WDSE ♪ DR. CHRISTENSEN: GOOD EVENING AND WELCOME TO “DOCTORS ON CALL.” I'M DOCTOR RAY CHRISTENSEN, FACULTY MEMBER FROM THE DEPARTMENT OF FAMILY MEDICINE & BIOBEHAVIORAL HEALTH AT THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, DULUTH CAMPUS AND FAMILY MEDICINE PHYSICIAN AT THE GATEWAY FAMILY HEALTH CLINIC IN MOOSE LAKE.

I AM YOUR HOST FOR OUR PROGRAM TONIGHT ON NEUROLOGIC PROBLEMS, HEADACHES, STROKES, MS, AND PARKINSON’S, AND POSSIBLY HEAD TRAUMA AND OTHER THINGS WE MIGHT THROW IN.

THE SUCCESS OF THIS PROGRAM IS VERY DEPENDENT ON YOU, THE VIEWER, SO PLEASE CALL IN YOUR QUESTIONS OR SEND THEM IN TO OUR EMAIL ADDRESS ASK@PBSNORTH.ORG.

OUR PANELISTS THIS EVENING INCLUDE DOCTOR KEN RIPP, A FAMILY MEDICINE PHYSICIAN WITH THE COMMUNITY MEMORIAL HOSPITAL RAITER FAMILY CLINIC IN CLOQUET.

DOCTOR PAUL SANFORD, AN INTERNAL MEDICINE SPECIALIST WITH ASPIRUS-ST. LUKE'S.

AND DOCTOR JADHAV VIKRAM, AN INTERVENTIONAL NEUROLOGIST WITH ESSENTIA HEALTH.

OUR MEDICAL STUDENTS ANSWERING THE PHONES TONIGHT ARE NICOLE FALL FROM PINE ISLAND, MINNESOTA.

TOMMY MARTIN FROM TACOMA, WASHINGTON.

AND WYATT WINDHORST FROM ALEXANDRIA, MINNESOTA.

AND NOW ON TO TONIGHT'S PROGRAM, .

THANK YOU FOR JOINING ME TONIGHT.

FIRST, TALK A LITTLE BIT ABOUT YOUR PRACTICE AND WHAT YOU DO.

DR. RIPP: I AM JUST A SMALL TOWN FAMILY DOC, FOR 30 YEARS NOW.

MOSTLY CLINIC BASED, SOME IN THE HOSPITAL.

TAKING CARE OF PATIENTS IN THE HOSPITAL A LITTLE BIT.

DR. SANFORD: I AM AN INTERNAL MEDICINE DOC, I DON’T DO HOSPITAL ANYMORE.

ALL IN THE OFFICE.

JUST THINKING ABOUT THINGS.

[LAUGHTER] DR. CHRISTENSEN: AND DR. VIKRAM.

DR. VIKRAM: I AM ONE OF THE STROKE AND INFLAMMATION NEUROLOGIST AT ESSENTIA.

WE DEAL WITH PROBLEMS OF THE BLOOD VESSELS OF THE HEAD, NECK AND SPINE LIKE STROKES AND PEOPLE HAVING ANEURYSMS, AND BLEEDS IN THE BRAIN.

I HAVE BEEN CALLING MINNESOTA MY HOME FOR THE PAST 15 YEARS, AND DULUTH FOR ALMOST EIGHT OR NINE YEARS NOW.

DR. CHRISTENSEN: I THINK A GOOD PLACE TO START PROBABLY IS ON STROKE.

THERE’S BEEN A LOT OF CHANGES SINCE I LEFT THE EMERGENCY ROOM AND THAT PART OF PRODUCT -- PRACTICE OVER THE LAST FEW YEARS AND WE GOT TO MORE STROKE CENTERS AND SO ON.

WHAT DO WE MEAN WHEN WE SAY STROKE?

DR. RIPP: THERE ARE TWO TYPES OF STROKE.

THE MAJORITY OF THEM ARE A BLOCKED BLOOD VESSEL TO THE BRAIN SO THERE’S A PART OF THE BRAIN THAT’S NOT GETTING ENOUGH OXYGEN AND NUTRITION, SO THAT PART OF THE BRAIN CAN DIE UNLESS WE INTERVENE.

AND THERE IS A BLOOD VESSEL BREAKS OPEN AND THAT CAN BE EVEN MORE CATASTROPHIC, BECAUSE THE BLOOD CAN0 ACCUMULATE IN THE BRAIN AND THAT IS VERY IRRITATING.

DR. CHRISTENSEN: ANYTHING TO ADD?

DR. SANFORD: THOSE ARE THE MAIN TYPES OF STROKE.

IF YOU TAKE AWAY OXYGEN AND GLUCOSE, THE BRAIN IS NOT HAPPY.

DR. CHRISTENSEN: ONE OF THE THINGS THAT I THINK IS INTERESTING, I AM OLD.

IT USED TO BE WE START LOOKING AT HEART HOSPITALS.

AND THEN AS I CAME TO THE UNIVERSITY, WE STARTED LOOKING FOR STROKE HOSPITALS AND I WONDERED HOW THAT WOULD WORK OUT.

DR. VIKRAM, THERE’S BEEN A LOT OF CHANGES WITH STROKE AND THINGS WE CAN DO.

RIGHT NOW IF WE HAVE SOMEONE WITH AN ACUTE HEART, PRETTY MUCH BUT LET’S GET THEM IN, AND WE DON’T TREAT HEART ATTACKS ANYMORE.

IT HAS GONE AWAY.

HOW DOES THIS WORK WITH STROKE AND WHAT ARE WE LOOKING FOR TIMEWISE AND SO ON?

DR. VIKRAM: ESSENTIALLY IT RUNS ALONG THE SAME LINES.

WITH EVERY PASSING MINUTE, YOU ARE LOSING BRAIN CELLS.

EVERY MINUTE THE PART OF A BRAIN DOES NOT GET OXYGEN, YOU ARE LOSING CLOSE TO 2 MILLION BRAIN CELLS WILL NEVER GROW BACK.

THAT IS PRETTY DEVASTATING, THE TIME THE BRAIN IS DEPRIVED OF OXYGEN AND GLUCOSE SO IT BEHOOVES THE PATIENT TO GET TO THE NEAREST CENTER TO GET THE CLOTBUSTING MEDICATION.

FROM THERE ON, THEY HAVE TO GO TO A CENTER WHERE IT THE -- IF THE BLOOD VESSEL IS BLOCKED OR OCCLUDED, THEY CAN GO IN AND USE A CATHETER TO OPEN UP THE BLOOD VESSEL AND RESTORE BLOOD FLOW TO THE PART OF THE BRAIN AND THE NUTRIENTS NEEDED TO KEEP THE BRAIN WIRED.

DR. CHRISTENSEN: I KNOW IT WORKS.

IT HAS BEEN GREAT IN A FEW PATIENTS.

PAUL, HOW DO YOU KNOW WHEN SOMEONE IS HAVING A STROKE?

DR. SANFORD: WHEN PEOPLE LOSE SYMMETRY IS ONE THING.

ALL OF A SUDDEN MY LEFT ARM, I CAN’T MOVE IT.

OR HAVE TO FACE IS DOWN, OR YOU ARE LOSING VISION IN ONE EYE.

ANY TYPE OF AN ALTERATION IN NORMAL FUNCTION, YOU HAVE TO HUNT RIGHT THEN FOR A STROKE.

DR. CHRISTENSEN: AND THE IDEA IS MOVE FAST.

DR. SANFORD: THE QUICKER THE BETTER.

DR. VIKRAM: TIME IS IMPORTANT.

ONE EASY MNEMONIC TO REMEMBER FOR PATIENTS AND FAMILIES.

IT IS CALLED BE FAST.

B STANDS FOR BALANCE, IF YOU ARE LOSING BALANCE AS IF YOU ARE TIPSY BUT HAVE NOT HAD ALCOHOL.

E IS FOR EYES.

IF YOU LOSE VISION ON ONE SIDE.

F IS FOR FACE.

A IS ARM AND LEG OR WEAKNESS OR HEAVINESS.

S IS FOR SLURRED SPEECH.

IF YOU HAVE ANY OF THESE SYMPTOMS.

THEN T IS FOR TIME.

CALL 911 OR GO TO THE NEAREST ER.

DR. CHRISTENSEN: HOW DOES THIS WORK -- YOU WORK FOR ESSENTIA.

WE ARE DEALING WITH NORTHWEST WISCONSIN AND NORTHEAST MINNESOTA AND BIG AREAS.

HOW IS THAT WORKING OUT WITH TRAVEL TIME?

SOMEBODY IS COMING IN FROM THE NORTHWEST ANGLE.

DR. VIKRAM: YESDR.

VIKRAM:.

WE DEAL WITH THIS DAY IN AND DAY OUT.

IT IS A HUGE GEOGRAPHICAL AREA DEALING TO THE UPPER PENINSULA OF MICHIGAN AND THE TRANSPORT TIME ITSELF MIGHT TAKE A COUPLE OF HOURS OR MORE.

AND IN INCLEMENT WEATHER WE CAN HAVE, SO IS VERY IMPORTANT FOR GOOD RECOGNITION OF STROKE SYMPTOMS, GETTING THEM TO THE ER IN A TIMELY MANNER, AIRLIFTING THEM AND BRINGING THEM HERE.

THAT IS VERY IMPORTANT.

DR. CHRISTENSEN: ONE OTHER THING BEFORE WE LEAVE STROKE, I THINK WE COVERED IT PRETTY WELL.

WE ARE TALKING EARLIER ABOUT HEAD TRAUMA.

HOW DOES YOUR INTERVENTIONAL SKILLS WORK WITH HEAD TRAUMA?

SUBDURAL, EPIDURAL OR WHATEVER?

DR. VIKRAM: THAT’S A VERY INTERESTING POINT BECAUSE NOWADAYS, NEW RESEARCH KEEPS ON COMING AND IT IS A RAPIDLY EVOLVING FIELD.

IN NORTH LAND, WE HAVE A HUGE DENSITY OF OCTOGENARIANS, NONAGENARIAN’S AND EVEN CENTENARIANS.

TRAUMA IS UNFORTUNATELY ONE OF THE THINGS THAT OLDER PATIENT POPULATIONS HAVE TO DEAL WITH, AND THEY CAN HAVE BLEEDING INSIDE THE BRAIN.

IT IS UNIQUE WHEREIN THE BLEEDING IS NOT WITHIN THE SUBSTANCE OF THE BRAIN ITSELF.

IT IS CALLED SUBDURAL HEMATOMA.

SO IT IS BETWEEN THE SKULL AND THE BRAIN SUBSTANCE.

OVER TIME, THE BLOOD CAN KEEP ACCUMULATING AND PRESENT IN A VERY INSIDIOUS MANNER, VERY PROGRESSIVELY SLOWLY.

WHAT WE CAN OFFER TO SUPPLEMENT SURGERY IS PUTTING A CATHETER-BASED APPROACH, BUT IF YOU PUT A CATHETER THROUGH THE GROIN, GO UP THROUGH THE NECK AND TRACE THE BLOOD VESSELS THAT GO ALONG THE UPSIDE, A THE SCALP AND DIP INTO THESE MEMBRANES.

THE IDEA IS, YOU CAN PUT IN SOME PARTICLES AND SOMETHING TO BLOCK THESE SMALL RANCHES.

THE SOURCE ITSELF HELPS PREVENT THE ACCUMULATION OF THE BLOOD AND THAT CAN PREVENT THE RECURRENCE.

THAT ALLOWS THE ODE -- OLDER PATIENT POPULATION TO REMAIN IN RECOVERY AND THAT IS THE GOAL BEHIND THIS.

DR. CHRISTENSEN: THANK YOU SO MUCH.

A LOT OF INFORMATION.

WE ARE GETTING SOME QUESTIONS ON MULTIPLE SCLEROSIS SO I WILL SWITCH GEARS JUST A LITTLE BIT.

CAN YOU HELP US OUT?

DR. RIPP: MULTIPLE SCLEROSIS IS A CONDITION, THERE ARE SEVERAL DIFFERENT TYPES IN HOW IT PROGRESSES.

IN THE BRAIN, THERE ARE PARTS OF THE BRAIN THAT START TO LOSE THE CODING AND THEN THERE’S THESE CELLS THAT START TO GROW AND THERE’S ALMOST SCAR FORMATIONS IN THE BRAIN.

IT CAN BE TRICKY TO DIAGNOSE EARLY BECAUSE THE SYMPTOMS CAN BE VERY SUBTLE.

A LITTLE LOSS OF COORDINATION.

MAYBE YOU WERE NOT ABLE TO USE YOUR HANDS SO WELL AND THEN THEY ARE BETTER AND THESE ARE YOUNG PEOPLE OFTEN.

UNLESS YOU CATCH IT AT THE TIME, YOU MIGHT NOT CATCH SYMPTOMS.

IT IS A SURGERY TO SEE IF IT HAPPENS.

