YOUR HEALTH AND MEDICAL QUESTIONS.

SO LET ME WELCOME A GUEST WE HAVE THIS EVENING.

I AM JOINED BY DR.JANET NUNN AND PHYSICIAN WITH CENTRAL MICHIGAN COLLEGE OF MEDICINE THANK YOU FOR TAKING THE TIME TO BE HERE TONIGHT.

BEFORE WE GET TO THOSE QUESTIONS FROM THE PHONES CAN YOU EACH TALK ABOUT YOURSELVES AND YOUR AREA OF SPECIALITY SO THE VIEWERS KNOW WHAT YOU SPECIALIZE IN.

DR.AMARI.

WE WILL START WITH YOU.

>> YEAH.

I AM BASE TRAINING.

I AM A FAMILY MEDICINE BOARD OF PHYSICIAN BUT ALSO DID A FELLOWSHIP IN MANIPULATIVE MEDICINE, SO I AM BOARD CERTIFIED IN MEDICINE AS WELL AS PRIMARY CARE SPORTS MEDICINE SO IT IS KIND OF THREE TIERED SPECIALITY.

FAMILY MEDICINE, OMM, SPORTS MEDICINE.

>> AWESOME.

OK. HI EVERYONE.

AM DR.JANET NUNN.

I AM A PSYCHIATRIST AND SPECIALIZE IN THE MEDICATION MANAGEMENT OF MENTAL ILL WITNESS WHICH CAN BE DEPRESSION, ANXIETY, SUBSTANCE ABUSE, AND EVEN MORE SEVERE MENTAL HEALTH DISORDERS LIKE SCHIZOPHRENIA, BIPOLAR DISORDER IN ADDITION TO MEDICATION.

WE ALSO DO SOME SUPPORTIVE THERAPY WORK AND WE WORK CLOSELY WITH SOCIAL WORKERS AND PSYCHOLOGIST AS WELL TO PROVIDE A FULL TREATMENT.

3:00.

>> GOT IT.

>> ALL RIGHT.

ALL RIGHT.

SO FROM MENTAL HEALTH CARE TO FAMILY, FAMILY CARE, AND SPORTS MET SIN, WE ARE ABLE TO ANSWER A VARIETY OF QUESTIONS HERE TONIGHT.

THANK YOU.

THAT IS GREAT.

SO DR.S WHILE WE WAIT FOR THOSE, THOSE PHONES TO LIGHT UP.

FOR THE QUESTIONS TO MAKE THE WAY UP HERE, ACTUALLY, LET ME, AT YOU AT HOME, WATCHING YOU TONIGHT.

LET ME TELL YOU HOW TO GET YOUR QUESTIONS TO THUS EVENING.

SKIPPING AHEAD.

IF YOU HAVE A QUESTION FOR A GUEST TONIGHT THERE ARE A FEW DIFFERENT WAYS FOR TO YOU BE A PART.

THOUGH SHOW IS FUELED BY YOUR CALLS AND BY YOUR POST SO TO START CALLING THE NUMBER ON THE SCREEN RIGHT THERE.

844-975-3343.

OR YOU COULD, IF YOU ARE WATCHING ON FACEBOOK, YOU CAN POST THE QUESTION ON FACEBOOK ALL THE QUESTIONS ARE CALLED IN.

ARE IS COMPLETELY ANONYMOUS.

DON'T HESITANT TO PICK UP THE PHONE IF YOU HAVE A QUESTION.

WE'RE HERE TO HELP YOU.

SO NOW, BACK TO WHAT I WAS SAYING WHILE WE WAIT FOR THE QUESTIONS TO MAKE HAIR THEIR WAY UP HERE.

WE HAD THIS TOPIC ON A FEW TIMES THIS YEAR AND I DO WANT TO ALSO SAY QUICK THANK YOU TO CMU'S COLLEGE OF MEDICINE FOR PROVIDING GUESTS.

WE HAD PHYSICIANS FROM THE COLLEGE MEDICINE ON QUITE A LOT THIS YEAR.

UNDERSTANDABLY GIVEN OUR CURRENT SITUATION WITH THE PANDEMIC, SOB WE APPRECIATE YOU ALL TAKING THE TIME TO AND OUR AUDIENCE'S QUESTIONS.

AFTER MANY MONTHS, IT SEEMS LIKE WE ARE STARTING TO SEE A LIGHT AT THE END OF THE VERY, VERY DARK TUNNEL, OBVIOUSLY, STILL SEEING CASE OF COVID HERE HIGHER THAN WHERE WE WANT THEM TO BE BUT MORE PEOPLE ARE GETTING VACCINATED I BELIEVE NOW WITH UNDER 50% OF THE POPULATION HERE IN MICHIGAN HAVING GOTTEN THE VACCINATION SO PROGRESS EARLIER THIS YEAR THE CDC RELEASED GNAW GUIDELINES FOR PEOPLE WHOLE ARE FULLY VACCINATED THEY CAN BE OUTDOORS WITHOUT A MASK OR IN A CROWDED AREA THEN THIS MORNING THE GOVERNOR LEASED GNAW TIMELINES ON RETURNING TO FORMAL DEPENDING ON THOSE NUMBERS WE HAVE A GRAPHIC FOR THAT CHART THERE.

