Mast cell activation syndrome is a condition that most doctors have never heard about, yet it is an important cause of illness that is underrecognized and, as a result, misdiagnosed. It belongs in the category of chronic inflammatory illnesses with symptoms including fatigue, allergy-like symptoms and problems with virtually every organ system in the body. Dr. Lawrence Afrin is a leading scientist and clinician on mast cell activation syndrome. Dr. Afrin is based out of the University of Minnesota and the author of the book Never Bet Against Occam, a book detailing his clinical experiences and knowledge of this mysterious disease.  

Dr. Jack Berger discusses his experiences as a medical consultant to the California Medical Board and a regular expert witness in cases in which doctors are accused of mis-prescribing opioids. Dr. Berger has served as the director of residency training in regional anesthesia and acute pain medicine since 2000 and holds the academic rank of Professor of Clinical Anesthesiology at the Keck School of Medicine of the University of Southern California. He has been practicing pain medicine since 1982. 

Metabolic medicine is a fascinating paradigm to treat the individual patient. The individualization of care, everyone agrees, is the future of medicine, but the assessment and use of readily available patient parameters--things easily obtainable today--is still rare. Dr. Michael Rothman joins us today to discuss metabolic medicine and how he uses it in his clinical practice MD Wellness in New Jersey. Board-certified in internal medicine and emergency medicine, Dr. Rothman employs a unique approach that tracks dynamic clinical and laboratory measures, such as urinary pH, to determine the underlying imbalances in his patients. The identification and correction of dualities is one of the core principles of this approach. These dualities are familiar to most physicians, but not usually thought of as directly treatable entities. Distinctions like sympathetic and parasympathetic, anabolic and catabolic, acid and alkaline comprise some of the foundational categories. Dr. Rothman proposes specific life-style changes and the judicious use of lipid compounds to correct these measures with the goal of restoring health rather than masking symptoms. He also discusses one of his greatest influences, Dr. Emanuel Revici, a legendary physician in his time whose reputation and prescient work has largely been forgotten. Learn more about Dr. Rothman from his website at mdwellnessmd.com and his Amazon five-star rated book Edibolic Stress. 

Dr. Ritchie Shoemaker returns to discuss the diagnosis and management of a condition he discovered as a physician-researcher, chronic inflammatory inflammatory syndrome (CIRS). CIRS is important because it is a scientifically-validated condition that affects millions of Americans, most often in the form of chronic illness after mold exposure. (One out of every two buildings in the United States is water-damaged.) Genetically vulnerable patients develop a wide range of symptoms including fatigue, depression, muscle soreness and other symptoms and are often misdiagnosed by the medical establishment as having fibromyalgia, chronic fatigue syndrome or a psychiatric condition. In our first conversation, Dr. Shoemaker discussed how he came to discover this mysterious illness as a family medicine doctor in Maryland. In this second part, we turn our attention toward all things clinical including the case definition of CIRS, the main symptoms, biomarkers, genetic susceptibility, visual contrast sensitivity testing and the treatment protocol. To learn more, we highly recommend his books Mold Warriors and Surviving Mold and his website survivingmold.com. 

Ritchie Shoemaker, M.D. is a recognized leader in the field of biotoxin-related illness. Dr. Shoemaker was a primary care physician in Pocomoke, Maryland who began treating a mysterious illness in 1996 related to a Pfiesteria outbreak in the Chesapeake Bay. His subsequent journey in patient care, advocacy and scientific research led him to identify a common underlying pathway called the Chronic Inflammatory Response Syndrome (CIRS). CIRS is the end-result illness that occurs after exposure to biotoxins in genetically susceptible individuals. Dr. Shoemaker identified the same clinical symptoms, vision problems and alterations in blood work reflecting underlying inflammatory and immune irregularity in patients who became chronically ill after exposure to a wide range of biotoxins from Pfiesteria, blue-green algal blooms in Florida, tick bites and, most prevalent, mold from water-damaged buildings. He is the author of Mold Warriors and Surviving Mold. Dr. Shoemaker is joining us for a two-part interview. In this first segment, he discusses the events that led to his discovery of CIRS. The second segment will focus on the clinical work-up of CIRS. Learn more at Dr. Shoemaker's website survivingmold.com

Our guest today is Stuart McGill, PhD. Professor McGill is a Professor of Spine Biomechanics at the University of Waterloo. He has over 400 scientific publications including three text books: Low Back Disorders, Back Mechanic and Ultimate Back Fitness and Performance. Professor McGill will be discussing low back pain evaluation and management with us today. You can learn more at his website backfitpro.com.

