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#6: Unintentional Weight Loss

Hello and welcome to the Medical Narratives podcast with Dr. Michael Gordon. I'm Regina Starr and in today's episode we will continue our series on the top 10 issues affecting the elderly. We are excited to present another informative episode on the topic of unintentional weight loss.

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RS: Hello and welcome to the Medical Narratives podcast with Dr. Michael Gordon. I'm Regina Starr and in today's episode we will continue our series on the top 10 issues affecting the elderly. We are excited to present another informative episode on the topic of unintentional weight loss. According to the Mayo Clinic, unexpected weight loss or losing weight without trying, particularly if it's a significant amount, may be a sign of a medical disorder. The point at which unexplained weight loss becomes a medical concern is not exact but many health care providers agree that a medical evaluation is called for if a patient loses more than 5% of their weight within a year, especially in older adults. So for example, a 5% weight loss in someone who is 160 pounds (72 kilograms) is 8 pounds (3.6 kilograms). In someone who is 200 pounds (90 kilograms), it's 10 pounds (4.5 kilograms).

RS: Hello Michael, I am looking forward to our conversation today.

MG: Hello, hope it works out well.

RS: It will.

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Dr. Michael Gordon recently retired after a fulfilling career as a geriatrician that spanned 56 years, 44 of which he spent working at the Baycrest Center in Toronto. He is Emeritus Professor of Medicine at the University of Toronto. Dr. Gordon is a recognized ethicist and a thought leader on all topics of care of the elderly and end-of-life decisions. Currently, Dr. Gordon provides part-time professional medical consulting mainly in the domain of cognition and memory loss.

Principles of Geriatric Palliative Care

Teaser: 

Albert J. Kirshen, MD, FRCPC,

(Internal, Geriatric, Palliative Medicine), Emeritus Associate Professor, Dept. of Family and Community Medicine, Faculty of Medicine, University of Toronto, formerly consultant palliative care physician, The Temmy Latner Centre for Palliative Care, Interdepartmental Division of Palliative Care, Sinai Health System, Toronto, ON.

CLINICAL TOOLS

Abstract: Palliative care aims to relieve suffering and enhance the quality of life for those with chronic, progressive or life-threatening illnesses. However, seniors' palliative care needs are often poorly recognized, assessed, or managed, resulting in adverse outcomes. This article explores the importance of recognizing, assessing, and managing symptoms for older adults needing palliative care. It offers insights into how physicians and healthcare providers can improve the quality of life for seniors by addressing their pain and symptom management needs.
Key Words: palliative care, symptom management, older adults, geriatrics, pain management, quality of life, recognition, assessment.
Palliative care aims to improve the quality of life for seniors with chronic, progressive or life-threatening illnesses.
Healthcare providers need to tailor symptom management to the unique characteristics of older adults, including cognitive and sensory impairments.
Recognition, assessment, and management of symptoms are critical components of palliative care.
A comprehensive approach that includes communication, pharmacological and non-pharmacological interventions can improve the quality of life for seniors in need of palliative care.
Communication with patients, caregivers, and other healthcare professionals is key to recognizing seniors’ palliative care needs.
Assessment of seniors’ symptoms should be tailored to their unique characteristics, including cognitive and sensory impairments.
A comprehensive approach that includes pharmacological and non-pharmacological interventions is essential for optimal symptom management in seniors.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Caregiving, palliative care, symptoms, management, older adults, geriatric, pain management, quality of life, recognition, assessment

Diabetes Complications: Erectile Dysfunction

Teaser: 

Dean Elterman, MD, MSc, FRCSC,

Associate Professor, Division of Urology, University Health Network, University of Toronto, Toronto, ON.

CLINICAL TOOLS

A clear relationship, with shared risk factors, exists between diabetes, ED and CVD.
Use of ED as a harbinger of CVD is most predictive in younger men (ED may precede CVD by 2-5 yrs, 3 avg).
The identification of ED may allow for risk reduction and preventative measures in large numbers of men.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Diabetes-Endocrine Disorders, diabetes, diabetic management, treatment, erectile dysfunction
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Diabetes Complications: Diabetic Nephropathy

Teaser: 

Louis-Philippe Girard, MD, MBT, FRCSC,

Clinical Nephrologist, Associate Professor, University of Calgary, Calgary, AB.

