Simply PM&R

Guest: Peter C. Rhee, D.O.Host: Jeffrey S. Brault, D.O. (@JeffBrault)Summary: Spinal cord injuries are often devastating for our patients. What are some of the surgical options that are available for patients to regain function in their upper extremities? Peter C. Rhee, D.O., sheds some light on life and function-altering procedures, providing expert insight on helping a patient plan for this type of procedure.Deeper Dive:American Spinal Injury Association’s International Standards for Neurological Classification of Spinal Cord Injury: https://asia-spinalinjury.org/wp-content/uploads/2016/02/International_Stds_Diagram_Worksheet.pdfPatient Story: https://sharing.mayoclinic.org/2018/03/05/right-handed-once-more-thanks-to-unique-orthopedic-surgery/

Guest: Michelle S. Gittler, M.D.Host: Jeffrey S. Brault, D.O. (@JeffBrault)“Anything that is going to impact the health of the people I serve should be looked at seriously.” Michelle S. Gittler, M.D., outlines the ways in which doctors can, and should, get involved in large-scale advocacy for their patients. She makes the argument for why advocacy should be taught as a core competency in medical school and how to teach it to future physicians.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.

Guest: Cara P. Prideaux, M.D.Host: Jeffrey S. Brault, D.O. (@JeffBrault)Sports medicine is a distinct medical specialty combining modalities from several other specialties. What exactly is sports medicine and who can be seen in a sports medicine clinic? What is the testing that should be performed at the sideline at the time of injury? Dr. Cara Prideaux answers these questions and discusses when and how to get the athlete back into their preferred physical activity after an injury.

Guest: Billie A. Schultz, M.D.Host: Jeffrey S. Brault, D.O. (@JeffBrault)Billie A. Schultz, M.D., shares her insights on everything related to concussions, from diagnosis to recovery. She outlines the five domains of concussion symptoms, how to rest your patient after a concussion, and when to get the interdisciplinary team involved in post-concussive care.

Guest: Molly A. Feely, M.D. (@mollyfeelymd)Host: Tracy McCrayEpisode 10 of 10: Dr. Molly Feely, who is board certified in palliative care, internal medicine, and family medicine now practicing full time palliative care at Mayo Clinic in Rochester, talks about best practices for Management of Opioid Side Effects. Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.

Guest: David C. Weber, M.D.Host: Jeffrey S. Brault, D.O. (@JeffBrault)David C. Weber, M.D., shares his expert insight on strokes, intervention, and rehabilitation. He answers questions such as: “How does someone know if they or a loved one is having a stroke? What early interventions are available?” Dr. Weber also goes into some depth about rehabilitation, including when and what to order, and how to counsel patients in finding a facility to meet their needs.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.

Guest: Halena M. Gazelka, M.D. (@hmgazelkamd) Host: Tracy McCrayEpisode 1 of 10: Dr. Halena Gazelka, an anesthesiologist boarded in pain and palliative medicine at Mayo Clinic in Rochester, talks about best practices for Opioid Monitoring and Considerations for Tapering. This podcast is brought to you by the Opioid conference held each year as a part of Mayo Clinic’s Continuing Medical Education.Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.

Guest: Erica Bellamkonda, M.D.Host: Jeffrey S. Brault, D.O. (@JeffBrault)How do we measure and improve specific quality indicators, including those required by various government bodies? Where do you even start? How effective do you need to be when you are completing a project? Dr. Erica Bellamkonda discusses quality improvement projects, including how to choose a project, steps to completing a project, and how to follow up once completed using the PDSA (Plan, Do, Study, Act) strategy.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.Deeper Dive: Mayo Clinic Quality Academy offers their Fundamentals of Quality Improvement – Bronze Level course online: https://ce.mayo.edu/quality/content/mayo-clinic-fundamentals-quality-improvement-%E2%80%93-bronze-level-online

Guest: Holly L. Geyer, M.D.Host: Tracy McCrayEpisode 8 of 10: What legal and ethical obligations do physicians have when prescribing opioids? How can we address systemic issues that need improvement? Dr. Holly Geyer, internal medicine physician at Mayo Clinic in Arizona, shares her thoughts on what is currently being done to combat the opioid crisis and what additional steps can be taken to make a difference.Claim CME credit at ce.mayo.edu/opioidpc.

Guest: Randy A. Shelerud, M.D. Host: Jeffrey S. Brault, D.O. (@JeffBrault) Back pain is very common. Filtering out a serious underlying condition is top priority, but what are the best practices for what comes next? What kinds of treatment plans are available for acute back pain? When should advanced imaging be considered? Dr. Randy Shelerud covers best practices for management of back pain. Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.

