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Ortho Eval Pal: Optimizing Orthopedic Evaluations and Management Skills
Send us a text-Today we'll be discussing a recent patient of mine who presented with left LE paresthesia and difficulty walking.-I'll review the evaluation and discuss the management process.(Video) Hyperthyroidism with myelopathy(Video) Cervical Myelopathy(Video) Transverse MyelitisMyelopathy playlist videos
Dr. Wells and Dr. E go over some recent research updates on Cervical Myelopathy. Can you recognize early signs, do you only look for upper motor neuron signs? What about Hoffman's or Babinsky? Dr. Wells talks about the differences in onset and Sx between radiculopathy and myelopathy and what you should add to your exam.Untold Physio Stories is sponsored byComprehend PT- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!The Eclectic Approach Network - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out EDGE Mobility System's Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com
Welcome to Season 2 of the Orthobullets Podcast.Today's show is Foundations, where we review foundational knowledge for frontline MSK providers such as junior orthopaedic residents, ER physicians, and primary care providers.This episode will cover the topic of Cervical Myelopathy, from our Spine section at Orthobullets.com.Follow Orthobullets on Social Media:FacebookInstagram TwitterLinkedInYouTube
Degenerative myelopathy [my-ah-LAH-pah-thee] is a progressive disorder that targets a dog's spine, ultimately reducing…
Degenerative myelopathy [my-ah-LAH-pah-thee] is a progressive disorder that targets a dog's spine, ultimately reducing their ability to use their hind legs. The cause remains a mystery, but it likely involves...
Ahren Geilenfeldt, DO, Providence Medical Group, South - Physical Medicine & Rehabilitation/Electrodiagnostic Medicine CME Credit Available for all Providence Providers In order to claim CME credit, please click on the following link: https://forms.office.com/r/kxFUSn6ue9 (or copy & paste into your browser) Accreditation Statement: Providence Oregon Region designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 creditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Providence Oregon Region is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Planning Committee & Faculty Disclosure: The planning committee and faculty have indicated no relevant financial relationships with an ACCME-defined ineligible company. Their planning contributions were evidence-based and unbiased. All financial relationships (if any) have been mitigated. Original Date: November 21, 2024 End Date: November 20, 2025
Ahren Geilenfeldt, DO, Providence Medical Group, South - Physical Medicine & Rehabilitation/Electrodiagnostic Medicine CME Credit Available for all Providence Providers In order to claim CME credit, please click on the following link: https://forms.office.com/r/kxFUSn6ue9 (or copy & paste into your browser) Accreditation Statement: Providence Oregon Region designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 creditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Providence Oregon Region is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Planning Committee & Faculty Disclosure: The planning committee and faculty have indicated no relevant financial relationships with an ACCME-defined ineligible company. Their planning contributions were evidence-based and unbiased. All financial relationships (if any) have been mitigated. Original Date: November 21, 2024 End Date: November 20, 2025
Moderator: Roland Wiest (Bern, Switzerland)Guest: Randolf Klingebiel (Bielefeld, Germany)In this episode, Roland Wiest and Randolf Klingebiel explore rare causes of myelopathy, a challenging condition due to its infrequent occurrence and diverse origins. They discuss the diagnostic workup, imaging protocols, and differential diagnoses, emphasizing the importance of collaboration between neurologists and neuroradiologists in managing these complex cases.
I am pleased to present a carefully selected collection of high-quality care products that I have found beneficial for dogs suffering from Degenerative Myelopathy and various mobility issues at Woody's Place Senior German Shepherd Sanctuary. This compilation will help you identify which items are effective for your beloved pet and which may not be ideal! Quality care products for dogs facing Degenerative Myelopathy (DM) and other mobility challenges are vital resources that can greatly improve their well-being. These items are crafted not only to offer support but also to foster independence, enabling dogs to move around more comfortably. By utilizing appropriate harnesses, canine wheel chairs, and supportive beds, pet owners can alleviate discomfort and lessen the anxiety linked with mobility difficulties.(Disclosure: Woody's Place Senior German Shepherd Sanctuary may receive a small commission from our Amazon-preferred product storefront, which supports that sanctuary.) Our complete Amazon preferred product list:Woody's Place ~ Senior German Shepherd Sanctuary, Inc.'s Amazon PagePalliative Care Devices for Older Dogs:https://www.amazon.com/shop/woodysplaceseniorgermanshepherdsanctuary/list/2CP3KWXU8T82D?ref_=cm_sw_r_cp_ud_aipsflist_aipsfwoodysplaceseniorgermanshepherdsanctuary_3ZGZ6D9GAQX8N69BJ48FMobility Assistance Devices:https://www.amazon.com/shop/woodysplaceseniorgermanshepherdsanctuary/list/1K971JYALW9MN?ref_=cm_sw_r_cp_ud_aipsflist_aipsfwoodysplaceseniorgermanshepherdsanctuary_MF2BMXGVX7R38023F001Incontinence Care Products for Older Dogs:https://www.amazon.com/shop/woodysplaceseniorgermanshepherdsanctuary/list/1EXCF972FL8KL?ref_=cm_sw_r_cp_ud_aipsflist_aipsfwoodysplaceseniorgermanshepherdsanctuary_TYW643RG4W7KMDQJWQ6EOrthopedic Dog Beds:https://www.amazon.com/shop/woodysplaceseniorgermanshepherdsanctuary/list/10AL0LKAMKLK7?ref_=cm_sw_r_cSupport the showYou can find Woody's Place Senior German Shepherd Sanctuary online at:www.wpsgss.orghttps://www.facebook.com/woodysplacesgsshttps://www.instagram.com/wpsgss/https://www.youtube.com/channel/UC7Tb1hKnOWEamQstkqAxEygWe would LOVE it if you could leave a thumbs-up or comment! Please and Thank you! You can support our podcast by going to http://www.patreon.com/LifeWithOldDogsEvery little bit helps, and your support is what keeps the #Lifewitholddogs podcast going.