SO THERE YOU SEE NUMBERS.

AS OF THIS MORNING.

WE ARE JUST BEGINNING UNDER 50% VACCINATED AND THE MORE PEOPLE WHO ARE VACCINATED THE HIGHER PERCENTAGE GOES THE VIEWER RESTRICTIONS WE HAVE TO.

SO THERE IS PROGRESS HERE.

SO DOCTORS REAL QUICK, HOW, CAN TALK A LITTLE BIT ABOUT HOW EASY AND SIMPLE IT IS TO GET VACCINATE HERE IN CENTRAL MICHIGAN?

>> YES.

SO I MEAN, JUST EVEN IN THE LAST MONTH, OUR VACCINATION HAS BEEN WAY MORE READILY AVAILABLE EVEN FOR OUR STUDENTS AND OUR FACULTY AND POPULATION HERE ON CAMPUS FOR THE GENERAL COMMUNITY.

YOU KNOW, NOW, BEING ABLE TO BE 16 AND NOW 12 AND ABOVE BEING ABLE TO GET VACCINATED SO JUST A MATTER OF FIGURING OUT, IF YOU GENTS THE TWO-STEP VACCINE, WHETHER IT IS MODERNA OR PFIZER.

WHEN IS A GOOD SAFE TIME FOR YOU TO BE ABLE VIABLE GET VACCINES NOW THAT ALSO, THERE IS A PAUSE HAS BEEN TAKEN OF THE JOHNSON & JOHNSON ONE-TIME VACCINE, THAT IS ONE THAT IS MORE INTERESTING TO A PARTICULAR PERSON NOW FOR FIGURING OUT WHERE IS THAT AVAILABLE.

YEAH.

THE ONLY DIFFERENCE IN IF YOU ARE GETTING A TWO-STEP VACCINE, THERE IS ONE TIME, THE TWO-STEP VACCINE HAS TO BE THE SAME VACCINE SO HAS TO BE MODERNA VACCINE GIVEN BOTH TIME AND CAN'T A FEWER AND MODERNA.

SOP THE AVAILABILITY HAS JUST INCREASED AND KEPT ON INCREASING AS WEEKS ANT MONTHS GO BY THEN WE KNOW WE ARE IN THIS POSITION BACK IN JANUARY AS FAR AS THE NUMBER OF VACCINATION CLINICS WE HAD EVEN ON CAMPUS.

SO AS TIME GUESS ON.

IT IS ONLY GOING TO GET BELTER AND BETTER AS FAR AS AVAILABILITY, SO I THINK EVERYBODY IS GOING TO BE NOW MORE READILY ACCESSIBLE SO EBB SHOULD BE EVEN MORE INCLINED TO GET IT.

>> IT SEEMS LIKE HERE IN ISABELLA COUNTY.

A SIGNIFICANT JUMP WITHIN THE LAST COUPLE OF WEEKS, TOO.

TO SOMEONE WHO MAY PUSH TO STAY ON THAT TOPIC REAL QUICK.

TO SOMEONE WHO MAY HAVE CONCERNS ABOUT GETTING THE VACCINE.

WHAT WOULD YOU TELL THEM.

EVERYBODY HAS DIFFERENT CONCERNS, SURE.

YOU KNOW, IT WINCE OF THOSE THAT FIRST THERE IS A CONCERN ABOUT HOW THIS VACCINE WORKS.

WELL, MRNA.

SO ESSENTIALLY, TO PUTT IT MILDLY THE VACCINE SHOWS THE BODY HOW TO MAKE, YOU KNOW, THE PROPER ANTIBODIES TO THE COVID SO IT IS LAKE A BLUEPRINT THAT GETS INTRODUCED HERE ALREADY NATURAL IMMUNE SYSTEM SO THAT IS ONE OF THE BET ARE WAYS TO HAVE A VACCINE ACTUALLY WINNER CONSIDERING A LIVE VIRUS.

SO YOU KNOW, THERE IS A LOT OF SAFETY DATA KEEPING COMING OUT EVEN MORE AND GENERAL MEDICINE PUT OUT HOW SAFE IT IS FOR PREGNANT PATIENTS TO EVEN GET IT SO THE MORE WE HAVE IT THROUGHOUT, THE MORE SAFETY DATA IS COMING OUT, THE MORE, THE MORE REASONS WE HAVE TO SAY IT IS A SAFE VACCINE TO GET, AND KNOWN SIDE AFFECTS LIKE ADVERSE EFFECTS THAT HAPPEN WITH ANY VACCINE, YEAH.

THAT COULD HAPPEN.

BUT OVERALL, SAFETY OF IT IS JUST BEING MORE PROVEN EVERYDAY.

>> GOT I.

>> WE HAVE A CALLER FROM PRUDENVILLE TONIGHT THIS IS A QUESTION FOR YOU.

