Seeing your primary doctor regularly is essential to good health at any life stage, and knowing your baseline can help you determine when something isn’t right or when to see a specialist. And when your doctor thinks you should seek specialty care, you’re in luck. The Twin Cities area has a wealth of quality specialty clinics and providers for any condition that’s ailing you. Here, we cover some of the common reasons people seek specialty care, how these conditions are treated, and what you can do to stay in your best health.
It’s never too soon to get a check on your hearing and the health of your ears, and your primary care doctor is your first stop. At your annual exam, your doctor can go over any questions you have about your hearing. If you have risk factors for hearing conditions, or you’re over 40, your doctor may give you a referral to see an audiologist. “Currently Medicare requires a physician’s referral for a hearing evaluation to be covered,” says Dr. Paula Schwartz, audiologist and founder of Audiology Concepts. “This ensures that [the patient’s] hearing is managed in tandem with their physician and audiologist.”
Age-related hearing loss or changes are common, but people of all ages see audiologists due to many factors, especially lifestyle—attending loud concerts, riding a motorcycle,regularly mowing the lawn, or swimming without proper ear protection.
Over time, activities like these can negatively impact hearing. Audiologists provide rehab for hearing loss or ear injuries, recommend and fit hearing aids, rehabilitate balance disorders caused from inner ear issues, and help patients manage ringing or buzzing in the ears or head—known as tinnitus—and increased sound sensitivity, known as hyperacusis.
“Unfortunately, people typically don’t see an audiologist until they’re noticing difficulties in hearing. We encourage earlier testing to establish a baseline so we can counsel on appropriate hearing protection to avoid future hearing loss.”
—Dr. Paula Schwartz, Audiology Concepts
“Unfortunately, people typically don’t see an audiologist until they’re noticing difficulties in hearing,” Schwartz says. “We encourage earlier testing to establish a baseline so we can counsel on appropriate hearing protection to avoid future hearing loss.”
There are two main types of hearing loss, and the treatment is different for each. Conductive hearing loss is when sound waves aren’t traveling efficiently through the ear canal and the eardrum to the middle ear. For patients with conductive hearing loss, surgery can be a potential solution to modify the structure of the inner ear to enable clearer hearing. In this case, an audiologist will recommend an appointment with an otolaryngologist, or ear, nose, and throat doctor.
The other form of hearing loss is known as sensorineural, when background noise can be loud and high-pitched sounds might be muffled. Most likely, age is a factor in this kind of hearing loss, but for infants and children it could result from a congenital infection or abnormality. While sensorineural hearing loss can’t be cured, it can be corrected with hearing aids.
As people age, diminished hearing can affect their personal lives. For patients who have trouble tuning out background noise, especially in bustling places like restaurants, it can cause a delay in verbal response as they try to decipher what’s being said. Over time, that lag can negatively affect relationships as conversations move faster than a person with hearing loss can keep up. The good news is that new hearing aid technology is now available that could significantly improve patients’ quality of life. According to Schwartz, last year saw a major advancement in hearing aid technology, called OPN by Oticon.
“[This] recent advance in technology is a paradigm shift in the way that hearing aids have worked to date,” says Schwartz, who adds that OPN has a processor so fast it is able to reduce background noise, even between words. “This technology is an exciting option for individuals looking for the most natural hearing and peak hearing performance in the most difficult listening situations with connectivity to the world around them.”
No matter the type or severity of your condition, a checkup with your primary care doctor and a referral to an audiologist is recommended. A baseline exam from an audiologist can come in handy if you ever experience major hearing changes, so you’ll be closer to finding a solution.
Nearly two-thirds of Americans experience lower back pain, but only 63 percent seek treatment, according to the American Physical Therapy Association. Whether you’re one of the majority of Americans experiencing back pain or not, it’s a good idea to get a checkup from a chiropractor. “Everybody should get checked out (including a spinal X-ray) after the age of 18 once a year,” says Dr. Eric Koehler, chiropractor and founder of Premier Health. A chiropractor will take scans or X-rays to assess your condition, and will suggest exercises, rehab, and other treatments to correct any problems in order to help you avoid surgery.
“There is certainly a time for surgery, but our goal is to help those patients turn their situations around,” says Dr. Jamy Antoine, clinic director at The Disc Institute of Minnesota, which promotes non-invasive treatment for disc conditions. “We want to give patients the right tools to heal their discs, and help them get their lives back.”
After the problem area has been identified, Antoine uses IntraDiscNutrosis—a non-surgical treatment created by the Disc Institute to target and correct the root cause of problems like bulging or herniated discs, degenerative disc disease, stenosis, and sciatica. IntraDiscNutrosis boosts the disc’s own recovery system by identifying what it needs to repair itself—like movement, hydration, and good nutrition. Many patients think their disc can’t heal and they’ll need to get steriod injections or have back surgeries the rest of their life. “This is simply not true,” says Antoine. “The body can heal with the right tools.”
Antoine adds that about 98 percent of the clinic’s typical patients see significant improvement not only in their symptoms but also in their daily functioning, such as housework, hobbies, work, and sleep. “We have a three-year durability study showing that after three years post-treatment, we still have a 96 percent success rate.” He acknowledges that surgery is sometimes necessary, but trying different non-surgical approaches can also solve the problem for the short and long term.
At Premier Health, Koehler and team examine patients as young as 1 week old—however, they try to avoid X-rays on anyone younger than 18. To check for injury or inflammation in young patients, Koehler uses a special computerized scan which detects heat (the inflammed pain areas). These scans are especially helpful in treating kids who can’t communicate, so doctors can find the source of the pain.
“Many of our patients have been desk workers for years. All of that sitting takes a toll on the spine and discs. Sitting is to the spine as sugar is to the teeth!”
—Dr. Jamy Antoine, The Disc Institute of Minnesota
Treatment for back pain varies depending on the kind of injury. In auto accidents, for example, typically joints and ligaments are torn, so treatment could last up to six months. Other injuries may only need a few sessions with a chiropractor to heal.
Koehler and Antoine agree that no matter what the injury, it’s important to follow recommended therapy before and after surgery. “When joints aren’t moving, over time they will fuse together, and when that happens, it’s too late,” says Koehler. “I’ve had patients skip follow-up appointments, and I see them three years after treatment, but their joints [have] fused together and now they need to have surgery, so I can’t help them.” The takeaway: Don’t skip the physical therapy, keep joints moving, and don’t miss the follow-up appointments.
Changes in Sight
Glasses, contacts, “cheaters,” and persistent squinting are so common we barely blink an eye to them anymore. But changes in vision can be serious, and without the proper testing and tools, your condition might get worse or you could be ignoring an underlying medical issue.
If you’re over 40, it’s a good idea to make an appointment with an eye doctor every other year—or once a year if you have glasses or contacts, or are 65 and older—to ensure the health of your eyes. Dilating the eyes, something your eye doctor will do that your primary doctor won’t, can offer a wider view of all the internal parts of the eye behind the iris to discover abnormalities, disease, or injury.
“Even if you just come in for a routine eye exam, we can diagnose serious conditions like glaucoma, which has no visible symptoms early on,” says Dr. Steven Hepokoski, optometrist at Park Nicollet Clinic. “Letting this go untreated can lead to significant loss of vision and becomes harder to treat the longer you wait to get it checked out.”
Fortunately, if you’re one of more than 3 million people who have glaucoma, there are treatments that can slow down or even stop blindness. When he began practicing 35 years ago, Hepokoski says it was common for patients to go blind from glaucoma. Now it’s rare, as drugs, drops, and laser procedures have advanced to help slow down or stop the disease.
Most commonly, people see an optometrist to get a prescription for glasses or contacts, says Hepokoski. “But the next common reason I see patients is a red, uncomfortable eye—pink eye.” Pink eye, or conjunctivitis, is spread easily and can happen as a result of allergies or a bacterial or viral infection. Pink eye can go away on its own, but doctors will often prescribe antibiotics to speed up the healing process.
While antibiotics do help in many cases, Hepokoski cautions that a reddened eye can also be the result of a viral infection, ulcer, inflammation, or dry eye. “The only way to know for sure is to get an examination by an eye doctor who can look at the eye with a microscope and know the signs to watch for.”
General practice doctors are a great first stop when you think you’ve got something in your eye, but for a serious eye injury or a harmful object in the eye, optometrists have a variety of microscopes—as well as special instruments to remove foreign bodies—that your primary doctor doesn’t have. “If the foreign body is metallic it can be far more severe and we need to check to make sure the particle didn’t penetrate the eye,” Hepokoski says.
Eye doctors can also advise on lens prescription changes and discuss any concerns about vision changes as a result of medications you’re on.
“Even if you just come in for a routine eye exam, we can diagnose serious conditions like glaucoma, which has no visible symptoms early on.”
—Dr. Steven Hepokoski, Park Nicollet Clinic
Skin is the body’s largest organ, and its condition can reveal a lot about your health—from your age, to what you eat, to how much time you spend in the sun, to telltale signs of internal illness like lupus or diabetes.
Dermatologists in the Twin Cities are seeing a spike in patients seeking preventative skin cancer care through routine checks of moles and skin.
According to the American Cancer Society, skin cancer is the most common form of cancer, and it affects about 3.3 million Americans each year. “Studies have shown that family physicians are 50 percent accurate in diagnosing skin cancers, whereas dermatologists are 80 percent accurate,” says Dr. Brian D. Zelickson, dermatologist at Zel Skin & Laser Specialists. Family practice physicians can diagnose and treat some dermatologic conditions, but they’re also looking at the whole body. A dermatologist will focus on the skin and is more likely to catch those issues early on, says Zelickson.
Dr. Mimi Lam, fellow of the American Academy of Dermatology and dermatologist at Integra Dermatology, says sun exposure has primarily contributed to many of the mole changes and skin cancer developments. “Baby boomers have more issues as a result of previous sun/environmental exposures that occurred years ago when sun protection and education was not as well known as it is now,” says Lam.
The American Cancer Society recommends wearing SPF 30 or higher on any parts of the body exposed to the sun—no matter the time of year—and reapplying often. In addition to the amount of sun exposure, skin color and genetics also play a role in the likelihood of developing skin cancer.
It’s recommended you see your dermatologist regularly—especially to monitor any suspicious moles and to check those hard-to-see places on the body. “If left undiagnosed or untreated, cancerous lesions can develop and potentially spread through the body and affect other organs,” cautions Lam.
In addition to keeping up with skin cancer checks, acne, especially reoccuring adult acne, is another reason to visit a dermatologist. Acne isn’t just for the prepubescent. It can happen well into adulthood, and occur on any part of the body. If you’re a woman, you may experience hormone-related breakouts, especially on the chin and jaw, during times of the month when hormone levels are shifting. Stress, diet, and genetics also play a role in acne, says Zelickson.
Dermatologists treat acne differently depending on the kind, severity, and area of the body.
To combat acne, Zelickson recommends avoiding aggravating factors like certain foods and hygiene products made with certain chemicals or oils, and adding treatments, which can include a topical antibiotic and retinoid. If needed, he may recommend adding oral medications such as antibiotics, and hormone therapy. There are also alternatives to medications and hormone therapy, like laser treatments that target acne under the skin’s surface and zap the bacteria at the root—decreasing acne with as little as one session. The bonus to this method is that these lasers will also help with hyperpigmentation from acne on the skin, and/or scarring that can result from aggravated skin as surface acne is eliminated or extracted.
If you’re concerned about certain therapies, your dermatologist can answer your questions and walk you through alternative methods or better ways to avoid acne, especially if it is stress, diet, or lifestyle related.
Urinary Incontinence in Women
The National Association for Continence estimates that more than 25 million Americans suffer from urinary incontinence, and only one in 12 seek help. “Doctors are not good about asking the right questions because it’s an uncomfortable, embarrassing thing (for patients) to discuss,” says Dr. Matt Weinrich at OBGYN West. Women who have given birth are particularly prone to the condition. You can start the conversation by bringing up any concerns or changes to your bladder with your primary care doctor, who may then refer you to an OBGYN or urologist.
“The typical patient I see for urinary incontinence is a woman in her 30s or 40s. However, the incidence of urinary incontinence is higher in older women. Women in their 30s and 40s with urinary incontinence are more likely to seek treatment.”
—Dr. Melvin L. Ashford, Minnesota Womens’s Care
Stress, urge, and mixed are the three ways in which urinary incontinence presents itself. The most common form is stress incontinence, which is leakage during exercise, coughing, or sneezing. Urge incontinence is when you can’t make it to the bathroom in time, getting up multiple times in the night, or feeling like you have to go multiple times every hour. Mixed is a combination of both. “We see mostly stress incontinence and urge incontinence, otherwise known as overactive bladder, which is seen most often with [women who’ve had] vaginal births,” says Weinrich. “It’s a leak [caused by] stress such as coughing, sneezing, laughing,and exercising.”
Similarities within each are weakening of the bladder muscle and surrounding tissue. Dr. Melvin L. Ashford, executive and medical director at Minnesota Women’s Care says the cause is multifactorial. “The incidence does increase with age, and for women with a history of childbirth and obesity.” However, Ashford says, women with none of these factors can also suffer incontinence because of genetically weak connective tissues or other underlying conditions that affect the nerves, muscles, or connective tissues of the pelvic floor.
The good news is there are many ways to alleviate or fix these unwanted issues. “Urinary incontinence is a treatable condition with many options, says Ashford. “The best thing is to find a center with a depth of experience and varying options—success rates are high in that setting.”
Surgical treatments for stress incontinence include a bladder sling in which the doctor inserts surgical mesh through a vaginal incision that loops around the neck of the weakened bladder to support it, and then the body’s connective tissue grows around the sling to support it. From there, the doctor closes the surgery with a small lower abdominal incision—essentially creating a hammock for the bladder so it stays in proper placement.
Weinrich says the bladder sling is 85 to 90 percent effective in treating stress incontinence and has been used for almost 20 years. “It’s a minimally invasive outpatient procedure that takes about 20 minutes to perform,” he adds.
For non-surgical solutions in stress incontinence, pelvic floor therapy and weight loss are recommended, though they’re only about half as effective in treating urinary incontinence. “There’s also fluid restriction or avoiding exacerbating triggers such as caffeine, alcohol, and medications,” says Weinrich. “Diuretics for blood pressure control or water retention can be changed to result in symptom reduction.”
There are a few surgical options for urge incontinence: cystoscopic Botox injections to relax the bladder muscles and allow for more urinary storage and less frequent urges to use the bathroom, and InterStim therapy, which is a device placed under the skin in the hip area with a wire that connects to a device that sends electrical impulses to the sacral nerves, suppressing bladder contractions. Both doctors agree that these surgical therapies result in success with minimal side effects.
Non-surgical treatments for urge incontinence are available as well, such as pelvic floor rehabilitation, which strengthens the pelvic area muscles so there’s better control of the bladder. “New modalities have recently become available using laser or Radiofrequency energy transvaginal. These methods are not invasive, have no downtime, and have shown promising results,” says Ashford. “At Minnesota Women’s Care we utilize Thermiva and Femilift for patients desiring non-invasive options.” These therapies use a laser or RF energy to modify and strengthen the inner vaginal muscles and tissue—boosting strength to combat bladder control problems.
Millions of Americans struggle with urinary incontinence and the numbers are growing as baby boomers age. OBGYN doctors can assist women in choosing the medication, therapy, or surgery option that’s right for their body and lifestyle.
Injury and Chronic Pain
The Twin Cities is an active place, with sports for all seasons, a multitude of parks and fitness centers, and a nationally recognized bike culture. We’re always on the move, increasing our risk of injury, which keeps the demand for orthopedic doctors and specialists growing.
A fall on a leg twisted in the wrong way, a harder-than-average hit during a football game, or not adequately stretching before working out can land you in a doctor’s office. Your primary care doctor may recommend ice, rest, and physical therapy, but if symptoms don’t resolve within a week or two, you need to see an orthopedic specialist.
More than 650,000 opioid prescriptions are dispensed on an average day in the United States.
—IMS Health National Prescription Audit
“If left untreated, cartilage or ligament damage can get worse and require a more complicated treatment plan than if your injury was addressed earlier in the treatment process,” says Dr. Jeffrey Furmanek, who specializes in knee and shoulder injuries at Summit Orthopedics.
The treatment for cartilage or ligament damage is typically physical therapy to get the joints moving properly again, but if that doesn’t work, or the tear is bad, surgery may be required to repair the damage. “If a meniscus tear isn’t treated promptly, it could advance to the point where a joint replacement is necessary,” says Furmanek, who adds that seeing a specialist early on and getting the treatment and potential surgery necessary can help the body avoid post-traumatic osteoarthritis, which could lead to even more surgeries for joint replacement.
The same early intervention surgery advice goes for rotator cuff tears. “When surgery is delayed, the tear can get larger, become chronic, or may even become irreparable. Delay can turn a minor surgery into a more complicated problem requiring shoulder replacement,” Furmanek says. The takeaway is that seeing a specialist for trauma or injury to these parts of the body could save you from more surgeries and more severe injuries if left untreated.
At MAPS Medical Pain Clinics, patients come in for persistent pain following spine surgery, complex regional pain syndrome, and head and neck pain. Dr. David M. Schulz is a medical director at MAPS Medical Pain Clinics, and is an interventional pain specialist, board certified in anesthesiology and pain management, so he’s seeing patients to treat and manage their pain. Some of these treatment plans include physical therapy, medication, spine injections, and implantable pain control devices.
Primary care physicians may successfully treat some patients with early stage chronic pain using medications and referrals to physical therapy and psychology, Schultz says. However, many patients end up not responding to this treatment and develop chronic pain.
Pain medication, such as opioids, is not meant to be a long-term fix. “If patients get on pain medication like Percocet, and they’re on them for three to four weeks, a high percentage will get addicted that quickly,” says Dr. Gary Wyard, orthopedic surgeon and chief medical officer at Twin Cities Orthopedics. “A lot of people who’ve had failed back surgeries have a reason for chronic pain, but it’s compounded and made worse sometimes by their chronic use of opiates.”
Schultz agrees: “The longer the chronic pain persists, the harder it is to treat, and the more life complications develop: anxiety, depression, addiction, damage to social relationships, and job loss.”
Interventional pain specialists like Schultz are tasked with staying abreast of new ways to manage chronic pain to avoid over prescription of opioids when another alternative would be better. Some of these opioid alternatives are non-addictive medication, minimally invasive procedures, and implantable pain control devices (pain pumps).
Aside from cancer patients with chronic pain, patients are being prescribed non-narcotic and non-steroid medications. “We’re able to help a portion of the population without being as invasive as we were in the past, and we can give them improvement without the downside of a big open surgery,” says Wyard, who adds that this approach cuts down on the need for post-surgery opioids. “And, we’re even doing more total joint surgeries on an outpatient basis, which is something that’s relatively new as opposed to having the patients in the hospital for a week.” These advances in orthopedic treatment are paving the way toward a more manageable approach to chronic pain and care.