Regardless of the underlying cause of spinal cord disease, we have many tools at our disposal to improve symptoms and function in these patients. Even better, technology in this area is advancing rapidly. In this episode, Lyell Jones, MD, FAAN, speaks with Kathy Chuang, MD, author of the article “Symptomatic Treatment of Myelopathy,” in the Continuum February 2024 Spinal Cord Disorders issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Chuang is an instructor in neurology at Harvard Medical School and assistant in neurology co-director at Paralysis Center, Massachusetts General Hospital and Spaulding Rehabilitation Hospital in Boston, Massachusetts. Additional Resources Read the article: Symptomatic Treatment of Myelopathy Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Transcript Full transcript available on Libsyn Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the show notes. Subscribers also have access exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the show notes. AAN members, stay tuned after the episode to hear how you can get CME for listening. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum Lifelong Learning in Neurology. Today, I'm interviewing Dr Kathy Chuang, who has recently authored an article on symptomatic management of myelopathy in the latest issue of Continuum, on spinal cord disorders. Dr. Chuang is a neurologist and physical medicine and rehabilitation specialist at Mass General, where she serves as Co-Director of the MGH Paralysis Program and Chief of the Neuromuscular Rehabilitation Program. Dr Chuang, welcome, and thank you for joining us today. Would you introduce yourself to our listeners? Dr Chuang: Hi, my name is Kathy Chuang. As you said, I'm a neurologist at Mass General Hospital specializing in neuromuscular medicine, also physiatry, physical medicine, and rehab. And I'm glad to be here. Dr Jones: Thank you for joining us. Basically, if we want to know more about managing spinal cord disorders, we have come to the right person, right? Dr Chuang: I try to do my best with all patients - yep. Dr Jones: For our listeners who are new to Continuum, Continuum is a journal dedicated to helping clinicians deliver the highest quality neurologic care to their patients, and we do this with high-quality and current clinical reviews. For our long-time Continuum Audio listeners, you'll notice a few different things with our latest issue and series of author interviews. For many years, Continuum Audio has been a great way to learn about our Continuum articles. Starting with our issue on spinal cord disorders (this issue), I'm happy to announce that our Continuum Audio interviews will now be available to all on your favorite open podcast platform, with some exciting new content in our interviews. Dr. Chuang, your article is absolutely full of extremely helpful and clinically relevant recommendations for the treatment of myelopathy, regardless of the cause. If there were one single most important practice-changing recommendation that you'd like our listeners to take away, what would that be? Dr Chuang: I think the most important thing to take away is that spinal cord injury of any type spans so many organ systems, it is good to get people - or multidisciplinary care - involved early on. There's eighteen model systems for spinal cord injuries scattered across the US. Those can be great avenues of resources for patients and for practitioners, for people around. Physical medicine and rehab specialists (our physiatrists or spinal cord injury specialists) can be very useful. And then, also for each individual organ system, there are specialists involved. And so, having that multidisciplinary care is probably the most important thing for a patient that's suffering from myelopathy because every patient is different and coordinating that care is so important to them. Dr Jones: So, teamwork is probably the most important thing, and I think most of our listeners who have taken care of patients with spinal cord disorders realize that that's really key. Your article - it leads off with such a great review of one of the big problems with myelopathy, which is spasticity management. From a medication perspective, I think many of us struggle with the balance between controlling the spasticity and some of the side effects of those medications, like sedation. How do you walk that fine line, Dr. Chuang? Dr Chuang: Spasticity management, like everything else, is patient directed. It depends on what the patient is most complaining of. If a patient has spasticity but they're not actually having any complaints from it, we don't need to treat, because of fear of side effects. I tend to try to use focal procedures (like botulinum toxin injections) earlier on, in order to try and spare side effects of antispasticity medications. Use of other conservative therapies, like bracing, stretching, is very essential. Another thing to consider is that dantrolene doesn't usually have side effects - cognitive side effects, at least - and actually can be monitored pretty closely for hepatotoxicity, which is its major side effect. Other possibilities are the baclofen pumps, which can be very useful in patients with spinal cord injury because their spasticity is often more in their lower limbs than in their upper limbs. By using multimodality approaches, we can definitely limit the amount of cognitive side effects of medications. Dr Jones: That's fantastic. Do you start with that multimodal at the beginning, or do you step into it with one, then the other, then the other? Dr Chuang: I usually start off with a low-dose baclofen because they usually have generalized tone - first, in order to see if they have cognitive side effects with it and if so, at what dose. Also, so that insurers have a trial of some medication before we proceed to something as expensive as botulinum toxin injection. But yes, if there's significant focal spasticity, especially, I try to bring in botulinum toxin injections as early as possible, just because of the possibility of minimizing the effect. Dr Jones: That's a great point - that you can start these from multiple angles and start them early. And great point about dantrolene - I think the hepatotoxicity makes many of us nervous. But it's a key point there - that it can spare some of the cognitive side effects. Dr Chuang: Yes, and actually, it can be monitored pretty closely. As long as a patient has access to labs, we can check liver function tests weekly or every two weeks until you're on a stable dose, and after that, only at intervals. And it can be weaned off just as quickly. Dr Jones: Fantastic. Another issue that you cover really nicely in the article, that I think is an underrecognized complication of spinal cord diseases - neuropathic pain. What's your approach to that problem, Dr. Chuang? Dr Chuang: Neuropathic pain is very, very tough to treat a lot of times. I usually give the chance of gabapentin, pregabalin, and duloxetine early, just to see if we can start managing their pain early and to try to prevent potentiation of pain. But I also tend to try to get pain management specialists on early, and also keep in mind that there can be other causes of pain other than just the actual spinal cord injury itself. Because of deafferentation and reafferentation, patients may think of neuropathic pain, and it could be something as simple as appendicitis. If there's a change in pain, there always needs to be a workup for acute causes. Again, multidisciplinary treatment, especially with pain specialists, can be really helpful. Dr Jones: Great point about thinking of other causes, including appendicitis or the musculoskeletal things that I'm sure can be pain generators in this pain population, right? Dr Chuang: Yeah, it's very common. Patients can often fracture themselves just with a simple transfer and that can cause a huge flare-up of pain. So, not all pain should be just dismissed as being neuropathic or just from the spinal cord injury itself. Dr Jones: Great point - thank you. Another topic that you cover - that I think is mystifying to many of us - is the neurogenic bladder problems that occur in patients with myelopathy. You talk about the different types - how do you tell them apart? Dr Chuang: It's hard to tell them apart from a patient perspective because a patient will just say that they have difficulty with urination. With a spastic bladder or detrusor sphincter dyssynergia, oftentimes, patients will complain of a short stream and having to force things out. And with an atonic bladder or flaccid bladder, they have difficulty initiating a stream. What can be useful are postvoid residuals - where, if a patient is in the hospital, or if you have access to an ultrasound, or if they see a urologist - after they void, you measure the amount of urine left in their bladder. You can see whether it's a smaller amount, which is suggestive of a spastic bladder, versus a large amount, or an atonic or flaccid bladder. The standard procedure that's done to measure these are also urodynamic studies that are done, oftentimes, by urologists, where they can actually measure pressure volumes and oftentimes get EMG recordings of the actual bladder - the sphincters. Dr Jones: Perfect. When you do those postvoid residuals (easiest done with ultrasound), what's the general cutoff you use to say - that's a small amount that might be suggestive of a spastic bladder? Dr Chuang: I would say, probably less than a hundred. And then, if it was flaccid, more than five hundred. If there's in between, it may fall into either category. Dr Jones: Got it. When you think about neurogenic bladder, what are the treatment options? How do they vary between the different types that patients may have? Dr Chuang: If you have an atonic or flaccid bladder, the main possibilities for patients just are, oftentimes, Credé maneuvers (or pressure on the bladder) in order to try and help with the bladder to squeeze urine out. But a lot of times they need clean intermittent catheterization or maybe placement of a suprapubic catheter long term. For patients who have a spastic bladder or detrusor sphincter dyssynergia, we can use anticholinergic medications, like bethanechol, tolterodine - those medications - in order to try to relax the sphincter a little bit and then allow the urine to pass through. You can also have BOTOX injections to these sphincters of the bladder as well, which can be useful to relax them so that they can allow the urine to pass through. But a lot of times, a mainstay of treatment is intermittent catheterization, also for patients with severe detrusor sphincter dyssynergia, so that we can maintain small bladder volumes and not develop hydronephrosis, urinary tract infections, and complications of holding urine in the bladder. Dr Jones: Thanks for that, Dr. Chuang. Another part of your article that I thought was really fascinating, and probably will cover some new ground for our readers and listeners, is the use of nerve