CLINICAL TOOLS

The hallmark of Diabetic Nephropathy is albuminuria. Albuminuria is a marker of poor renal and CV prognosis and should be identified in all patients where CKD is suspected.
Organ protection should be a priority in patients with DN. Very solid evidence exists for the SGTL2i class as it pertains to renal protection. Patients with DN are at very high risk of CV disease and its complications. There are robust data demonstrating CV protection when SGLT2i and GLP-1RAs are used in patients with DKD.
A1C control remains a critical component of preventing the progression of DN and can now be achieved in a safe manner with newer agents that do not cause hypoglycemia.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Diabetes-Endocrine Disorders, diabetes, diabetic management, treatment, nephropathy
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Diabetes Complications: Diabetic Neuropathy

Teaser: 

Aaron Izenberg, MD, FRCSC,

Neurologist, Sunnybrook Health Sciences Centre, Assistant Professor, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Neuropathy is a very common complication of diabetes with sensorimotor neuropathy being the most common subtype of diabetic neuropathy
Other types of diabetic neuropathies include autonomic, treatment-induced, diabetic lumbosacral radiculoplexus, and mononeuropathies
Diagnostic testing for sensorimotor neuropathy includes bedside testing (e.g., Monofilament) and electrodiagnostic methods
Treatment of sensorimotor diabetic neuropathy includes achieving good glycemic control and appropriate use of pain medications
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Diabetes-Endocrine Disorders, diabetes, neuropathy, diabetic management, treatment
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Diabetes Complications: Diabetic Retinopathy

Teaser: 

Carol Schwartz, MD, FRCSC, DABO,

Assistant Professor, University of Toronto, Ophthalmologist, Sunnybrook Health Sciences Centre, Toronto, ON.

CLINICAL TOOLS

Appropriate screening
Good systemic control of blood sugar, hypertension, dyslipidemia and renal function
Timely treatment involving intra-vitreal anti-VEGF injections, laser photocoagulation when appropriate and surgical intervention when necessary
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Diabetes-Endocrine Disorders, diabetes, diabetic retinopathy, diabetic management, treatment
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Urinary Tract Infection in the Older Population: Not Always So Simple

Teaser: 

Michael Gordon, MD, MSc., FRCPC, 1 Nada Abdel-Malek, MPH, MD, CFPC (COE),2

1Emeritus Professor, University of Toronto, Toronto, ON. 2Department of Family and Community Medicine, Baycrest Health Sciences, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Urinary tract infections (UTIs) are common in older adults, with prevalence increasing with each decade above sixty-five. UTIs in older adults can be multi-factorial in terms of etiology, risk factors, symptoms, and interventions. A history of heart failure and diabetes increases the risk of UTIs in older adults, and these patients should be closely monitored for symptoms of infection. An enlarged prostate and urinary retention can be an all too common scenario leading to UTIs in older men. UTIs can cause acute confusion and disorientation in older people and should be considered as a possible cause of such new onset symptoms. Physicians should be aware of the variety of presentations and implications of determining a UTI in older adults.
Key Words: urinary tract infections (UTIs), older adults, risk factors, symptoms, interventions confusion, disorientation, heart failure, diabetes, enlarged prostate, urinary retention.
Urinary tract infections (UTIs) are common among the North American population, with prevalence increasing in older adults. Those with a history of heart failure and diabetes are at increased risk.
With the introduction of antibiotics before WWII, and then during the ensuing decades, treatments for UTIs moved away from previously used home-grown remedies.
Physicians should be aware of the variety of presentations and implications of determining a UTI in older adults.
The first case study describes an 84-year-old man with acute onset confusion, disorientation, and urinary retention, who was admitted to the hospital and treated with antibiotics and a small dose of an antipsychotic.
UTIs can cause acute or sub-acute confusion and disorientation in older adults and should be considered as a possible cause of such symptoms.
An enlarged prostate and urinary retention is a recognized syndrome of UTIs in older men.
UTIs are a common cause of confusion and disorientation in older adults, and should be considered as a possible cause of these neurological symptoms.
A history of heart failure and diabetes increases the risk of UTIs in older adults, and these patients should be closely monitored for symptoms of infection.
An enlarged prostate and urinary retention can be the underlying cause of UTIs in older adults, and these patients should be evaluated for infection if this constellation of findings exist.
UTIs in older adults can be multi-factorial in terms of etiology, risk factors, symptoms, and interventions, and physicians should be aware of the variety of presentations and implications of determining a UTI in this population.
It is important to use broad-spectrum antibiotics in older adults with UTIs, especially if they are antibiotic-naive patients.
Older adults with UTIs are at risk of harm if they try to remove their catheter or IV; it is important to use soft restraints as needed to ensure patient safety.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Gender & Health, Men’s Health, Women’s Health, Urogenital Disorders, urinary tract infection, older adults, risk factors, symptoms, interventions, heart failure, diabetes, diabetic, urinary retention
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Editor's Note, Volume 13 Issue 1

