Vanessa Becker - Lakeview Clinic

Age-Related Macular Degeneration

by Vanessa Becker | Feb 21, 2024 | Eye Care, General

What is Age-Related Macular Degeneration, and could it impact me?

Age-related macular degeneration, or AMD, is a disease in the back of the eye which impacts a person’s central vision. It is the most common cause of severe vision loss in people aged 50 or older. The effects of AMD range from mild blur or distortion of central vision to profound central vision loss. The prevalence of AMD increases significantly as we age. A census done in 2019 revealed that approximately 2% of Americans aged 40-44 were living with AMD, but that number rose to 46.6% for people who were 85 or older. Annual dilated eye exams are important for early diagnosis and management of the disease.

What are the Risk Factors for AMD?

The biggest risk factor for AMD is age, specifically anyone over the age of 50. Other risk factors include smoking, high blood pressure, a diet high in saturated fats and cumulative UV light exposure over the course of a person’s life. The most common symptoms of AMD are blurry vision, distorted or wavy central vision, difficulty recognizing faces or a dark blind spot in the center of vision. If you or anyone you know is over 50 and has developed any of these symptoms, contact your local eye care provider and schedule a dilated eye exam.

Are there different types of AMD?

There are two different forms of AMD: dry (nonexudative) and wet (exudative) macular degeneration. Although both can cause central vision loss, dry AMD is generally more common and less severe. In dry AMD the nerve tissue in the center of the retina slowly breaks down causing gradual central vision loss. Progression of dry AMD can convert to wet AMD. During wet AMD abnormal vessels begin to grow under the retina. Those vessels leak and hemorrhage, causing more damage to the macula. Wet AMD usually causes faster and more severe loss of central vision than dry AMD.

Retinal Images from Fundus Photography Machine.

What can be done for AMD?

Prevention and early diagnosis are key factors in limiting vision loss from AMD. Protecting your eyes from harmful UV light, not smoking, and eating a diet higher in dark leafy green vegetables are ways to take an active approach in trying to prevent the start of AMD. The Eyecare Team at Lakeview Clinic includes Dr. Bradley Ludwig, Dr. Tracy Jackson and Dr. Thomas Bryan. They have many years of experience using retinal cameras and other forms of diagnostic imaging to diagnose and manage patients with age related macular degeneration. Once a patient is diagnosed it cannot be cured, so the goal of treatment is to prevent progression. Lifestyle modifications and vitamin therapy specifically formulated for dry AMD is the standard treatment. If the disease converts to wet AMD, referral to a retinal specialist is required for further treatment.

Dr. Thomas Bryan, optometrist. at Lakeview in Waconia, MN.

Dr. Thomas Bryan, O.D.

Dr. Thomas Bryan is an optometrist practicing eye care at Lakeview Clinic in Waconia, Minnesota. He enjoys all aspects of optometry, but especially medical cases and contact lens patients.

Heart Disease

by Vanessa Becker | Feb 13, 2024 | Healthy Living, Internal Medicine, Uncategorized

Prevention & Early Signs

It’s February and love is in the air. Can you feel that thump, thump in your heart for your special someone? Valentines, Chocolates, candlelit dinners, and sweet poems. February also brings National Heart Awareness month. Let’s first look at steps to prevent heart disease and second discuss early signs of heart disease.

Prevention is Ideal

I encourage patients to focus on modifiable risk factors. What is a modifiable risk factor? Something we can change with effort and work. Items such as diet, weight management, stress levels, physical movement, environment, and optimizing pertinent medical risk factors are a few.

Diet: What is the best diet? Food that delivers high levels of nutrients, tastes good and has lower calories. Aim for colorful, natural, single ingredient foods. Food such as chicken, broccoli, avocado, oatmeal, raspberries, sweet potatoes, spinach. Nutrients, fiber, antioxidants, and omega fatty acids in these foods can help with weight management, cholesterol levels and inflammatory markers.

Weight management: This is a problem in America. Look at your weight as something that could lengthen your life or shorten it.

A balanced approach with goal setting, nutrition guidelines, activity minimums and accountability are key. Ask yourself “Why do I want to lose weight?” This helps formulate a plan. Ask your doctor for some help too!

