Chief Concerns 2.0 Kickoff

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Hello, dear listener, and welcome back to the Neurotransmitters, your Everything Neurology podcast.
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Uh we are your hosts.
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I am Dr.
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Michael Kentris, and I am joined, as always, by Dr.
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Galena Geikman.
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How are you today, Galena?
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Hey, Michael, I'm doing well.
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Thanks a lot for having me back on.
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And uh hi listener, thank you for listening.
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So, you know, the people who have been paying attention have noticed that uh we've been doing these recordings together.
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And so, you know, I want to thank you, Galena, for kind of giving me a shot in the arm for improving the regularity of our show and uh breathing some some new life into it.
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So first of all, thank you for that.
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Well, Michael, thanks for having me.
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And thank you for the kind words.
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It's really been my pleasure.
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I think you're right.
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We all need an accountability buddy.
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And I have not had this much fun with my CME uh for years.
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So thank you so much for the chance to be on the show.
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Absolutely.
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So so we've been covering in our our chief concern series, you know, many of the most common complaints.
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Gosh, I know complaints, so negative.
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But many of the things that concerns, Michael.
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Concerns.
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I know, concerns.
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I can't help it.
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I've it's been it's been beaten into me for over a decade.
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But we've been covering some of the most common things that's that we're likely to see in neurologic practice, particularly on the on the primary frontline side.
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And we are now kicking it up to 2.0.
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So what can our listeners expect as we go forward in this series?
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Well, just to review what we've covered, we really focus initially on thinking about essentially the diagnosis of some of these common concerns.
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So when a per person comes into your clinic, what do you do on history?
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What do you do on exam?
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What do you do with that initial workup?
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Such as, for example, we've covered the approach to dizziness, the approach to headache management, kind of at that frontline level, the approach to a undifferentiated gait disorder.
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And what all these had in common was that we didn't quite get to that second level of management and second level of like more complexity.
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Cause of course, if it's the simple thing, it's the simple thing, but many of the times it's not a simple thing, or that first pass diagnostic approach may not reveal the answer.
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And so what we thought was uh for those dear listeners who've gone through, you know, step one of the course and are ready for step two, we really wanted to get into a little bit of that, what comes next.
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So as I mentioned, the first thing that we're gonna be doing in this second part of the series is revisiting a few of the topics and diving into management.
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Again, at that first initial level, but then also the next step.
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And um I'll throw back to you about what topics we're gonna start with.
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And then for a few of the topics, um, they'll feel not so familiar.
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They'll be potentially new topics where we're gonna get into kind of how we think about them.
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And some of these topics are those that may not necessarily be seen at the primary care level, but they might be seen at the primary neurology provider, whether it's a general just or uh neurology APP who is managing lots of general neurology in the practice and wants to get a little bit more up to speed on some of the subspecialty topics.
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Well said.
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We will be having some familiar voices, if you will, joining us again talking about, as you said, tremors, dizziness, neuropathy, balance issues, some of the kind of bread and butter things.
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And hopefully we'll be getting into some of the more challenging topics, such as perhaps selection of anti-seizure medications, selection of MS medications, and really getting kind of into some of those brass tacks in terms of, you know, how do you dose such and such a medication?
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You know, which which do you prefer to start with, which you know can be a nest to get into all on its own in terms of which medication and why.
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And uh I find that in my own experience, the answer is usually it depends.
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Which I had a medical student shadowing me recently who called me out on that because patients would ask me, it's like, well, what do you think about this?
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And I was like, well, it depends.
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And apparently I say that a lot.
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So my apologies to everyone who's had to listen to me talk.
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But uh but I'm hoping to take away some lessons myself from some of these conversations and uh start to talk with some of our colleagues about some of these, you know, once we kind of get into their unique perspectives on management of these common conditions.
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And we will be eventually moving into more esoteric topics as well, things that the general neurologist might struggle with or might need to be tapping a subspecialist for.
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And so we we definitely plan to continue this kind of down the rabbit hole.
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And uh we hope you guys are all along the ride with us.
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Yeah, it's incredibly exciting for me as well.
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I think your point about it depends is a good one.
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It depends on the individual practitioner, depends on the patient in front of you, depends on your area of practice, and also the, you know, are you in an urban setting, rural setting?
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So I think that we absolutely recognize that listeners around the country and maybe around the world will have a different experience than us.
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And so we welcome you to call in, to debate, to uh share your experiences or to ask your questions, to which we'll try to answer something other than it depends, but we'll see what the question is.
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And the idea being that this is just a way to upscale all of us a little bit more.
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You know, those of us, like for example, my practice pattern as a general neurologist working in an academic medical center is very different than someone who's a general neurologist elsewhere.
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And so there are things that I'm is part of my bread and butter that maybe isn't part of someone else's, and vice versa.
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And hopefully we're demonstrating here not just that there is a right answer out there, because there often isn't, but that there remains a kind of curiosity in one's career over time for continuous learning and improvement.
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And I'm certainly excited to upskill myself, as I said, and hopefully it trickles down to some others.
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Very true, very true.
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I feel like I I learned so much from having these conversations with people and picking up new tips and tricks.
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And I I want to reemphasize what you said, Galina, that we we very much want our listeners to write in.
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Uh we don't have a phone line to call in, but uh but there is a little record your voice and send it in.
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That's right.
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You know, uh we could we could set up a speak pipe.
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Maybe we'll do that.
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Uh if we do, it will be linked in the description below.
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Uh but if you don't want to record yourself, you can always send us a text message via the link in the show notes.
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You can send us an email uh via our website at theneurotransmitters.com, or you can find us on X and send us a DM at neuro underscore podcast.
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So we would love to hear from people about comments on past episodes, suggestions for future topics, questions for future experts, as well as if you are interested, if you yourself are a neurology professional and interested in coming on and doing some teaching, reach out to us, or if you have someone you would suggest that we reach out to.
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All suggestions are welcome, even though all may not be taken up, but we will definitely read them.
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So yeah, I I think this is a a great chance for us to kind of engage with our neurology community at large and see what is it that people want and uh can we provide that for them?
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Yeah, I'm not gonna call them out by name, but I do want to give a shout out to those who've already written in.
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It means so much to us that what we're sharing has been educational, has changed your practice already in some ways, has given you either more knowledge or just more confidence about how to proceed forward.
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So we do read them.
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It means a lot to us.
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And um, yeah, we're so excited that many of you are joining us on this journey.
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Yes.
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And, you know, for for those, since this is kind of an educational venue, I do want to make sure that we plug Galena's other podcast, Neuropraxis.
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So for those who are interested, what's your what's your elevator pitch for for that podcast, Galena?
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Thanks, Michael.
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That that came out of left field.
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I thought we were here for our cheap concern series, but it's very kind of you to ask.
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So I had the distinct pleasure of starting a podcast last year, started in November, and we've been publishing monthly since.
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It's the Neuropraxis Podcast, the Educator, Neurology Education Podcast.
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And credit to you, Michael, for inspiring me and giving me the behind-the-scenes mentorship to make this possible.
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So uh look out, everyone will at some point have an episode on mentorship, and this was a great example of that.
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But really, we cover all things neurology education.
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So a little bit less content.
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So we're not teaching about neurology, but we're teaching about teaching.
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So it's covering the latest in neurology education research, thinking about how theory can inform our practice as a clinical teacher or uh education researcher, and also hearing about the often, as we say, atoxic and not straight and narrow career journeys of people in neurology education, how they came to find that identity as an educator, develop themselves and build a career around it.
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So if any of that sounds interesting, we'd absolutely love to hear from you and um hope you hear from us, and maybe we can include a link to that as well.
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Absolutely.
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And, you know, I'm just gonna keep you know inflating your ego.
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So the the other project Galina's working on, which I'm a huge fan of also, is the Neurohumanities Network.
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And we do have some interviews planned on the horizon with her and her team members about that.
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But again, would you give us another elevator pitch for your for your other project?
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Uh okay, got it.
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Uh I I'm getting I'm getting the drift here now.
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Um, thanks again, Michael.
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So shameless self-promotion is our theme today, listener.
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So our our Neurohumanities Network is another passion project.
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Uh it was something that was started together with Mattia Rosso and Charlie Palmer.
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And the two of them had an in-person network of neuroshumanities enthusiasts at MUSC, where they were residents.
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And that translated about two years ago into an online community that we formed.
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We offer monthly seminars on any topic and truly any topic at the intersection of arts, humanities, and neurosciences.
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So could cover various clinical fields like psychiatry, neurology, neuros, uh, neurosurgery.
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But also we love to hear from people coming in at a different angle.
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So artists and those who are humanists, for example, philosophy professors or just people who want to share their thoughts.
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But we have a monthly cadence of these webinars with some chance for Q ⁇ A discussion.
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And then we have quarterly what we call booster sessions where you can roll up your sleeves and actually engage in art and humanities practices yourself.
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So we've done things like culinary arts following a recipe and um doing poetry readings, music listening, yoga nidra meditation.
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And next week we have our virtual online community mindful tea tasting.
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So lots of different ways to get engaged.
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Um, you know, use all of your senses, vision, hearing, smelling, tasting, to enjoy the world of arts and humanities and its implications for us as neurology providers and and really trying to instill that humanism back into our practice.
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Yeah, it is it has been so neat to watch that thing develop.
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I I haven't been able to make it to as many live sessions as I would like, but uh, even just watching the YouTube recordings after the fact, it's it's some very fascinating stuff, and definitely I think it it's it's kind of the stuff that gets you that you know, like back when you were first thinking about becoming a neurologist or a psychiatrist, and you know, why is the brain so cool and why does it matter?
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And just really kind of taking in the bigger picture at large.
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And then, as you said, you really drill down into some of those details of the neuroscience in some of those sessions too.
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And it's it's very fascinating, a lot of very interesting perspectives, interesting uh speakers.
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So I I can't recommend it enough.
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But uh very cool stuff, and I'm looking forward to talking with uh with you and your other co-founders about this uh in the not too distant future.
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So it should be very fun.
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And yes, we'll include links to both the the Neuropraxis Podcast and the NeuroHumanities Network YouTube channel.
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Well, I will just say one quick point further about the NeuroHumanities Network, and maybe this is a prelude to our conversation about it, but it was just a nice reminder, as you said, like these are the reasons that got us into training, and it's very true.
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And I think that what's what's often missed, I think, is the fact that this these skill sets and this interest is not, you know, it shouldn't be separate from our training.
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It's not like it brought us in and then we have to like re find it.
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And I think that we too often discount it in our training.
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And part of what we're doing with the network is trying to show that close observation, humanistic practice, like a sense of what, you know, reading the room, situational awareness, uh, having the type of inquiry that we approach in arts and humanities is actually part and parcel of our work as a clinician.
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And I think we've been doing a little bit of that here too, you know, talking about the way someone describes their symptoms matters, the way they experience them matters.
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I mean, I still remember of Marcus and like all his tips about like how the neuropathy actually feels like heavily diagnostic.
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And so it's been really fun to see these threads of connection to weave, this tapestry between the two topics.
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But yeah, I think we're all trying to find a way to integrate in our practice.
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And hopefully we can bring a little bit of the art, uh, shall we say, of medicine here to this work as well, not just the science of it.
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Right.
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It's a it's a good reminder that your patients aren't just a bundle of symptoms waiting around for you to disentangle them and diagnose and treat, that they are people with their own lives and experiences and giving a, like you said, just a broader perspective.
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So it's it is good, right?
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We focus perhaps too much on the the neuro and not enough on the humanity in our day-to-day practices.
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Because, you know, neurologic symptoms, they're nice, neat, clean lines.
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At least like we like we like to tell ourselves that humans are are messy and noisy and make you tired.
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Yeah, no, no, the neurological diseases tend to paint outside the lines.
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Right.
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They don't follow they don't follow the paint by numbers.
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I know, I know, right?
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It's it's what you learn in the textbooks versus what you see on the wards and in the office.
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So it's uh it's a good reminder of of the many varied experiences that uh can make up you know daily life for for the average person.
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So great work over there.
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Any final thoughts, Galena?
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Well, let me turn it turn it back to you, Michael, because you asked me what I'm doing when I'm when I'm not on the podcast.
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But how about you?
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What's keeping you busy these days?
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And you've always got something interesting going on.
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Sure.
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So so yeah, I guess we'll we'll do a little life updates, but uh let's see.
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So I'm doing a lot.
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Uh you know, my wife and I have a small plot of land.
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Uh so I've been working on a chicken coop lately, which has been taking up a lot of time.
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And then uh I believe Galena's referencing before we were recording, I've been working on a project completely not neurology related.
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Well, it's a narrow humanities project, so it's very fitting.
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I suppose it's it's more humanities.
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My my brother and I are doing another recording for a podcast called Brothers Reading Books.
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So, you know, my brother, Will, and I are both uh sci-fi fantasy nerds.
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Surprise.
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And uh we have been recording ourselves going through some old science fiction books.
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We started off with Dune, and uh, we have been moving through Kunan the Barbarian short stories, and we are planning to jump back into science fiction after we finish that.
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So we've got around a dozen episodes or so at the time of this recording up.
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So if you are interested in listening to two people talk about books, particularly older science fiction and fantasy, feel free to check it out.
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I had one of my friends actually listen to it.
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So my brother and I have voices that are very similar sounding to one another.
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And someone accused me of just setting up two different microphones and moving back and forth between them and recording myself talking to myself.
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That is not, in fact, what happened.
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That would be very sci-fi.
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Right.
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It's just uh the unreliable narrator trope.
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But uh no, there are two of us, but we just sound alike.
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It's been like that since we were kids.
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We'd answer the phone back when people had landlines, and uh our parents would even ask which one of us it was.
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So so that does happen.
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Uh but yeah, we we talk a we go into pretty in-depth stuff.
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We again, it's not neurology related whatsoever, but uh it is on the humanities side of things, I suppose.
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So that's I guess that's my my other side project that's been going on.
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I would say for anyone out there, the bar for podcasting is so low.
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And it's been a great excuse to just, you know, my brother and I we live in different cities, and we we don't talk as much as we should.
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So it's been a great excuse for us to meet up on a relatively regular weekly basis, talk for about an hour or two, and uh yeah, just have a good time, you know, nerding out.
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So I would encourage anyone who's interested in podcasting to, you know, start it up.
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You know, even if you're just doing one for family.
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People who are interested, I do recommend the Buzz Sprout official podcast, BuzzCast.
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Hilarious, run by the administrators over there.
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So if you're interested in podcasting, they it's not necessarily the most brass tacks thing, but it talks a lot about kind of the philosophy of podcasting and the why of podcasting.
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And uh they're very passionate people about podcasting.
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That's why, in part, this is an audio-only recording.
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I often am listening to podcasts and audiobooks when I am working uh around the house and out in the yard.
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And so I need to be looking, you know, if I'm operating like heavy machinery at what I am doing.
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And so I'm very much in favor of an audio first format, and uh that is why the neurotransmitters remains an audio podcast uh as of this day.
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So so anyway, you know, that's uh a little bit of a uh my own philosophy of podcasting.
00:19:09.119 --> 00:19:12.400
But but yeah, real conversations, as Galina knows.
00:19:12.480 --> 00:19:19.680
Uh, we did not script this whatsoever, so we are just meandering, but we will not keep you on the hook too much longer, listener.
00:19:19.759 --> 00:19:22.160
Uh, this is more of a life update podcast update.
00:19:22.240 --> 00:19:24.880
And uh as always, thank you for listening.
00:19:25.119 --> 00:19:27.680
Galena, anything else you would like to add?
00:19:28.240 --> 00:19:33.759
Yeah, no, I I thank you for taking us back to the roots of of the philosophy.
00:19:33.920 --> 00:19:58.559
Because I will say, um, I mean, you started with saying thanks, and and I'll just say thanks right back to you because I think the chief concern series is really just that it's neurologists chatting about how we how we think about these things without, you know, that sense of a right answer or a scripted objectives or a clear, clear, you know, approach to the teaching.
00:19:58.640 --> 00:20:02.000
And so we understand it may not work for everyone.
00:20:02.079 --> 00:20:06.240
You know, if you're looking for that like board review, you may not get it here.
00:20:06.319 --> 00:20:17.759
But if you're looking for honest conversations and embracing of the uncertainty that is the work that we do every day and and and finding the humor in it, um hopefully you'll join us for part two.
00:20:18.319 --> 00:20:18.559
Yes.
00:20:18.720 --> 00:20:20.400
No, I think that's a great point.
00:20:20.559 --> 00:20:30.720
That there are people doing that work of the board review and the journal article updates and you know, like the official stuff from the AAN or the Neuro Review Podcast.
00:20:30.880 --> 00:20:33.200
I think it's from the folks at Yale, if I remember right.
00:20:33.440 --> 00:20:34.559
You know, great stuff.
00:20:34.720 --> 00:20:38.480
We're we're messier over here, and uh that's the way we like it.
00:20:38.720 --> 00:20:42.799
So uh but uh but I I enjoy very much what they do as well.
00:20:42.960 --> 00:20:49.920
But but there's good people already doing it, and I'm I'm happy to kind of get into the weeds where things get a little fuzzier, you know.
00:20:50.079 --> 00:20:53.759
We're we're working on our level U evidence uh guidelines over here.
00:20:53.920 --> 00:20:56.319
We're you know, expert opinions only.
00:20:57.680 --> 00:20:59.200
No, that's not entirely true.
00:20:59.440 --> 00:21:01.759
But uh but I do appreciate them very much.
00:21:01.920 --> 00:21:09.519
So yes, uh thank you all for listening as always, especially to this particularly meandering uh recording today.
00:21:09.599 --> 00:21:11.920
Uh well maybe we'll clean it up a little bit, but probably not.
00:21:12.160 --> 00:21:16.400
But again, if you want to reach us, you can click the link in the show notes.
00:21:16.480 --> 00:21:23.599
You can text us, you can email us at theneurotransmitters.com, and you can always send us a uh DM on X.
00:21:23.839 --> 00:21:28.720
I think we're on Instagram as well, although not as active lately, uh, Neuro underscore podcast.
00:21:28.880 --> 00:21:35.200
So thank you all for listening, and we'll be coming back with our second iteration of the chief concerns.
00:21:35.599 --> 00:21:36.799
Thank you, everyone.