I'm Dr.

Ray Christensen, faculty member from the department of family medicine and biobehavioral health at the University of Minnesota Medical School Duth campus and a family physician at Gateway Family Health Clinic in Moose Lake, Minnesota.

I am your host for our episode tonight about neurologic conditions, diagnosis, new treatments, and prevention.

The success of our program is very dependent upon you, the viewer.

So, please call in your questions or send them to our email address askpbsnorth.org.

Joining me tonight is Dr.

Toga Etoga Han Han a board-certified family physician with Aspirus Health Two Harbors uh who provides comprehensive care of with all ages and works closely with the many many medical specialists to help patients manage neurologic concerns both acute and in long-term settings.

Our phone volunteers tonight are Jacob Steinbach from Austin, Minnesota, Alex Lindren from Fergus Falls, Minnesota.

They are standing by to answer your calls.

And now on to tonight's program on neurologic conditions, diagnosis, and treatment as well as prevention.

Probably the most important.

Thank you for joining us.

Dr.

Hanhan, good to see you again.

Been a while.

Yeah.

A lot of years that we've gotten to know each other.

Uh why don't you tell us a little bit about your practice?

Sure.

Uh I'm a family physician up in Two Harbors uh at Aspirus Lake View and uh there we do hospital care uh as well as uh see people in the clinics and uh as you might imagine tonight's episode neurological conditions is is pretty vast and yeah we we see a lot of that uh in family medicine and as a family physician you're working in the clinic as well as nursing home and the hospital.

That's right.

All the way across.

So, you're seeing the breath of ages across the way, right?

Is there anything particular in your practice that you enjoy that you'd like to talk about?

Oh, gosh.

Uh, neurologically.

Oh, neurologically.

Um, no.

I I I kind of like thinking about uh the neurological system.

We should probably even just talk about what that is.

I mean we we talk about kind of a central nervous system which includes the brain, the spinal cord and then we talk about the peripheral nervous system which is everything that leaves there.

Once it leaves the central area we call that peripheral and they can both cause problems for people.

I mean of course they help us function but they can there can be disorders of those.

One of the things that as I've gotten older and my patients have gotten older with me, I've been seeing more and more of dementia and and struggling with those those changes of aging uh and finding it hard sometimes to get referrals out and get help and also have good evaluation uh of those patients.

Uh in your clinic, I assume you see quite a few people with dementing changes.

Yeah.

And are there you want to describe the are there different types?

Yeah, there's uh many uh there's different types of dementia depending on uh how what's going on in somebody's brain.

I like to think of dementia memory actually is like a spectrum.

So, uh there's a time in our lives where we have good memory and good kind of brain functioning.

And for some people that decreases as we age and uh that's I think that's common enough.

And if you ever if somebody gets to the point where their memory has gotten poor enough where they need others to do their daily living or to kind of help them with the daily tasks of life, getting dressed, getting bathed, making food, etc.

We we call that dementia.

And uh the most common by far is Alzheimer dementia.

And uh technically uh I mean if if you kind of see it happening and you can kind of see some brain scans that kind of look like this is probably Alzheimer uh it probably is although we can't confirm that really until somebody has passed and looking at their brain tissue.

You and I talked earlier a little bit about prevention.

uh what are the things that so let's go back and start younger what are the things you can do to prevent some of these changes or or are there no or are there are there no things that will be helpful yeah by far uh the thing with the most evidence behind it is simply moving your body exercise we know that's uh very good uh for uh uh dementia prevention memory loss prevention etc And then uh as time goes on uh it's important to do other things as people lose memory with aging.

So making sure that glasses are up to date if necessary.

Making sure that people are able to hear so hearing aids etc.

And then basically being social.

Uh I think one of the things that we saw during CO 19 for example is people with memory loss if they had to be by themselves that really rapidly got worse and uh so when people are with other people and they're social uh that can really be very helpful for memory.

You brought up the hearing piece that it seems like more and more uh one of the major problems with dementia and with problems with aging is the hearing.

Um are you finding that in your practice too?

Oh, absolutely.

And if you think about how important that is, I mean, hearing is one of the ways that we kind of appreciate what's going on in our world.

And if that disappears, if we kind of lose that sense, uh, then all of a sudden we've lost some information about what's going on in our world, and you can imagine how that can cause some decline.

Yep.

The other thing that's really important that I see is where we've where you've got a husband, wife, a couple, or a, you know, two people together.

It's nice sometimes to have that extra person there to help work back and forth and make sure that each takes care of themselves uh and uh is is helpful when needed to fill in a little bit at those times.

I agree.

Yeah.

Alcohol, is that a good thing or a bad thing?

And uh great question.

Uh as long as alcohol has been around, it's very open.

That's right.

That's right.

There keeps on there there's all these different uh opinions about it, it's probably not great.

Uh um you know, and really any substance that you put in your body, be it smoking, etc.

uh kind of smoking decreases kind of blood flow to the brain and alcohol similarly kind of alters our senses just like we were talking about with hearing.

So that's probably not great over time either.

The other thing just to finish off the prevention is your comments or thoughts on the Mediterranean diet and its value to u health and one for from one standpoint but also possibly for pre for prevention.

Yeah.

Right.

Because in the Mediterranean diet, we're talking about good fats, uh, fish, olive oil, things like that.

And those really, uh, our brain requires a lot of fat cells.

And, and, uh, if we're, you know, there's that old adage, you are what you eat.

I think to some degree that's that's true.

And there's the one other piece that's happening as we age, and that's loss of muscle.

You you brought up exercise earlier and I think everything we can do to keep people moving and keep them exercising and keeping muscle build up is very helpful.

Muscle's helpful when you fall so you don't break things hopefully and uh it's also uh very very important as far as keeping your uh agility and so on as you get a get older.

Right.

We um also deal with quite a few people who have had strokes.

Uh there's a lot of things that have been done that have been helpful with strokes.

I think that the treatment of atrial fibrillation, I've watched my 50 years of practice where we really didn't know what to do with it, just slow it down to the point where we try to ablate the atrial fibrillation and we've gotten rid of a lot of those little tiny strokes and so on that come down.

and it seems like we've been able to do a lot to back off with the problems that we see with stroke.

Um what are your thoughts uh as far as the types of stroke that you see?

Yeah.

Uh by far the most common common is what we call a schemic stroke where there's a blockage of a vessel.

So a certain part of the brain is not getting appropriate blood flow and so um uh that's very important to just understand that that's going on and uh one thing you can do to prevent that is make sure that you're keeping your blood pressure under control.

you're knowing your numbers in terms of cholesterol if your cholesterol is high.

Uh treating it um and keeping it down to a reasonable level so those those vessels don't get blocked.

I wasn't paying attention to the questions, but we kind of touched on this a little bit.

How can I tell if I'm developing some type of a dementia compared to normal aging?

Where's that process?

I know as I got into a little older all of a sudden I don't remember names or I can't remember names.

What are what other things that really is not a part of dementia but a part of aging?

How do you differentiate there?

Yeah.

And and there's uh rightfully so, right?

A lot of people get anxious about that.

Uh and so you start kind of second guessing.

I mean, at any point in your life, you might forget a name or forget what you're doing when you walked into a room.

And those are really kind of normal things.

Uh, some patients have described to me an episode where, for example, they're uh driving to somebody's house and all of a sudden things don't look familiar to them even though they've, you know, driven this route many, many times or uh just don't recognize where they are.

and they it's really some place where they've been uh over and over again and that might be a sign that something is progressing beyond the normal age related memory loss.

That one actually comes up quite a bit.

I was on my way home and all of a sudden I wasn't sure where I was at or I came to a corner and I didn't know which way to turn and had to sit for a while.

I think if you're having those kind of difficulties, then it'd be good for you to sit down and talk to your uh friendly family physician or your primary care physician and discuss some of these.

Yeah.

Getting lost.

And then the other things that happen getting lost in the house or other the other place where I've seen problems is uh how you handle cookware and heat and fire, the stove and so on.

Those are places where people get into trouble sometimes too.

So it's and the other thing is just being at home, especially those of us who live out in the rural areas, uh people sometimes get lost.

So that's important.

And just a quick push for medical alert or something, some way of tracking people uh is very helpful sometimes with those situations.

How can I tell the difference between a normal headache and one that is more concerning?

Quick switch on you.

Yeah.

Well, yeah.

So, headaches are very common.

uh a concerning headache to me uh is really I mean you bring up age uh but uh you know anything after about age 40 or so and if it's a very brand new s symptom it's worth inquiring about with your family doc uh you might need some head imaging.

It could be just a plain old headache, but after about age 40, we start worrying, could there be something else going on in the in the brain uh just due to aging alone.

Um and then uh other headaches that are worrisome are ones with exertion uh or might wake make you up wake you up in the middle of the night.

But um uh if all of a sudden you're getting headache when you're exercising or doing another activity uh such as having sex uh that where you're exerting yourself that is worrisome.

Uh as well as if you've had the worst headache of your life that's always uh worth going to the ER for.

Yes.

This one's a little harder because I don't know there's great answers, but dizziness and we I don't know where you are, but usually when I talk to elders, I kind of like to know if they they've had dizziness or if there's problems or lightadedness or falls, those type of things.

Thoughts on dizziness?

Oh boy.

So, dizziness, uh, how do you describe it?

Yeah.

Yeah.

a neur neurologist uh uh once told me that the word dizziness sounded was kind of like fingernails on a chalkboard because he didn't exactly know what that was.

So dizziness can mean a lot of things in our world.

Everything from the world is spinning, right?

Uh is one type of dizziness versus kind of uh that feeling like you're going to pass out kind of lightaded.

Uh, and then dizziness can also mean just kind of unstable for some people, just kind of like uh they feel like they might just be able to topple over.

And uh that's always worth looking into no matter what.

Um and uh it can happen for any number of reasons uh including the medicines that we're prescribing.

Uh so there there's a that's so that's complicated enough where it's worth seeing somebody for it.

And inadequate fluid intake is another one.

Absolutely.

When they when they uh get get low on fluid.

The other thing that's I've always felt is important is I I like the patient to describe the dizziness for me.

Um I don't try to I don't like putting words in their head in their mouth of what it should be like or what they're feeling.

I want to know what you feel, right?

And that that's helpful also.

So, uh, my friend has Bell's palsy.

What can I do to prevent it?

Uh, so let's back up a little bit.

Uh, Bell's paly, we talked about central nervous system versus peripheral.

So, Bell's paly is, um, one of the, we call them cranial nerves, one of the nerves that actually lives in the skull.

Uh, it's the seventh one down.

And that one can get diseased for any number of reasons.

The most common in our area really is Lyme disease.

Uh but uh it's also very common that we don't know why and we call it idiopathic Bell's palsy.

Uh and uh it and people end up with kind of a drooping face.

So their eyelid doesn't want to close all the way and their eye might be droopy, their mo mouth may be droopy.

maybe uh uh they're drooling and that can also uh kind of mimic a stroke.

Always worth getting seen if you have something like that.

Uh but true Bell's palsy if if you have it, I think the question was how long is it going to last or what can you do about it?

No, that wasn't part of the question, but go ahead.

Uh so um yeah so like if it's Lyme disease for example we're going to treat the Lyme disease but almost everybody ends up on a course of steroids sometimes um we think like herpes uster one of the viruses might be involved so a lot of times people end up on antivirals as well and and for most people it's going to last weeks to months uh I had read that uh at about six months about 85% of the time it's going to be resolved.

Uh but um for some people it can be longer in some people it can be chronic in a in a small minority of people.

There's a question regarding essential tremors.

What are they and what can a person do about them?

Yeah.

So uh essential tremor uh is probably inheritable probably came from relatives.

So it's it's basically a tremor where uh and it can be as uh mild as when somebody is reaching for something or holding a a cup of coffee, they might be experiencing some central tremor or some essential tremor or their head may be bobbing.

That may be how severe it is.

Um, and unfortunately treatments I think I shouldn't say I was going to say they're kind of disappointing, but there's a couple medications we reach for.

Uh, propranolol is one.

Primadone is another.

And, uh, I think our occupational therapists are really good with this type of thing.

Sometimes like a weighted utensil or a weighted coffee mug might be helpful to people.

um uh at the University of Minnesota, they have a movement disorders clinic and and sometimes I've reerred patients there uh and they're doing all kinds of interesting things uh some um brain stimulators and things like that to reduce that.

Opening up the question about tremors, it's interesting, a question just came in.

uh what is the difference between Parkinson's and familial tremor and treatment there a little bit if you want to go down that road a little bit.

Yeah.

So uh Parkinson disease uh one of the things uh that that people would experience is usually a resting tremor.

So for example it's almost always one of the hands.

doesn't have to be, but but uh and it's almost always on one side where when somebody is just relaxed, they have their hands on their legs or they have their hands on their lap.

One of their hands might be experiencing a tremor.

We call it a pill rolling tremor because it actually looks like somebody's rolling a pill kind of in their hand kind of class.

This is all kind of textbook.

uh nobody fits in the textbook, but um so uh when somebody's got a resting tremor like that, it's probably worth at least thinking about Parkinson disease.

And a lot of those folks will be end up seeing a neurologist to see if if they agree or if they are worried about Parkinson disease.

And uh familial tremors are almost always different.

They're they're tremors with intention.

So when you go to reach for something, your hand might be experiencing a tremor.

Uh but when you're just seated, there's nothing no tremor going on.

And with Yes.

And with Parkinson's generally, they're able to eat and whatever they're doing, the the tremor is not a problem at that point.

That's right.

It goes away.

Yeah.

And there's of course there's all the other things that come along with Parkinson's when it gets more severe having to do with the gate and walking and the tendency to fall forward backward.

There's there's all kinds of different side effects or effects of of Parkinson's itself.

Treatment I agree neurology uh medications helpful generally to some extent.

That's right.

Yeah.

the uh essential treamers.

I don't remember if you said or not.

Um alcohol apparently helps those.

That's right.

Yeah.

I don't even want to say that, but Yes.

That's not necessarily a reason to go there.

Yeah.

But it's a great question that we ask when when people come in with complaint of tremors.

What is BPV?

Uh BPV is benign.

So uh the initial the letters stand for benign, B is benign.

Uh P is positional and V is vertical.

So when you put those together, uh benign means harmless.

It's not really harmless.

It can be really debilitating for some people, but the the point is this is not something like a stroke.

Uh and then is positional vertigo.

So vertigo uh is that type of dizziness where the room might be spinning.

I I tell people does it feel like you're on a merrygoround or patients sometimes say feels like I'm on a merrygo round but it's positional in nature.

So in other words uh sometimes in the morning they might look one way or roll over in their bed and all of a sudden the room is spinning and then it goes away.

Uh, and it has to do with the inner ear, uh, with these tiny little grains in the inner ear called odoliths.

And, uh, it's very fixible.

Uh, there's all kinds of things that can cause it, viruses or, uh, or trauma.

Uh, and the treatment involves just positioning the head in a certain way so we can put those darn lists back where they belong and let that vertigo go away.

It's fairly common.

There's a question about CIDP, chronic inflammatory demiinating neuropathy.

What is it and why don't we treat it more with diet, exercise changes, imunosuppressants?

I don't know this disease.

I don't either.

But but there's a bunch of demyating myelinating diseases and uh and and that's one of I think many.

Well, there's multiple scerosises in there somewhere, too.

Correct.

Yeah.

Gian Beret, there's a bunch of them.

So, one of the questions is if you have multiple scerosis, can you get dementia?

Um, I don't know the answer to that question.

I will just say regarding multiple sclerosis, uh, treatments are really good these days and people can live a regular life.

uh and uh uh it's really pretty amazing that the treatments we're we're doing these days with multiplerosis.

And personally, I don't know that I've ever seen I don't I'm not aware of multiple scerosis and dementia traveling in the same in the same vein and traveling together.

So I agree.

What are the causes of peripheral neuropathy and what are treatment options?

Yeah.

So, uh, thinking about the nervous system, when we talk about peripheral neur neuropathy, we're talking about everything outside of that spinal cord.

So, uh, it could be anything.

Uh, the most common, I suppose, peripheral neuropathy, and correct me if I'm wrong about this, Dr.

Christensen, but you know, is usually a a type of compression.

You can have a compression from a a disc in your back pressing on a nerve.

Uh some people if they fall asleep on a on an armchair you can end up with a neuropathy of your arm for example because it gets pinched.

So it's almost always when they're getting uh compressed in some way.

Do you need surgery for carpal tunnel?

We've got a minute.

Yeah.

Uh if some people do if their nerves are kind of weak enough and if it's severe enough Yeah.

They It's actually a pretty simple surgery where they basically just clip the carpal tunnel and freeze the nerve and the hand is better functioning.

I want to thank you for tonight.

This is uh been a oneperson show.

You've done a great job of walking through several different diagnosis and difficulties here tonight.

Um I wasn't much help.

My voice is too soft.

I think it's going away.

But uh thank you very much for doing this.

And I want to thank everybody that's helped us over the last year and my fellow uh hosts uh over the last several months.

This is our last show of the year except for the mental show next week.

I want to thank Toga Hanhan and all of our student volunteers for their help tonight.

Uh, please join us next week when Mary Mohouse will host a panel discussion about living with purpose, exploring how a sense of meaning and direction can support mental health, build resistance, and improve overall well-being.

She's going to do this with experts from around the region.

And if you're looking for more tips, tricks, or conversation around health and wellness in the Northland, make sure to check out Northern Balance on PBS North YouTube channel.

Thank you for watching and joining us for this season 40 number 44 of Doctors on Call.

Again, thank you and good night.