Guest: Holly L. Geyer, M.D.Host: Tracy McCrayEpisode 7 of 10: Dr. Holly Geyer, an internal medicine physician, who serves on the Opioid Stewardship Program at Mayo Clinic in Arizona, discusses issues of dependency and addiction. What’s the difference between dependency and addiction? Claim CME credit at ce.mayo.edu/opioidpc.

Guest: Casey M. Clements, M.D., Ph.D. (@CaseyClmnts)Host: Tracy McCrayEpisode 6 of 10: How do you assess whether a patient has become addicted? What do you do if you suspect opioid use disorder or addiction? Dr. Casey Clements, an emergency physician and practice leader, who works in the Opioid Stewardship Program at Mayo Clinic in Rochester, shares his insights on treating opioid misuse in the emergency setting.Claim CME credit at ce.mayo.edu/opioidpc.

Guest: Jonathan T. Finnoff, D.O. (@FinnoffJonathan)Host: Jeffrey S. Brault, D.O. (@JeffBrault)What procedures can be performed utilizing ultrasound? What type of tools are required to do these minimally-invasive procedures? How does the procedure unfold and what is the evidence behind the safety and efficacy of these? Dr. Jon Finnoff discusses what’s currently in the translational phase of research, the process of candidate selection, and the how these procedures compare to their traditional counterparts.  Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR and Mayo Clinic Sports Medicine @mayoclinicsport.Deeper Dive: Ultrasound-Guided Cutting Wire Release of the Proximal Adductor Longus Tendon: A Feasibility Study https://doi.org/10.1177/2325967119866010Ultrasound‐Guided Cutting Wire Release of the Posterior Iliotibial Band: A Feasibility Study https://doi.org/10.1002/pmrj.12340Ultrasound-Guided Cubital Tunnel Decompression in a Collegiate Swimmer: A Case Report doi: 10.1097/JSM.0000000000000680Ultrasound-Guided Fasciotomy for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation doi: 10.1016/j.pmrj.2016.09.002Ultrasound-Guided Fasciotomy for Chronic Exertional Compartment Syndrome: A Case Report doi: 10.1097/JSM.0000000000000777A Non-Scalpel Technique for Minimally Invasive Surgery: Percutaneously Looped Thread Transection of the Transverse Carpal Ligament doi: 10.1007/s11552-014-9656-4A Clinical Study of the Modified Thread Carpal Tunnel Release doi: 10.1177/1558944716668831

Guest: Casey M. Clements, M.D., Ph.D. (@CaseyClmnts)Host: Tracy McCrayEpisode 5 of 10: Dr. Casey Clements, an emergency physician and practice leader, who works in the opioid stewardship program at Mayo Clinic-Rochester, shares his insights on opioid therapy from the Emergency Department perspective. What is drug diversion? How do you know a patient isn’t receiving prescriptions from multiple physicians?Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.

Guest: David C. Patchett, D.O.Host: Tracy McCrayEpisode 4 of 10: Family practitioner, Dr. David Patchett, from Mayo Clinic in Arizona shares the additional challenges associated with prescribing opioids to special populations, and discusses how and when to reassess a patient’s therapy. How do you know when to taper a patient? What are the symptoms of opioid withdrawal and how can you mitigate them? Claim CME credit at ce.mayo.edu/opioidpc.

Guest: Margaret A. Moutvic, M.D. Host: Jeffrey S. Brault, D.O. (@JeffBrault)When it comes to inflammatory joint conditions, what rehabilitation strategies should you employ with your patients? How should your patient’s exercise when they have joint pain? Dr. Maggie Moutvic discusses managing joint and connective tissue disorders.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.

Guest: David C. Patchett, D.O.Host: Tracy McCrayEpisode 3 of 10: Dr. David Patchett, family practitioner at Mayo Clinic in Arizona, answers common questions family practitioners often face when treating patients with pain management issues. What are best practices when prescribing opioid therapy? How do you weigh the potential benefits of opioid therapy with the identified risks? Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.

Guest: Halena M. Gazelka, M.D. (@hmgazelkamd)Host: Tracy McCrayEpisode 2 of 10: What are the different guidelines when treating chronic versus acute pain with opioid therapy? Dr. Halena Gazelka, an anesthesiologist boarded in pain and palliative medicine at Mayo Clinic in Rochester, talks about the importance of “starting low and going slow.” What are the alternatives for chronic pain management? Dr. Gazelka also covers non-pharmacological and implantable device alternatives for the treatment of pain.Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.

Guest: Mohamad Bydon, M.D.Host: Jeffrey S. Brault, D.O. (@JeffBrault)Dr. Mohamad Bydon discusses harnessing autologous, adipose-derived, mesenchymal stem cells to treat blunt traumatic spinal cord injuries. He details how the the ground-breaking clinical trial is setup, the safety and efficacy goals of the current study, and what they hope to do in phase two.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.Deeper Dive: CELLTOP Clinical Trial: First Report From a Phase 1 Trial of Autologous Adipose Tissue–Derived Mesenchymal Stem Cells in the Treatment of Paralysis Due to Traumatic Spinal Cord Injury: https://doi.org/10.1016/j.mayocp.2019.10.008To learn more about Mayo Clinic’s Neuroinformatics Lab visit here: https://www.mayo.edu/research/labs/neuro-informatics/aboutFor inquiries regarding the study email: neuroinformatics@mayo.edu

Guest: Halena M. Gazelka, M.D. (@hmgazelkamd)Host: Tracy McCrayEpisode 1 of 10: Dr. Halena Gazelka, an anesthesiologist boarded in pain and palliative medicine at Mayo Clinic in Rochester walks us through the basics of opioids and the current state of this national crisis. What is an opioid? How bad is the opioid epidemic and how did we get here?Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.

Guest: John H. Hollman, PT, Ph.D.Host: Jeffrey S. Brault, D.O. (@JeffBrault)As the corner stone of the rehabilitation team, physical therapy has transformed over the last 10 – 20 years. Dr. John Hollman reviews what it takes to earn a Doctorate of Physical Therapy along with current trends in residency and fellowship options. Listen in as he covers the KISS principle to patient exercise adherence and nationwide direct access.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.

Guest: Thomas P. Pittelkow, D.O., M.P.H.Host: Jeffrey S. Brault, D.O. (@JeffBrault)How do you treat acute vs chronic pain? Dr. Thomas Pittlekow details how he approaches patient education around pain and treatment options for chronic pain including spinal cord and peripheral nerve stimulators and who stands to benefit most. Dr. Pittelkow outlines best practices for prescribing opioids and the reasons behind them. He shares how he’s helping patients “live better, feel better, and move better” using a multimodal approach.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.Deeper Dive: CDC Guidelines for Prescribing Opioids for Chronic Pain https://www.cdc.gov/drugoverdose/prescribing/guideline.htmlMayo Clinic Pain Rehabilitation Center https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/resources-for-physicians

Guest: Jonathan Finnoff, D.O. (@FinnoffJonathan)Host: Jeffrey Brault, D.O. (@JeffBrault)Leg and buttock pain seem synonymous in athletes. How do you narrow down the differential diagnosis? Dr. Jeff Brault presents a series of cases to Dr. Jonathan Finnoff. Do you know the diagnosis? How would you approach one of these cases? Dr. Finnoff walks through his approach from presentation to treatment, offering his expert insight on things to consider when evaluating patients with leg and buttock pain. Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR and Department of Sports Medicine @mayoclinicsport. Deeper Dive: Exertional Leg Pain https://doi.org/10.1016/j.pmr.2015.08.012 Evaluation of the Athlete with Buttock Pain doi: 10.1249/JSR.0b013e3182423d71 The Gluteal Triangle: A Clinical Patho-Anatomical Approach to the Diagnosis of Gluteal Pain in Athletes https://bjsm.bmj.com/content/43/6/460 Variability of the Ischiofemoral Space Relative to Femur Position: An Ultrasound Study https://doi.org/10.1016/j.pmrj.2015.03.010 Variability of Ischiofemoral Space Dimensions with Changes in Hip Flexion: an MRI Study https://doi.org/10.1007/s00256-016-2508-2 

Guest: Amy E. Rabatin, M.D. Host: Jeffrey S. Brault, D.O. (@JeffBrault)Pediatric patients are not just little adults. Dr. Amy Rabatin lays out the main differences to be aware of when treating this patient population, how you can specialize in this field, and what types of conditions are typically seen. She also discusses how to manage obesity in children with disabilities and how to manage the barriers they face when being active, and how to keep these kids safe while participating in sports.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.

Guest: Kathryn M. Alfonso, D.O. and Ike B. Hasley, M.D. Host: Jeffrey S. Brault, D.O. (@JeffBrault)What questions should you ask on interview day? How do you make the final decision? Dr. Brault discusses what factors into resident perceptions and decisions with two of Mayo Clinic’s current PM&R residents, Kathryn Alfonso, D.O. and Ike Hasley, M.D. What is your programmatic culture? How do you make it through the filter to a top choice for applicants?Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.Deeper Dive: The Student Doctor Network: https://www.studentdoctor.net/ 

Guest: Carmen M. Terzic, M.D., Ph.D. Host: Jeffrey S. Brault, D.O. (@JeffBrault)While heart attack survival rates are increasing, these patients are often left with functional deficits that require treatment. Dr. Carmen Terzic dives into cardiovascular rehab for the post-event patient, aiming to gain control of risk factors, making lifestyle changes with the aim of prevention, and helping patients to maintain these changes long-term.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.

Guest: David C. Weber, M.D. Host: Jeffrey S. Brault, D.O. (@JeffBrault)Dr. Dave Weber discusses healthy aging, what it is, what it isn’t, and how you can help your elderly patients optimize their quality of life.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.

Guest: Stephen J. Wisniewski, M.D. Host: Jeffrey S. Brault, D.O. (@JeffBrault) How do you counsel your patients about the risks and benefits of corticosteroid injections? How long should you expect their pain relief to last and how do you decide when and if to repeat one? Dr. Stephen Wisniewski discusses the choice between treatment with corticosteroid injections versus NSAIDS, side effects, and the benefits of using ultrasound guidance. Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR. 

Guest: Russell Gelfman, M.D.Host: Jeffrey S. Brault, D.O. (@JeffBrault)How do you determine what work restrictions would be most beneficial? When is maximum medical improvement determined and how does it relate to disability ratings? Even though the job landscape has changed from the dawn of worker’s compensation and insurance, work rehabilitation has maintained the same goal: return patients back to full duty employment. Dr. Gelfman lays out the specialist’s take on the Biopsychosocial Model in application to work rehabilitation, the need for more practitioners in this field, and how to develop this skillset within your practice.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.Deeper Dive: AMA Guides® to the Evaluation of Work Ability and Return to Work https://commerce.ama-assn.org/store/ui/catalog/productDetail?product_id=prod1230017&navAction=push The Work Disability Functional Assessment Battery (WD-FAB) DOI: https://doi.org/10.1016/j.pmr.2019.03.004

Guest: Andrea L. Cheville, M.D. Host: Jeffrey S. Brault, D.O. (@JeffBrault) What exactly is cancer rehabilitation? How can we keep our patients working and living their best life during cancer treatment? How do these patients differ from other rehabilitation patients? Dr. Andrea Cheville shares her insights on the Mayo Clinic multidisciplinary approach to providing rehabilitative care for cancer patients. This includes those actively going through chemotherapy and/or radiation treatments, as well as patients whose treatment has concluded. Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR. 

Guest: Andrea J. Boon, M.D. Host: Jeffrey S. Brault, D.O. (@JeffBrault) When is it appropriate to order an electromyography (EMG)? How early is too early to get results? When do you run the nerve conduction and/or the needle exam? Dr. Andrea Boon discusses how to best approach the needle exam and which muscles are the best to needle. Neuromuscular ultrasound is playing in electrodiagnostics and conditions like carpel tunnel syndrome? Dr. Boon shares her pearls for utilizing ultrasound and calling myopathies and radiculopathies. Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR. 

Guest: Jeffrey M. Thompson, M.D. Host: Jeffrey S. Brault, D.O. (@JeffBrault) Abnormal movement patterns that aren’t caused by a motor disease can be very difficult to diagnose and treat. Often, these conditions are a diagnosis of exclusion. Patients can see multiple providers before receiving a proper diagnosis. But how do we help these patients regain normal gait? Dr. Jeff Thompson discusses the Behavioral Shaping Therapy (BeST) approach. Listen in as he tells you how to set your patients up for success when diagnosed with a functional movement disorder. For more on Mayo Clinic's BeST program, visit https://mayocl.in/2MJ6sNJ. Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.

Guest: Kristin L. Garlanger, D.O. Host: Jeffrey S. Brault, D.O. (@JeffBrault) What is the role of stem cells in treating spinal cord injuries? What’s the research demonstrating in motor outcomes after epidural stimulation? Dr. Garlanger steps through multiple causes of non-traumatic spinal cord injuries and the need for research around outcome predictions. Listen to learn about adaptive exercise for your patients and how to help them be active with spinal cord injuries. Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR. 

Guest: Jacob L. Sellon, M.D. (@jlsellon) Host: Jeffrey S. Brault, D.O. (@JeffBrault) PRP, BMAC, prolotherapy, placental derivatives, and microfragmented adipose tissue. What are they, what can we treat with them, and what does the evidence support? Dr. Jacob Sellon dives into these questions and discusses difficulties in the exploding field of regenerative medicine. Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.