A LOT OF TIMES IT CAN BE AN EPISODE AND IT CAN BE WEEKS, MONTHS, EPISODES OR ONLY ONE EPISODE IN THEIR LIFE.

IF YOU HAVE MS, IT CAN PROGRESS.

IT CAN BE STEADY PROGRESSION.

SOME PEOPLE JUST HAVE ONE EVENT, SOME PEOPLE HAVE AN EVENT EVERY SO OFTEN, SOME PEOPLE HAVE AN EVENT AND LOSE FUNCTION WITH EACH EVENT.

DR. CHRISTENSEN: PAUL, IS THERE ANY WAY TO TREAT THAT?

ONE OF THE QUESTIONS THAT COMES UP, THEY ARE TALKING ABOUT STEM CELL TRANSPLANT THERAPY VERSUS CURRENT THERAPY.

I DON’T KNOW ABOUT STEM CELL.

AS FAR AS CURRENT THERAPY, MINE HAS ALWAYS BASICALLY BEEN PHYSICAL THERAPY, GOOD CARE AND I DON’T REALLY KNOW OF MEDICINES FOR IT.

DR. SANFORD: THERE ARE A LOT OF MEDICINES NOW FOR MS. DR. RIPP: THERE ARE IN VARYING AMOUNTS OF IMPROVEMENT THAT MIGHT BE EFFECTIVE.

BUT THERE’S NOTHING THAT WILL CURE IT UNFORTUNATELY.

THE HOPE IS SLOW PROGRESSION AND KEEP FUNCTIONING.

SOME OF THE NEWER METHODS CAN BE DRAMATIC BUT STEM CELL, THAT WILL BE AT A RESEARCH FACILITY.

THAT IS MORE OF A CLINICAL TRIAL STUFF.

DR. VIKRAM: I AGREE.

THERE MIGHT BE ANECDOTAL REPORTS THAT PEOPLE MIGHT HAVE SOME IMPROVEMENTS, BUT AGAIN, UNLESS THERE IS A GOOD CLINICAL TRIAL THAT SHOWS EFFICACY OF STEM CELLS, IT WOULD NOT BE MAINSTREAM TREATMENT.

I SHOULD SAY THAT MS FIELD HAS REALLY BY LEAPS AND BOUNDS, THERE ARE NEWER DRUGS EVERY COUPLE OF YEARS THAT HAVE SHOWN A LOT OF PROMISE.

AND WITH GOOD IMPROVEMENTS IN GOOD ABILITY OF THE PATIENT TO MAINTAIN THEIR INDEPENDENCE FOR A LONG PERIOD OF TIME.

DR. CHRISTENSEN: WHAT ARE SOME OF THE INITIAL SYMPTOMS FOR MS. DR. SANFORD: A LITTLE BIT OF SPASTICITY, WEAKNESS THAT WILL SUDDENLY BECOME WORSE, DOUBLE VISION, TROUBLE WHEN YOU ARE SWALLOWING, OR THINGS MIGHT GO DOWN THE WRONG HATCH AND COME OUT YOUR NOSE.

A WHOLE SPECTRUM OF DIFFERENT SYMPTOMS.

IF YOU ARE TRYING TO EAT A CHEESEBURGER, IT BECOMES MORE DIFFICULT.

DR. CHRISTENSEN: JUST KEEP GOING WITH THAT.

IS THERE ANYTHING DIAGNOSTIC?

I THINK IT COMES DOWN TO HISTORY.

DR. RIPP: WHAT WILL HAPPEN IS A PATIENT WILL PRESENT WITH NEUROLOGICAL SYMPTOMS THAT IS ACUTE AND DIAGNOSABLE MEANING YOUR ARM IS PLASTIC OR WEEK AND THAT IS NOT RIGHT.

THAT WILL USE -- LEAD TO AN MRI IN THE BRAIN.

A LOT OF TIMES WE HAVE SUSPICION AND WE LOOK.

WE ARE HOPING NOT TO FIND ANYTHING BECAUSE IT IS NOT A GREAT DIAGNOSIS.

HOPEFULLY IT IS JUST A LITTLE NERVE IRRITATION THAT GOES AWAY.

SOMETIMES PEOPLE DO A NEEDLE INTO THE SPINE AND TAKE OUT FLUID AND THEY CAN MAKE A DIAGNOSIS THAT WAY.

DR. CHRISTENSEN: A PERSON CALLS AND FROM BRADENTON -- BRINSON WITH A RECENT SENSATION IN THE LEFT SHOULDER LIKE BUGS CALLING.

IS THAT NEUROLOGICAL?

DR. SANFORD: IF YOU DON’T LOOK AT IT AND SEE BUGS CRAWLING, YOU HAVE TO THINK ABOUT SOMETHING IRRITATING ONE OF THE CERVICAL NERVES FROM THE NECK.

BUT YOU REALLY HAVE TO EXAMINE THE PATIENT, CHECK STRENGTH, CHECK REFLEXES.

BUT UNTIL PROVEN OTHERWISE, IT IS PROBABLY BUGS.

[LAUGHTER] OR SHINGLES.

THAT IS RIGHT.

DR. CHRISTENSEN: I THINK THIS MIGHT BE YOUR DIRECTION, SEVERE CERVICAL DEGENERATION WITH SPINAL STENOSIS, PINCHED NERVES IN THE SPINE CAUSING SEVERE HEADACHES.

WHAT CAN THIS PERSON DO?

NSAIDS DON’T WORK, HEATING AND STRETCHING DO.

DR. VIKRAM: THAT’S A VERY GOOD QUESTION BECAUSE THIS IS A COMMONLY SEEN AILMENT.

AS PEOPLE AGE, THEY ARE GOING TO HAVE SOME ARTHRITIC CHANGES.

THE SPACES BETWEEN THE VERTICAL COLUMNS WILL DECREASE.

THE NERVES IN THE NECK WILL GET PINCHED AND CAUSE NECK PAIN AND SOMETIMES THE NECK PAIN CAN BE RADIATING TOWARD THE HEAD AND THEN YOU CAN HAVE HEADACHES FROM THAT.

WE ALL -- CALL THEM CERVICAL HEADACHES, ORIGINATING FROM THE NECK.

THIS CAN HAVE SEVERAL ISSUES.

IN ADDITION TO HEADACHES, IF THE NERVES ARE GETTING PINCHED TOO MUCH AND SUPPLYING STRENGTH TO THE ARM, YOU WILL START FEELING WEAKNESS IN THE ARM OR SENSORY PROBLEMS IN THE ARM.

SO IT HAS TO BE LIKE A GRADUATED APPROACH BECAUSE IT DEPENDS ON HOW BAD OR SEVERE THE NARROWING OR STENOSIS IS.

THE BEST WAY TO TREAT IT IS MEDICALLY FIRST AND PHYSICAL THERAPY, ALLOWING THE SPACES TO OPEN UP.

GENTLE EXERCISES, THOSE KIND OF THINGS.

IF THAT DOESN’T HELP, THE NEXT STEP WOULD BE TO GET INJECTIONS LIKE CORTISONE SHOTS TO DECREASE INFLAMMATION.

IF THAT DOESN’T HELP, THEN OBVIOUSLY THE PRIMARY CARE PROVIDER OR INTERVENTIONAL PAIN PROVIDER WILL REFER TO THE NEUROSURGEON TO SEE IF THE PATIENT WILL QUALIFY FOR SURGERY TO OPEN UP SPACES AND ALLOW THE NERVES TO BREATHE A BIT MORE, AND POSSIBLY CAUSING PROBLEMS FOR THE SPINAL CORD, THAN THE PATIENT WILL NEED SURGERY SOONER THAN LATER.

DR. CHRISTENSEN: PAUL, MIGRAINE HEADACHES.

GIVE US A BRIEF PRIMER ON THAT.

DR. SANFORD: PEOPLE GET ONE-SIDED, PROFOUND HEADACHES, SOMETIMES PRECEDED BY LIGHTS FLASHING, ASSOCIATING WITH NAUSEA AND VOMITING.

IT MEANS THE VESSEL, TWO TYPES, ONE WHERE THE VESSEL IS DILATING TOO MUCH AND THE OTHER WHERE IT IS CRUNCHING DOWN TOO MUCH.

THERE ARE DIFFERENT WAYS OF TREATING IT BUT IF YOU USE A TRYPTOPHAN TYPE MEDICINE AND ONE WITH NARROWING, IT CAN MAKE A COMPLETE STROKE.

SO THEY CAN BE VERY VERY SERIOUS AND YOU HAVE TO HAVE SOMEONE WHO KNOWS WHAT THEY ARE DOING, FIND OUT WHAT KIND OF MIGRAINE AND HOW TO PREVENT IT.

THERE ARE LOTS OF GOOD PROPHYLACTIC MEDS TO PREVENT MIGRAINES.

DR. CHRISTENSEN: THE MUSCLE CONTRACTION HEADACHE, WE HAVE HEARD ABOUT THAT.

ARE THEY ALL RELATED?

IN YEARS’ PAST, WE USE CONSIDER IT A CONTINUUM.

DR. RIPP: THERE IS THE CLASSIC MIGRAINE HEADACHE WHERE YOU GET THE UNILATERAL POUNDING HEADACHE.

ASSOCIATED WITH OTHER NEUROLOGIC SYMPTOMS LIKE NAUSEA OR VISION SYMPTOMS.

A TENSION HEADACHE IS MORE OF A BAND LIKE PRESSURE HEADACHES AND USUALLY PEOPLE GET THAT WITH STRESS AND THEY RUB THEIR HEAD.

IT IS ON A SPECTRUM.

SOME SAY IT’S PART OF MIGRAINES AND SOME SAY IT IS NOT.

THERE’S NOT A BLOOD TEST YOU CAN DO.

THE TREATMENT IS A LITTLE DIFFERENT.

THE MIGRAINES, THERE ARE SOME SPECIFIC MIGRAINE SPECIFIC TREATMENTS.

THE TENSION HEADACHES, THE MIGRAINE MEDICINES DON’T NECESSARILY HELP THAT, BUT THEY DO TYLENOL AND IBUPROFEN, THE OTHER THE COUNTER STUFF -- OVER THE COUNTER STUFF.

MAKE SURE YOU ARE EATING WELL, HYDRATED, EXERCISING, NOT TOO MANY CHEESEBURGERS.

SO LIFESTYLE FOR ATTENTION TYPE HEADACHES CAN BE VERY HELPFUL.

DR. CHRISTENSEN: THERE’S A QUESTION HERE ABOUT MYASTHENIA GRAVIS.

IS THIS A PROGRESSIVE TERMINAL DISEASE OR ARE THERE TREATMENT OPTIONS?

DR. RIPP: OH BOY.

DR. SANFORD: I DIAGNOSED TWO CASES IN ONE WEEK.

IT IS SPOOKY.

THE NERVES DON’T COMMUNICATE WITH EACH OTHER, AND SOME MEDICINES CAN HELP SLOW THE PROGRESSION, BUT AS FAR AS I KNOW, THERE’S NO WAY TO STOP IT.

DR. CHRISTENSEN: WE ARE GOING TO MOVE ON NOW TO PARKINSON’S.

IT HAS BEEN SITTING ON MY LIST A LITTLE BIT.

THIS PERSON HAD A RECENT DIAGNOSIS OF PARKINSON’S IN THE FAMILY.

ANY ADVICE FOR FAMILY MEMBERS?

REGARDING SUPPORTING THIS INDIVIDUAL AND RECOMMENDATIONS FOR MEDICATIONS?

DR. RIPP: IF YOU DO HAVE A FAMILY MEMBER THAT’S A CLOSE RELATIVE, THAT DOES INCREASE YOUR RISK.

THERE’S NO WAY TO PREVENT YOU FROM GETTING THAT OTHER THAN TAKING CARE OF YOURSELF AND AVOIDING HEAD TRAUMA.

THAT IS PERKINSONISM WHICH IS DIFFERENT THAN PARKINSON’S DISEASE.

IT DEPENDS ON ONSET AND SYMPTOMS.

SOME PEOPLE HAVE MORE RIGIDITY.

SOME PEOPLE ARE BOTHERED MORE BY THE TREMOR.

BASED UPON THE AGE AND THE SYMPTOMS, WE DIRECT OUR THERAPY TO TREAT THE SYMPTOMS.

THE HOPE IS TO CONTROL IT WELL ENOUGH IF YOU HAVE SEVERE PARKINSON’S AND IT IS DISABLING AND THE MEDICINES ARE NOT WORKING, THERE ARE INTERVENTIONS SUCH AS GOING INTO THE BRAIN AND PUTTING A STIMULATOR IN, WHICH IS NOT SOMETHING WE DO IN THE OFFICE.

DR. SANFORD: SPEAK FOR YOURSELF.

[LAUGHTER] DR. VIKRAM: THE KEY WITH PARKINSON’S IS TO MAKE SURE THAT YOU WORK WITH A NEUROLOGIST THAT SPECIALIZES IN THAT LIKE A MOVEMENT DISORDER SPECIALIST.

THERE ARE LOTS OF TREATMENTS AVAILABLE AND THEY HAVE TO BE PROVIDED AT THE RIGHT TIME.

YOU DO NOT WANT TO DELAY.

SOMEONE WHO COULD BE A CANDIDATE FOR DEEP BRAIN STIMULATION IN THOSE KIND OF TREATMENTS.

BECAUSE IF YOU WAIT TOO LONG, BY THAT TIME IT MIGHT BE TOO LATE.

THE DOPAMINE RECEPTORS, EVERYTHING IS ALREADY DEPLETED.

WORKING WITH A MOVEMENT DISORDER NEUROLOGIST WOULD BE HELPFUL.

SOMETIMES YOU HAVE TO HAVE THE MEDICATIONS IN A WAY THEY ARE HELPFUL ALLOWING THE RIGIDITY TO OVERCOME AND ALLOWING THE ABILITY TO MOVE AROUND, BUT AT THE SAME TIME NOT HAVING TO DEAL A WHOLE LOT WITH THE SIDE EFFECTS OF THE MEDICATIONS ALSO.

SOME OF THESE MEDICATIONS AS WE GET OLDER WE’LL HAVE QUITE A BIT OF SIDE EFFECTS, AND THEN IT BECOMES ALMOST A JUGGLING ACT WHEREIN YOU HAVE TO MANAGE MEDICATIONS AND SIDE EFFECTS.

AND WHAT IS WORSE?

DR. CHRISTENSEN: CAN NEUROLEPTICS CAUSE THIS KIND OF PROBLEM?

DR. RIPP: CERTAIN MEDICATIONS CAN GIVE YOU A PARKINSON’S APPEARANCE, BUT IS NOT THE DISEASE.

SO THAT IS ONE OF THE THINGS WHERE YOU HAVE TO SORT OUT, IF YOU SEE A PATIENT WITH A TREMOR, IS THAT JUST A FAMILIAR TREMOR, IS IT PARKINSON’S, IS IT SIDE EFFECTS FROM THE MEDICATION?

IT CERTAINLY CAN BE.

I’M SURE PAUL DOES THIS, ANY PATIENT WITH A SYMPTOM, WE LOOK AT MEDICATIONS AND SEE IF THERE’S A SIDE EFFECT WHICH CAN HAPPEN.

DR. CHRISTENSEN: WE TALKED ABOUT DEMENTIA EARLIER.

DOES DEMENTIA TRAVEL WITH PARKINSON’S DISEASE?

DR. SANFORD: YOU CAN OFTEN FIND DEMENTIA IN PEOPLE WITH ADVANCING PARKINSON’S, BUT NOT NECESSARILY.

PERKINSON -- PERKINSONISM HAS MANY EFFECTS, ONE OF THE ONES THAT I SEE IS THE LOSS OF AUTONOMIC NERVOUS SYSTEM LIKE MOBILITY OF THE INTESTINES, THE BIGGEST THING I WORRY ABOUT IS A FAULT AND A BROKEN HIP.

DR. VIKRAM: THERE IS ONE PARTICULAR SUBSET CALLED LEWY BODY DEMENTIA WHERE YOU HAVE SOME PARKINSON FEATURES.

YOU CAN HAVE DEMENTIA, HALLUCINATIONS, AGGRESSIVE BEHAVIOR.

THAT CAN BE VERY CHALLENGING TO MANAGE.

IT DEPENDS ON WHAT THE PATIENTS ARE PRESENTING MORE WITH.

EXAMINING THE PATIENT AND GETTING THE RIGHT DIAGNOSIS.

DR. CHRISTENSEN: ELDERLY PATIENT HYDROCEPHALUS TREATMENT.

DR. VIKRAM: I ALWAYS LIKE TO SAY IT IS A DIAGNOSIS OF EXCLUSION.

YOU HAVE TO MAKE SURE YOU HAVE EXCLUDED ALL OF THE POSSIBILITIES FOR THE PROBLEMS THAT ARE BEING ATTRIBUTED TO HYDROCEPHALUS BEFORE COMMITTING THEM TO A TREATMENT, WHEREIN YOU HAVE TO PUT IN A DRAIN TO TAKE THE EXCESS FLUID OUT DIRECTLY, LIKE THE ABDOMINAL CAVITY.

HYDROCEPHALUS IS ACCUMULATION OF MORE AND MORE FLUID INSIDE THE FLUID FILLED SPACES IN THE BRAIN.

THAT’S WHY THE PATIENT MAY HAVE SOME PROBLEMS, LACK OF COGNITIVE DECLINE AND NOT ABLE TO AMBULATE WELL.

A NEUROSURGEON CAN PUT IN A DRAIN DIRECTLY BETWEEN THESE SPACES AND TRACK IT INTO THE ABDOMINAL CAVITY.

DR. CHRISTENSEN: EFFECTIVE TREATMENT FOR ESSENTIAL TREMOR.

WHAT IS IT?

DR. RIPP: THE BETA BLOCKERS OWN.

NARCOTICS.

SO BETA-BLOCKERS, A BLOOD PRESSURE MEDICINE CAN WORK.

PRIMEDONE CAN WORK.

SOMETIMES YOU GET LUCKY, I DID HAVE ONE PERSON RESPOND TO THIS.

DR. SANFORD: YOU DID?

MY GOSH.

DR. RIPP: YES.

IT IS A TOUGH ONE.

DR. SANFORD: THERE IS NO SIMPLE CURE.

DR. CHRISTENSEN: OTHER TRIMMERS WE SHOULD WORRY ABOUT?

PARKINSON’S, IT’S A DIFFERENT TREMOR.

DR. SANFORD: CLASSIC PILL ROLLING PURITY OF.

DR. CHRISTENSEN: AS WE KIND OF COME TO THE END, WE ARE COMING INTO THE SPRING SEASON.

YOU GUYS ARE TAKING CARE OF.

PEOPLE OUT IN THE COUNTRY LYME DISEASE IS COMING UP AT THIS TIME OF THE YEAR.

WE WILL HAVE A PROGRAM AT THE MED SCHOOL, DR. BEN CLARK.

WE ARE GOING TO SHOWCASE THIS.

LYME DISEASE CAN CAUSE NEUROLOGIC DISEASE ALSO.

YOU MAY HAVE SOMETHING TO SAY ABOUT THAT.

I ENCOURAGE PEOPLE THAT THEY ARE WELCOME TO COME TO THIS PROGRAM.

IT IS FREE, THERE’S PARKING.

I CAN’T REMEMBER WHAT DAY IT IS IN MARCH.

ANY THOUGHTS ON LYME DISEASE?

DR. VIKRAM: WE LIVE IN ENDEMIC LYME DISEASE COUNTRY.

ANYONE WHO COMES IN WITH VERY WEAK SYMPTOMS, ANYONE SHOULD BE CHECKED.

LYME DISEASE IS ONE OF THE SYMPTOMS THAT CAN MIMIC A STROKE AND SEVERAL OTHER PATHOLOGIES ALSO.

EARLY TREATMENT -- EARLY IDENTIFICATION AND TREATMENT.

YOU CAN CURE IT SO THAT SHOULD NOT BE A PROBLEM ONCE YOU CAPTURE.

DR. CHRISTENSEN: DEEP BRAIN STIMULATION.

ARE THERE PROVIDERS IN DULUTH THAT HANDLE THIS PROBLEM?

DR. VIKRAM: TO THE BEST OF MY KNOWLEDGE, MOST PATIENTS TEND TO GO TO THE CITIES.

OR MAYO.

ONCE THE DEEP BRAIN STIMULATOR IS PUTTING, A NEUROLOGIST WHO SPECIALIZES IN MOVEMENT DISORDERS OR HAVE GOOD EXPERIENCE, THEY CAN DO THE PROGRAMMING SO THE PATIENTS DON’T HAVE TO GO TO THE CITIES ALL THE TIME.

DR. CHRISTENSEN: VERY GOOD.

THANK YOU GUYS.

THIS HAS BEEN A GREAT DISCUSSION.

I WANT TO THANK OUR PANELISTS, DOCTOR KEN RIPP, DOCTOR PAUL SANFORD, AND DOCTOR JADHAV VIKRAM, AND OUR MEDICAL STUDENT VOLUNTEERS NICOLE FALL, TOMMY MARTIN, AND WYATT WINDHORST.

PLEASE JOIN MARY MOREHOUSE NEXT WEEK FOR OUR LAST PROGRAM OF THE SEASON ON THE DSM-5.

THANK YOU FOR WATCHING.

GOOD NIGHT!

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