, but it can help.

Things like doing the Wordle... I'm not trying to advertise for anything, don't get me wrong.

- Gotta do crossword puzzles.

- Yes, crossword puzzles, Sudokus.

But there's something also to be said for social engagement, having a network of whether it be family, friends.

And things that I also tell patients, things that we don't even think about, as we get older, our hearing becomes poor sometimes, many times.

And it can be very easy for people to withdraw when that happens.

You might notice your grandparents, great-grandparents, when there's a big family party, it's hard to keep up when you can't hear well, so people kind of disengage from the conversation.

And this, over time, can be really detrimental to your health.

So I try to tell people, even if I'm seeing them for a spine problem, say the basics are see your primary care doctor, get your vision checked, get your hearing checked.

Another huge thing related to brain and spine problems is working on balance.

Because working on your balance then can fight this problem of falling and what can come with it.

- A lot of people as they get older, too, worry about Alzheimer's, dementia.

Can you tell us the difference actually between Alzheimer's and dementia?

Because I think people use them interchangeably, yeah.

- Interchangeably, absolutely.

So dementia is kind of this overall umbrella term that we use for kind of confusion that comes with the aging process.

It's, again, just a general term.

And under this large umbrella of dementia, there are many different pathologies.

One of them as Alzheimer's.

Parkinson's can have a component of dementia with it.

And it's very frustrating, of course, for patients, for their family members, to receive this diagnosis of dementia.

Because oftentimes, as surgeons, there's not anything we can do to help or to reverse it.

But there is one instance of this, under this umbrella of dementia in which we can make a difference.

And this is a very important thing for our primary care doctors and for people in general to know about.

And this is called normal pressure hydrocephalus.

How this presents, we kind of learn this classic triad in medical school of wet, wacky, and wobbly.

So wet is urinary incontinence, trouble controlling your urinating.

Wacky is kind of dementia, confusion, difficulty remembering things.

And wobbly is an unsteady gait, difficulty walking.

And so this classic triad is paired with a head CT, when we do a scan of the brain.

It shows the ventricles, the fluid spaces in the brain are very large.

And this is something that we do often see in the elderly population as the brain shrinks.

But when the large ventricles are paired with those three symptoms, we can work it up for normal pressure hydrocephalus and a shunt, putting a tube to connect the brain, to drain that fluid into the abdomen can really reverse those symptoms.

So this is one hopeful dementia diagnosis under that large, overwhelming umbrella.

- Is that procedure relatively new, or has that been around for a while?

- No, it's been around.

It's been around, yeah.

It's called a ventriculoperitoneal shunt.

- Never heard of that before.

So at what age do you think people should start trying to be cognizant of those Ws?

- Well, I would say, probably around 60s, start keeping an eye out for it.

In general, we probably are treating people in their 70s and 80s with the shunt is when we most see people.

But I do think the three Ws are a great thing to have in the back of your mind as we all get older and our families get older.

- As we get older, and let's say, we get a yearly checkup, is our physician typically looking out for symptoms of maybe brain issues, or is it something where something happens, and then you go to your doctor and say, hey, I wanna know what's going on.

- Right, it's usually the latter.

Because while we have preventative screening for colon cancer and things like that, we really, it doesn't make sense to do an annual head CT or something along those lines.

Because a CT does carry radiation.

So it's not something that we order willy-nilly.

It's something that we order when we're specifically looking for something.

So it's more following those symptoms and then leading down the road to work it up.

- So give us some examples of something.

Let's say you have a person in their mid to late 60s.

They know they're slowing down.

But at what point should they be concerned about something that's happening to them, thinking, oh, maybe I should go to the doctor and have this checked out?

- Well, in all honesty, it normally comes when family members notice it, you know.

Because it's hard to accept as we get older that anything is slowing down.

I mean, why can't I still run at the same pace when I was 30?

Why can't I maybe still do a cartwheel or anything like that?

But what we often see is family members are kind of picking up.

But it could also be the patient themselves that are saying, I am just, I'm not remembering where things are in my house.

Or especially if you're driving, getting confused about a route that you know you've taken probably your whole life, these are big kind of red flag warning signs.

- And in that case, should a person go to their regular family physician first- - Yes.

- and then if something happens- - I always say that is the best place to start.

Because in general, hopefully you have a great relationship with your family doctor.

They've known you for years, decades even.

So it's hard for me as a surgeon, when I meet you in a snapshot in time for 30 minutes.

I can make a stark judgment.

But I don't know how that evolution has been over time.

So I always say start with your family doctor, who knows you the best.

But it's also important as a patient to advocate for yourself.

And if you feel like something isn't right, keep pushing until you get answers.

You might not like the answer, but at least an answer.

- Sure, have to advocate for yourself.

Tell us about, you know, people often wonder with dementia and Alzheimer's, Parkinson's, are those genetic?

- Oh.

(laughs) - No easy answer on that one?

- Right.

Right.

There's a lot of speculation now that there may be genetic links.

And there's a lot of research going on about it.

So the answer is potentially, I would say.