Editor's Note, Volume 13 Issue 1

D’Arcy Little, MD, CCFP, FCFP, FRCPC Medical Director, JCCC and HealthPlexus.NET

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Acne Vulgaris: 2023 Update

Teaser: 

Amir Gohari1 Joseph M. Lam, MD, FRCPC,2

1 University of British Columbia, Vancouver, British Columbia, Canada.
2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

CLINICAL TOOLS

Abstract: Acne vulgaris is a chronic pilosebaceous inflammatory disorder that affects almost 85% of those aged 12 to 24 years. Its pathophysiology is an interplay between androgenic activity, follicular epidermal hyperproliferation, retention hyperkeratosis, and Cutibacterium acnes infection. Strong evidence exists for high glycemic index diet as a trigger. Diagnosis is clinical and management is based on lesion types, with options including retinoids, benzoyl peroxide, antibiotics, oral contraceptives, and spironolactone.
Key Words: acne vulgaris, inflammatory disorder, comedones, Cutibacterium acnes.
Acne vulgaris is the most common skin condition observed in adolescent and pre-adolescent patients and has a significant psychological burden.
The plugged follicles of acne allow for Cutibacterium acnes overgrowth which triggers the release of heat shock proteins, porphyrin, proteases, and squalene peroxides, leading to inflammation.
Topical retinoids are used for open and closed comedones, while topical antibiotics and benzoyl peroxide are used for inflammatory lesions. Oral antibiotics are added for moderate to severe inflammatory acne. Hormonal therapy and isotretinoin are used to target the excess sebum production.
Acne may reflect an underlying disease. Patients that present before 7 years of age may have an underlying endocrinopathy. For women with acne, the possibility of polycystic ovary syndrome (PCOS) should be addressed.
Acne lesions can be non-inflammatory, in the form of open or closed comedones, and/or inflammatory, in the form of papules, pustules, and nodules. Treatment should be targeted to the type of acne the patient presents with.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Dermatology, acne vulgaris, inflammatory disorder, comedones, Cutibacterium acnes
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#23: Rosacea

Welcome to 3P: Pills, Pearls, and Patients where we will discuss current events in medicine, stories from real patient-physician encounters, and gain insight into what it's like being a physician in today's society.

Please note that while the first episode is available to listen to without registration, accessing additional episodes will require you to subscribe and log in.

  Back to Pills, Pearls & Patients (3P)

 

Hello and welcome to the next episode of 3P, Pills, Pearls and Patients. Today, we're going to continue our series in dermatology. And we're speaking about rosacea.
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Dr. Marina Malak is a family physician in Mississauga, Ontario and a lecturer and faculty member at the University of Toronto. She is actively involved in medical advocacy, and is a board member of the Mississauga Primary Care Network. She is also a member of the National Committee of Continuing Professional Development at the College of Family Physicians of Ontario, and a member of the Research Ethics Board at Trillium Health Partners.

She is passionate about patient care; medical education; and promoting mental, physical, and emotional wellness. She enjoys reading, writing, public speaking, puzzles, doodling in her bullet journal, and creating drawings on Procreate.