Hearing Matters Podcast

Chronic Medical Conditions and Hearing Loss with Dr. Gerda Maissel

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In the latest episode of the Hearing Matters podcast, discover why asking the right questions can make all the difference in understanding your health care decisions. Dr. Maissel sheds light on the critical gaps in doctor-patient communication and the often-overlooked nuances of hearing healthcare. Explore the necessity of comprehensive audiometric evaluations and learn how evolving medical guidelines, like those for blood pressure, reflect the ever-changing landscape of healthcare.

Did you know there's a strong link between diabetes and hearing loss? Our conversation with Dr. Maisel reveals this connection and its broader implications for overall health, emphasizing the importance of managing blood sugar levels to prevent long-term damage. We also discuss the risks of untreated hearing loss and its potential ties to dementia, advocating for early action to protect cognitive health. Plus, get acquainted with the Progressive Tinnitus Management protocol, a successful strategy for managing tinnitus and hearing loss. Tune in for an episode packed with invaluable advice and resources that empower you to take charge of your health with confidence.

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Blaise M. Delfino, M.S. - HIS:

Thank you. You to our partners. Cycle, built for the entire hearing care practice. Redux, the best dryer, hands down Caption call by Sorenson. Life is calling CareCredit, here today to help more people hear tomorrow. Faderplugs the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters Podcast. I'm founder and host, Blaise Delfino and, as a friendly reminder, this podcast is separate from my work at Starkey.

Dr. Douglas L. Beck:

Good afternoon. This is Dr Douglas Beck with the Hearing Matters Podcast, and my guest today is the amazing Dr Gerda S Maisel. She has started an amazing website and written quite a few wonderful articles, and that's why we're speaking to her today. Dr Maisel is actually a physician physical medicine and rehab and, dr Maisel, if you would tell us a little bit about your bio, where you went to school and the positions you held?

Dr. Gerda Maissel:

Sure, I went to medical school in Syracuse, I did my residency in Philadelphia and I've worked over the years in a number of different places. Before I founded the business, I had worked both at HealthQuest in New York and Health First in Florida, but now I work nationally as a private patient advocate.

Dr. Douglas L. Beck:

Which is brilliant, in addition to the website I do want to point out because I think I met you through the Foglight, which is on Substack, and it's a subscription or non-subscription I believe you can do it either which way and you have some fascinating articles there and I'll just mention one or two and you tell me the greatest hits, if you could. As far as the most important takeaways, when I go back to when doctors and patients don't actually speak the same language, that one to me struck home and I think that it was a very familiar topic, very important. What are your takeaways from doctors and patients not speaking the same language, from doctors and patients not speaking the same language?

Dr. Gerda Maissel:

Well, it's such a common problem where physicians say one thing and often imply certain things and the patients don't hear what the doctor is saying. It's not that they're stupid or they don't understand words, it's that there's a huge subtext in medicine. So an example that I often give if it's midnight and you get a phone call and the doctor on the other end says hi, I'm just checking to see what your mom's code status is, well, the simple answer is oh, mom's a full code, which means that she wants CPR done and would agree to be intubated. But there's a whole subtext which is mom is not doing well. That's why we're checking, because we're about to put a tube in her throat and we're not sure that's a good idea. So we really want to make sure before we do that.

Dr. Douglas L. Beck:

You know this is so important. I mean, when you think about in hospitals and medical settings. When we call a code, that means something very, very bad is going on right now and needs immediate attention. But do patients know this?

Dr. Gerda Maissel:

Sometimes they do and sometimes they don't, and so it's just very helpful to listen and ask clarifying questions, and I encourage people, when they are at all unclear or uncomfortable, just ask questions till you're clearer and then run it by somebody. If there's a friend or someone in the family who's a nurse or a doctor, talk with them and say here's what the doctor said. I'm still trying to understand it. There's so much nuance in healthcare decisions that you really want to make sure that you have a good handle on what's being said and what's being implied.

Dr. Douglas L. Beck:

The points you raised are very important and of course, they're covered in your article in detail. In the fog light on Substack, we run into the same issue in hearing healthcare. Quite often when a patient takes a hearing screening, the problem there is a screening is almost useless. I mean, it's my personal opinion, but I think many of us feel the same. You know, we give pure tones at, let's say, 250, 500, 1,000, 2,000, 4,000, maybe 8,000, maybe a 25, 30, 35 decibels and based on that hearing screening, we say you passed or you failed. Now what the patient hears if they pass a screening like that, they hear oh, my hearing's normal. I spoke to Dr Mizell, I spoke to Dr Beck, my hearing's normal. They said I passed.

Dr. Douglas L. Beck:

None of those pure tone screenings can actually tell us what your ability is to understand speech. And that's far more important. I've never had a patient come in and say Dr Beck, I need to speak with you. I'm not understanding tones as well as I used to, you know. But that's what happens with screenings, right? Is we give them this, this tiny little bit, and they take off and run with it, and often incorrectly.

Dr. Douglas L. Beck:

Now the other side of screening is if we do comprehensive audiometric evaluations rather than screenings. Of course it does cost a little bit more, but it's generally covered by Medicare under CPD code 92557. And it's covered by most insurance companies. So why people offer screenings? I think it's just to get people in the door, but I don't think it's useful because if you pass the screening, I don't know enough about how you're doing in cocktail party noise, restaurant noise, I don't know how clearly you're understanding speech, but you did pass the screening and very few people will bother to get a screening unless they suspect something's wrong and that screening won't detect most of it.

Dr. Douglas L. Beck:

I was looking at one of your early top chronic condition papers and I found that to be so interesting because so many of them do relate to hearing loss and listening disorders. And I know we've recently changed blood pressure readings which at one time were like 145 dystolic and systolic down to 70s. 140 to 70 might have been considered quasi-normal 50, 60 years ago and then it went down to something like 125 over 70. And what is it now? What is the normal range of blood pressure that is acceptable?

Dr. Gerda Maissel:

When it comes to blood pressure, there's ideal, there's acceptable, there's oh my goodness there's the emergency room. You know there's a variety of ranges, but what I can tell you is that right now, the new goal is for a systolic, which is the big number, to be below 120. And that you're absolutely right. That has come down.

Dr. Douglas L. Beck:

And that seems like a real challenge. I mean, as you're aging, doesn't your systolic tend to go up?

Dr. Gerda Maissel:

Yeah, your blood pressure does tend to go up, and blood pressures are one of those things where there is a balance, especially as people get older I'm talking in their 80s and 90s, not necessarily 60s and 70s when you might well have 20, 30 years ahead of you, but when you're to the point where you might have, let's say, 10 years or less ahead of you and it's hard to know many doctors are more comfortable not looking for tight blood pressure control, because a really tight blood pressure control, because a really tight blood pressure control, comes with a trade-off.

Dr. Gerda Maissel:

And that trade-off can be. A person feels dizzy. Some of the medicines have side effects of excessive fatigue. Sometimes you get insomnia. There's a variety of side effects and I think we have to be wise, both as consumers of health care and as physicians who are prescribing it, to always look at the person involved and not just look at the number, sure, interpret and come to a mutual understanding as to what the goals are and why for this individual.

Dr. Douglas L. Beck:

And when you speak about lower blood pressure, if you take a patient who's, let's say, 70s, 80s, 90s, and you lower their blood pressure to 115 over 70 through medical care, their perfusion to their organs is reduced as well. Right, and isn't? The perfusion throughout their brain is reduced. And you know the blood pressure is not just perfusion, but you know it's the measure of how blood is flowing through the vessels. And when we're at, let's say, 140 over 90, and we're very down to maybe 110 over 70, you're going to. I can see how so many people in that age group would be dizzy and they would have less perfusion to the organs and they would probably not feel quite as good. Or am I way out there?

Dr. Gerda Maissel:

I mean, what you're raising is a very valid point, and when you combine that with the reality that as we get older we don't metabolize drugs as well, what you sometimes see is that people are on certain doses of drugs and those drugs are hanging around longer and then perhaps are interacting with something they're taking for their prostate which is also lowering their blood pressure. We see people not just on drugs for blood pressure where they might be on three or four drugs, but a whole series of other drugs, and then you get the interactions and you get all kinds of things. So I'm a strong believer that you have to look at the person.

Dr. Gerda Maissel:

Which makes total sense, absolutely the context of their getting older and the drug interactions. And most people are not taking their blood pressure every day. So in the example that you use, let's say we did bring somebody down to less than a systolic of less than 120. Well, as they are metabolizing those drugs more slowly, their blood pressures may be going even lower and they won't know it until they're dizzy and they fall on their head.

Dr. Douglas L. Beck:

And this is a very common presentation that we see in audiology clinics, because audiology involves vestibular analysis, testing and diagnostics and rehab, of course. And these patients are very different from a patient with benign, paroxysmal positional vertigo. You know a BPPV patient. These are patients who are often weaker and they struggle to stand up and they have blood pressure issues when they get up and they can exacerbate dizziness across their day. Tell me about arthritis, because in audiology I'll tell you about this.

Dr. Douglas L. Beck:

Many people have arthritis, of course, and we're talking primarily about osteoarthritis, and when they do, it's very difficult to manipulate a hearing aid into your ear and do the fine motor control that's required. And luckily, probably 70 or 80%, maybe 85% of the market now is rechargeable batteries, so they don't have to take out these tiny little batteries, peel the label off them, stick them in the hearing aid, close the hearing aid and then figure out how to get it in your ear. But arthritis is a big deal in older patients and this interacts quite a bit with audiology patients. So tell me your take on this. I presume osteoarthritis is the number one challenge.

Dr. Gerda Maissel:

Yeah, osteoarthritis is incredibly common and it's one for which we only have symptomatic treatments right now. We don't have ways to cure it or prevent it, and so it's extremely common as people get older. And rechargeable does help when it comes to hearing aids, but that fine motor, as well as grip strength, can become an issue for all of us. I mean, I'm not in my 70s or 80s or 90s and I couldn't get the spaghetti jar open yesterday and I had to go ask my husband, who also couldn't get it open.

Dr. Douglas L. Beck:

He's getting it open too.

Dr. Gerda Maissel:

And so, literally, he had to get out. I don't know I didn't pay attention because I was cooking, but he had to get out the something called gizmo to get my jar open. And we're just laughing because we're not that old and yet this little thing is getting in our way, and so it happened.

Dr. Douglas L. Beck:

I'm in the same boat. I'm also not 70 quite yet, but I've been a guitarist for about 50, 60 years and I play piano and guitar and you know my brain remembers how to do it, but when I'm doing fast things my fingers won't do it as well. You know I really struggle and the hardest thing are chord changes. Anybody with arthritis in their hands will know this. You know, if you're going from like a C to an F, to an F minor to an F7, oh my goodness. You know you got to do it pretty slowly and you have to force yourself to take control of it.

Dr. Douglas L. Beck:

But it's a bony process and it only goes one way at this time. I mean, as you say, we have relief for it through different medicines, but no cure. And in fact I was at a conference this weekend in Las Vegas and one of the things that came up was there's very, very few cures for any of these things that we're talking about. There's medical management which is incredibly effective and highly beneficial, but we rarely cure disease. Is that true in your mind?

Dr. Gerda Maissel:

That's interesting. I mean, it's a yes and a no to that. I mean, if we look broadly and I think about cures, antibiotics come to mind, yeah, and you know, just seeing.

Dr. Douglas L. Beck:

And hep C. We can cure hep C right.

Dr. Gerda Maissel:

Well, there's a number of infectious diseases that a generation ago, you know I mean, part of why we have so many people living into their 90s is I mean, I don't know if you know the old saying pneumonia is an old man's friend.

Dr. Gerda Maissel:

But, that old saying was sort of saying that if you got pneumonia you would pass fairly easily. Whether that's right or wrong is another story, but in the past if people got a pneumonia or a urinary infection they would die. Now, with easy availability of appropriate oral antibiotics, we cure those infectious illnesses, so in that way medicines come a long way.

Blaise M. Delfino, M.S. - HIS:

Even if you were talking.

Dr. Gerda Maissel:

I'm thinking about. Well, I don't know if it's a cure, but joint replacements for osteoarthritis have come a long, long way, and so people can get their hips, their knees, and now I'm seeing a lot more shoulder replacements.

Dr. Douglas L. Beck:

A lot of shoulders. Yeah, I've run into that too.

Dr. Gerda Maissel:

When we get to fingers, let me know because Fingers is a different story, and so I think as boomers, I think as boomers, we want to stay 30, 20, 30, forever. It's just what we want, and I'm sure these generations wanted that too, but I think boomers particularly want it and expect it.

Dr. Douglas L. Beck:

Yeah, I think so, and they're willing to pay for it, which is a big deal because it's not inexpensive. Tell me about your thoughts with diabetes. Of course there's a very, very high correlation between hearing loss and diabetes. We've known about this for 40, 50 years now.

Dr. Douglas L. Beck:

I did a paper gosh must've been 35, 40 years ago at the American Academy of Otolaryngology, head and neck surgery with a very famous otolaryngologist from St Louis, dr John Gladney. Unfortunately, john passed about 20 years ago, I guess, but back then, dr John Gladney, unfortunately John passed about 20 years ago, I guess. But back then 40 years ago, when he and I worked together at St Louis University, he was noticing that very many of his patients who had diabetes had mild to moderate sensory neural high frequency loss and many of them were dizzy. And this is before you could really detect microvascular changes in the inner ear and the changes in the ret ear and you know the changes in the retina and things like that, because you know we've only had CT and MRI for about 35 years now. I mean, we didn't have them 40 years ago.

Dr. Douglas L. Beck:

But what are your thoughts on relationship with diabetes? When you have a patient with diabetes type 2, which is the more common in adults. Do you think about hearing loss as a general practitioner these days, if that's fair to say? Do you worry about that or do you ask about that? Or is diabetes something that we just deal with by itself?

Dr. Gerda Maissel:

Well, with diabetes, many people conceptualize it as, oh my blood sugar is too high, Like, oh my blood pressure is too high, but they don't necessarily think about that.

Dr. Gerda Maissel:

When you have high blood sugar over a long period of time, it damages your blood vessels and, as you just mentioned the term microvascular and it damages the little bitty blood vessels, including the ones around and feed the nerves. And when nerves are damaged all kinds of things happen, including higher risk for amputation and hearing loss. And with diabetes, all healing of any type takes longer, and so if you have a surgery you're not going to heal quite as quickly. And it goes on and on from there. So I find myself often in conversations with people with diabetes to help them understand the trajectory that can happen. Don't necessarily jump up and down and say your kidneys, your ears, your toes, but I do help people understand that it really makes a big difference in the long run if blood sugars are appropriately controlled, and that, of course, you also get into conversations about diet and I don't want to go too far off topic, but gut, microbiome and some of the things that we're really learning about that truly help us in the long run.

Dr. Douglas L. Beck:

Yeah, a friend of mine, Dr Keith Darrow, has a book on nutrition that he wrote primarily for hearing care professionals to work through diet, exercise, nutrition with their patients and I'd recommend that book. When we talk about dementia and, by the way, we're still going down the top chronic conditions that are on that one paper that was so good. Dementia we don't have time to do a whole class on it. But there's different types of dementia. The number one of all, two-thirds of all dementia is Alzheimer's, but there's 200 different types of dementias and before we get to full-blown Alzheimer's, that's a 25 to 30-year process from when we have microcellular changes until the patient is demonstrating memory and similar problems. But then there's mild cognitive impairment.

Dr. Douglas L. Beck:

Now, this number I read in the JAMA. It was about, I want to say, october 2022. And I have it in my records. I could find it. But they estimated that of USA residents over age 65, 22% have mild cognitive impairment. We know through multiple research studies that there's a high correlation between untreated hearing loss in at-risk patients and dementia. So I wonder if you can give me your take on this again as a physician, because we see the world in similar but slightly different eyes because we have different training, but I'm curious your thoughts on the relationship between MCI, dementia maybe Alzheimer's and hearing loss.

Dr. Gerda Maissel:

Well, I feel like sometimes I've become the hearing loss evangelist. When I remember I was on a trip it was a two-week trip, well, 10 days but I was on a trip with a group of people and one of the people on the trip had very significant hearing loss, to the point that they, you know, they'd have to go to the front. They'd stand there like this, they would sort of get the directions wrong. We'd have to go look for the guy and I quietly pulled him aside and I said listen, what's going on with your hearing?

Dr. Douglas L. Beck:

Yeah.

Dr. Gerda Maissel:

And he was like, oh, I just I don't want to deal with it. I know it's a problem and I said I totally understand your frustration but by not correcting your hearing loss you're risking both not being able to correct it down the line and having trouble understanding words and being one of those people with a hearing aid who still can't hear, and you're increasing your risk for dementia. And he's like dementia, I'm like it's very, very well studied. Now you are at higher risk if you have uncorrected hearing loss to get dementia. It is worth overcoming your own apprehensions and getting your hearing corrected, and I raise this constantly to people. It's one of the things. We've all gotten so comfortable with glasses, but why we're not comfortable with hearing aids, it doesn't make sense to me.

Dr. Douglas L. Beck:

When you talk about at-risk, let me just review some of that for the listeners.

Dr. Douglas L. Beck:

The at-risk person with untreated hearing loss includes certainly older folks, you know, senior citizens, certainly those with hearing loss, certainly those who are on multiple pharmacologic treatments, multi-pharmacy people, people who are in lower socioeconomic groups. And what happens as your auditory system, as your hearing, as your balance degrade over time which you know they do your brain is still plastic. Many people know the term neuroplasticity, so your brain is plastic and all of a sudden you're getting less and less sound coming through your ears and your brain is constantly adapting to that sound coming in, even though that sound is erroneous, and so it muddles your thoughts. It can for many people because they're not getting the full complement of sound and that, I think, is critically important to those who progress on, to dementia secondary to hearing loss. So my quote on that and some people would argue about it, but it's my personal thought untreated hearing loss tends to exacerbate cognitive decline in at-risk patients and again the at-risk would be the older patient, more significant hearing loss, lower socioeconomics and multi-pharmacy patients.

Dr. Gerda Maissel:

And many people fit into that polypharmacy category as they get older which is another pet issue that I have, which is, doctors are really good at starting medicines, but we're lousy at stopping them.

Dr. Douglas L. Beck:

Do you have a number when you say, okay, patients on six meds, four meds. Is there a point where you say I got to look at all this. This isn't making sense anymore?

Dr. Gerda Maissel:

Well, the statistics are that around five, I think it's an 80% chance of a significant drug interaction or side effect. So that's the definition of polypharmacy is five or more. But many of my clients come to me, especially folks in their 80s and 90s, and they can be on 20 to 30 medications that have accumulated over time and sometimes they're taking duplicative supplements. For example, I have a gentleman who was on three forms of vitamin D. He was taking vitamin D and there was a vitamin D in two of his supplements. Sure, he checked the level and he was too high and he ended up, you know, really peeling that back.

Dr. Douglas L. Beck:

Well, how do you feel about OTC meds? Because a lot you know you take vitamin D prescription but some people are just going to take the 600 milligrams that's you know, with calcium OTC and they usually don't tell their doctors about that. Right, the OTC vitamins, minerals meds that they're taking do they mostly? Reveal those, or do you have to really ask about that?

Dr. Gerda Maissel:

You have to ask, and when I do a med review for one of my clients, I want to know everything they're on. Supplements can certainly be useful, but the problem with many supplements is you don't know exactly how much of what is in the supplement. They're not regulated the same way that a drug is, and a supplement is going to contain things that potentially interact, and so I think you just have to be smart about what you choose to take. And the other thing that I'll mention about all of this is that there's a certain profit motive in supplement sales. We just need to have a little bit of a buyer beware attitude when it comes to supplements. But yes, they count as drugs.

Dr. Gerda Maissel:

The other thing that people should just be aware, especially when they're taking vitamins other thing that people should just be aware, especially when they're taking vitamins, is to know the difference and perhaps look up what is fat soluble versus what is water soluble. So a water soluble vitamin, like vitamin C, you can take extra and it'll leave your body. But vitamin D, which is fat soluble, if you take extra, especially if you're older or a little heavy, it's going to hang around longer.

Dr. Douglas L. Beck:

Yeah, it's going to dissolve into your body you know a lot of medical care now, um, when you go to see your, your gp, or you're reading, you know, some available medical books, talk about inflammation and and I think that everybody's a little bit confused on this, because we do have non-steroidal anti-inflammatory drugs like ibuprofen, which is also called Advil, which is sold under many names and labels. But I don't think that if you take Advil every single day, you're actually helping yourself. But you tell us because you're the expert. So what is inflammation? Where does it come from? What do you do about it?

Dr. Gerda Maissel:

Well, inflammation is one of these both real and overstated things that can be out there. So inflammation is the body's reaction to something foreign or something wrong.

Dr. Douglas L. Beck:

And it could be an infection right.

Dr. Gerda Maissel:

It can be anything that the body perceives isn't right, and there's a difference between generalized inflammation, which can make you just feel awful, and local inflammation.

Dr. Gerda Maissel:

You know, if I cut my hand, I'm going to have an inflammatory response where blood is going to come into the area, the little blood cells come in and it's part of the body trying to heal the wound.

Dr. Gerda Maissel:

But your whole body can also react to things and it can be also a reaction to something in your environment, to allergies. It's a very deep and complicated subject, but I will tell you that there is a lot of thought around our modern life triggering excess inflammation and there's a whole series of theories about it, from not enough exposure to soil bacteria when we're young, because we don't let our kids play in the dirt to not to harp on food, but that the food that we eat is not the food that our grandparents ate, and the pesticides or the particular food or the processing may be causing inflammatory reactions in our body. And there's a whole category of illnesses, autoimmune illnesses that were never well understood, are still not well understood, but that people are no longer willing to just be dismissed by their doctors and say there, there, dear, you're just being anxious, and so there's more push appropriately so for taking people with inflammatory illnesses far more seriously.

Dr. Douglas L. Beck:

Yeah, and I think it's come full circle almost where, as you said earlier, the patients were nursed along and these could be irritable bowel syndrome. These could be people and I think it's come full circle almost you know where, as you said earlier, the patients were nursed along and these could be irritable bowel syndrome. These could be people who have fibromyalgia. These could be people who have migraine, right, and we don't know exactly what causes any of these. These are symptoms that are assembled into that profile and then you get that diagnosis. But I don't think we know to this day. I've written a few papers on migraine over the years because we think the number one cause of dizziness I don't know if you'd agree with this, but the number one cause of dizziness in patients is actually not their vestibular system, it's actually migraine. Migraine causes more dizziness than do vestibular issues and I've read that quite a number of times in different journals and I spoke with a lot of ENTs who would say the same thing that patients often get mislabeled Meniere's disease versus migranous vestibular, versus endolymphatic high drops and all these things and it's really hard to tell. We used to have tests in audiology I mean we still do like electrocochleography, which is when, if a patient was suspected of Meniere's disease, we could put some electrodes on their head and around their ear and we stimulate their ear and we look at what's called the ECOG, or we're looking at an action potential versus a summating potential, and then what happens is if you have a certain ratio that's consistent with Meniere's disease, but if you don't have that ratio, that doesn't mean you don't have Meniere's disease. So I think these are things, some things in life you can't prove. You can't prove anybody has pain. You can't prove that they have a headache. You can't prove that they have. You know tinnitus, right. But I want to get back to something that we said earlier.

Dr. Douglas L. Beck:

Many types of hearing loss, many types of tinnitus, many types of significant pains and problems can be managed very, very effectively. And I want to speak about this particularly with tinnitus, because often when people have tinnitus, particularly adults, and they go to see most physicians, the physicians will say things like well, we all have tinnitus, you have to get used to it. Well, there's nothing you can do. Well, you know, you have to learn to live with it. And none of that is correct.

Dr. Douglas L. Beck:

Tinnitus and hearing loss are always problematic and we can't cure hearing loss at all. But we can absolutely manage hearing loss, probably 98, 99% of all patients who have hearing loss of various types and degrees In tinnitus. I remember this came out of Oregon Health Sciences. They said 90% of patients who follow a protocol called PTM progressive tinnitus management 90% of the people who do that will effectively manage their tinnitus. So there's quite a bit we can do. But I think often you have the specialty areas like optometry or ophthalmology or otolaryngology versus neurotology versus audiology versus hearing aid dispensing and it gets back to where we started is that they don't necessarily talk to each other. So you know, some people are giving out information from 30, 40, 50 years ago when they went to school, and not appreciating that everything has changed since then.

Dr. Gerda Maissel:

You know I have a couple of comments for you. Yeah, please. So one is on dizziness. Yeah, so people often go to the doctor and they say I'm dizzy. And I encourage people to separate out lightheadedness, that feeling you know, like of near fainting or just you know sometimes people call it stars in their eyes or almost blacking out. There's a feeling that we know is lightheadedness. That is different from vertigo, which is a feeling of spinning. And I encourage people to, when they talk to their doctor and they say they're feeling dizzy, to not only say dizziness like lightheadedness or dizziness like things are spinning, but also to try to identify does it change or is it triggered by getting up or any other thing that they know of that triggers their dizziness? Because if you just show up at a doctor and you say you're dizzy, you could trigger a multi-million dollar workup with a brain MRI and cardiac monitors and eventually they realize oops, it's actually vertigo. So you want to differentiate what kind of dizziness and anything that seems to trigger it when you describe it to your doctor.

Dr. Douglas L. Beck:

Well, listen, dr Meisel, I am so delighted to spend time with you and this is always an enlightening conversation. I really appreciate it. I want to recommend people go to MyAdvisor, which is MyMDAdvisorcom, so it's M-Y-M-D-A-D-V-I-S-O-Rcom. It's a joy to speak with you and I hope we'll do this again, and I just can't tell you how happy I am that we're able to get together and make this happen.

Dr. Gerda Maissel:

Thank you so much.

Dr. Douglas L. Beck:

My pleasure, thank you.

People on this episode

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Blaise M. Delfino, M.S. - HIS

Host
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Dr. Douglas Beck

Co-host