transfers or surgical treatment of weakness, basically. Tell us about that and how it's used in patients with myelopathy. Dr Chuang: For patients with myelopathy, it's used often in the upper extremities. If a patient has voluntary control of either elbow flexion or elbow extension (usually, elbow flexion), you can oftentimes have the ability to transfer nerves into the finger flexors and allow voluntary hand closure. If there's supination or wrist extension, you can oftentimes allow transfers of branches of the nerve - for example, from the supinator, or from the branch to the extensor carpi radialis brevis, into the finger extensor - so that, over a period of nine to twelve months, we'll be able to slowly regrow the nerve back in and allow the denervated muscle to become reinnervated with a voluntary controlled muscle and then restore voluntary finger extension, which can be extremely beneficial - just being able to voluntarily open and close their hands. Dr Jones: Right. And it sounds like the goal is really that functional use of grip and use of the upper limb. Not really so much for transfers, I imagine - is that not so much the goal? Dr Chuang: If there's less than antigravity strength of elbow extension and reasonable external rotation strength, you may be able to get elbow extension strong enough antigravity, and at that point a patient may be able to transfer independently - with a lot of training. Dr Jones: Wow, that's fantastic - thank you. There's lots of therapeutic options, really, for many of these complications, which I think is an important point for our readers and our listeners to take home. When you look into the future, Dr. Chuang, what do you see on the horizon as the next generation of care for patients with spinal cord disorders? Dr Chuang: I see a huge, expanding field, both of therapeutics - there are stem cell trials all over the world; there are neurorestorative hormones that are being tried. I'm very excited about the advent of robotics, with motors being basically shrunk down to the size of millimeters, and exoskeletons becoming lighter and lighter. I suspect that, long term, we'll be able to have robotic exoskeletons to be able to help patients walk and move their limbs normally. I know there are clinical trials right now involving orthoses that are controlled with brain interfaces that will hopefully help restore function in patients who need it. Dr Jones: It sounds like science fiction, but a lot of that technology exists now, right? Dr Chuang: Yes, it does. We definitely have prototypes of multigear hands with multiple directions. Now, the problem is trying to find the way to control these motors and to control these robotic hands and legs. Dr Jones: Caring for patients with myelopathy I imagine can be challenging, but I imagine it can also be quite rewarding. Tell us, Dr. Chuang, what drew you to this work specifically, and what do you find most exciting about it? Dr Chuang: I want to help people move better. I'm a physiatrist by training, and our job as physiatrist is to try to get people back to their activities of daily living as soon as possible; to try to remove any barriers to becoming active, independent people in their society. And so, I think that spinal patients that suffer from myelopathies or other spinal cord injuries have a lot of potential in the amount of activities that they can do and the way that they can contribute. I've seen patients who have been paralyzed and unable to move their hands at all develop tenodesis scripts, initially in order to just pick up things and then later obtain voluntary control of opening and closing their fingers. And it's huge in terms of what they can do in their everyday lives. Just being able to see that is just really rewarding. And even being able to help patients navigate society around them is just a hugely rewarding experience. Dr Jones: I imagine that must be really fantastic to see folks regain those milestones. Dr Chuang: Yes. Dr Jones: It's pretty unusual for someone to have done a neurology and a physiatry residency. So, between me and you and all of our listeners, which residency was better? Dr Chuang: Wouldn't trade one without the other. Probably wouldn't have done the one without the other, either! Dr Jones: What a great, diplomatic answer. Okay, good. Dr Chuang: It's true. Dr Jones: Yeah. You avoided offending all the neurologists and physiatrists out there. And really fascinating discussion, Dr. Chuang. It's an outstanding article. I think it's a must-read for anyone who takes care of patients with spinal cord disorders. I want to thank you Dr. Wang for joining us and for such a thoughtful, fascinating discussion on symptomatic management of spinal cord disorders. Dr Chuang: Thank you, Dr. Jones for having me today. Dr Jones: Again, we've been speaking with Dr. Kathy Chuang, author of an article on symptomatic treatment of myelopathy in Continuum's most recent issue on spinal cord disease - please check it out. And thank you to our listeners for joining today. Dr. Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, please consider subscribing to the journal. There's a link in the episode notes. We'd also appreciate you following the podcast and rating or reviewing it. AAN members, go to the link in the episode notes and complete the evaluation to get CME for this episode. Thank you for listening to Continuum Audio.
The spinal cord is a fragile network containing hundreds of millions of neurons, all passing through a conduit about the size of a dime. A consistent, organized approach to the diagnosis of spinal cord disease is necessary to give patients the best possible care. In this episode, Teshamae Monteith, MD, FAAN, speaks with Carlos Pardo, MD, author of the article “Clinical Approach to Myelopathy Diagnosis,” in the Continuum February 2024 Spinal Cord Disorders issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Pardo is a professor of neurology and pathology at Johns Hopkins University School of Medicine and director of the Johns Hopkins Myelitis and Myelopathy Center in Baltimore, Maryland. Additional Resources Read the article: Clinical Approach to Myelopathy Diagnosis Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud American Academy of Neurology website: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Transcript Full Transcript Available Here Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal, from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast of the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the show notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the show notes. AAN members, stay tuned after the episode to hear how you can get CME for listening. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. Today, I'm interviewing Dr Carlos Pardo about his article on an Integrative Clinical Approach to Myelopathy Diagnosis, which is found in the February 2024 Continuum issue on spinal cord disorders. Dr Pardo is a professor of neurology and pathology at Johns Hopkins University School of Medicine in Baltimore, Maryland. Welcome to the podcast. Carlos, thank you so much for this wonderful article. I think it was great! Dr Pardo: Thank you very much for the invitation and, particularly, to continue to write about myelitis and myelopathy - that is one of my passions in my activities as a clinical neurologist. And I think that this is basically one of the areas in which I thought, after finishing my residency training here, to focus, because there was absolutely no good understanding of the biology, clinical profile – particularly, understanding of the pathophysiology of myelitis and myelopathies, and what was called (at that time) transverse myelitis. So, that is what I have spent the past 25 years is try to understand that concept and apply what I was trained, as a neurologist and neuropathologist, to be translated in the clinical practice. Dr Monteith: Great. Well, I definitely want to know - how did you get into this area? Dr Pardo: That's a very nice question. Dr Monteith: I'm going to give you an easy one. Dr Pardo: I was trained as a clinical neurologist, but at the same time was trained as a clinical and experimental neuropathologist. When I finished my residency training, along with some of my co-residents and colleagues in my residency training, we took the challenge to take a neurological disorder that was called at that time transverse myelitis, to investigate diagnosis, clinical neurology of those patients, and investigate the etiological factors contributing to that. Very soon, we discovered that that group of patients that we call transverse myelitis was a very heterogeneous group of patients. And that basically put us in the situation to expand our approach to investigate what were those etiological factors contributing to those pathologies that we call, at that time, transverse myelitis. Since then, we have been focused on that. We have been focusing on characterizing patients with inflammatory myelopathies, with vascular myelopathies, with patients with infection disorders associated myelopathies. That is one of the main messages of the paper, and is - we need to think in a very etiological approach, because the variety of etiological factors that may contribute to spinal cord disorders is quite broad - it's very extensive. We need to be extremely careful when we approach those patients. There are very common myelopathies, there are very rare myelopathies. So, obviously, we always look for the commonalities and common pathologies, but we shouldn't basically forget about those myelopathies that may be rare but are present. I will say, frequently, we ignore the possibility of metabolic-associated myelopathies because we don't see those too much. But after we do an analysis of that equation - the clinical profile, temporal evolution, lesion topography, and biomarkers in imaging, blood, spinal fluid - and we don't find a clear explanation, we need to stop a little bit and think more about other things that we are missing. And frequently, metabolical disorders of the spinal cord are missed, or other type of pathology. That the reason the clinician need to have open mind and, occasionally, need to think out of the box, particularly when there is no clear answer to the search for etiological factors. Dr Monteith: I mean, when we think about spinal cord lesions, they can obviously be devastating because they affect patient's ability to ambulate. Why don't you tell us the most important takeaways from your article? Dr Pardo: Yeah, so this is a very important aspect of the article. The first thing is, if we are going to treat the patient, if we are going to focus in the management of a clinical problem, we need to understand first, what is the clinical diagnosis? What is the cause of the problem? Importantly, what is the etiology or the etiological factors contributing to that problem? The first thing that I always emphasize is, we are not able to treat a patient with a neurological condition if we don't have a very precise diagnosis, regardless what we are investigating in that patient. Specifically, for spinal cord disorders, there is a multitude of etiologies and pathogenic factors and other causes of the disease that may be involved. For that reason, the clinician, the health care provider, need to be aware about how to approach that question; is, we need to answer first the cause and the profile of the spinal cord disorder. And when we need to answer the cause, we need to focus first in evaluating clearly what has been the evolution of the symptoms, how is the neurological exam, how the evolution of the symptoms are going to help us to identify those etiological factors that we are looking for. For that reason, in the approach that I am suggesting to take in patient with the spinal cord disorder, the first critical element of that approach is to sit down and talk very well with the patient about what is going on - what are the main symptoms that are present, what has been the temporal evolution of those symptoms, and what has been basically the pattern of progression of those symptoms - because those are the clinical elements that will facilitate the clinician a much better understanding for the clinical diagnosis. Evaluating the clinical profile of symptoms and evaluating the temporal profile of symptoms is probably the first step for solving that critical equation about the diagnosis of spinal cord disorders. The main target is to establish a diagnosis. Dr Monteith: And that's really the bread and butter of neurology, because we have a global audience and we have some neurologists that practice in areas with very limited resources. But you do speak of some very cool things that I want to also touch on, such as precision medicine, the advances in biomarker development and neuroimaging, as well as investigating different viral etiologies in the pathology of spinal cord disease. So, can you just speak to some of that? You've been in this field now - you said, 25 years - how that evolution has helped you better treat patients. Dr Pardo: That's a very important question, because in 25 years we have learned tons about myelopathies, myelitis, and noninflammatory myelopathies - and it's quite amazing. I think that one of the most important aspects of spinal cord disorders is that, in the past 25 years, we have learned about mechanism of the disease in spinal cord disorders. Back in the 20th century we used the term transverse myelitis, and one of the main messages that I have for the clinicians who are reading the article is, please stop using that terminology. We have now capability to establish a more precise diagnosis, a more etiologically oriented diagnosis. If you can take a look at what happened in the past 25 years, understanding spinal cord disorders is quite amazing. We have a better understanding of the immunological factors that contribute to myelopathies. We are able to diagnose myelopathies associated with aquaporin 4 disorders, or MOG-associated disorders, or demyelinating diseases, or infectious disorders. So, in the past 25 years, with a combination of different tools in laboratory studies, studies of spinal fluid analysis, studies of the blood, we have basically able to identify biological markers that may guide us to treat more precisely those patients that are suffering from immune-related disorders. In the same way, imaging has contributed dramatically to improve our understanding of myelopathy. We are able to use neuroimaging studies to differentiate in better way, what are the myelopathies that are associated with vascular etiology, versus myelopathies that are associated with inflammatory etiology. In other words, the 25 years have provided all set of tools (assays, imaging techniques) that allow us to establish a better and precise diagnosis that facilitate etiological diagnosis. And in that way, we avoid the use of the term, transverse myelitis, that I frequently say is a basket diagnosis that is not taking us anywhere, because we are not using properly the etiological diagnostic approach. Dr Monteith: In the setting of all of this evolution, what do you still find challenging, and as well, rewarding in treating these types of patients? Dr Pardo: The best reward that we obtain when we establish this type of diagnosis is that we are able to facilitate better recovery, we are able to identify the factors associated with the problem, and eventually, to target, in a better way, those factors that are contributing to the problem and identify potential avenues for full recovery of the spinal cord. If we are dealing, for example, with patients with suspected inflammatory myelopathies, and we are able to identify an antibody that is contributing to that inflammatory myelopathy - like in the case of neuromyelitis optica - I think that the reward is that we are going to avoid a very long process that is going to decrease our ability to rescue that spinal cord and facilitate improvement of that patient. If we identify a vascular myelopathy and we are able to establish promptly a precise diagnosis of a stroke of the spinal cord, that will avoid that the patient goes in a very long road of treatments that even may be more harmful for that patient. And in that way, we are able to contribute the recovery and facilitate improvement of those patients with vascular spinal cord disorders. This is the reward: the reward is that we are able to facilitate a much better recovery of those patients and, in that way, to improve outcomes in those patients that are suffering myelopathies. Dr Monteith: What's been some of the more surprising cases in your practice, in terms of patient presentations, surprise recoveries, or whatever? Dr Pardo: One of the best rewards that we have seen in our research (clinical research) in the past several years is to be able to provide a much better framework for evaluating patients. The other aspect is to be able to identify patients that have very specific pathologies, like strokes of the spinal cord - ischemic pathology of the spinal cord that may be acute ischemic pathology or even chronic evolving pathology. In that way, actually, we have been able to establish much better protocol for assessment of those patients. That is actually one of the major aspects of our progression in terms of understanding the spinal cord disorders. And that is the reason - once again, I emphasize that when we use the term transverse myelitis and we erroneously diagnose patients with transverse myelitis when they are experiencing vascular pathologies of the spinal cord, we are basically not serving well those patients. That is one of the emphasis that I always include in the manuscript is, it is much better to spend time establishing a diagnosis (etiological diagnosis) rather than treating empirically diagnosis that probably are not going to be very well served by using treatments that probably are not going to benefit the patient. For example, when we deal with patients that have vascular myelopathies associated with chronic venous abnormalities, like happen in dural arteriovenous fistula, we are deserting those patients by treating them with IV methylprednisolone or treating them with IVIG, or treating them with immunosuppressive treatments. This is a critical element of the precision approach to establish a better diagnosis in patients with myelopathy. Dr Monteith: And then, your article spoke a little bit about recent outbreaks of infectious etiologies - viral etiologies. Can you talk a little bit about that? Because sometimes we send off these tests and they come back nonspecific or negative, and we have a sense that this was an infectious process. Maybe there was a prodromal phase, or something like that. Can you speak about your excitement in the area of advances in these methodologies? Dr Pardo: Yeah - this is an important aspect of the clinical conversation. Our patients may provide initial clues for identification of potential risk factors, such as infections, as etiological factors contributing to spinal cord disorder. When you are discussing with patients about specific symptoms that emerge after they have experienced either illnesses or systemic symptoms (like fever, chills, rash, or anything that look like an infection disorder) it's extremely important for the clinician to try to characterize that in much better way so we can use those elements of the investigation to determine if infection disorders may be involved as etiological factors in those myelopathies. We were trained to think about transverse myelitis as either an immunological-mediated disorder or an infection-mediated disorder. That's the reason I think that the clinician need to be open-minded when he's interviewing the patients to acquire, as much as possible, elements of the clinical history that may focus or avoid that the clinician pay too much attention to things that are not involved as etiological factor. Infection disorders frequently may produce neurological problems, and, obviously, spinal cord inflammation is one of those neurological problems. However, it's very important that the clinician be critical in the assessment of those potential risk factors. I frequently discuss with the students and residents in our ward that it's okay to think about West Nile myelitis when we are in the summer, but we are not able to discuss specifically about West Nile myelitis in middle of the winter, and particularly because those are etiological factors that are associated with seasonality and those are etiological factors that are associated with some risk factors that include, for example, mosquito transmission of a virus. When we talk about acute flaccid myelitis with our pediatric patient population, we need to think about circulation of viruses, and we need to think about if that is the right period of circulation of the virus that we are suspicious that is producing that spinal cord disorder. Again, the clinician need to be aware about the particularities of some infection disorder - seasonality, modes of transmission - to think about what is going on in terms of etiological factors, particularly infections, as part of causes of spinal cord inflammation. Dr Monteith: Let's talk a little bit about some controversies - things that maybe lead to overdiagnosis or underdiagnosis. Dr Pardo: It's a very good question, and I appreciate the controversy, always. One thing that is going back to the basis of the article is the precise diagnosis is strictly dependent of equation that involves different factors. We are not able to diagnose spinal cord disorders just using one factor of that equation. This is something that is extremely important for the clinician and health care provider. We are not able to establish a precise diagnosis just when we use only neuroimaging studies. We need to bring the clinical profile of that patient, the neurological examination, the neuroimaging studies, the spinal fluid analysis to the same