Our guest today is Dr. Fadel Zeidan. Dr. Zeidan is an assistant professor of neurobiology and anatomy at Wake Forest School of Medicine and associate director of neuroscience at the Center for Integrative Medicine. His programmatic line of research is focused on determining the neural mechanisms that mediate the relationship between self-regulatory practices and health.  He is especially interested in determining if and how mindfulness-based mental training regimens affect pain and health.  Dr. Zeidan will be discussing the effects of mindfulness meditation on a spectrum of pain outcomes.

Our guest today is Anna Maria Aloisi, MD, PhD. Professor Aloisi studied at and now teaches at the University of Siena. Her research activity focuses on pain and hormonal-induced effects in pain mechanisms. She will be discussing opioid-induced hypogonadism with us today.

We welcome return guest Roger Chou, MD. Among his many titles and distinctions, Dr. Chou is a Professor in the Departments of Medicine and Medical Informatics & Clinical Epidemiology at Oregon Health & Science University (OHSU) School of Medicine. He will discuss his recent article Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis A Systematic Review and Meta-analysis published in the Annals of Internal Medicine.

On today’s episode we welcome Salim Hayek, MD, PhD. Dr. Hayek is currently the chief of the Division of Pain Medicine at University Hospitals and Professor in the Department of Anesthesiology at Case Western Reserve University. He obtained a Bachelor of Science degree in Biology with Distinction at the American University of Beirut in 1987 and a medical degree in 1991. Following a residency in Anesthesiology training at University Hospitals of Cleveland, he completed a PhD in Cellular Physiology at Case Western Reserve University in 2000 and subsequently obtained fellowship training in Pain Medicine at the Cleveland Clinic Foundation. He is well-published and serves on the editorial board of most pain journals. Dr. Hayek has had a number of service accomplishments at the local and national levels and is an editor of a textbook entitled Pain Medicine. Published in 2015, it is the first textbook to bring together the four main disciplines in managing pain: anesthesiology, neurology, physical medicine and rehabilitation, and psychiatry.

On today’s episode we welcome Jane Liebschutz, MD MPH. Dr. Liebschutz has been the Program Director of the Family Medicine­General Internal Medicine­-General Pediatrics Fellowship at the Boston University Medical Center since 2010. She is board certified in internal medicine and preventive medicine, and is an experienced researcher and educator, working across disciplines and with trainees pursuing diverse career goals. Her research agenda focuses on the intersection of violence, mental health and substance abuse withgeneral medical care, including active NIH grants in implementation research. She has been Principal Investigator or co-Investigator on over 12 training grants aimed at post­doctoral fellows. Dr. Liebschutz will be discussing her article “Managing chronic pain in patients with opioid dependence” published in a June 2014 issue of Clinical Treatment Options in Psychiatry.

We welcome Roger Chou, MD. Dr. Chou is a Professor in the Departments of Medicine and Medical Informatics & Clinical Epidemiology at Oregon Health & Science University (OHSU) School of Medicine. He is Staff Physician in the Internal Medicine Clinic at OHSU and has served as Director of the Pacific Northwest Evidence-based Practice Center since 2012. Dr. Chou's research interests are systematic review methodology, meta-analysis, screening and preventive services, guideline development, and drug effectiveness. He has conducted systematic reviews in a number of areas, including chronic pain and musculoskeletal conditions, screening and prevention, diagnostic testing, and prognosis. Dr. Chou has served as Director of the American Pain Society clinical guidelines program, the GRADE methodologist for the World Health Organization’s Division of Reproductive Health, is a member of the Cochrane Back Review Editorial Board, and co-chair of the National Quality Forum Musculoskeletal Standing Committee. Dr. Chou is on several journal editorial boards and is an author on numerous scientific articles published in peer-reviewed journals. He will discuss his systematic review from a February 2015 issue of Annals of Internal Medicine entitled “The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop.”

We welcome Sabrina Paganoni, MD, PhD. Dr. Paganoni is a physician at Spaulding Rehabilitation Hospital and Massachusetts General Hospital’s Physical Medicine and Rehabilitation Service. She is board certified in physical medicine and rehabilitation and neuromuscular medicine and her clinical interests include amyotrophic lateral sclerosis, electrodiagnostic medicine and neuromuscular disorders. We will be discussing her article “Rehabilitation in Amyotrophic Lateral Sclerosis: Why It Matters” published in 2014 in the journal Muscle and Nerve.