WELL, MAYBE.

DO YOU HAVE ANY SUGGESTIONS FOR SOMEONE WHO GETS PANIC ATTACK BEFORE BOWEL MOVEMENTS?

INTERESTING QUESTION.

SO I THINK THAT WOULD PRIMARILY BE A PSYCHO THERAPEUTIC FRAME TO TRY MANAGE THAT.

I WOULD SUGGEST, AND THIS IS GOING TO SOUND CORN WHERE I, I THINK IT WOULD WORK, YOU KNOW, I WOULD SUGGEST DOING SOME DEEP BREATHING EXERCISE, SOME MINDFULNESS, KIND OF BEFORE YOU NEED TO DO THAT, JUST TO BRING YOURSELF HERE, NOW, CENTERED.

IT IS PROBABLY THE BEST WAY TO HAN DEAL THIS.

DON'T THINK IS A MEDICATION FOR THAT.

I THINK THAT IS THERAPY-BASED PACIFIC.

I CAN SEE THAT.

I KNOW KIDS, LIKE LITTLE KIDS MAY HAVE, YOU KNOW, LIKE SOME ANXIETY THERE.

CALLER FROM LAKE AND WHAT CURE FOR RINGING IN EARS?

>> WHAT CURE?

RIDGING IN THE EARS CAN BE A NUMBER OF THINGS.

>> A LOT OF REASONS.

YEAH.

AT MARE OF GETTING THE PROPER INVESTIGATION AS TO WHY YOU HAVE RING IN THE EARS THEN I WOULD BE ABLE TO TELL YOU A PROPER TREATMENT OF IT ON WHY YOU ARE HAVING.

RINGING IS A CONCERN AND NEEDS TO BE CHECKED OUT.

>> GOT IT.

>> THEN ANOTHER QUESTION FOR YOU IT IS ACTUALLY TWO OF THEM.

WHEN DOES BIPOLAR DISORDER SHOW UP IN?

>> GREAT QUESTION.

>> YEAH.

SO BIPOLAR DISORDER IS ACTUAL ACTUALLY QUITE RARE IN CHILDREN.

A LOT OF TIMES CHILDREN WHO ARE VERY ANGRY, GET IRRITATED QUICKLY, VIOLENT, EVEN, THAT IS OFTEN INTERPRETED AS BIPOLAR DISORDER WE SOMETIMES USE THE SAME MEDICATIONS FOR THAT AS YOU WOULD BIPOLAR DISORDER BUT IT TYPICALLY TRUE BIPOLAR DISORDER APPEARS LATE EARLY 20 THAT HE TIMEFRAME.

SO IF YOU KNOW, THERE IS A CHILD THAT IS SLEEP DISTURBANCES OR VIOLENT BEHAVIOR AND OUTBURST I RECOMMEND TAKING THAT CHILD TO PRIMARY CARE THEN MAYBE SEEING PSYCHIATRY AFTER THIS.

FOR KIND OF AN EVALUATION BUT THOSE SYMPTOMS CAN BE, YOU KNOW, OFTENTIMES, THEY ARE ADHD SYMPTOMS THAT PEOPLE ARE SEEING IN THEIR CHILDREN AND THAT IS THE CENTER AS LIKE BE A BIPOLAR SORT OF THING.

VERY RARELY TRULY BIPOLAR DISORDER WHICH IS GREAT NEWS.

WHERE DO YOU RECOMMEND TO TAKE SOMEONE THAT MAY HAVE SOME QUESTIONS FOR ABOUT THEIR CHILD?

DO YOU START KIND OF A PRIMARY CARE NOON I WOULD RECOMMEND STARTING WITH THE PRIMARY CARE PHYSICIAN.

PRIMARY CARE PHYSICIAN MAY REFER YOU A PSYCHOLOGIST OR WITH KIDS WE TYPICALLY LIKE TO START WITH THERAPY FIRST IF WE CAN.

WE'RE NOT GOING TO JUMP TOP MEDICATION UNLESS WE REALLY NEED TO IN CHILDREN.

SO GOING TO SEE PSYCHOLOGIST AND GET AN EVALUATION ABOUT KNOW YOUR CHILE AND WHAT THEY ARE DOING IS THE BEST FLAYS START.

SURE.

GOT.

THEN THE NEXT PART OF THE QUESTION IS WHY ARE PEOPLE WITH BIPOLAR DISORDER HESITANT TO TAKE THEIR MEDICINE?

>> YEP.

THIS IS A CONSTANT STRUGGLE IN PSYCHIATRY SO PEOPLE WHO ARE TRULY BIPOLAR THAT IS CHARACTERIZED BY PERIODS OF DEPRESSION, PERIODS OF BEING VERY HIGH OR MANIAC, THEN, PEOPLE ARE MANIAC, THEY FEEL REALLY GOOD.

THEY ARE HAPPY.

THEY ARE VERY PRODUCTIVE.

THEY ARE FULL OF ENERGY.

THE PROBLEM WITH THAT IS THE LONGER IT GETS ON.

IT IS ACTUALLY QUITE DAMAGING TO THE BRAIN.

OVER TIME, PEOPLE CAN HAVE COGNITIVE IMPAIRMENT DEVELOPMENT IF THEY HAVE MANIA THAT HAS BEEN UNTREATED SO WE ENCOURAGE MED CAUTION FOR THAT REASON TO BRING PEOPLE DOWN, KIND OF IN THE MIDDLE TO PROTECT THE BRAIN AND ITS FUNCTIONING AND ANOTHER REASON I HEARD FROM CINEMAS WHO ARE BIPOLAR THAT THEY WILL TELL ME THEY ARE NOT AS CREATIVE, KNOW, THEY ARE NOT AS HEWS CALL OR WHATEVER IT IS THAT THEY WANT TO BE ON THE MEDICATION BECAUSE THEY DON'T HAVE THAT MANIC KIND OF A FLAIR, BUT IT REMINDS PEOPLE THAT SYMPTOMS GETS WITH OVER TIME.

YOU KNOW, YOUR BRAIN WILL GET DAMAGED IF YOU TAKE YOUR MEDS, YOU ARE MUCH LESS LIKELY TO END UP IN THE HOSPITAL OR THINGS OF THAT NATURE.

>> SO THAT GOES ALONG WITH THE NEXT QUESTION HERE.

A CALLER OF HOW SHOULD ENCOURAGE A FAMILY MEMBER TO TAKE PRESCRIBED MEDICINE FROM A PSYCHIATRIST.

STRESSING THOSE, THOSE REASONS YOU JUST MENTIONED.

>> YEAH.

FAMILY SUPPORT IS REALLY KEY.

I THINK WHEN PEOPLE ARE WELL AND STABLE THAT'S THE TIME.

AND THIS IS HOW IT AFFECTED US AS A FAMILY AND YOU, HE IF YOU GO OFF OF THE MEDICATIONS, GAIN, THESE THINGS WILL COME BACK AND WE'LL HAVE ALL THE PROBLEMS , FAMILY SUPPORT IS REALLY IMPORTANT.

>> ABSOLUTELY.

SWITCHING GEARS NOW.

WHAT ARE SOME METHODS OF COVID PRESENCE OTHER THAN THE VACCINE I DON'T KNOW THERE ARE ANY.

>> WELL PREVENTIVE MEASURES OBVIOUSLY JUST KIND OF KEEP WITH WE'RE DOING WEARING A MASK, KEEPING YOUR HANDS CLEAN, AND YOU KNOW, THE SOCIAL DISTANCE PART OF IT IS ALSO PRETTY KEY, YOU KNOW, BUT ALSO, IF YOU ARE WORK BLASE ARE CONCERNED ABOUT A COWORKER SITTING IN YOUR SPACE THAT KIND OF A THING.

YOU KNOW, I HAVE MULTIPLE SHARED OFFICES AROUND CAMPUS SO EVERYBODY IS WEARING A MASK BUT STILL I FEEL A NEED AND IMPORTANT TO WIPE EVERYTHING DOWN.

THERE IS I AM FORTUNATE THERE IS CLOROX WIPES AND LYSOL WIPE, BLEACH WIPES AROUND SO YOU ARE NEVER GOING TO BE WRONG IN DOING THAT.

YOU KNOW, THAT IS TO DO THAT, TOO.

ANYTHING THAT YOU WOULD ALSO STANDARDLY DO TO KEEP YOUR ENVIRONMENT CLEAN, AS WELL AS THE THINGS THAT WE HAVE BEEN SAYING ALL ALONG WITH THE CDC AS FAR AS MASK WEARING IS THE BEST PREVENTIVE THING TO DO.

SURE.

GOT IT.

ALL RIGHT.

WE GOT, WE ARE GETTING A LOT OF QUESTION CASTLE AND QUESTIONS.

THANK YOU.

KEEP THEM COMING.

WE HAVE 1MANSS SO THE PHONES ARE STILL RINGING.

AGAIN, THE NUMBER IS 844-957-3343.

STICKING WITH COVID.

CALLER FROM BIG RAPIDS JUST GUILTY OVER COVID HOW LONG SHOULD THEY WAIT TO GET THE VACCINE THAT THERE IS A TIME PERIOD THERE THEY NEED?

>> SO THERE IS SOME DATA OUT THERE SAYING YOU NEED TO PROBABLY WAIT THREE MONTHS BUT NOT EVEN SO MUCH THREE MONTHS AS THE CDC IS SAYING THE SAME THING AS FAR AS WHEN YOU ARE OVER YOUR SYMPTOM AND YOU ARE DONE SHAVING SYMPTOMS YOU CAN ACTUALLY GO GET A COVID VACCINE AS SOON AS YOU ARE ASYMTOTIC SO DON'T WAIT A CERTAIN PERIOD OF TIME AND AFTER YOU HAVE DONE THE ISOLATION OR WHATEVER IT MAY BE AND YOUR SYMPTOM FREE.

THEN YOU ARE ABLE TO GET A VACCINE.

>> ARE PEOPLE WHO HAVE HAD COVID THEN GET THE VACCINE, IS THERE ANY STUDY, THEIR SIDE EFFECTS MAY K STRONGER THAN SOMEONE WHO HAS NOT HAD COVID?

>> I DON'T KNOW IF THAT IS TRILLION ACTUALLY BLUSHED YET OR ANY RESEARCH RIGHT NOW?

THERE IS THAT GENERAL BELIEF I HAD.

YOU I MAY HAVE IT.

THAT IS NOT SAY WOULDN'T HAVE HAD THOSE SYMPTOMS.

SO IT IS NOT REALLY OUT THERE RIGHT NOW.

I THINK IT IS SOMETHING THAT A LOT OF PEOPLE SURMISE MAY HAPPEN.

>> STRONG ANTIBODIES, RIGHT?

THAT MAY TREK THEM NOW.

WHEN PEOPLE GO SHOW UP TO RECEIVE VACCINE.

WHAT MATERIALS IS BEING GIVEN OUT TO EXPLAIN AB I COULD BE.

DO THEY GET PAPERWORK TO EXPLAIN WHAT THOSE SIDE EFFECTS ARE.

THERE IS A HANDOUT AND INFORMATION ON CDC WEBSITE.

EVERY VACCINE CLINIC THAT I WASTED AND BE A PART OF.

WE ARE GIVING A HANDOUT AS TO WHAT TO EXPECT YOU KNOW AND WHAT TO DO AS FAR AS IF YOU GET THE MILD SYMPTOM OR IF YOU GET MORE SERIOUS TYPES AND WE DON'T WANT ANYONE GOING HOME AFTER ARE A VACCINE SAN WHAT TO DO NEXT OR WHAT SHOULD I EXPECT TO FEEL YOU KNOW, WE WANT PEOPLE TO FEEL PRETTY SAFE AND SECURE ABOUT WHAT THEY KNOW ABOUT IT.

>> YOU KNOW, WHEN SOMEONE WALKS IN A CLINIC THERE IS, THEY ARE ASKED A LIST OF QUESTIONS, TOO.

I KNOW, TO HELP THEM UNDERSTAND A LITTLE BIT BETTER, TOO.

WE HAVE A QUESTION FROM FACEBOOK NOW.

MY SEASONAL EFFECTIVE DISORDER IS BAD THIS YEAR.

WHAT CAN I DO TO OVERCOME THIS?

DOCTOR, ANY SUGGESTIONS?

>> VERY COMMON PROBLEM UNFORTUNATELY.

IN THE NORTHERN STATE, YEAH.

YES.

I THINK IT IS IMPORTANT TO RECOGNIZE THAT CYCLE IN YOURSELF AND TRY TO GET AHEAD OF.

OK. BEFORE YOU KNOW, THE WEATHER BECOMES DARKER.

THERE IS A FEW THINGS THAT WE DO, THE FIRST THING WHICH WE SHOULD BE DOING IN MICHIGAN IS TAKING VITAMIN D SUPPLEMENTS.

LOW LEVELS OF VITAMIN D IS LINKED TO LOW MOOD, LOW ENERGY, ALL OF THAT STUFF.

90% OF US ARE DEFICIENT IN MICHIGAN IS NOT HIGHER.

SO EVERYBODY TAKE YOUR VITAMIN D YEAR AROUND.

OK.

THE OTHER THING THAT IS VERY EASY TO DO IS TO USE A LIGHT LAMP.

SO YOU CAN GO ON AMAZON AND PURCHASE LIGHT LAMP LIKE$40-$50.

YOU ACTUALLY HOLD.

IT IS LIKE A LITTLE HEADBAND THING THAT SITS AROUND YOUR HEAD AND HAS SPECIFIC LIGHTS THAT YOU DO FOR 30 TO 60MEN MS ABOUT FIVE TIMES A WEEK.

KIND OF MIM IN THE SUN, THE BEAM, YOU CLOSE YOUR EYES AND IMAGINE THAT YOU ARE THERE.

THAT HAS BEEN SHOWN TO BE HELPFUL AS WELL.

FAMILY THAT DOESN'T WORK, THOSE THINGS DON'T WORK THEN WE DO HAVE SOME PATIENTS THAT WILL PUT ON ANTIDEPRESSANT MOTHERS FALL-WINTER AND COME OFF IN THE SPRING AND SUMMER AND GO BACK ON AGAIN AS IT GETS CLOSE ARE THE VAST MAJORITY OF PEOPLE DO OKAY WITH THE LIGHT LAMP IN THE VITAMIN D AND START GETTING A LITTLE BIT BET ARE NOW THAT THE WEATHER WITH IS GETTING WARMER.

YEAH.

EXACTLY THEM THIS SUN IS COMING OUT MORE.

YEAH.

THINGS ARE WARMING.

YOU OK. CALLER SAYS I HAVE MYSTERIOUS PAIN IN THE LEFT ANKLE THE X RAYS DIDN'T SHOW ANYTHING.

DO YOU HAVE ANY IDEAS.

KNOW IT IS HARD TO DIAGNOSE IF YOU DIDN'T SEE.

THEY TELL ONE THING.

WILT TELL YOU ABOUT THE BONY THINGS THAT COULD POSSIBLY BE GOING ON IF YOU HAVE PAIN ABOVE THE ANKLES CAN YOU KNOW, BE THERE ARE A LOT OF MUSCLES THERE A LOT OF TENDONS THERE AND BLOOD VESSELS THAT ARE LISTEN TO AND NERVES SO SOUNDS LOOK THE NEXT TRICK IS TO SEE IF IT IS NOT BONNY OR M RAY DONE THAT IS NEGATIVE AND SOFT TISSUE RELATE THEN WAYS TO INVESTIGATE THAT.

SO LIKE FOR EXAMPLE.

I DO A LOT OF IN OFFICE ULTRASOUND AND AGE TO ACCESS SOFT TISSUE SO ONE START THAT COULD BE DONE.

THEN ALSO SOME MIGHT TRY TO SEE IF IT IS TRULY MUSCULAR.

YOU MAY GET SENT FOR PHYSICAL THERAPY.

IF PHYSICAL THERAPY DOESN'T DID ANYTHING.

THEN YOU MAY GET A DEEPER MR TOY SEE WHAT IS GOING ON.

SO THESE ARE ALL THINGS THAT COULD HAPPEN IN THAT KIND OF LOGICAL PROGRESSION AND YOU SEE PAIN IF YOU DON'T HAVE ANY KNOWN CIRCULATION ISSUERS NEUROPATHY THAT KIND OF A THING.

SO HOPE THAT THEN.

>> OK. >> THANK YOU.

THAT WAS A GOOD DETAILED ANSWER.

THANKS.

>> SO THE NEXT QUESTION, WITH THE COVID RACK SEEN WOULD THE RESPONSE BE LESS EFFECTIVE FOR SOMEONE WHO TACKS INFUSION FOR CROHN'S DISEASE.

>> AS FAR AS LESS?

>> MAYBE THEY ARE WORRIED THEY WON'T GET THE FULL VACCINE.

>> NO.

I THINK YOU KNOW, I ALWAYS RUN BY, IF YOU ARE ON ANY TYPE OF BIOLOGICAL MEDICATION YOU WANT TO RUN POSSIBLE SIDE EFFECTS WITH THE DOCTOR AS FAR AS WHAT COULD HAPPEN IF I AM ON THIS PARTICULAR MEDICATION, BUT NOT THAT I KNOW OF THAT I AM HEARING TOO MUCH OF SAID INFECTION EITHER BEING DECREASED BECAUSE PI AM ON A CERTAIN MEDICATION OR EFFECTS OF THE VACCINE BEING INCREASED BECAUSE OF CAUSING MORE SIDE EFFECTS, SOB, WE HAVE NOT HEARD ANYTHING YET ABOUT ANY MEDICATIONS CAUSING THE VACCINE TO BE IN EFFECT OR LESS EFFECTIVE.

OKAY.

THAT IS GOOD.

CALLER FROM ROSCOMMON IS LYME DISEASE STILL A PROBLEM IN MICHIGAN.

>> WELL, I WOULD SAY WHERE YOU HAVE DEER, YOU HAVE DEER TICS AND IF YOU ARE IN AH AREA THAT HAS DEER YOU SHOULD BE WORRIED ABOUT DEER TICS IS LYME DISEASE MORE KIND OF, WE LEARN IT MORE TO BE EASTERN LIKE BORDER LIKE NORTHEAST CORNER KIND OF THE U.S. KIND OF A THING.

YEAH.

BUT THAT BEING SAID.

WE HAVE LYME DISEASE, OCCUR IN THE MIDWEST, TOO.

WE HAVE A LOT OF WOODED AREAS.

WE HAVE THAT HAPPENING.

SO THERE ARE U.S. THAT ARE STRONGER BUT NOT GOING TO SAY IT IS NOT IN MICHIGAN AND IT CAN BE.

>> IT COULD BE.

ANOTHER FROM FACEBOOK.

WHAT ARE WARNING SIGNS AS YOU LOOK FOR I THINK MY SISTER IS STRUGGLING WITH DEPRESSION AFTER-- OK.

SORRY.

WHAT ARE WARNING SIGNS HERE, SISTER MAY BE STRUGGLING WITH DEPRESSION AFTER BEING LAID OFF FROM WORK.

>> WHAT ARE SIGNS?

>> WELL, THE BIGGEST THING THAT I THINK FAMILY MEMBERS AND LOVED ONES SHOULD WATCH OUT FOR IS ISOLATION.

SO IF YOU HAVE A LOVED ONE THAT STOPS REACHING OUT, STOPS CALLING WHERE YOU SHALL STOPS ENGAGING YOU.

THAT IS A WARNING SIGN THERE MAY BE DEPRESSION KIND OF SETTING IN.

ANOTHER COMMON THING THAT HAPPENS VERY EARLY ON WITH DEPRESSION IS SLEEP DISTURBANCE.

SO SOMEBODY IS TOLLING YOU THAT HARD TO SLEEP, THEY ARE HAVING BAD DREAMS, SOMETHING LIKE THAT.

THAT WOULD BE CONCERNING AND THEN, JUST I THINK JUST DECLINE IN SELF-CARE NEEDS AS WELL.

SO MAYBE NOT SHOWERING AS MUCH.

NOT PUTTING AS MUCH EFFORT INTO PERSONAL APPEARANCE AS NORMAL.

THOSE THINGS WOULD BE CONCERNING FOR ME.

>> OK.

HERE IS AN INTERESTING QUESTION.

I WOULD PROBABLY REFER-- SO CALLER'S WIFE GOT FIRST DOSE MODERNA SHOT BUT RECEIVED JOHNSON & JOHNSON ARE THEY COMPATIBLE OR NOT?

THEY ARE NOT, RIGHT?

WHAT ADVICE DO YOU HAVE FOR THEM?

>> YEAH.

FIRST OFF.

DON'T KNOW HOW YOU GOT BOTH.

BUT AFTER THE JOHNSON & JOHNSON ONE, SHOULD BE PRETTY MUCH DONE NOW.

>> YEAH.

>> SO YOU MIGHT NOT EVEN HAVE TO PURSUE.

YOU SHOULDN'T PURSUE A THIRD ONE.

>> A SECOND DOSE MODERNA.

AGAIN, THAT IS UNIQUE ONE.

I HAVE NOT HEARD OF ANYONE DOING THAT YET.

>> YEAH.

>> I WOULD THINK AFTER YOU HAVE TAKEN THE ONE-TIME DOSE ONE, YOU NO LONGER NEED TO COMPLETE THE TWO-TIME DOSE ONE.

>> RIGHT.

PROBABLY A GOOD IDEA TO CHECK WITH YOUR FAMILY PHYSICIAN ON THIS ONE.

>> FOR SURE.

>> NEXT QUESTION FROM FACEBOOK.

ARE OVER-THE-COUNTER ALLERGY MEDICINES GOOD ENOUGH TO COMBAT SEASONAL ALLERGY OR SEEK PRESCRIPTION FROM MY DOCTOR.

>> SO YOU FIRST HAVE TO START WITH THOSE.

THE OVER-THE-COUNTER, YOU KNOW.

THEN THERE IS MULTIPLE DIFFERENT BRANDS, THERE IS DIFFERENT TYPES, THEN, ONLY, IF YOU TRIED THOSE THINGS.

THEN YOU HAVE TO GIVE THEM A GOOD SHOT.

YOU HAVE TO GIVE THEM MAYBE EVEN A YEAR TO FEEL SO THEY ARE ACTUALLY GOING TO DO THINGS FOR YOU DURING THE TIMES WHERE SEASONS CHANGE AND ALLERGIES BECOME PRETTY BAD.

>> SURE.

IF YOU ARE NOT NOTICING A CHANGE AFTER THAT AMOUNT OF TIME.

THEN IT MAY BE TIME TO YOU KNOW, THEN NOT JUST SEE THE PRIMARY DOCTOR BUT THE PRIMARY DOCTOR MAY HAVE TO SEND TO ALLERGIST TO GET TRUE ALLERGY TEST AND ZERO IN ON WHAT IS KEEPING THEM GOING.

SURE.

ABSOLUTELY.

I THINK THERE IS LIMIT AS TO FOR SOMETHING LIKE FLONASE RIGHT.

YOU ARE SUPPOSED TO TAKE IT FOR A CERTAIN AMOUNT OF TIME.

YOU SHOULD TAKE IT DEGREES.

NOPE, YEAH.

ANOTHER QUESTION FROM FACEBOOK.

SHOULD LEAGUE TEAM STRETCH BEFORE PRACTICE TO HAVE INJURY?

THEY ARE SIX AND SEVEN YEARS OLD.

YEAH.

IN THAT AGE GROUP, THEY ARE TO BE HONEST, THEY ARE RESILIENT SO YOU OTHER KAY EITHER WAY.

MOST OF OUR SPORTS MED RESEARCH SHOWS US WHEN YOU GET TO THE OLDER START GETTING TO TEENAGERS, THE MOST EFFECTIVE STRETCHING IS STRETCHING THAT OH COARSE AFTER PRACTICE OR YOUR EVENT OR WHATEVER AC OF IT IS.

NOT TO SAY THAT SOME PEOPLE DON'T STRETCH BEFORE THEY GO FOR RUN AND ITS OK.

I FINES TO DO THAT.

THE TRUE LIKE EVIDENCE-BASED, KNOW, WHERE IS STRETCHING THE MOST EFFECTIVE?

STRETCHING IS EFFECTIVE AFTER THE ACTIVITIES OVER.

AGAIN, BUT THEN IN THAT YOUNG AGE GROUP, IT IS NOT ENOUGH TO MAKE A DIFFERENCE REALLY.

>> BUT PROBABLY A GOOD THING TO GET IN THE HABIT OF.

RIGHT.

MAYBE STARTING THAT.

FOR SURE.

>> THAT PRACTICE SO AGAIN YOUR SPECIALISTS ONE OF THE PEGS SPECIALTIES IS SPORTS ED SIN SO NOW IS COVID AFFECTED COLLEGE SPORTS AND HEY SCHOOL SPORTS?

>> LOADED QUESTION.

>> KNOW A LOT GOING ON IN THAT ONE.

I WORK AS TEAM PHYSICIAN IN THE COLLEGE SETTING AT DIVISION ONE UNIVERSITY AT CENTRAL MICHIGAN 1:00 AS SOON AS THE SPORTS GOT CANCELED AND EVERY SPORT AROUND THE COUNTRY GOT CANCELED A YEAR AGO.

THE FIRST QUESTION EVERYBODY'S MINE IS WHAT ARE WE GOING TO DO TO BRING EVERYBODY BACK THAT IS WHEN ALL SPORTS MEDICINE DOCTORS NOT ONLY MY CONFERENCE IN THE MAC CONFERENCE, BUT ALSO REGIONALLY NATIONALLY GOT TOGETHER.

WE HAD MANY WEBINARS AND TALK TO DISEASE ABOUT WHAT ARE THINGS WE NEED TO CONSIDER WHEN BRINGING THEM BACK.

SLOP SLOWLY WE REALIZED THE IMPORTANT OF GEEING TESTED, OK.

SO STARTING OUT A TESTING STRATEGY WHAT WOULD BE THE BEST TO KEEP EVENTS GOING.

KEEP EVERYBODY SAFE.

THEN, THEN ALSO, WHENEVER A VACCINE GETS DEVELOPED.

ARE WE THEN GOING FEEL SAFE DOING AND ALLOWING 100% AND 50% THOSE TYPE OF THINGS BUT IN MY EXPERIENCE AS WHAT I HAVE SEEN IN THE SPORTS FIRST IT STARTED WITH EVERYBODY GETTING SOMEWHAT OF A UNIFIED TESTING STRATEGY AND FOR IN SEASON SPORTS FOR US 5 TO 6 TIMES A WEEK FOR OUT OF SEASON SPORT AND TWO TESTS A WEEK AND USUALLY THOSE ARE ALTERNATING BETWEEN RAPID TEST OR R TRUE TEST FOR COVID SO FIRST GETTING THAT VUG FUTURED OUT THAT WAS HAPPENING CONFERENCE BY CONFERENCE.

SO THEY WERE DECIDING WHAT THE TESTING STRATEGY WOULD BE THEN AS THINGS PROGRESS THE NCAA LEVEL THEN, THEN, YOU KNOW, NCAA IS COMING WIN THEIR TESTING STRATEGY OF WHAT THE ATHLETES NEEDED TO DO.

YEAH.

THEN YOU KNOW FOR ATHLETE TEST POSITIVE ON THE RAPID TEST AND GET PCH TEST TO CONFIRM IT AND CONFIRM THEN THEY ARE GOING TO BE IN ISOLATION THEN IT IS ABOUT DOING A CONTACT TRACING LOOK WOULD YOU DO A CONTRACT TRACING ON ANYBODY AND FIGURING OUT WHAT TEAMMATE AND WHO ARE CONSIDERED CLOSE CONTACT BECAUSE THOSE PEOPLE IN ISOLATION IF YOU HAVE ENOUGH OF A TEAM THAT IS IN ICING ISOLATION OR QUARANTINE THEY CANNOT COMPETE SO ON PAUSE THIS IS THE THING THAT WE HAVE BEEN WRESTLING WITH ALL YEAR.

IT HAS MADE THE YEAR INTERESTING.

>> YEAH.

THANKFULLY, WE HAVE VACCINE NOW THAT IS, YOU KNOW, HENNING 3:00 HELPING THE LIGHT AT IN THE OF THE TUNNEL.

IS THERE.

HE WE'RE GETTING CLOSER.

WE ARE JUSTS ABOUT OUT OF TIME.

SO I JUST WANT TO AGAIN THANK YOU BOTH FOR BEING HERE TONIGHT.

THANK YOU AT HOME FOR WATCHING REAL QUICK, I WANT TO THANK OUR GRADUATING SENIORS WE HAVE BRYSON JACQUELINE THEY HAVE BEEN HERE WITH US ALL SEASON LONG AND WITHOUT THEIR HELP AND DEDICATION THAT SHOW WOULD NOT HAVE COME ON THE AIR.

THANK YOU, GUYS, WE WILL BE A ALL THE BEST ON THE FUTURE JOURNEY HERE THANK YOU AT HOME FOR WATCH, CALL, POSTING YOUR QUESTIONS WE APPRECIATE YOU TAKING THE TIME TO WATCH AND WE HERE TO HP YOU.

THANKS FOR WATCHING.

HAVE A GREAT NIGHT.

WE'LL SEE YOU IN THE FALL WITH NEW LIVE EPISODES.