- Okay, and is there anything... You know, we mentioned staying active, talking to people, and maybe not doing those things that are bad for your body.

Any other things that you recommend people do and not do, to hopefully prevent getting some of these conditions?

- As you mentioned that we forgot to really highlight, not smoking is huge.

Smoking is, everybody knows this, even smokers in general know this, it is so bad for your body.

It's bad for every organ.

It's bad for your spine.

It's bad for your brain.

So this is a huge thing.

It decreases oxygen delivery to every organ of your body.

- I was gonna say, tell us why it's bad for the brain.

Because I think people think lungs, heart, obviously, but tell us about the blood flow and things like that.

- So, decreases blood flow, it affects your arteries, all of the vessels in your brain.

And as you mentioned, we all know that it hits the lungs.

But what a lot of people don't realize is, when you have lung cancer, lung cancer very often can spread to the brain.

We see a lot of metastatic tumors that have come from the lung, and then people develop brain tumors.

And in general, it is in people who have smoked.

- As a neurosurgeon, can you kind of break down a little bit... You know, you mentioned all the things that people come to see you about, which is a lot, but what are some of the the biggest ones?

- So biggest ones are brain tumors, compression fractures is huge, so a fracture of the spine, and then degenerative changes of the spine.

So these are words that maybe you've heard of, lumbar stenosis, cervical stenosis, lumbar radiculopathy.

There's all kinds of words that fall under this, again, umbrella of degenerative spine changes.

And what this means is, again, as we get older usually, arthritis and wear and tear on the joints in the spine can cause a thickening of the joints themselves.

So I always tell people, if you've seen someone with really bad arthritis in their knuckles, how those knuckles become super overgrown, the same thing happens in the joints in your spine.

And those joints become thickened and overgrown, and they push in on the canal where your nerves pass through.

So you can imagine if the space for the nerves should be this big, and with arthritis, it becomes much, much smaller, the nerves that go to your arms, to your legs become severely pinched off.

So people come to see us with maybe pain that shoots down the arms, pain that shoots down the legs.

Or the biggest one that comes with that narrowing is something called neurogenic claudication, when people say, you know, I cannot stand or walk more than 10 minutes.

If I'm standing washing the dishes, I've gotta lean over.

If I'm at the grocery store, I am leaning on the shopping cart.

That's a huge one.

So if you ever find yourself unable to stand, walk more than a few minutes, this is definitely something to look into.

Because surgery can make a huge difference and totally give you quality of life back.

Not in every case, of course, but in general.

- When you're talking about surgery, especially on your brain and your spine, that's scary territory.

I mean, what kind of risks are involved in that for the patient?

- We always say, anytime you have surgery, this is kind of my blanket statement, bleeding and infection, of course, anytime we cut the skin, and consequences of anesthesia, which are admittedly a little bit greater as we get older.

But now we're operating on people in their 90s, and they're going home the next day.

Not always, again.

But other risks of surgery itself depends on where it is.

In the brain, there's risk of seizures.

There's risk of weakness.

In the spine, if we're working around the neck, we're working around the spinal cord, the carotid artery, the esophagus.

This is all high real estate areas.

But for us, it's a big deal for a patient, of course, but for us, we're very comfortable in that region.

- A lot of people, you say surgery, doesn't matter where, and they're like, no thank you.

- Right.

- And a lot of people would just love to take a magic pill and make it all better.

So tell us a little bit about some of the medications that are out there.

And I know there's... That magic pill, that magic bullet usually doesn't exist.

But what is out there that can help people with these different conditions?

- I always tell people, unfortunately, I don't have a magic wand, like we all wish we had.

But as far as medications, I really urge people to stay away from narcotics.

We all know that these are super addictive.

And when you have a chronic problem, especially with your spine, narcotics are not going to help.

They will help in the short term.

But your body will slowly adjust and require more and more and more of that.

- Now, when you say narcotics, are you talking about pain pills?

- Yes.

Yes, sorry.

- Okay.

- Thank you for clarifying.

These are Norco, oxycodone, hydrocodone, kind of under that blanket term.

But things that can help, over the counter, the category of NSAIDs, so this is Aleve, ibuprofen, a little bit stronger is naproxen, meloxicam.

These are very good for that arthritic pain that people can develop.

Other medications that are good for nerve pain, that kind of radicular pain that can shoot down the arms, shoot down the legs, this is a class of gabapentin, Lyrica, things along that nature that can be helpful.

In the short term, if we see someone that maybe they're on a blood thinner, so they can't have surgery today, we have to wait a few days, steroids can help a lot in the short term.

So a Medrol Dosepak is generally what we give, when you take six pills, then you take five, then you take four, and you taper down.

But, again, that's really only a short-term solution.

- Okay, so there are some things out there that might help, but like you said, nothing's perfect.

- [Megan] Right.

Right.

- Now I want you to take off your neurologist hat and put on your psychiatrist hat.

- Oh boy.

(laughs) - How do you, when you see that family member who you think is having issues, especially one that's stubborn, how do you get them to see a doctor or get them to change their lifestyle?

What's your advice?