equation. That is one of the controversies, because in the past, we relied heavily on neuroimaging studies for establishing a diagnosis of myelopathies. But I believe that has been a little bit of a mistake because we have been ignoring major elements of the clinical history and neurological examination. And probably the best example of that is the example of spinal cord strokes. When patients show up in the emergency department with acute onset of weakness and sensory problems, and an MRI show a lesion in the spinal cord, that is not automatically a myelitis. That is an acute spinal cord disorder in which the clinician has the responsibility to establish the precise diagnosis. This is one of the major messages that I want to give to our colleagues in the clinical setting is, we need to interview the patient; we need to characterize the clinical profile and make sure that what we see in the spinal cord MRI fits the clinical profile, the neurological examination, and even the spinal fluid analysis of that patient. One of the controversies that we have frequently is to diagnose patients with spinal cord strokes, because there is no gold standard for those diagnosis, unfortunately. It's a diagnosis that is comprised by several layers of assessment. In that way, we need to reach, basically, a consensus how to deal with those patients and how to manage those patients correctly. Dr Monteith: So, of course, we have a broad, I guess, “background” of listeners - from residents, medical students, even lay audience, as well as, of course, from neurologists. But why should a resident go into spinal cord disease as a subspecialty? Dr Pardo: It's a very important aspect of the central nervous system function. I always equate the spinal cord as the major avenue for the neurological function in the human body. If there is a very good connectivity in our brain and brain hemispheres, that connectivity is not going to be effective if there is not a healthy and very good function in the spinal cord. The spinal cord is the best avenue for execution of many of the function of the central nervous system. And in that way, a clinician who is working in neurology need to be aware about the spinal cord - need to be aware about the pathophysiology of the spinal cord. Because even if there is not any element of cognitive function in the spinal cord, we have all of the major avenues that facilitate the human function in the spinal cord - motor function, autonomical function, sensory function – so, most of the central nervous system function needs to go through the spinal cord. And the clinician (neurologists and residents) need to be aware - fully aware - about how to approach disorders of the spinal cord, how to identify correctly disorders of the spinal cord, and how to evaluate and treat those disorders. Dr Monteith: Well, thank you - I really appreciate this talk. I really appreciate your article. It was very thorough, including “the bread and the butter,” the approach to a patient clinically, but also all the new innovation in your field and all of the excitement. And of course, your story, too. So, thank you so much. Dr Pardo: Thank you, Tesha, for inviting me to this interview, and I hope that at least the main message is very well taken. Remember, the main goal of my proposal in this article: number one, is to get rid of the diagnosis of transverse myelitis; number two, that the clinician and health care providers establish a better etiological diagnosis that facilitate better recovery of patients, better management, and better outcomes in patients with spinal cord disorders. Dr Monteith: Thank you, Dr Pardo for joining me on Continuum Audio. Again, today we've been interviewing Dr Carlos Pardo, whose article on an integrative clinical approach to myelopathy diagnosis appears in the most recent issue of Continuum on Spinal Cord Disorders. Thank you to our listeners for joining today. Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, please consider subscribing to the journal. There's a link in the episode notes. We'd also appreciate you following the podcast and rating or reviewing it. AAN members,go to the link the episode notes and complete the evaluation to get CME for this episode. Thank you for listening to Continuum Audio.
Iwan and Ben are joined by the winners of the Myelopathy.org Research Award 2023 - Aditya Vedantam and Kajama Satkunendrarajah - for their investigation of how breathing is affected in DCM, with some stark findings and potential implications for our understanding of fatigue. The prize is awarded by the charity's scientific steering committee to the best scientific study aligned with one of the research priorities each year. You can read more about the award at https://myelopathy.org/research-award/.
Sarah joins Megan to talk about degenerative myelopathy, the changes in our understanding of the condition, and how we can best treat it. They discuss an internal vs external approach to treatment, and how we can combine them, diet, oxidative stress, physical stress, balancing the right amount of exercise, and so much more. Learn more about Sarah MacKeigan: https://upwarddogrehab.com/ Learn more about CuraCore: https://curacore.org/vet/ To learn about Onlinepethealth, watch a free webinar, or join any of our Facebook groups, click here: https://onlinepethealth.com/podcast
Sarah joins Megan to talk about degenerative myelopathy, the changes in our understanding of the condition, and how we can best treat it. They discuss an internal vs external approach to treatment, and how we can combine them, diet, oxidative stress, physical stress, balancing the right amount of exercise, and so much more. Learn more about Sarah MacKeigan: https://upwarddogrehab.com/ Learn more about Respond Systems: https://respondsystems.com/ To learn about Onlinepethealth, watch a free webinar, or join any of our Facebook groups, click here: https://onlinepethealth.com/podcast
Welcome to the first episode of "Ready for Renewal." In this series, we embark on a journey together, navigating the path to preparation and recovery from myelopathy surgery. Let's dive into the process of getting our physical space ready, starting with one room at a time. --- Send in a voice message: https://podcasters.spotify.com/pod/show/kani-gahima/message
MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: July 18, 2017In this BrainWaves brief, we review the major infections of the spinal cord with anatomic localization of disease and clinical management. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. This episode was vetted and approved by Colin Quinn.REFERENCESCho TA, Vaitkevicius H. Infectious myelopathies. Continuum (Minneap Minn) 2012;18(6 Infectious Disease):1351-73. PMID 23221845We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.
Iwan and Ben pause for reflection, 10 years since they first came together to create Myelopathy.org (alongside Mark Kotter), and almost 5 years since the research priorities were established in DCM. The community and reach of the charity has grown significantly over this time, which has become a powerful platform for progress. However alongside opportunity, the size also brings operational challenges. It feels like Myelopathy.org is at a tipping point, and to truly kick on we need to focus on growing financial investment. What can be done? Where could this go? Some of the critical topics discussed. If you have ideas or suggestions do get in touch ben@myelopathy.org.
It's a Myelopathy Matters Exclusive! Iwan and Ben are joined by Myelopathy.org researcher Irina Sangeorzan, to hear about the new Core Information Set. This forms part of a wider project called Shared DCM, and funded by the Evelyn Trust, to help people affected with DCM take a more active role in the decision making around their care. As Iwan likes to say, “Knowledge is Power”. The use of a CIS in this manner is a first for healthcare. We hear why it was needed, how it was formed and what it hopes to achieve.
At present, treatment for myelopathy varies widely. Although various surgical treatments are well known, there are currently no guidelines for the many non-operative domains of care (e.g. pre- and post-operative rehabilitation, pain relief, physiotherapy, nursing). In a powerful initiative led by Prof Chad Cook from Duke University, the RECODE-DCM Perioperative Rehabilitation Incubator is bringing together experts from all relevant disciplines to write management guidelines. Iwan shares his story, as a reminder of why filling this important knowledge gap could provide many simple, immediate gains for people living with myelopathy.
In this episode, we review the high-yield topic of Cervical Myelopathy from the Spine section. Follow Orthobullets on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
In this episode, we hear from neurologist Lindsay Tetreault from NYU. Lindsay has been leading the work of the RECODE-DCM Diagnostic Criteria incubator, tackling the all-important question of how to provide a timely, accurate and reliable diagnosis of DCM. Voicing the concerns of individuals living with DCM, Iwan reflects on the profound importance of shortening the time to diagnosis; and Ben explains why the combined perspectives of the multidisciplinary RECODE-DCM network are key to unlocking this research priority.
Steve Marden joins Megan to speak about Degenerative Myelopathy. Steve has been treating DM for almost over 30 years and eventually discovered a missing component in his approach that was hindering his success. He started addressing the problem and saw amazing results. Learn more about Steve Marsden:https://goldstandardherbs.com Discount Code: OPH To learn about Onlinepethealth, watch a free webinar, or join any of our Facebook groups, click here: https://onlinepethealth.com/podcast
MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 In this week's episode of Teaching through Clinical Cases, Dr. Michael Rubenstein (episode #17, "The FAME clinic in Tanzania") leads a discussion on the evaluation of a young patient with a rapidly progressive gait difficulty with numbness and paresthesias. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. This episode was vetted and approved by Michael Rubenstein. REFERENCES Goodman BP. Metabolic and toxic causes of myelopathy. Continuum (Minneap Minn) 2015;21(1 Spinal Cord Disorders):84-99. PMID 25651219 Kriegstein AR, Shungu DC, Millar WS, et al. Leukoencephalopathy and raised brain lactate from heroin vapor inhalation ("chasing the dragon"). Neurology 1999;53(8):1765-73. PMID 10563626 Kumar N, Elliott MA, Hoyer JD, Harper CM Jr, Ahlskog JE, Phyliky RL. "Myelodysplasia," myeloneuropathy, and copper deficiency. Mayo Clin Proc 2005;80(7):943-6. PMID 16007901 Pema PJ, Horak HA, Wyatt RH. Myelopathy caused by nitrous oxide toxicity. AJNR Am J Neuroradiol 1998;19(5):894-6. PMID 9613506 Stabler SP. Vitamin B12 deficiency. N Engl J Med 2013;368(21):2041-2. PMID 23697526 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.
Listen as Phoebe Hart takes us on her journey with Hugo, her endearing, 12 y.o., mixed breed rescue that was diagnosed 1.5 years ago with Degenerative Myelopathy (DM), a neurological disease with no known cure that causes progressive paralysis. Phoebe shares her reaction when she learned of Hugo's diagnosis. She stresses the importance of not panicking, but rather processing, as she assembled a care team that supports both Hugo and herself. Phoebe also discusses the resources, equipment and supplies she found useful, and the many "pivots" that were necessary as Hugo's disease progressed. Ironically, Phoebe describes Hugo's life now as more enriched than before his diagnosis despite his hind legs no longer working. We examine the physical and emotional stress related to the 24/7 care for any being (also known as compassion fatigue.) Although euthanasia is likely inevitable, Phoebe shares that as long as Hugo keeps exhibiting his can-do attitude and joyful outlook, she will be at his side, celebrating his daily victories and enjoying the company of her best friend. For more information, go to Living with Dogs with Disabilities, Sarah MacKeigan's online educational platform for owners of dogs with DM and disk disease.Join Living with Dogs with Disabilities on Facebook.For DNA testing for DM through the University of Missouri, click here.For general information about DM from the University of Missouri, click here.Support the showFollow us on Facebook, Instagram, TikTok, and YouTube @ PetAbility Podcast!PetAbility is affiliated with Dr. Buzby's Toe Grips to keep your dog from slipping. You may order your dog's Toe Grips via two options. 1) When you order at toegrips.com and use the promo code PETPOD22 at check out, you will receive 10% off your first order and PetAbility receives 10%. 2. When you order using this link: https://shop.toegrips.com/petpod22, the entire 20% will go to support our show.PetAbility is affiliated with ADogsBestLifeBox.com. When you subscribe to receive their awesome enrichment kits using the coupon code PETPOD22 , you save 10% on your first order and get a free gift, the Scout and About Compact Training Pouch and PetAbility gets 10%PetAbility is affiliated with HedzUpPets watercollars at SaveDogsFromDrowning.com. When you purchase your own watercollar by using coupon code PETPOD...
Myelopathy Matters is back; into its four year. Ben is joined by Liz Roberts, Myelopathy.org's programme manager for RECODE DCM. RECODE DCM is the charity's new myelopathy ‘think tank', creating an international and multidisciplinary ecosystem, working alongside those living with myelopathy, to accelerate new discoveries and ensure the enter the clinic. We hear from Aria Nouri, Surgeon Scientist from Geneva and chair of a RECODE DCM international working group looking at the onset of DCM (the Natural History) and what that means for quality care today.
It's Iwan's turn to pick a favourite from the archives; we return to 2021 when Ben spoke to Prof Abdul Lalkhen following the release of his book “Pain and the feeling brain”. Abdul is a Pain Physician from Manchester, and helps to unlock the basis for pain and how it applies to myelopathy. As Iwan attests, understanding is a foundation of taking control. Pain is a much under appreciated consequence of myelopathy, and we are delighted Abdul has since joined the scientific advisory board for Myelopathy.org. We look forward to tackling this issue further.
Ortho Eval Pal: Optimizing Orthopedic Evaluations and Management Skills
In today's episode, Cervical Myelopathy Cluster, I talk about...✅ Causes of cervical myelopathy.✅ Signs and symptoms of cervical myelopathy.✅ What the 5 most common predictive clinical findings are.✅ How to perform the tests.✅ How to manage patients with cervical myelopathy and so much more!(Video) Cervical Myelopathy Cluster(Video) Hyperefflexia, clonus and a positive Hoffman's test(Video) Myelopathy playlistSponsors: Medbridge and Robin HealthcareWant to join the OEP community? Click HERE to jump onto our email list. SUBSCRIBE at the bottom of the page.Ask me your ortho evaluation questions and I will answer them on the show: paul@orthoevalpal.comCome visit our WEBSITE!! Click HERE to check it outGet our downloadable 1.5 hour shoulder anatomy with cadaver dissection lectureGet our downloadable 7.5 hour cervical and lumbar continuing ed courseGet our downloadable 6.0 hour shoulder continuing ed courseBe sure to "follow" us on our new Facebook PageI finally made it to Instagram. Stop by and check us outAre you looking for One on one Coaching? We have it!Be sure to check out our 460+ videos on our YouTube Channel called Ortho Eval Pal with Paul Marquis#cervicalmyelopathycluster #specialtests #cervicalspine #myelopathy #physicaltherapypodcasts #dptpodcasts #occupationaltherapypodcasts #Physicaltherapy #DPT #Medicalproviders #sportsmedicine #athletictraining #occupationaltherapy #orthoevalpalSupport the show Thanks for listening! If you like our podcast, be sure to check out more of our great content at OrthoEvalPal.com, Instagram and Youtube. We'd love a rating or review on your podcast platform. And, as always, be kind to each other and take care!!
Meet Illyssa. She is raising two special needs children, one with autism and one with degenerative myelopathy. She shares a wealth of advice for other families and opens our eyes to what life is like for her and her boys. It's a touching, inspirational peek into their lives. Stay tuned for part #2. Connect with Illyssa on IG: https://www.instagram.com/tussinglady/ Learn more about Carson and his charity here: https://carsontussing.com/?fbclid=IwAR1ERmW1-Niv41P2unBK-x0OpD_8IgEcVj5oVuw7VAzqNMe3OaWdF8-Z3QU Brought to you by Team EvoAZ at eXp Realty and Ms Ocean Booty. Music and Lyrics by Susan Goyette. Have a topic you want us to cover? Comment below to share your idea! http://MOMnationUSA.com
Jason Friedrich, MD, discusses his recent SpineLine article, "Managing the Gray Areas of Degenerative Cervical Stenosis: Mild Myelopathy and Asymptomatic Cord Compression" with moderator Alex Michael, MD.
Iwan and Ben are joined by Dr Maryse Fortin, Physiotherapist and Clinical Researcher at Concordia University, Canada to hear about how she has been using MRI to characterise the shape and make up of neck muscles in people with DCM. Maryse shares her early findings and talks about how her group are building on this, to explore how they technique could inform care.
Ortho Eval Pal: Optimizing Orthopedic Evaluations and Management Skills
In today's episode, I break down what the Inverted Supinator Test is, how to perform it, what a positive test presents like, what a positive test means and so much more!!
Ben and Iwan are joined by Dr Mark Kotter Chief Investigator of RECEDE-Myelopathy, the first drug trial testing with a medicine called Ibudilast can help repair the spinal cord after surgery. Dr Kazuko Matsuda from Medinovca, the pharmaceutical company behind the drug, explains the mechanism and wider opportunities.
In this episode of the #lifewitholddogs podcast, we take a look at the importance of keeping a positive mental well-being while caring for our older German Shepherds.As our German Shepherds age, they may require more hands-on care due to disease, illness, or mobility issues. All of which will require more of your time and energy.When we reach the stage of hospice care, caregiving can consume most of our life and become overwhelming. If you find yourself in the situation now with your older German Shepherd, then this episode is for you. It is important to remember that you are not alone.If you have an older German Shepherd with degenerative Myelopathy, we have a support group that is free to join.Here is the link if you are interestedfb://group/2009914109023556?ref=shareWe hope you like this season and gain valuable information from the #lifewitholddogs Podcast.You can find Woody's Place Senior German Shepherd Sanctuary online at:www.wpsgss.orghttps://www.facebook.com/woodysplacesgsshttps://www.instagram.com/wpsgss/https://www.youtube.com/channel/UC7Tb1hKnOWEamQstkqAxEygWe would LOVE it if you could leave a thumbs up or comment! Please and Thank you!You can support our podcast by going to (http://www.patreon.com/LifeWithOldDogs)Every little bit helps, and your support is what keeps the #Lifewitholddogs podcast going.Support the showSupport the show
In this episode, we review the high-yield topic of Cervical Myelopathy from the Spine section. Follow Orthobullets on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://anchor.fm/orthobullets/message
Iwan takes charge of the podcast this month, as he interviews Ben Davies about MoveMed, a mobile monitoring system for neuromuscular disease he has been developing. Ben is joined by Alvaro Yanez, a co-developer, to describe the origins of MoveMed; why it was developed and what are the next steps towards clinical care. The team advertise a new online study, with collaborators from the University of Cambridge called EMPOWER, which offers people with a neurological condition the opportunity to test, provide feedback and help further refine MoveMed. Further information can be found at the study website: https://movemed.io/empower
We meet the adorably cute Brussels Griffon, and learn about the complex condition degenerative myelopathy.
In this episode we welcome back Tauni from Shade Out DM. Joining us, as well, Molli from Bubba's Buddies. Both of these organizations are fighting against DM in many ways. Shade Out DM supplies support to the DM community for pawrents facing the journey as well as educating on the prevention of the disease through testing before breeding. Bubba's Buddies raises funds for research and a cure. Join us to hear more about both organizations, how you can help join the fight, and learn about the mascots: Tauni's rainbow bridge corgi KC and Molli's boxer: Bubba! We are so moved by their stories and their dedication to fighting this condition! https://shadeoutdm.com/ https://www.bubbasbuddies.org/ #degenerativemyelopathy #DM #dogswithdisabilities #petlifestyle #pethealth #canineals #shadeoutdm #bubbasbuddies --- Support this podcast: https://anchor.fm/candie-kemp/support
Hey there, folks. This is the last episode of season 4, Degenerative Myelopathy. This season we spoke to the fine folks of Shade out DM and shined a spotlight on their mission to bring awareness to Degenerative Myelopathy and the need for further research, so that we have a better understanding of the disease, what we can do to help our fur friends should they be diagnosed with the disease, and hopefully find a cure to end DM once and for all!You can find that episode here : http://bitly.ws/sH28 or on any major podcast platform.To learn more about Shade Out DM, check out their website: https://shadeoutdm.com/Next, we spoke with the wonderful folks of Dr. HempDog, our go to CBD products.Dr. HempDog products are MORE than just CBD because they contain a full-spectrum of cannabinoids and potent Terpene profileIf you would like to try it, you can get 10% off on us by going to: https://drhempdog.com/discount/WOODYSPLACE and entering discount code "WOODYSPLACE"To learn more about this wonderful company, and their products, be sure check out the podcast: http://bitly.ws/s7wBNext, There mission: "We believe that pets are family and that elderly, disabled, and handicapped pets deserve to live a happy, healthy life." and we couldn't agree more!We cover quite a bit in this podcast in regard to Walkin' Pets mobility devices that we use for our residents with Degenerative Myelopathy and other mobility diseases, products we weren't aware of, and even a new product that on the horizon. All of which help us help our furry companions live their lives to the fullest even if they don't get around quite as readily as they once did.You can find that episode here: http://bitly.ws/s7wBAnd you can learn more about their products here: https://www.handicappedpets.com/After that we had the privilege to speak with the fine folks of Bubba's Buddies. Bubba's Bubbies, a 501 c 3 nonprofit organization partners with NC Veterinary Hospital, MU College of Veterinary Medicine, Tufts University, and Ohio State University to start the next DM clinical research study. "Bubba's Buddies is excited to announce new partnerships in our support to university and veterinary health centers to further clinical trials and other DM research! Project DM is a consortium of veterinarians and researchers committed to finding a cure for canine degenerative myelopathy (DM). $100,000 is needed to launch the next DM Study and Bubba's Buddies is on a mission to make that happen!"How can you help this worthy cause? You can donate directly through their website at: https://www.bubbasbuddies.org/You can check out the podcast here: http://bitly.ws/sH4cAnd finally, we have some exciting news. Woody's Place is going to be offering Pet grief counseling in the future. We are still working out the details, but it won't be much longer now, so stay tuned!Support the show
This week we chat with Molly Cooke of Bubba's Buddies. Molly and her husband saw a need to raise awareness and find a cure for Degenerative Myelopathy when their dog, Bubba was diagnosed with DM and Bubba's Buddies was born.Bubba's Bubbies, a 501 c 3 nonprofit organization partners with NC Veterinary Hospital, MU College of Veterinary Medicine, Tufts University, and Ohio State University to start the next DM clinical research study. That's right! They are all working together to find a cure for DM!"Bubba's Buddies is excited to announce new partnerships in our support to university and veterinary health centers to further clinical trials and other DM research! Project DM is a consortium of veterinarians and researchers committed to finding a cure for canine degenerative myelopathy (DM). $100,000 is needed to launch the next DM Study and Bubba's Buddies is on a mission to make that happen!"How can you help this worthy cause? You can donate directly through their website at: https://www.bubbasbuddies.org/Or make a purchase through their online store at: https://www.bubbasbuddies.org/collections/ways-to-helpAnd for more nuggets of goodness from Bubba's Buddies check out their Finding a cure page here: https://www.bubbasbuddies.org/pages/finding-a-cureFolks, if you've ever had a dog with DM or know of a dog with DM, then you know how vital it is that further research is performed to have more answers, more resources, and most importantly, a cure, so please be sure to check out all the great work our friends at Bubba's Buddies are doing.https://www.facebook.com/BubbasBuddiesDMSupport the show
In this episode, we cover the following:What is Cervical Myelopathy?What causes it?How do we assess for it?What imaging is utilized?What type of medical intervention is typically used for these patients?The purpose of this podcast is to provide useful, condensed information for exhausted, time-crunched Physical Therapists and Student Physical Therapists who looking to build confidence in their foundational knowledge base and still have time to focus on other important aspects of life. Hit follow to make sure you never miss an episode. Have questions? Want to connect? Contact me at ptsnackspodcast@gmail.com or check out more at ptsnackspodcast.com. On Instagram? Check out the unique content on @PT_Snacks!Need CEUs but low on time and resources? Go to https://www.medbridgeeducation.com/pt-snacks-podcast for $175 off a year subscription. Use the promo code PTSNACKSPODCAST. This is an affiliate link, but I wouldn't recommend MedBridge if I didn't think they offered value.Willing to support monetarily? Follow the link below to help me continue to create free content. You can also support the show by sharing the word about this show with someone you think would benefit from it.Support the show
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This season (season 4) we are taking a deep dive into Degenerative Myelopathy which is a common, merciless neurological disorder in senior German Shepherds that surfaces anywhere between 7 and 14 years of age and is seen more in males than females. It is a slow, progressive spinal cord disorder similar to Amyotrophic Lateral Sclerosis (ALS) in humans, which starts with a loss of balance and coordination that progresses to muscle weakness. Then, in time the dog will be unable to support himself, which will lead to paralysis resulting in quadriplegia or paraplegia. Eventually, death occurs from respiratory failure due to paralysis of muscles around the chest cavity. There is no cure for Degenerative Myelopathy, but supportive care and Physical Therapy may slow down the progression of the disease. In this podcast, we'll share our experiences with DM and bring on guests who specialize in DM, mobility devices, and pain/anxiety relief experts. Our goal for this season of the #Lifewitholddogs podcast is to arm you with as much DM knowledge as possible should your senior German Shepherd be stricken get it.DM blog post link:https://www.wpsgss.org/post/degenerative-myelopathy-dm-an-all-too-common-merciless-disease-in-senior-german-shepherdsWoody's Place Senior German Shepherd support group:https://www.facebook.com/groups/search/groups_home/?q=wpsgss%20degenerative%20myelopathy%20support%20groupYou can find Woody's Place Senior German Shepherd Sanctuary online at:www.wpsgss.orghttps://www.facebook.com/woodysplacesgsshttps://www.instagram.com/wpsgss/https://www.youtube.com/channel/UC7Tb1hKnOWEamQstkqAxEygWe would LOVE it if you could leave a thumbs up or comment! Please and Thank you!You can support our podcast by going to: (http://www.patreon.com/LifeWithOldDogs)Support the show
Iwan and Ben meet Esther Martin Moore, a person living with degenerative cervical myelopathy who was inspired by virtual family get togethers during the pandemic, to create an equivalent for people living with DCM. These 'virtual coffee breaks' have been very well received, and are now taking place across the globe. Esther explains how the positivity and understsanding shared by those attending, has been so effective - and can extend the support Myelopathy.org offers.
