Vascular Medicine Series: Thoracic Outlet Syndrome

Host: Darryl S. Chutka, M.D. Guests: Sam Farres, M.D.; and Ryan A. Meverden, PA-C Thoracic outlet syndromes is a great masquerader and often mistaken for a variety of other health conditions including cervical radiculopathy, carpal tunnel syndrome, rotator cuff injury or even multiple sclerosis. It has several causes which account for the variety of its clinical presentations. Because of this, the diagnosis is commonly delayed or diagnosed incorrectly.  Yet, it’s crucial to establish an early and accurate diagnosis as this can prevent potential progression of neurologic damage or in some cases life-threatening vascular complications. It also prevents unnecessary treatments and inappropriate interventions. The topic for this podcast is “Thoracic Outlet Syndrome” and my guests include Ryan Meverden, PA-C, a physician assistant in the Vascular Center at the Rochester campus of the Mayo Clinic and Sam Farres, M.D., Division Chair of Vascular Surgery at the Florida campus of the Mayo Clinic. As we discuss thoracic outlet syndrome, we’ll review the variety of presenting symptoms, potential complications, appropriate tests to evaluate patients and effective management strategies. Mayo Clinic Talks: Vascular Medicine Series | Mayo Clinic School of Continuous Professional Development Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts 

Host: Darryl S. Chutka, M.D. Guest: Stan Henkin, M.D. Peripheral arterial disease is a manifestation of atherosclerosis and becomes more common with advancing age.  In its early stages, it can be quite difficult to diagnose. Although claudication is the most classic symptom, many remain asymptomatic, especially if they have limited ability to ambulate. Although risk factor modification is important in disease management, overall treatment options have been somewhat disappointing. How can we diagnose PAD early and are there advantages in recognizing the disease in an early stage? What are the best ways to establish a diagnosis and what treatment options do we have available?  Our topic for this podcast is “Peripheral Arterial Disease” and these are questions I’ll asking my guest, Stan Henkin, M.D., a vascular medicine specialist from the Department of Cardiovascular Medicine at the Mayo Clinic. Mayo Clinic Talks: Vascular Medicine Series | Mayo Clinic School of Continuous Professional Development Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts 

Host: Darryl S. Chutka, M.D. Guest: Ana I. Casanegra, M.D., M.S. For many decades, we really only had one option for providing chronic anticoagulation, warfarin. We learned how to manage the many drug and food interactions, frequently changing the warfarin dose as we tried to keep our patients in therapeutic range. Now we have a variety of choices with the direct-acting oral anticoagulants, or DOAC’s. How do the newer agents compare to warfarin in effectiveness? Are they really safer than warfarin? Do they ever require any monitoring? What’s the latest on reversing the anticoagulant effect? I’ll be discussing these topics and more with my guest, Ana I. Casanegra, M.D., M.S., a vascular medicine specialist at the Mayo Clinic. The topic for this podcast is “How to Choose Your Anticoagulant”. Mayo Clinic Talks: Vascular Medicine Series | Mayo Clinic School of Continuous Professional Development Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts 

Host: Darryl S. Chutka, M.D. Guests: Christopher Francois, M.D. The risk of thoracic aortic dissection increases as the diameter of the aorta widens. A diameter greater than 5 cm is associated with an increased risk of dissection in the general population. Patients with Marfan Syndrome have defective connective tissue and dissection commonly occurs with diameters less than 5 cm. Other health conditions associated with aortic dilation and potential dissection include Ehlers Danlos and those with bicuspid aortic valves.  It therefore becomes extremely important to accurately assess the aorta. Fortunately, we now have a variety of imaging tools available and several of these tools are relatively new. My guest for today’s podcast is Dr. Christopher Francois, from the Department of Diagnostic Radiology at the Mayo Clinic and he’ll bring us up to date regarding the most recent imaging techniques as we continue our series on vascular medicine. We’ll discuss who’s at risk for an aortic aneurysm, when some of the more traditional imaging is indicated and when we should consider some of the newer imaging tools. Mayo Clinic Talks: Vascular Medicine Series | Mayo Clinic School of Continuous Professional Development Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts 

Host: Darryl S. Chutka, M.D. Guests: Thais D. Coutinho, M.D., and Kristen A. Sell-Dottin, M.D. Genetic factors predispose selected individuals to hereditary aortic aneurysms leading to aortic dilation and potential dissection.  They can be seen in a variety of known genetic syndromes, and they differ from aortic aneurysms associated with aging and chronic, uncontrolled hypertension. Early recognition is critical in the management of these patients in preventing serious, often life-threatening aortic dissection. How common are hereditary aortic aneurysms? When and how should we screen patients for this condition? Is a genetic consultation recommended? When should we involve a vascular surgeon when at risk patients are identified? These are some of the questions I’ll be asking my guests, Thais D. Coutinho, M.D., a cardiologist and cardiac surgeon, Kristen A. Sell-Dottin, M.D., both from the Mayo Clinic. We’ll be discussing “Hereditary Aortic Aneurysms and Dissection” as part of our podcast series on “Peripheral Vascular Disease”. Mayo Clinic Talks: Vascular Medicine Series | Mayo Clinic School of Continuous Professional Development Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts 

Host: Darryl S. Chutka, M.D. Guest: Jacob K. Dey, M.D. Bell’s Palsy is the most common cause of 7th cranial nerve dysfunction and clinically, it has a relatively abrupt onset resulting in unilateral facial paralysis. Fortunately, the majority of patients recover completely without treatment. Unfortunately, in some cases, the facial paralysis is persistent, and surgical intervention may be indicated to help restore facial symmetry. When do patients reach maximum improvement in their facial asymmetry? What is facial synkinesis? What are the various surgical options and how is it determined which one is best for the patient? The topic for this podcast is “Correcting Facial Paralysis Associated with Bell’s Palsy” and these are some of the questions I’ll be asking my guest, facial plastic surgeon, Jacob K. Dey, M.D., from the Division of Facial Plastic & Reconstructive Surgery at the Mayo Clinic. Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts

Host: Darryl S. Chutka, M.D. Guest: Gregory A. Poland, M.D. Measles is a viral illness that very recently was considered rare in this country but unfortunately has seen a resurgence in recent times. It’s highly contagious and can lead to severe complications including encephalitis and potentially death. There is an effective vaccine and it’s typically administered along with mumps and rubella as the MMR. The vaccine was introduced in the 1960’s and resulted in a dramatic reduction in the incidence of measles. Despite overwhelming evidence of the vaccine’s safety and efficacy, vaccine hesitancy has resulted in measles outbreaks in communities with lower immunization rates. The topic for today’s podcast is measles and my guest is Greg A. Poland, M.D., a general internist and vaccine research specialist at the Mayo Clinic. We’ll discuss the clinical manifestations of measles, the measles vaccine, vaccine hesitancy and how we as clinicians can most effectively educate our patients about measles. Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts Are you a medical professional, ready to ignite your passion and fuel your success? Join us October 23rd-25th in beautiful Pasadena, California or via livestream for GRIT, where innovation meets inspiration. GRIT in Medicine: Growth, Resilience, Inspiration & Tenacity 2025 will empower healthcare professionals with skills and resources to excel through productivity, personal development, and professional community. Leaders in business and healthcare will present evidence-based strategies and practical tips and tools to promote professional and personal well-being, and you’ll leave encouraged and energized for excellence. Visit ce.mayo.edu/GRIT2025 by September 1st with the discount code GRIT2025 to save $100 on registration. See you soon for GRIT!

Host: Darryl S. Chutka, M.D. Guest: Stacy D. D’Andre, M.D. When we diagnose a patient with cancer, we typically focus on finding the most effective treatment for that malignancy: surgery, radiotherapy, chemotherapy, or immunotherapy. However, to a patient, the diagnosis of cancer means much more. Patients commonly experience fear and anxiety just from receiving the diagnosis. Other symptoms may include insomnia, depression, pain, and symptomatic effects from the treatment including nausea, loss of appetite and fatigue to name just a few. The Mayo Clinic Comprehensive Cancer Center has developed an integrative approach to help patients manage the variety of symptoms associated with malignancy. It centers around a multi-disciplinary team which assesses each patient individually and incorporates a variety of complementary treatments as well as physical and emotional support. It also includes nutrition and dietary supplement counseling and recommendations regarding exercise and movement. In this podcast, we’ll learn more about this fascinating approach to treating patients with cancer as we discuss “Integrative Oncology” with my guest, Stacy D. D’Andre, M.D., from the Department of Oncology at the Mayo Clinic. Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts Are you a medical professional, ready to ignite your passion and fuel your success? Join us October 23rd-25th in beautiful Pasadena, California or via livestream for GRIT, where innovation meets inspiration. GRIT in Medicine: Growth, Resilience, Inspiration & Tenacity 2025 will empower healthcare professionals with skills and resources to excel through productivity, personal development, and professional community. Leaders in business and healthcare will present evidence-based strategies and practical tips and tools to promote professional and personal well-being, and you’ll leave encouraged and energized for excellence. Visit ce.mayo.edu/GRIT2025 by September 1st with the discount code GRIT2025 to save $100 on registration. See you soon for GRIT!

Host: Darryl S. Chutka, M.D. Guest: Melinda J. Hahm Bariatric surgery is very likely the most effective method for long-term weight loss. It’s not unusual for patients to lose well over 50% of their excess body weight. As a result, a variety of chronic health risks are reduced including diabetes, cardiovascular disease, sleep apnea, hypertension to name just a few. Exercise, associated with bariatric surgery is important to help achieve and maintain long-term weight loss and help prevent regaining the weight lost. The topic for this podcast is “Exercise and Bariatric Surgery” and my guest is Melinda J. Hahm, an exercise physiologist from the Mayo Clinic. Some of the topics we’ll discuss include the benefits of exercise associated with bariatric surgery, when patients should start an exercise program in relation to their surgery and what type of exercise is best to help maintain weight loss. Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts

Host: Darryl S. Chutka, M.D. Guest: Eric J. Moore, M.D. Salivary gland tumors can be benign or malignant, as well as primary or metastatic. Malignant salivary gland tumors usually present after the 6th decade, whereas benign lesions tend to occur a bit earlier, usually in the 4th to 5th decades. An interesting statistic is that the vast majority of salivary gland tumors occur in the parotid, only about 10% occur in the submandibular salivary gland and less than 4% in the minor salivary glands. Fortunately, most parotid tumors are benign. Previous radiation as well as occupational exposure to silica and nitrosamines have been linked to malignant parotid tumors. What should a primary care clinician do when we discover a mass in the parotid gland? What imaging studies are helpful? What treatment is available and what happens if the tumor recurs? These are all questions I’ll be asking my guest, Eric J. Moore, M.D., Chair of Otolaryngology and Head and Neck Surgery at the Mayo Clinic as we discuss “Parotid Gland Tumors”. Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts