- Hi, and welcome to "Ask The Specialist."

Tonight we ask the doctors on WCMU, public television.

(upbeat music) Hi, and welcome back to another live edition of "Ask the Specialists."

My name is Stephanie Mills, I'll be your host for the next half hour asking local doctors your health and wellness questions.

So thanks for joining us tonight.

Let me introduce our guests to you this evening.

I'm joined tonight by Dr. Lacey Gardner and Dr. Michael McConnon with the Isabella citizens For Health here in Mount Pleasant.

I just wanna say, thanks guys for joining us this evening.

- [Michael] Thank you.

- [Lacey] Certainly glad to be here.

- Before we start diving into our questions, doctors can you take a minute to tell our viewers who are watching us tonight a little bit about yourselves - I'm Lacey I'm from Mount Pleasant.

I graduated CMU's PA program in 2007, and I've been mostly in family medicine here in town since then.

- [Stephanie] Okay, awesome welcome.

- Thank you.

Dr. McConnon.

- So I'm also at Isabella Citizens For Health.

I'm a family physician I've been in Mount pleasant since 2014.

Before that I was in the Navy.

Really love the community and so we have a great practice, yeah.

- Awesome.

Again, thank you for taking the time to be here.

To our audience, watching us this evening.

If you have a question for our physicians tonight there are a few different ways for you to be a part of this conversation.

You can call the number that's on your screen.

It's 844-975-3343.

If you're watching us on Facebook tonight you can also post your question there and it will make its way up to me.

So there are a few different ways for you to be a part of this conversation.

Everything that's asked here is completely anonymous so don't hesitate to pick up the phone and give us a call tonight.

Doctors, while we wait for those questions to make their way up here we've done this topic a lot over the last few months and it's understandably been pretty popular given our situation right now with COVID and the pandemic.

So I wanted to give an update real quick on the latest numbers that came out this afternoon from the State which is we're still going through a pretty positive moment, I think right now.

I think are the daily confirmed cases today.

It was just under 1400 which brings our number to 585,352 total confirmed cases since the start of the pandemic.

Another bright spot is the positivity of tests coming back, dropped below 3% today and then another good news is... More good news is, the total number of vaccinations that have been administered is over 2.6 million.

So again, I think that there's good things happening there's progress and I think people are starting to feel a little bit more hopeful.

But to stick with the vaccine right now I think a lot of people still have questions about it mainly who qualifies, who's eligible?

Can you talk a little bit to those CDC guidelines?

Where are we with that right now?

- Yeah, I'll start and right now... Well we have the two vaccines that are approved Moderna and Pfizer, Johnson and Johnson is on the way.

Right now, people over age 65 here in Michigan can get it.

Certain counties have different rules just depending on how how they've rolled it out.

I think starting March 1st more food workers can get it particularly people that work in agriculture are eligible for the vaccine.

We still have teachers, healthcare workers, nursing home residents.

If some of them haven't been vaccinated yet are still eligible for it as well.

More vaccine doses are being rolled out, more sites, continue to become vaccine distribution sites to administer it.

More pharmacies are getting it, some clinics are getting the vaccine and getting it out there in the community.

So I just recommend people put their name on any list they can.

- And that's a good thing.

With the point that you bring up.

How can people get registered?

What are some suggestions that you can offer?

- I think different locations have different plans in place.

We have, when you call our main number.

At our office there's a selection for our COVID hotline that has some information on how to go for it with our clinic.

I know, I think the health department is registering people mostly online.

I think one of the challenges I've heard is that many places registered primarily online and some of our patients that are at the highest risk, maybe older people that don't have a great deal of experience with the internet and hopefully their families can help them, but- - Sure, and I know that, I think some people have had luck registering with like Meijer or Rite Aid I think too was giving choices there too.

Okay, cool.

All right.

So switching gears real quick, talking about the flu.

There was a report I think today that this week that the flu has dropped significantly.

I think we probably know why that's the case but can you speak a little bit to that?

- Sure and we see the same in our practice.

I think there is a couple of big reasons.

Number one, is the social distancing and number two, would be wearing masks.

Those two things together I think are the biggest drivers of a decreased influenza.

The other great thing is people are washing their hands we should have been doing that a long time, but I think that's helped a lot.

And we've seen a lot higher numbers of flu vaccine given this year too.

- Okay, got it.

Now, if someone is still interested in getting a flu vaccine can they still get a flu vaccine?

- [Michael] Mm hmm - Okay.

- [Lacey] Yep.

- All right.

We have our first call from Pentwater this evening.

They wanna know.

Do you believe that Osteoarthritis injections are helpful or do they hurt?

- Well, I think it depends on exactly what type of injection we're referring to.

There's a couple options most specifically with knees.

I'm not sure if they're referring to steroid injections for osteoarthritis like cortisone shots or if they're referring to there are some that are to increase the fluid in the knee.

Like Synvisc, Supartz are a couple of the names.

So I'm not sure which one they're referring to.

I don't think there is a great deal of evidence in long-term benefits, though there can be some short term relief from those kinds of things, I think in conjunction with a lot of other, with the exercise being the main thing that is helpful they may provide some short-term relief, but- - [Stephanie] Okay.

- Yeah, and to go on that with.

so for different osteoarthritis, you know knees definitely the ones we do the most injections with but you can do injections in ankles, whatnot.

And they are really a stop gap to help people to get to do those exercises which are very important in osteoarthritis and to work on exercise, weight loss.

That sort of thing which also help osteoarthritis a great deal.

- Okay, all right.

Next question, caller from Manistee, tonight "Have they found the cause of trigeminal neuralgia?

Am I saying that right?

- Yes, trigeminal neuralgia.

- [Stephanie] Okay.

Yeah.

I mean, we kinda know the pathophysiology of it with the trigeminal nerve getting inflamed, it can sometimes have some impingement from the vasculature as...

I'm doing the thing where it is.

(laughing) And they can actually target that with gamma procedures and that's been kind of really a crazy awesome thing that they can do but medication works pretty well for it too but it is, it's very debilitating, not great disease.

- Okay, got it.

Next question.

"Are there any home treatments for gout?"

- Yeah, I mean, there are, I mean if a lot of people were to do the cherry juice or cherry extract, yeah.

Anti-inflammatories help on... Again of gout big thing is avoidance of the triggers.

- [Stephanie] Okay.

- Mainly alcohol.

- Got it all right.

A question that we get a lot on this topic during doctors is leg cramps, people with leg cramps in the evening, what can they do to find some relief?

- [Michael] Yeah - Well sometimes they can be associated with electrolyte imbalances.

Magnesium being low is one of the particular triggers.

So I think they should probably seek their provider's input first of all, to make sure that they don't have something off along those lines.

Sometimes magnesium supplements are gonna be recommended that may help.

Important to be hydrated, exercising, stretching after exercise but most commonly magnesium would be one of the main things we recommend.

- What about kids with restless legs and that, Is that the same thing?

Do you think it's a magnesium issue?

Is it a growing issue?

- Probably with children it's more of a growing issue, and other things that can trigger that, caffeine.

So if kids are drinking too much caffeine or too much sugar that can play a role with it.

For all kids and adults too, making sure you have good fitting shoes, with decent support, that helps a lot.

Stretching even more so than for kids but for adults is really the tried and true evidence-based approach to it.

Doing calf stretches before bed can really help reduce those spasms.

For kids with restless legs, really what you wanna do is make sure they're getting enough play during the day not sitting around too much, not drinking too much caffeine and high sugar stuff.

- Okay, all right.

Good advice.

Next caller, "My feet feel like they are swelling "and getting sensitive when I lay down "should I be concerned?"

I know this is probably hard without actually seeing.

- Yeah, and it really depends on the age of the person, what medications they take.

I would really recommend they seek out their provider and discuss some of that with them.

- Okay, all right.

Caller from Ionia.

"Have you experienced anyone having any type "of negative reactions to the vaccine "while taking biologic medication?"

- I've not seen any specific reactions, I don't believe there was any specific studies that I could point to, of people on biologic type medicines.

I'm assuming they're referring to medications for RA and that type of medication.

And at this point I think we feel that the risk of COVID to people with that autoimmune system is potentially high and so I think that any potential risk of the vaccine is probably far outweighed by the benefit of helping them prevent COVID.

I have not, in the people that I've seen who've who've had the vaccine and have been on those medicines, I've not seen any problems for any of them.

So I still am certainly recommending it for people in that group.

- Absolutely.

And it's a go along with, potential side effects.

I think people have heard that there are potential side effects from the vaccine but it doesn't sound like there are any different than other vaccines.

Correct?

- There are some little bit more significant the Shingrix vaccine which is a shingles vaccine actually has a very fairly similar reaction to the COVID-19 vaccines.

I don't wanna undersell the side effects because people do have them.

I mean, fevers, body aches headaches, lymph node swelling.

One of the things we did see with the COVID vaccine is that if you've had the vaccine you shouldn't have a mammogram for at least a month to six weeks later because you'll have lymph node swelling under the arm which can sometimes lead to a false positive mammogram.

So we'd recommend not doing that.

So there are real short-term side effects.

The thing that... Well to what Lacey said is exactly true though that was that the risk of COVID with the longterm effects of that far outweigh the risk of the vaccine?

- Sure, absolutely.

We were talking a little bit prior to starting the show about the mental health impact that the pandemic has kind of created overall.

And I wanna take a minute to talk about that because I think that a lot of people are struggling with mental health especially in Michigan this time of year it's hard and there's all these other factors right now.

So for someone that might be having a difficult time with mental health, where's a good starting point for them to find some help.

Can you talk a little bit about what you... How are you helping?

- I think starting with the primary care provider is one of the main options.

We do a good majority of the treatment of mental illness in our community and in many communities most of the country.

I think primary care is the place to start, will very likely may offer things like referral or recommendations for a therapist or potentially medicines.

We can talk with them about weighing those risks weighing the benefits, what's gonna be best for them.

And, with familiarity in our community of who therapists that might be a good fit for them are or if medicine's an appropriate option, many of those can be managed by primary care.

And if we don't feel that it's something intended for primary care, if it's best that we refer to a psychiatrist, we can certainly do that.

But I think definitely seeking help is really important.

Especially at this point, I think there's a lot of people that have limited their contact with healthcare providers most of them are unaware of the fact that many of us can do tele-health, we can talk with them over the phone, we can do video chats.

There's a lot of things we can do if they don't feel comfortable coming to our office, if they feel like there's too high of a risk of COVID by coming into the office they wanna do a lot of home based a lot, we can do that way.

So hopefully they can feel comfortable.

- And that's a really good point that you bring up.

Telehealth has really taken off.

And it's such a convenient way, I think to get in touch with someone, not just mental health necessarily but even just regular doctor visits I think too, it's happening more and more.

Awesome, all right.

Cool, caller from Charlevoix, "What are some treatments for gastroesophageal reflux - Gastroesophageal reflux.

- Sure.

- So yes.

So that's heartburn.

So great treatments for heartburn.

There's a lot of over-the-counter treatments.

There's a famotidine there's omeprazole, esomeprazole.

The trade names or Pepcid, Prilosec and Nexium, those types of things.

But there's a lot of dietary things you can do too.

Cutting down on acidic food, cutting down on spicy foods, cutting down on coffee, caffeine, eating earlier in the day so that you're not eating an hour or two before you lay down at night that's huge.

Eating smaller meals, stopping when you're full.

I mean, that kind of stuff really can help and have a great benefit with gut.

- Sure, absolutely.

We have a question from social media.

Let's go to that.

"Is having kidney stones removed "considered an elective surgery?"

- I mean, it depends on how big they are, if they're obstructing.

If you have an obstructing kidney stone, then that would not be considered really an elective procedure 'cause you don't want that to go on.

I mean, anyone who's had a kidney stone knows you really want that taken care of pretty quick.

- Okay, next question.

"I'm told I have no..." Caller's told that they have no iron "and specialists can not figure it out.

"It's not my GI tract "and they've had multiple infusions.

"So what could this be?ú - If I'll kind of start there.

'Cause that sounds like they've had a decent workup.

Hopefully they've had some different endoscopies looking at the stomach the colon looking for malabsorption, which can happen if there's any problem with the GI tract and they're not absorbing the iron in.

That would be my thought.

I don't know if you have any other thoughts on that, Lacey.

- Yeah, I don't necessarily.

Typically the workup starts with an EGD and colonoscopy but the visualization of the small intestine that's kind of between there is sometimes more complicated.

They can do capsule endoscopy which takes a look at the small bowel.

They may need some small bowel biopsies to find out.

Typically the GI tract in some capacity is very likely to be the source there.

It may be less that it's not the GI tract and more that they need to find where the GI tract is or why they're not absorbing.

- Or in also menstruating women if you have very heavy cycles and periods you lose a lot of iron that way too.

- Sure, okay.

Next question.

Person has low sodium and potassium levels.

What could be the cause of this?

- So there's a lot of things.

Medications, there's a lot of medications that will affect your sodium and potassium levels.

So if they have that hopefully they're discussing with their doctor about that.

If they drink actually too much water.

You can drink too much water that's...

So if you're trying to drink a gallon of water a day or more, drinking when you're not thirsty that can do it.

But that's probably less likely.

There's some adrenal issues that can lead to low potassium and low sodium.

Very rare though.

Typically it's medication or diet.

- "What are the best supplements for a diabetic?"

- So I'm gonna start 'cause I'm not a big supplement fan- - Okay, all right.

- By and large I think if you take a supplement if you take a multivitamin, let's say and you feel like that helps you, great more power to you.

Lot of studies have been done that they're really not that beneficial.

The supplements that are helpful for pretty much anybody.

Vitamin D here in Michigan, 1000 to 2000 units a day, that's not harmful, that probably helps people.

Fish oil maybe has some benefits with our eyes, with the joints not as much cardiovascular, it does give you a good fish burps.

That's pretty effective at that.

Vitamin B12.

A lot of people are low on particularly people that don't eat a lot of fresh vegetables or are vegan or if they're alcoholic can have low B12.

Beyond that, I don't know if you have anything else.

- I would tend to agree.

I don't think that there is a great deal of evidence for many supplements, except for, in people who are low in.

And so if there's specific symptoms if they're specific reasons then their provider may order labs looking at their B12, looking at potentially their vitamin D, things like that and then we may recommend specific supplements.

Oftentimes when we pick a multivitamin I feel like there's a competition amongst the multivitamin companies to list as many different ingredients as they got.

- [Stephanie] That ain't right.

- All that really means is there's a very tiny amount of each of those things.

And if they're actually low in B12 a multivitamin probably isn't gonna have enough of what they really need.

So I don't think there's any one size fits all recommendation on that.

- So if not supplements then probably just following a healthy diet, right?

- [Michael] Yeah.

- Okay.

- [Michael] More plants.

- [Lacey] Yes - More plants.

"I'm calling from Mount pleasant.

"Can someone be misdiagnosed with epilepsy?

"Does it appear randomly "or as a child?"

Or does it appear randomly when you're a child?

- Well, epilepsy doesn't always present itself in childhood.

So someone certainly could develop a seizure disorder in adulthood.

It can be misdiagnosed.

There's overlapping types of symptoms, there are conditions, particularly in people with something called a convulsion disorder which can look a lot like seizures that can present if they have sometimes severe trauma or anxiety different things in their history can contribute to that.

So it certainly could be misdiagnosed, typically an EEG is done and that evaluates for seizure activity.

And so sometimes we can tell them that.

Okay, next question.

"Parkinson's disease.

"What is it?

"How's it caused?

"Is there a cure for it?"

- So Parkinson's disease is a degeneration of a part of the brain related to dopamine.

And unfortunately it's a progressive disease that we don't have a cure for at this point in time.

We have symptomatic treatment for it but there's not unfortunately a good cure.

And Parkinson's can have a wide variety of symptoms from resting tremor, to difficulty with walking, gait problems, constipation, urinary retention.

But what I would tell anybody with Parkinson's and particularly early onset Parkinson's.

Even though it's a progressive disease, we don't know the rate of it.

Unfortunately everyone has that story of someone who had a rapidly progressive Parkinson's.

However, there are many people that have Parkinson's for years and years and it slowly develops.

And so it's not a death sentence by any stretch but it is something that is progressive.

- How do you manage those symptoms?

- There's a lot of different medications.

I mean, pretty much unfortunately that's mostly medications.

There are vagal nerve stimulators which are actually electrodes are placed.

And those are for very severe Parkinson's patients with a lot of tremors, but otherwise it's mostly just medication.

- What about physical therapies is that another way to kind of manage that too - There is a specific type of physical therapy called the Big and Loud program, and that is particularly helpful and that can help with both some of the speech aspects, as well as balance and walking and that focus on as it says, helping them make big loud movements.

- Sure, okay.

Perfect, next question.

"Can taking multiple medications with side effects "cause compounding side effects that make you feel worse?"

- [Michael] Yes.

- [Lacey] Absolutely.

- Yes, so that's probably one of those things where, make sure your doctor is aware of all your medications that you're taking.

- And in my pitch for primary care which Lacey and I are both in.

I mean that's where a really good primary care provider can take a look particularly if you're seeing multiple specialists, look at your med list, put it together figure out if there are significant interactions and help to discern a good care plan for you.

- Okay.

Back to another vaccine related question.

Caller from Midland wants to know is it safe to take the vaccine if they have a heart murmur?

- [Michael] Yes.

- Yes.

And there are some cases where doctors... Maybe everything should be discussed with your doctor.

- [Michael And Lacey ] Correct.

- Correct.

But for the vaccine, pretty much, if you don't have a significant allergic reaction to vaccines, 'most everybody's pretty safe for it to get it.

They're not live vaccine, so there's not a concern with that.

- Got it.

This caller suffered a bad fall with a head injury and was rushed to a trauma room, but the doctor never found that they had a few broken ribs.

They didn't initially find a few broken ribs.

How would they miss something like that?

Is that something that can happen later?

- I wouldn't say that happened later but- - [Stephanie] Again it's hard not to be there.

- Rib fractures on x-ray if what they did was an x-ray, sometimes are not easy to see 'cause you're taking that picture through lung tissue and so there can be kind of some lines that can obscure.

So rib fractures are not always picked up easily on x-ray.

The other thing is sometimes if there's no indication of underlying injury, we can't do a lot about rib fractures and so it's not always the first priority.

I imagine in a trauma situation, they're focused mostly on if there were a chest wall injury.

Was there injury to the lungs Was there injury to the heart?

They probably focused a lot of their attention on that.

And so it's not a deal that they maybe weren't picked up right away, just so that the patient could have had some good prognosis of when they could expect to feel better.

But it's not unheard of by any means that they'd be missed in that setting.

- Okay, we have one more question from Facebook "Will excessive hand sanitizer be harmful to my skin?"

- [Michael] It can dry out your skin.

- I was gonna say it's probably not super harmful but it definitely dries out our skin.

And it's winter so of course now we're feeling that dryness from multiple angles.

From the weather from hand sanitizer, and washing our hands more.

So just- - [Michael] moisturize' - You should have a good moisturizer.

- Yep, unscented moisturizers, the perfumes in a lot of those soaps and that can really actually aggravate the skin more.

- Sure, absolutely.

Well, we are just about out of time.

Thank you again, both for being here tonight and being a part of the program.

Thank you at home for watching.

We are going to be off for the next three weeks but we will be back with the new live show on March 25th.

We'll see you then.

Have a great night.

(bright upbeat music)