episode 12The last episode talks about Myelitis AND Autoimmune Myelopathy in spinal cord category in continuum Feb 2021DOI of study:10.1007/978_3_030_61883-4_27https://books.google.com/books?hl=en&lr=&id=qTsiEAAAQBAJ&oi=fnd&pg=PA433&dq=Myelitis%2BAutoimmune%2BMyelopathy%2Bspinal+cord%2Bcategory+(continuum)+++2021+&ots=PjTEg13DQM&sig=k0EDBMPko9wyv1favu1Lyofd9Qs#v=onepage&q&f=falseJournal watch:first Article: Self-perceived versus physician documented adverse events in patients with multiple sclerosis REGIMS - a pharmacovigilance registry for patients with multiple sclerosis in GermanyDOI of study:10.1016/j.msard.2022.103684https://www.sciencedirect.com/science/article/pii/S2211034822001997?casa_token=0DubVZHjMksAAAAA:_67S9LFKMd-VMqabUiNu9yykFeMZoIyOTi7Xt12J287ELGxN-opERpEnRbjilauBY-NUK9KfIwsecond Article: Telemedicine during the Coronavirus Disease (COVID-19) Pandemic: A Multiple Sclerosis (MS) Outpatients Service PerspectiveDOI of study:10.3390/neurolint13010003https://www.mdpi.com/2035-8377/13/1/3Third Article: Cerebrospinal fluid findings in COVID-19: a multicenter study of 150 lumbar punctures in 127 patientsDOI of study:10.1186/s12974-021-02339-0https://jneuroinflammation.biomedcentral.com/articles/10.1186/s12974-021-02339-0Thanks' Nano Alvand Co. for sponsorship MScasthttps://www.nanoalvand.com/
episode 11The second episode talks about Myelitis AND Autoimmune Myelopathy in spinal cord category in continuum Feb 2021DOI of study:10.1007/978_3_030_61883-4_27https://books.google.com/books?hl=en&lr=&id=qTsiEAAAQBAJ&oi=fnd&pg=PA433&dq=Myelitis%2BAutoimmune%2BMyelopathy%2Bspinal+cord%2Bcategory+(continuum)+++2021+&ots=PjTEg13DQM&sig=k0EDBMPko9wyv1favu1Lyofd9Qs#v=onepage&q&f=falsewith Journal watchhttps://www.nanoalvand.com/
episode 10The first episode talks about Myelitis AND Autoimmune Myelopathy in spinal cord category in continuum Feb 2021 DOI of study:10.1007/978_3_030_61883-4_27https://books.google.com/books?hl=en&lr=&id=qTsiEAAAQBAJ&oi=fnd&pg=PA433&dq=Myelitis%2BAutoimmune%2BMyelopathy%2Bspinal+cord%2Bcategory+(continuum)+++2021+&ots=PjTEg13DQM&sig=k0EDBMPko9wyv1favu1Lyofd9Qs#v=onepage&q&f=falseJournal watch:first Article: Recovery From COVID-19 in Multiple Sclerosis A Prospective and Longitudinal Cohort Study of the United Kingdom Multiple Sclerosis RegisterDOI of study:10.1212/NXI.0000000000001118https://nn.neurology.org/content/9/1/e1118.abstractsecond Article: Impact of Ramadan fasting on disease activity in patients with multiple sclerosis: a multicenter studyDOI of study:10.1080/1028415X.2021.2006955https://www.tandfonline.com/doi/abs/10.1080/1028415X.2021.2006955Third Article: Epigenetic Plasticity Enables CNS-Trafficking of EBV-infected B LymphocytesDOI of study:10.1371/journal.ppat.1009618https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.10096181Thanks' Nano Alvand Co. for sponsorship MScasthttps://www.nanoalvand.com/
Degenerative Myelopathy (DM) is a common, merciless neurological disorder in senior German Shepherds that surfaces anywhere between 7 and 14 years of age, and is seen more in males than females. It is a slow, progressive spinal cord disorder that is similar to Amyotrophic Lateral Sclerosis (ALS) in humans.In this #Lifewitholddogs podcast episode, we share our experiences with DM, products we use for supportive care, physical therapies that help keep our seniors with DM comfortable, and share the mistakes I (Dawn) made with Woody, my very first DM dog.Our correlating blog post this week has lots of imagery about DM and links for helpful supportive care products, so be sure to visit to get that additional information.https://www.wpsgss.org/post/degenerative-myelopathy-dm-an-all-too-common-merciless-disease-in-senior-german-shepherdsWe also have a Degenerative Myelopathy support group on Facebook where we share information about DM and you can post as well! It's free to join.https://www.facebook.com/groups/2009914109023556You can find Woody's Place Senior German Shepherd Sanctuary online at:www.wpsgss.orghttps://www.facebook.com/woodysplacesgsshttps://www.instagram.com/wpsgss/https://www.youtube.com/channel/UC7Tb1hKnOWEamQstkqAxEygSupport the show (http://www.patreon.com/#LifeWithOldDogs)
This week I have the absolute honor and privilege to share John Floresca's journey to recovery from a surfing injury. Almost two years ago John, an avid runner and coach was told that he would not likely regain function in his legs after suffering what is known as Surfer's Myelopathy while surfing in Hawaii. But don't ever tell John what he is, or isn't, capable of unless you want him to completely dismantle those ideas. When John was first injured, his prognosis was not great -- that being an understatement. He was told he would remain in a wheelchair with grade A paraplegia: complete paralysis. John was unwilling to accept that as the end and chose to fight despite a lack of hope from physicians. He knew his body and his mental fortitude will get him to dig deep and reach beyond expectations for his diagnosis. He was quickly downgraded to grade C: incomplete motor function below injury level. He recently began riding a stationary bike, something that had he given into his prognosis would never have been in the cards for him. John not only continues to work hard through his therapies, he has also returned to work in the film industry and most recently finished working through an entire season on the set of Saturday Night Live. He's breaking boundaries and paving the way for others. And through all that, John continues to find joy in helping his friends (myself included) reach their running goals. John's ultimate goal is to be able to walk again with no definitive timeline, but that doesn't keep him from celebrating every single win until he gets there.
Today's topic is no laughing matter. Similar to ALS in humans, Degenerative Myelopathy in Dogs is a harrowing disease that no pawrent should have to endure. Listen to our special guest (and Patreon!), Angela London, talk about her personal experience with DM with her German Shepherd, Steiff.Reach out and follow us!Instagram: @thezettyandindyshowFacebook: facebook.com/thezettyandindyshowPatreon: patreon.com/thezettyandindyshowOfficial Website: thezettyandindyshow.comWe'd love to hear your comments, questions, and suggestions about future shows! Make sure to tell your friends about us, and please rate, review, and subscribe on Apple Podcasts or wherever you get your podcasts. You can also subscribe on our website at thezettyandindyshow.com to stay updated with upcoming news and events. Also, please consider making a donation on our website, or become a valued Patreon to help us continue our show and our quest to get off kibble for good. F*ck Kibble! You can become a Patreon for as little as $3 a month which will include special perks like early access to our shows. Visit patreon.com/thezettyandindyshow for more details. New episodes drop every Monday!Each episode about 20 minutes, or the length of a decent dog walk!Laugh while learning about your pup!Support the show (http://patreon.com/thezettyandindyshow)Support the show: https://www.patreon.com/thezettyandindyshow
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