- Well, I'm big fan of the concept of inceptioning people, so putting an idea in their head and making them think that they came up with it.

This is my favorite thing to do.

- I do that- - I do it with patients - with my boss.

- all the time.

(both laugh) So there you go.

- Yeah.

- But the biggest thing is prioritizing safety.

And it's the patient, the patient safety, everyone around them, especially if we're talking about driving.

I see people sometimes with a foot drop.

If their foot is weak, I'll say, I hope you're not driving around Bloomington, because I'm driving around Bloomington.

So if you don't care about you, you better care about me.

Because if you can't hit that brake pedal, we're both in big trouble.

So I think emphasizing safety, and, again, if they don't feel that it's a problem for them, saying, what about everybody else on the road?

Or really emphasizing, we are doing this for you, and it's a safety issue.

- Yeah, I remember having to have that talk with my grandma.

We were kind of suspicious, but then one day, I had to follow her somewhere.

And witnessing what was going on was not good.

So yeah, those are tough talks to have.

And especially, again, you know, I know people who have hearing aids, but they don't use 'em.

Glasses, but they don't use 'em.

But when you're talking about your brain and your nervous system, I mean, that is serious, serious stuff to talk about.

- Yes.

- So when you have a relative who's getting older, again, what are some of the signs maybe you should look for that maybe they're just slowing down a little bit, and what's the difference between slowing down and needing to have a real lifestyle change?

- Right, so there's two factors.

There's slowing down physically, and then there's slowing down mentally.

Slowing down physically can be, well, you know, before, Grandma was able to, she was walking around, cleaning the house, doing everything by herself, and now she's maybe just cleaning the kitchen one day and then cleaning the living room the next day.

This is normal, physically slowing down.

When people get to the point that they are basically recliner-bound, when Grandma or Grandpa is sitting in the recliner... I always tell my parents, I will never buy a recliner, because it's so comfortable.

- I know.

- I sat in my parents' one time, and I said, I am never buying one, because this is way too comfortable.

But when you notice someone is basically living in their recliner, this is a physical problem.

But it also can pair with kind of the emotional and mental withdrawing.

Because not only are they physically in the corner, they're probably missing out on a lot of the engaging conversations that are happening.

As far as the mental decline, what's normal versus, what's normal slowing down versus what's abnormal, normal slowing down is maybe you have to remind them of things.

I mean, I always tell my husband, you have selective hearing.

So I don't know what is... I don't know if you're getting older, or you just don't listen to me.

(laughs) But the biggest issue is if they are confused.

They do not know where they are.

They do not know what's going on.

And especially as we get older, oftentimes we're hopefully staying in a community in which we're familiar.

So if you're getting confused going to a grocery store you've been going to for many, many years, this is a problem.

- Going back to falls, are there things people can do in their homes to, I mean, it's impossible to prevent 'em totally, but maybe to safeguard a little bit.

- So, again, it's very hard to accept that you need assistance in any way.

We all want to pretend we will be 30 forever.

But it's not the case.

It's not realistic.

So using a cane, it's a very hard pill for a lot of people to swallow, to acknowledge, I need this assistive device.

But it's a lot better to walk with a cane than to spend several days in the hospital after you have a nasty fall, so acknowledging when it's time to use help, getting around the house, whether that be a cane or a walker, and if you're worried about yourself or a family member, talking to your primary care doctor, and getting hooked up with physical therapy is a great way to start.

Because physical therapists can not only help strengthen the legs themselves but can also identify, oh, your gait, how you walk is not very steady.

Maybe we can talk about some ways to help you feel more comfortable when you're walking, when you're moving around the house.

So assistive devices is a big one.

Working on balance is huge.

Don't try this at home, I always say, without something to grab onto.

But it's a good test.

Can you stand on one foot?

Can you stand on the other foot?

How long can you do it?

And just every day while brushing your teeth, just trying to balance a little bit.

And paired with balance is core muscle strengthening.

So, again, this is a great thing that physical therapy can help with.

Or if you feel you don't need physical therapy, go to a gym, get a trainer.

They can show you exercises.

Or just go on the internet.

I mean, the internet is such a wealth of sometimes too much information, but just looking at basic core exercises.

When people come see me in clinic, I usually hop up on the bed and show 'em a few things that they can do at home.

We'll save that.

I won't make you do that today, but.

(laughs) - Well, I always, you know, tell older people in my family, too, you had kids for a reason.

Make them cut the grass.

- Totally.

Totally!

- You know?

Kids, grandkids, you don't need to be out there cutting the grass or, God forbid, on a ladder, you know, cleaning out your gutters.

- I had a patient recently who was two weeks post-op from a brain tumor, and he said, "Can I cut the grass?"

I said, no!

No.

- No.

- He said, "Well, it brings me a lot of joy."

I understand, but we're gonna... In the spring, the spring, you'll be ready.

(laughs) - Yep, you gotta be careful.

Well, this has been very great information.

We appreciate it.

Dr.

Megan Finneran is a neurological surgeon with Carle BroMenn Medical Center in Normal.

Thanks for all the tips.

- Thank you.

- Appreciate it.

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