Stress levels and environment: Stress is a natural part of life. However, stress hormones can be detrimental to the cardiovascular system. Learning how to recognize stress, minimize it and seek help when it’s too high is important. Exercise, prayer, meditation, gratitude, counseling, and medication are tools to help with this. Being aware of our environment is key. If you have control of leaving or taking a break from a stressful environment, then take the opportunity.

Movement: Strive for 150minutes a week of physical activity outside of your normal nine to five. Long walks, low impact cardio, resistance exercises such as body weight exercises, free weights, and resistance bands. Look for fun activities that allow for social interaction: golfing, skiing, skating, pickle ball, group fitness, frisbee golf are all great options to get moving.

Medical risk factors: Obesity, Diabetes, smoking, high blood pressure, highly processed diet, extreme stress levels, heavy alcohol use, strong genetic risk. Use the above suggestions with the guidance of your doctor to optimize treating these risks. Routine physicals, screening labs for diabetes, cholesterol and organ function, balanced diet, consistent movement, stress relief tactics will help prolong your life.

Now that you know a few preventative strategies let’s look for warning signs for cardiovascular disease. The hearts’ goal is to pump nutrient rich blood all over the body. Simply put, the pump has to squeeze hard enough, fast enough and through pipes (blood vessels) that are not damaged. If there is a problem in this process people need to recognize symptoms.

Warning Signs:

If the heart is not pumping hard enough, fast enough or efficient enough, then patients may experience leg swelling, fatigue, difficulty breathing, cough, dizziness, fainting spells, weakness and erratic blood pressure readings or heart rates.

If the heart is pumping too hard or too fast then the patient can experience headaches, shortness of breath, palpitations, vision problems or fainting spell. If blood vessels are blocked or narrowed, then symptoms vary depending on where the narrowing occurs.

If an issue is in the heart, chest pain or angina could develop as a warning sign of a heart attack, while narrowing in the legs can result in leg pain, cold feet, swelling and/or the development of chronic wound. Narrowing in the neck vessels can result in dizziness, confusion, and stroke like symptoms.

Conclusion:

I encourage you to take aggressive action using the prevention tactics outlined above. Also, if you are experiencing any of the warning signs, don’t hesitate to set up an appointment with your primary care provider or any of our great Lakeview Clinic providers. Happy Heart Month!!!

Peter H. Rogers, DO

Specialty: Internal Medicine, Pediatrics

Dr Rogers joined Lakeview Clinic in 2016. He holds dual board certifications in Internal Medicine and Pediatrics which allow him to provide comprehensive care to all ages.

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The Usefulness of Ultrasounds

by Vanessa Becker | Feb 7, 2024 | Family Medicine, General, Imaging, Internal Medicine, OB/Gyn, Pediatrics

~ Sonography Beyond Obstetrics ~

In medicine, we have a lot of tools to help our patients figure out what is causing their symptoms. An ultrasound is a diagnostic tool most people have heard of, and they are used often. Of course, we all know about ultrasounds being used for pregnant mothers in finding out if they are having a boy or girl, estimating due dates, etc. But it’s so much more than that!

One of the great things about ultrasound is that it’s quite safe. There isn’t the radiation concern that X-rays, or CT scans have, which is why we can use it in pregnancy, and is often a go-to for concerns with kids as we will discuss below. It’s also noninvasive, which means that although you will get some extra moisturizer with the ultrasound gel and pressure from pushing on the skin, there isn’t much risk either.

How it works – to avoid extra nerdy-ness, I’ll keep it brief. The ultrasound machine uses, as the name would suggest, sound waves that get sent through a handheld probe towards the body. The waves bounce off different material, or in our body, different substances and body parts such as bodily fluids, organs, air, soft tissue, bones and such. The sound waves then head back towards the probe. These returning sound waves are different depending on what they bounced off of, and the computer can help separate those different waves on the screen that you see. Most of the time all it can do is show different shades of white/black/grey, but believe it or not, to the trained eye, it shows a lot more than just snow on a screen!

Common Ultrasounds:

ECHO/Echocardiogram – This looks specifically at the heart and how well it is functioning. Healthcare professionals can see if valves are working properly, if you’ve had a prior heart attack or scarring before and can even determine if blood is flowing properly through the heart using Doppler ultrasound.

Obstetrics/pregnancy – Looking at the baby’s position, anatomy, or other issues that could be going on with the mother.

Abdominal – Used to examine gallbladders and find stones, examine kidneys to look for blockages from stones, examine liver to look at liver disease, and is even used to diagnose appendicitis in children.

Vascular – We commonly use ultrasound to help rule out blood clots in the veins and also look at the general blood flow of arteries to see if there is any narrowing or aneurysms.

Pelvic – This is more helpful for looking at women’s ovaries and uterus to evaluate for cysts, or other causes of abnormal bleeding.

And so much more!

Some health care providers, myself included, like to use something called a bedside ultrasound (or POCUS, short for Point-of-care Ultrasound) to help with patients in clinic. This can be used to take a quick look at things such as skin infections to see if there is any fluid to drain. It can also identify if there is any fluid around the lungs without needing an X-ray. However, we may often still order a formal ultrasound, as these tend to be a better-quality machine than point of care ultrasound. The benefit of POCUS is its accessibility in the clinic setting.

Some providers also use ultrasound to help with procedures, such as joint injections, ensuring the injection reaches the intended site. Another procedure often aided by ultrasound is biopsy. For example, in an Ultrasound-guided breast biopsy, ultrasound imaging is used to help guide the instruments to the site of abnormal growth.

We are happy to report that Lakeview Clinic is expanding the availability of ultrasound services in our Waconia Clinic. In addition to bedside ultrasound, we are adding sonography/ultrasound to our imaging department. This will mean added convenience for our patients and additional in-house diagnostic resources for our medical providers. As always, ask your provider if you have any questions about the imaging they order!

Lucas P. Labine

Dr. Lucas Labine is a Family Medicine provider at Lakeview Clinic. Dr. Labine sees patients at the Norwood and Waconia locations. During his third year of medical school, he had an extended rotation (with the RPAP program) at Lakeview Clinic and immediately loved the staff and patients alike. His interests include caring for the full family, pediatrics, complex care, procedures, family planning, preventative care, point-of-care ultrasound, and overall teaming with patients and forming long lasting relationships.

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Fatty Liver Disease

by Vanessa Becker | Jan 18, 2024 | Healthy Living, Internal Medicine

What is it and why should I care?

Often heard in the news is the degree to which your diet can impact your overall health. In general, people tend to think of diabetes, high blood pressure, and heart disease as consequences of a less healthy lifestyle, but a rising disease known as fatty liver disease also has significant adverse health outcomes. There are two types of fatty liver disease, known as alcoholic fatty liver and nonalcoholic fatty liver disease (NAFLD). With the rising rates of obesity in the world, NAFLD can be found in 25% of the population worldwide.

What does a “fatty liver” mean?

A fatty liver is often found on imaging of the abdomen such as with an ultrasound or CT scan. This is not something typically found on a physical exam. Fat on imaging looks different than normal liver tissue and is often found on imaging incidentally. Fatty infiltration can disrupt the normal function of the liver which includes filtering toxins from the blood, creating clotting factors for the blood in case of injury as well as helping manage blood sugar levels.

How can I prevent this?

It is recommended to visit a doctor at least once per year even if feeling well to ensure proper screening for more silent diseases like fatty liver disease. At these visits, the doctor will monitor weight and labs to include screening for metabolic disturbances like elevated glucose levels, cholesterol, and liver function. Ways to prevent this disease in everyday life include eating a well-balanced diet to include higher protein, lower carb foods and plenty of fruits and vegetables.The American Liver Foundation has a great 30-day liver healthy meal plan to get you started! Daily exercise is also important, aiming for 150 minutes of activity per week.

I developed fatty liver disease, now what?

If significant fatty infiltration exists, it is possible that lab values may be abnormal that can indicate liver dysfunction. These labs include AST, ALT, alkaline phosphatase, and bilirubin levels. These may be checked by your primary care provider regularly. In severe cases, the injury is so severe that it can develop into liver failure. Because of this, it is best to prevent and treat as early as possible to avoid these complications.

The majority of the time lifestyle modifications are the mainstay of treatment for this disease. This includes weight loss if overweight or obese, abstaining from alcohol, and avoiding any potential medications or herbal supplements that could further injure the liver. Other modifications include optimizing blood sugar control if diabetic and managing high cholesterol or known heart disease aggressively. If these modifications don’t improve the condition, typically patients will need to see a liver specialist for further treatment and guidance.

Jordyn N. Walter

Jordyn Walter, M.D. began practicing Internal Medicine at Lakeview Clinic in 2022. Dr. Walter has special interests in chronic disease management such as diabetes, heart failure and hypertension. She also utilizes point-of-care ultrasound.

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Medical Students Experience Lakeview through RPAP

by Vanessa Becker | Dec 29, 2023 | General

For over 50 years third year medical students have been training with Lakeview Clinic physicians as part of their medical training through the Rural Physician Associate Program (RPAP); a clerkship program run through the University of Minnesota Medical School. This program gives students the opportunity to focus on primary care in rural communities. Currently, students are located as far north as Bemidji and as far south as Austin/Albert Lea.

Some early participating RPAP students were Dr. Donald Sommers and Dr. Scott Ellingson, who became long-time Lakeview Physicians and have since retired. Current Lakeview doctors that participated in the RPAP program include Dr. Leah Clark, Dr. Abigail Elliott, Dr. Jaimee McPadden, Dr. Tara McMichael, Dr. Rebecca Siffring and Dr. Lucas Labine. It is fun to hear about the positive experiences these providers had during their student rotations at Lakeview. Because of his time as a RPAP student, Dr. Labine discovered where he would eventually practice medicine. “I picked Waconia for my RPAP site due to its reputation, location, and opportunities- little did I know that I would love it so much I would want to come back!” he stated.

“I picked Waconia for my RPAP site due to its reputation, location, and opportunities- little did I know that I would love it so much I would want to come back!”

Dr. Lucas Labine, M.D.

According to the University’s RPAP Program Office, 45 students have done medical clerkships at Lakeview Clinic over the years, beginning as early as 1974! Having all these amazing RPAP alumni demonstrates the success of the program reaching its intended goals. During this medical clerkship, students rotate through the various specialties such as OB/GYN, Pediatrics, General Surgery, and Internal Medicine at Lakeview. They are also provided with additional opportunities to learn about special areas of interest, spend time in our radiology department, and complete an ER rotation.

RPAP students finish their rotations at Lakeview Clinic having completed the Required Clinical Experiences (RCE) which is required of all medical students during their third year of medical school. Of the 250 to 300 U of M medical students from both the Twin Cities and Duluth campuses, 30 to 50 students choose to complete their clerkship through RPAP. Their reasons for choosing this program range from wanting the opportunity to have more patient interaction to wanting one on one mentorship with an established physician. Dr. Leah Clark “found Lakeview to be accommodating and expedient in facilitating [her special interest] in ultrasound guided musculoskeletal injections” during her time in the RPAP program.

All of this training takes place under the supervision of an established doctor known as a preceptor. Lakeview currently has three preceptors, Dr. Tara McMichael, Dr. Abby Elliot and Dr. Leah Clark, all of whom were RPAP students themselves! Dr. Todd Holcomb has also served as a preceptor. Physicians must be vetted prior to taking on the role of preceptor and need to become adjunct professors at the University of Minnesota in order to mentor students. We are grateful to have physicians willing to assume a critical role in the development of medical students. Lakeview preceptors help students develop clinical problem-solving skills and mentor future leaders in clinics, hospitals and our communities.

“Thank you for the tremendous work of providing excellent patient care, and your commitment to educate the next generation of physicians to serve our rural communities.”

-Dr. Kirby Clark, MD – Director, RPAP

A lot can change in 50 years, and while not all the communities we serve can still be considered rural, Lakeview does have clinics in rural communities and provides care for many patients from rural areas adjacent to the metro area. Lakeview Clinic is proud to be part of the Rural Physician Associate Program and its efforts to encourage students to practice primary care in rural communities. According to a study done by the University of Minnesota 41.2 % of RPAP students began their medical careers in rural clinics compared to 13.9% non-RPAP students. (U of M data from 1975-2017) RPAP students also entered Family Medicine and Primary Care at a much higher rate.

It is important that we continue to have Primary Care physicians available to residents of greater Minnesota. Rural clerkship programs like RPAP are only offered at approximately 20% of US medical schools. This makes both the program itself and physicians like those precepting at Lakeview Clinic an important part of future healthcare in our state.