We welcome guest Tenley Fukui, MA, LPC. Ms. Fukui will be discussing her recent study entitled A Randomized Control Trial of Hypnosis Compared with Biofeedback for Adults with Chronic Low Back Pain published in the European Journal of Pain.

Ms. Fukui is certified in clinical hypnosis by The American Society of Clinical Hypnosis. She has been in private practice for eight years in Houston specializing in chronic pain management, anxiety disorders, clinical hypnosis and biofeedback.

Her extensive training and experience include interning at the Michael E. DeBakey VA Medicine Center in the Chronic Pain Clinic and Trauma Recovery Program; conducting research at the VA for 12 years; and serving as past president of the Biofeedback Society of Texas.

We welcome guest Jamil Bashir, MD, a regenerative medicine and interventional orthopedics fellow at the Centeno Schulz clinic. He will be discussing his article The Emerging Use of Platelet-Rich Plasma in Musculoskeletal Medicine published in the January 2015 issue of The Journal of the American Osteopathic Association.

Dr. Bashir is a native of Rockville, Maryland and a graduate of the University of Maryland School of Medicine. After medical school he completed residency in Physical Medicine and Rehabilitation at The University of Miami Miller School of Medicine. Dr. Bashir worked closely with the Interdisciplinary Stem Cell Institute at the University of Miami, publishing a literature review on stem cell use in musculoskeletal diseases as well as helping to develop a pilot study investigating expanded stem cell use in the treatment of facet joint arthropathy.

We welcome Erin Reynolds, PsyD on today’s discussion of concussion evaluation and management. Dr. Reynolds is a clinical neuropsychologist and instructor at the University of Pittsburgh Medical Center Sports Medicine Concussion Program in the Department of Orthopaedic Surgery. She specializes in neurocognitive psychology, with a particular focus on sports concussion and its many related conditions. Dr. Reynolds offers expertise in the assessment of sports-related concussion, recovery within a pediatric and adolescent population, and biopsychosocial aspects of recovery from sports-related concussion.

Dr. Reynolds completed a doctoral program in clinical psychology from the Massachusetts School of Professional Psychology in Boston, Mass., a clinical neuropsychology residency at Bedford VA Medical Center in Bedford, Mass., and a neuropsychology fellowship in sports concussion at UPMC.

More information on concussions can be found on the UPMC Sports Concussion Program website at rethinkconcussions.com.

Our guest today is Gregory Carter, MD, MS.

Dr. Carter is board certified in physical medicine and rehabilitation and neuromuscular medicine. He is the medical director of St. Luke's Rehabilitation Institute in Spokane, Washington and serves on the faculties of the medical schools at the University of California, Davis and the University of Washington. 

Dr. Carter has been awarded with numerous distinctions for his clinical and research activities including the American Association of Neuromuscular and Electrodiagnostic Medicine's 2012 Distinguished Researcher Award which recognized him as the first investigator to report the effectiveness of cannabis in treating amyotrophic lateral sclerosis and noted the quality of the more than 150 peer-reviewed publications he has co-authored.

Dr. Carter will speak with us today about his clinical approach to treating patients with cannabis. 

Our guest today is David Cifu, MD. Dr. Cifu is Chairman and the Herman J. Flax, MD Professor of the Department of PM&R at the Virginia Commonwealth University (VCU) School of Medicine in Richmond, Virginia, the Chief of PM&R Services of the VCU Health System, the Executive Director of the VCU-Center for Rehabilitation Sciences and Engineering, and National Director of the PM&R Program Office and a member of the Senior Executive Staff for the Department of Veterans Affairs. He has been funded on 30 research grants and is PI or Co-PI on 8 current research grants totaling more than $25 million. In his 20 years as an academic physiatrist, he has delivered more than 425 regional, national and international lectures, published more than 165 articles and 65 abstracts, and co-authored 20 books and book chapters. He is also the Past President of the American Academy of PM&R. Dr. Cifu will discuss traumatic brain injury with us today.

Our guest today is Dr. David Berbrayer, a specialist in physiatry, Physical Medicine and Rehabiliation, certified by the Royal College of Physicians and Surgeons of Canada and the American Board of Medical Specialties.

Dr. Berbrayer completed his Master of Teaching program at the University of Toronto and the Harvard Macy Program. He has held numerous leadership positions both past and present: past vice president and chief of staff Lyndhurst-The Spinal Cord Centre; past president of the medical staff of Bloorview Kids Rehabilitation, the largest pediatric facility in Canada; division head, Section of Physiatry, Sunnybrook Health Sciences Centre (fully affiliated with University of Toronto); chairman section of Physiatry Ontario Medical Association; editor for Knowledge Now and member of the performance metrics committee for the AAPM&R; member of the education committee AAP and past chair of the membership committee of AAP; current chair of the education committee of the Canadian Association of Physical Medicine and Rehabilitation. He has won many awards nationally and internationally. 

Dr. Berbrayer discusses his recently published article entitled "Update on Evidence-based Treatment for Plantar Fasciopathy" published in the February 2014 issue of the American Academy of Physical Medicine and Rehabilitation Journal. 

Our guest is Joshua Hare, MD who is Chief Sciences Officer, Senior Associate Dean for Experimental and Cellular Therapeutics, Director of the Interdisciplinary Stem Cell Institute, and Louis Lemberg Professor of Medicine at the University of Miami Miller School of Medicine. Dr. Hare has published original research on regenerative medicine and the therapeutic potential of mesenchymal stem cells. 

Featured article citation: Bashir, Jamil, et al. "Mesenchymal Stem Cell Therapies in the Treatment of Musculoskeletal Diseases." PM&R 6.1 (2014): 61-69.

We discuss carpal tunnel syndrome with Dr. Nigel Ashworth, a physiatrist on the faculty of the University of Alberta in Canada. Dr. Ashworth has over thirty publications, among them original peer-reviewed research on carpal tunnel syndrome. Our conversation covers diagnostic (and electrodiagnostic) considerations and management strategies, including the evidence for bracing, corticosteroid injection and carpal tunnel release. 

References: 

Amirjani, Nasim, et al. "Corticosteroid iontophoresis to treat carpal tunnel syndrome: A double‐blind randomized controlled trial." Muscle & nerve 39.5 (2009): 627-633.

Marshall, S., Gaetan Tardif, and N. Ashworth. "Local corticosteroid injection for carpal tunnel syndrome." Cochrane Database Syst Rev 2 (2007).

Ashworth, Nigel L., and Jeremy DP Bland. "Effectiveness of second corticosteroid injections for carpal tunnel syndrome." Muscle & nerve 48.1 (2013): 122-126.

Disclaimer:

The PM&R Podcast is an independent project aimed at providing informational interviews with authorities in the field. As such, the views expressed on the podcast do not represent the views of any institution. Views expressed by our guests are not necessarily shared by The PM&R Podcast.

By listening to this podcast, you agree not to use the content as medical advice to treat any medical condition in yourself or others, including but not limited to patients under your care. Consult your own physician for any medical issues that you are having. This entire disclaimer applies to any hosts, guests and contributors; we are not responsible for damages arising from the use of the podcast.

This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog. 

In the second episode, co-hosts Lysander Jim, MD and Mauro Zappaterra, MD, PhD  discuss the medicinal use of cannabis in physiatry with Sunil K. Aggarwal, MD, PhD. In addition to conducting his dissertation research on the medical geography of cannabis, Dr. Aggarwal has published original research articles in numerous peer-reviewed journals on the medicinal properties of cannabis. His website can be found at cannabinologist.org. Dr. Aggrawal is completing his residency in Physical Medicine and Rehabilitation at New York University Langone Medical Center and will soon begin a clinical fellowship in Hospice and Palliative Medicine at the National Institutes of Health Clinical Center. He will be discussing an article he co-authored entitled Medical marijuana for failed back surgical syndrome: a viable option for pain control or an uncontrolled narcotic?

Cited article:

Aggarwal, Sunil K., et al. "Medical marijuana for failed back surgical syndrome: a viable option for pain control or an uncontrolled narcotic?." PM & R: the journal of injury, function, and rehabilitation 6.4 (2014): 363-372.

Disclaimer:

The PM&R Podcast is an independent project aimed at providing informational interviews with authorities in the field. As such, the views expressed on the podcast do not represent the views of any institution. Views expressed by our guests are not necessarily shared by The PM&R Podcast.

By listening to this podcast, you agree not to use the content as medical advice to treat any medical condition in yourself or others, including but not limited to patients under your care. Consult your own physician for any medical issues that you are having. This entire disclaimer applies to any hosts, guests and contributors; we are not responsible for damages arising from the use of the podcast.

This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog.