November 19, 2025 • 33 mins
DR. FELLOWS AND DR. SINGER OF MICHIGAN INSTITUTE FOR NEUROLOGICAL DISORDERS (MIND) DISCUSS HOW THEY PROVIDE COMPREHENSIVE AND COMPASSIONATE DIAGNOSTIC, THERAPEUTIC AND SUPPORTIVE SERVICES TO ADULT PATIENTS AFFECTED WITH NEUROLOGICAL CONDITIONS.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Light Up the D, a focus on what's
happening in our community from the people who make it happen.
Speaker 2 (00:07):
Here's your host.
Speaker 1 (00:09):
IHeartMedia Detroit Market President Colleen Grant.
Speaker 3 (00:13):
Good morning, and welcome to another episode of Light of
the DA. I'm your host, Colin Grant, and I'm joined
today by two gentlemen from the Michigan Institute for Neurological
Disorders also known as MINE. We have doctor Jonathan Fellows
and Daniel Singer. They are both Board certified neurologists at
the Michigan Institute for Neurological Disorders, Michigan's largest and most
(00:34):
comprehensive private neurological practice. Doctor Fellows leads the Mind Alzheimer's
Disease and Memory Disorder Center, discussing World Brain Day, the
rise of neurological disorders, and recent advancements in neurological treatments.
Please join me in welcoming from Mind, Doctor Jonathan Fellows
and doctor Daniel Singer.
Speaker 4 (00:53):
Thank you guys for joining me today.
Speaker 2 (00:55):
Pleasure to be here.
Speaker 4 (00:56):
Hey, doctor Singer, let's start with you.
Speaker 2 (00:58):
What is MIND so?
Speaker 5 (01:00):
Mind is a large, the largest private practice neurology group
in Metro Detroit. We like to say from in the
neurology world that we see all comers. So we people
often ask what you specialize in, although we do have
some specialty centers that will well mention. We sort of
pride ourselves that you know anybody who has any kind
(01:22):
of neurological disorder, whether it be something you know more
mild or some severe, real scary stuff.
Speaker 2 (01:28):
We're happy to see that.
Speaker 5 (01:29):
We over the last several years have grown our footprint
around Metro Detroit. We have four offices now and so
with our large team of physicians and advanced practice providers
nurse practitioners in pas, we are able to take care
of a very large population that seemingly is in ever
(01:51):
need of neurological care.
Speaker 4 (01:53):
And what you had.
Speaker 3 (01:54):
Mentioned, you know the services, what specific services do you provide,
and what conditions do you treat?
Speaker 5 (01:59):
So we treat, you know, the whole host of neurological
conditions from Alzheimer's and memory disorders, migraine and headache disorders,
movement disorders like Parkinson's disease, multiple sclerosis, migraine, low back pain,
muscle and nerve problems, so the whole host of anything
to do with the nervous system, which would include the brain,
(02:21):
the spinal cord, the muscles, and the nerves. And we
you know, do that with you know, I guess first
and foremost, you know, sort of service with a smile.
You know, we like to feel like we're a pretty
affable group of people and want to help care for patients.
And then we pride ourselves in having you know, high
level of diagnostics and technology as well. So we have
(02:45):
an imaging center, we have two MRI machines, We do
nerve and muscle tests and brain wave tests, and we
sort of try to fancy our practice as a one
stop shop where you could you can come and see
the doctor and get yours and get your results all
right on the spot.
Speaker 3 (03:02):
And doctor Singer Mind has five centers of excellence. Can
you tell us what is the center of excellence? Describe
it and what does it mean for patients and families
seeking treatment.
Speaker 2 (03:12):
In today's world?
Speaker 5 (03:13):
You know, people want to see sort of subspecialists and
people who see a lot of one disorder, and there
are certain areas in neurology that require not only just
some sub specialty, but in order to sort of keep
up on the latest advances and so we've broken our
practice up to some extent into these specialty centers which
(03:35):
I mentioned previously. Actually, so we have the Alzheimer's a
memory care center. We have a very large and active
Multiple scrossis center where we take care of patients and
do clinical research. We have a migraine and facial pain center,
a movement disorder center with predominantly that's Parkinson's, but other
movement disorders as well. We have a pain center with
(03:58):
interventional pain doctors.
Speaker 2 (04:00):
And that's the five.
Speaker 3 (04:02):
And that's what gives you the opportunity to serve so
many clients in so many different areas and nervous system
issues they might be having.
Speaker 4 (04:09):
Yes, correct, Doctor Fellows.
Speaker 3 (04:11):
World Brain Day was on July twenty second, and it
was aimed at raising awareness and offering brain health tips
in all stages of life. What tips would you offer
to achieve brain health? What are some some like what
you say, essential tips for keeping a person's brain health,
am preventing or delaying dementia.
Speaker 6 (04:29):
There's a lot of things that we can do that
we actually have complete control over. Some of them are
rather obvious. The first would be things like smoking and
drinking and what we call just habits. We know that
there's a direct correlation between tobacco use and heavy alcohol
use with the earlier onset or more robust sort of
progression of dementia. So first and foremost, who want to
(04:50):
counsel our patients to quit smoking. And then the literature
is a little bit confusing in terms of alcohol because
we use the term moderate, but then some people have
different deaths phoenicians in general, you know, we'd say one
drink per day for women, two drinks per day for men,
but again the jury is still out in terms of that.
Now there's also some other interesting information in that, because
(05:13):
when it comes to certain Mediterranean diets, some will promote
a certain amount of red wine to go with that
in terms of slowing down the aging process. So alcohol
is a little tricky in terms of that, but certainly
smoking cessation would be paramount. Another one that's really important
would be weight loss in controlling things like type two
diabetes melodis. Those two things have absolutely been linked to
(05:35):
again quicker onset of dementia and degenerative brain disease, cardiovascular
health and blood pressure management. The new recommendation would be
again not one twenty five, not one thirty but below
one twenty over eighty in terms of blood pressure control.
In terms of delaying the onset or slowing the progression
of dementia, sleep is a big one. We want to
focus on good quality sleep, you know, keeping blue light
(05:57):
out of the bedroom, working on good sleep. That's an
our podcast in and of itself. In terms of sleep management,
we want to work on things like social engagement and
cognitive engagement. We know that patients do better when they
are actively involved with other people, when there are maybe
lectures that they can attend. And it's interesting, you know,
(06:18):
we have a lot of patients that we see and
sort of individuals in their seventies, eighties and beyond. They
want to stay in their home as long as possible.
But when we talk about some of these senior living arrangements,
there's so many vibrant activities that they can become involved with,
and there's lots of data, lots of studies to prove
that that's actually highly beneficial in terms of preserving brain
health and preventing the onset of dementia. Diet, again, we
(06:41):
could talk for hours on that, but in terms of
you know, there's the Dash diet, there's mind diet, there's
Mediterranean diet, but in general, we want to look for
low fat, low red meat, low processed foods, fried foods,
things like that.
Speaker 7 (06:55):
Eliminate those as much as you can from your diet.
Speaker 6 (06:57):
More fish and omega threes if you're going to eat
quote unquote meat, heavy on the plant based diet, heavy
on berries, blueberries, strawberries, things like that, fruits that are
high in antioxidants and things like that. The last two
are really important in these we have complete control over.
First would be hearing loss. There's a lot of interesting,
very new studies that link hearing loss to an earlier
(07:20):
onset of dementia. So we want to be really cautious
and counsel our patients in terms of seeing the NT,
seeing the hearing specialist, and getting fitted for hearing aids
because there's a direct correlation with hearing loss and onset
of dementia. Some of that could be if you're not hearing,
you're not able to engage. That goes with some of
the social stuff we just talked about. The exact ideology
(07:41):
isn't completely known, but we know that's a direct correlation.
And the last, which is absolutely the one we have
the most control over, and at the most important would
be physical activity. So we know that patients who are
more active that exercise have a lower incidence of again
onset of dementia and slowing of progression of disease. And
the recommendation would be aimed for about one hundred and
(08:04):
fifty minutes per week of moderate intensity aerobic exercise and
then couple that with resistance training or weightlifting. You know
patients will often ask, oh, which one's better, and the
answer is both, it's a combination of both.
Speaker 3 (08:16):
Well, those are great tips and anything we can do
and that we can control to try to prevent the
onset is worthy of trying to add into our daily routine.
Can you give us a status on the like on
the status on the aging population with regard to neuro
neurological disorders? What is the status today with the aging population?
Speaker 4 (08:38):
Is it growing?
Speaker 3 (08:38):
Is it getting better? Are people taking better care of
themselves in these ways that might be reducing the onset
of dementia?
Speaker 6 (08:47):
So I think it's a combination of a lot of
those things you just said. So part of it is
we are taking better care of ourselves of ourselves which
means we are living longer, which also means that the
incidence of overall or pure number of cases of dementia
are absolutely on the rise, and these numbers are staggering.
Right now, the state of Michigan has about two hundred
thousand patients with alzheimer disease. If we look at the
(09:08):
whole United States, there's seven point two million Americans with
living with dementia, of which these are over age sixty five.
And when we talk about dementia, dementia's the umbrella term,
and underneath that umbrella lies Alzheimer's disease, which, by and large,
at any age group, Alzheimer's is still the most common
form of dementia no matter what age group you're talking about,
but especially as you get sixty, seventy eighty and beyond,
(09:29):
we're talking about ninety plus percent of all cases our
Alzheimer's disease. The economic burden is massive. We've got a
big problem with caregivers. We've got a big problem with
how to care for the aging population.
Speaker 3 (09:42):
Now.
Speaker 6 (09:42):
We have newer therapeutics on the that we're using now
that require intense monitoring.
Speaker 7 (09:47):
So this is a problem that isn't going away.
Speaker 6 (09:50):
But in fact, we have to come up with some
big solutions in terms of how to manage these folks
as we age.
Speaker 3 (09:55):
Yeah, like you said, the aging population is just going
to require more recent sources as the years go on.
What does MINDS Alzheimer's Disease and Memory Disorder Center offer
with regard to trying to help our aging population? And
can you tell us about the progress and promising new
drug therapies that are out there.
Speaker 6 (10:12):
Sure, so we mentioned a little bit before, but in general,
you know again that mind we have a lot of
neurologists that can care for the aging population, in particular
any what we call degenerative brain disease, of which Alzheimer's
disease would be by far the most common, the first
and foremost. We would do what's called a history and
physical examination. We talk to the patient and really we
(10:32):
want to talk to the caregiver as well. We want
to really understand. You know, I always tell patients I
want to hear what you have to say, but I
also want to see what others are saying, you know,
seeing about you, you know, what the outside is looking in,
so to speak. So it's really important that family or
caregivers come with the patient to the appointment and then
there's a host of like diagnostic testing that we do
something as simple of blood work to look for certain
(10:53):
vitamin levels, look for other what we call metabolic causes
for confusion or memory problems, things like that. We always
want to do some sort of a brain imaging procedure,
preferably an MRI of the brain. There's no radiation with
an MRI of the brain, and we can glean a
ton of really good information about why cognitive problems could
be going on from that. Sometimes we do what's called
an EEG where we look at the electrical brain waves
(11:14):
and we want to see if there's any asymmetry side
to side or what we call slow waves, looking for
any slowing of the brain waves. And then ultimately, if
we're really on the right track and we do some
like bedside cognitive testing, what we want to do then
is we want to look for what's called amyloid. And
amyloid is that bad sticky protein that gets into the
brain and is responsible for Alzheimer's disease. Amoloids what cause
(11:37):
us plaques. People hear about plaques all the time. You
can't see a plaque. Plaque is something you can see
under a microscope, but with certain tests like a spinal
tap or even a blood test, or probably the most
sensitive would be what's called an amyloid PET scan. That's
a certain type of nuclear medicine test. And if the
patient gets that test, then we can say with nothing's
one hundred percent, but with nearly one hundred percent certainty
(11:59):
that this patient has amyloid in the brain and with
the right clinical picture that equals Alzheimer's disease. And once
we do this onboarding process, which usually takes about four
to six weeks to get that done in terms of testing,
then we go on to discuss maybe one of the
new therapeutic medications, which are called monoclonal antibodies. And there's
two different drugs that are FD approved right now for
(12:20):
the treatment of Alzheimer's disease. And in a nutshell, what
they do is we infuse these drugs either every two
weeks or once a month, and what they do is
they stimulate the body's own inherent immune system to basically
make our own immune system eat away at the amyloid
that's in our brain or our blood vessels. These drugs
are not without side effects, but if we want to
just summarize it, in one sentence. These drugs can slow
(12:43):
the progression of disease by about twenty five to seventy percent,
depending on what stage of Alzheimer's disease the patient's in.
So we tell people all the time, these are very good.
We're not at great yet, we're at very good, but
it's certainly a wonderful first step in terms of treating
these folks.
Speaker 4 (12:57):
And this is the newly FDA approved blood.
Speaker 5 (13:00):
So the blood test was Yes, there is a new
FDA proof blood test that was FTA approved in May.
It thus far is not covered by medicare or insurers
to get it done yet.
Speaker 2 (13:14):
But the blood test is what's called a biomarker.
Speaker 4 (13:16):
Okay, so doctor Fellows, you were talking about a.
Speaker 6 (13:19):
Treatment, right, So Doctor Singer can relate to some of
the biomarkers. That's something that will actually look for amyloid.
That's one type of biomarker. And then the treatments are
two different drugs that are given as infusions to get
rid of the amyloid.
Speaker 3 (13:32):
Okay, got it all right, Please continue, doctor Singer.
Speaker 5 (13:35):
So the new blood test, which we're hoping to be
able to use clinically very soon, it's available clinically right now.
But it's a cash pay on a cash paid basis,
is a blood test to take. It's aimed at patients
or people who are fifty five years and older who
have some sort of cognitive concern with potentially a family history.
(14:00):
It's a pretty it correlates pretty decently. So they did
a study where they look to see the correlation of
the blood test and they compared it to the pet
scan and or spinal tap, and what they found was
that if a patient had a negative result, meaning they
didn't have this blood biomarker, there's about a ninety seven
percent chance that they did not have Alzheimer's disease. And conversely,
(14:24):
if they were positive, there was about a ninety two
percent chance that they did have it. So it's a
pretty relatively inexpensive and easy literally just a blood test
way to screen a lot of individuals. Because it's not
really commercially available yet. You know, we as the neurologists
are going to have to learn how to counsel patients
(14:45):
because there are you know, some things to be concerned about.
You know, take somebody who's fifty five years old, fifty
six years old, who's asymptomatic. But let's say both parents
had Alzheimer's disease. On one hand, if there was something
to do because we found out they were super high
risk other than all those lifestyle management things that we
already spoke about, then it would be great. And that's
(15:07):
sort of hopefully where all the research is going to go.
Take somebody that we say you're super high risk. Maybe
there's going to be a vaccine in the future, Maybe
there's going to be a pre clinical treatment to give
these patients, to say, your high risk. We know that
by the time you're sixty five, your risk is this,
and seventy five it's higher, and eighty five it's higher.
Speaker 2 (15:27):
So because your high risk, we're.
Speaker 5 (15:28):
Going to give you a treatment that as of this
moment doesn't exist yet. Without that, other than the lifestyle changes,
there are some medical ethical discussions to have with patients.
I hate to say it this way, but do you
want to know, right if there's nothing really to do,
would it cause somebody. There's some psychological things that go
along with that that we're still trying to navigate, but
(15:50):
as a general rule and patients who are symptomatic, it'll
end up being a great first step and may in
the long run, reduce the cost of working in a
patient up for therapies because we can say with pretty
good certainty with just a blood test that they have
amyloid in the brain, and therefore these amyloid targeted therapies
(16:10):
that doctor Fellows was mentioning would be a good choice
for them.
Speaker 3 (16:13):
That gives you a chance to manage them as early
as as early as possible. Correct, got it, Doctor Fellows,
can you describe the importance of like you know, we
were talking about how important it is for early detection
specifically with Alzheimer's, but with the detection of any neurological condition,
and what types of exams, tests, imaging and other assessments
you guys have available at mind that are used.
Speaker 6 (16:36):
Sure, so, one of the most important things that we
that we do in terms of patients with a memory
problem is we look at a brain imaging procedure and
the most commonly order test would be a brain MRI scan.
And when we do a brain MRI, which we are
able to do at our office, this test would be
done without contrast, so you don't need an IV or
anything like that, and we're able to get a great
(16:57):
deal of information, And the reason why it's important is
because we want to first exclude other causes for memory problems.
Has there been a previous stroke, Is there a lot
of what we call white matter disease. Is there what's
called hydrocephalus or extra fluid on the brain? Could there,
god forbid, be a brain tumor. Is there evidence of
previous brain trauma what we call subdural hematoma, and things
(17:17):
like that. So there's a lot of things that we
do to exclude sort of another structural ideology. And then
we go forth and say, is there an atro free
pattern atrophy justice a fancy word for shrinkage. Is there
a certain shrinkage pattern of the brain. Is it more
in the front part of the brain. Is it more
in the temporal lobes? Is it more in the bridal lobes.
And that can sort of help us sort of whittle
away at what we call the differential diagnosis, or we
sort of make a list of different things in our
(17:38):
head of what we think could be going on to
the patient, and then we sort of try to come
to some conclusions of the next sort of diagnosis for
the patient.
Speaker 3 (17:45):
So, and what's so exciting is that you guys now
have four locations. You just open a river View location
so you can do more to serve more people across
our community. Talk a little bit about the new Riverview location,
doctor Singer. It's like I said, your fourth and why
there and are there different services that you provide there
as opposed to your other locations.
Speaker 5 (18:04):
You know, we've been trying to sort of get down River,
and one of the reasons is that we've been in
I'll say kind of we're mid to southern Wing County
in Garden City for many years and then in Dearborn Heights.
What we found was that a lot of patients from
the Downriver community they were driving north to get to
us in those other communities, so we thought it was
a good opportunity to expand into that area. We're really
(18:28):
excited about our Riverview office. We have two neurologists that
are full time rousers there. We have one of our
nurse practitioners who is full time there, and we are
getting busier and busier. One of the things that is
most exciting about that office is in the multiple scrossest world.
So one of the doctors who's there full time is
(18:49):
multiple scrosses subspecialists and in the MS world, really the
most what we call highest efficacy or strongest treatments in
today's day and age are in few usion therapies, and
so as part of our office, we have a infusion
center that is there where we'll be able to service
patients both the infusion. The medications that we were mentioning
(19:11):
for Alzheimer's disease are infusion. And then also in the
multiple scrossiest world, we do a lot of infusion therapies
and so to be able to offer that service those patients,
we're driving from Downriver out to our Farmington office in
order to do that, and so to sort of bring
it closer to home to them, I think has been
a real plus.
Speaker 4 (19:28):
And how often would they have to do something like that?
Speaker 2 (19:31):
Is that?
Speaker 4 (19:31):
What's the regular cadence of that?
Speaker 5 (19:32):
Yes, So in the multiple scrossest world, there are a
few different infusions we use. Some of them are every
six months, some of them are once a month. And
then in the new Alzheimer's medications, the two that are
out now is one is once a month and one
is twice a month.
Speaker 4 (19:47):
Oh so that's great to have a little.
Speaker 5 (19:48):
Yeah, So some of that I'll be and I spend
time on that side of town. And you know, I
have patients that I've been seen in my Dearer Heights
Heights office for a long time, and there's this barrier
to get them just from a trap standpoint, you know,
to do the cadence of the treatment they need. And
therefore some things we have to pick other treatments not
my first choice as the physician, but I go to
(20:11):
my second choice because it's what's convenient and what makes
more sense for their lifestyle. And that certainly is part
of the part of the discussion. Now, I think that
we open this up, you know, more opportunity for them
with more treatment options, so that we can really try
to cater to a patient's needs on an individual basis.
Speaker 7 (20:28):
That's great.
Speaker 3 (20:28):
Do you guys see more growth in your future like
that serving a wider portion of the metro area.
Speaker 5 (20:34):
Yes, and we are, you know, we are constantly looking
to grow where We're always looking at new great neurologists
to hire and people to join our team. We have
been looking at other communities actually as we speak right now,
just nothing to announce.
Speaker 4 (20:51):
Yeah.
Speaker 3 (20:51):
Well, as doctor Fellows said, with the aging population, the
need is going to be even greater and being able
to serve people in wider area across the metro will
will be certainly.
Speaker 4 (21:01):
Be needed and valued.
Speaker 3 (21:03):
Many many people are fans of Billy Joel and you
know he was diagnosed with normal pressure hydrocephalus or NPH,
which is most common in people over sixty five. Can you,
guys describe what is it that he has? What is
NPH and the main symptoms and the causes of the condition,
the diagnosis and treatment.
Speaker 4 (21:22):
What's in for him.
Speaker 5 (21:24):
NPH or normal pressure hydrocephalus in Layman's terms, is water
on the brain. It's a really important diagnosis not to miss.
And part of that reason is because one of the
reasons we do MRI scans when we see patients with
the memory problems is it can present with memory problems
and be misdiagnosed as Alzheimer's disease, and yet the treatment's
(21:44):
very different, so especially caught early, it's a very treatable disorder.
We teach medical students that it has a triad of symptoms,
and the way we have medical students remember it as
we say wet, wacky, and wobbly, which stands for urinear
incontinence or trouble with your bladder, difficulty walking, specifically difficulty
(22:08):
initiating gait, some shuffling and initiating gait, and then the
and then memory problems. When that's caught early, because it's
it's an accumulation of fluid on the brain, it can
be treated and quite frankly reversed with a neurosurgical procedure
called a shunt where they put a basically a drain
(22:29):
from the fluid filled cavity in the brain and they
drain it down into the chest and it takes that
excess fluid and continuously drains it off, and the symptoms
are it's what we consider a reversible cause of dementia
if caught early. Interesting specifically, I'm Billy Joel, and I've
tried to look, you know, both as a fan and
just as a neurologist. There's not a lot of information
(22:51):
that I've seen about you know, treatments as far as
like sort of where it was caught for him or
what his doctors are doing or recommending for him. So
it's uncle year whether he's going to go through a
you know, a neurosurgical procedure or not. But there used
to be you know, back in the television days, there
was a public service announcement PSA commercial that said, you know,
(23:13):
were you diagnosed with Alzheimer's, But do you have these symptoms?
Ask your doctor about NPH And it really is is true.
It's kind of easy to miss and and something really
important to find because it's treatable and reversible if caught early.
Speaker 3 (23:29):
How long has the Michigan Institute for a Neurological Disorders
been around serving our community?
Speaker 6 (23:35):
Got the exact year? I don't know that I know
the exact nineteen sixty nine. Okay, wow, that's why we
brought out to your singer with he knows that year
nineteen sixty nine. Wow, and a number one. Where we
love where we work. We're there more than we're home,
so it's our either our first or our second home.
We're not really sure, and we're also really proud that
we often say it's We are now on our third
generation of doctors. So either folks have retired or unfortunately
(23:59):
they've since passed a way. But those are the first
generation of doctors at MIND, some the actual founders of Mind,
and they help build the initial practice. Doctor Singer and I,
we are, you know, sort of entering into the older
range of doctors. So we are now the second generation
and now we have some young thirty something doctors, so
they are are sort of getting closer to our children's
so they're the third generation of MIND. So we're exciting, Yeah,
(24:21):
really exciting, and we're particularly proud of that. And you know,
like we said before, we're going to continue to grow
and expand our footprint as well.
Speaker 3 (24:28):
Yeah, and the learnings upon learnings and upon learnings that
you guys can share and supporting each other and then
new generations. It's so exciting and it's understandable that you
would be able to expand with all of the years
and years you have of experience.
Speaker 4 (24:40):
That's great.
Speaker 3 (24:41):
So with that said, with those years and years and
years of experience, what types of advanced on site diagnostic
tests do you offer at MIND? Do you have all
of those advanced tests at all of your locations? Are
different advanced tests at different locations.
Speaker 6 (24:55):
So at our main office in Farmington Hills, we have,
you know, everything that we've talked about. We have on
site imaging, including MRI. We have diagnostic studies such as EEG,
which is used for memory dysfunction as well as epilepsy seizures.
Speaker 7 (25:11):
And epilepsy.
Speaker 6 (25:12):
We have EMG testing, which is nerve and muscle testing
sort of a We call it EMG, but it's really
two part tests where you do the nerve conduction velocity.
That's where we give you little electric shocks and measure
how well your nerves conduct electricity. And then one of
the doctors will take a little tiny almost like an
acupuncture needle, put it in the muscle, and we're able
to measure how well the nerve and muscle communicate with
one another. And with that test we can diagnose things
like what's called peripheral neuropathy. We can diagnose primary diseases
(25:34):
of the muscle and even more commonly things like carpal
tunnel syndrome, pinch nerves throughout the body as well as
pinch nerves in the neck and the back, stuff like that.
We have an active pain management department when you talk
about testing, so they do things called fluoroscopy, which where
they can actively find the exact area where a.
Speaker 7 (25:52):
Therapeutic like steroid or a.
Speaker 6 (25:54):
Lytokane something like a numbing medicine can go right to
the exact area where the patient is having a pro problems.
That's another sort of diagnosis, therapeutic all sort of wrapped
up into one. And then we have our whole infusion
center at MIND in the Farmington Hills location, and we
also have infusion centers at two of our other locations
at Dearborn Heights and at Roseville. No, I'm sorry, Roseville
(26:19):
and Riverview. See I get confused. They don't let me
out of Farmington Hills very often, so I don't have
as much insight into that all the time. In terms
of other testing, some of the EEG, e MG, those
can be done at any of our offices, but the
imaging is really done at our Farmington Hills office.
Speaker 3 (26:37):
And how do most people find out about you? Are
they referred from their doctor or are they like, there's
an issue, I need to make a phone call. How
does it come about that somebody ends up in your offices?
Speaker 7 (26:46):
I think it's both.
Speaker 6 (26:47):
So a lot of our referrals come from our colleagues
that are primary care doctors, whether they be internal medicine,
family practice, things like that. But quite frankly, we get
a lot of patients that a great example would be
you have more most grossis for example, well, the MS
community is a very tech savvy, tight knit group. So
they have Facebook groups and social media groups and they're say, oh,
(27:09):
I have this great physician at mind, you should get
a you should get an opinion from them. So a
lot of them is word of mouth from individuals who
have a similar disorder. And then also we see you know,
family members like say, for example, oh mom has migraine.
For example, it's not uncommon for us to see all
the kids with migrain because migrain has a genetic component,
much like a lot of other neurological diseases.
Speaker 4 (27:32):
That's interesting. How is AI going to affect your business?
Speaker 6 (27:36):
AI will affect every business, and medicine not excluded. I
would say, you know, medicine were a little bit probably
more behind on that. Interestingly, we just had some folks
come to our office and they had sort of like
an add on module to our imaging suite, and it
was very interesting they what they were showing us, and
an AI model could sort of take the information or
(27:58):
the data that an MRI machine is able to sort
of give us an image, and they can dive in
even deeper and look at an MS lesion and give
us more information. They could look at a brain that
is being treated with one of the Alzheimer medications, and
they could help us sort of understand if there's an
early side effect associated with the with the therapeutic that
(28:19):
we're using. Lots of things in terms of early detection
of disease. Other things that AI can be helpful with
would be just just managing your business and sort of
evaluating all the vast amounts of data that's that's that's
sort of crammed into our what's called e m R
or electronic medical record. So there's a great opportunity there.
Do you have anything else on the AH end.
Speaker 5 (28:41):
Well, I think, you know, patients often get frustrated in
today's day and age that you know, doctors are often
looking at their keyboards more than they're looking in the
patient's eyes. And where I think that AI is going
literally in an office setting, is there's going to be
an AI microphone just recording and docum manning the conversation,
(29:01):
which will allow for especially doctors who are necessarily great
typists per se in order to you know, have a
little more of face to face human interaction so the
patient can feel that the doctors engaging with them instead
of just engaging with their computer.
Speaker 4 (29:17):
Yeah, No, that's a huge advantage doctor singer. Do you
love what you do?
Speaker 2 (29:21):
I love what I do?
Speaker 4 (29:22):
What do you love about it?
Speaker 5 (29:24):
You know, I grew up my dad was a doctor,
and I love interacting with people, and unfortunately in neurology,
actually speaking of AI. In preparation for a lecture that
I'm giving in a few weeks, I was working on
this weekend and I asked chat GPT, what are the
top three medical diagnoses that people are afraid of? They
(29:48):
actually gave me the top three, and then they gave
some honorable mentions two more and of the top five,
neurological disorders were four of the five. So number one
was cancer all all told. Number two was Alzheimer's disease,
Number three was als Louke gerrig syndrome neurological, and then
(30:09):
in that honorable mention was multiple scrosis. So we often,
unfortunately have to navigate with patients and families through really
difficult discussions and difficult diagnoses. And I enjoy that part
of it. I enjoy sort of being there for the
patient and the families. And you know, there's all this
(30:32):
stuff that we as doctors complain about with electron and
medical record and billing and all of that stuff, but
the true you know, when I'm in a room with
a patient, that's really what I love to do. And
I can put up with the other stuff because I
really you know, back in school, I used to have
what I called the Sunday night blues, right, so on
(30:54):
Sunday nights you didn't sleep well because you had to
go back to school the next morning.
Speaker 2 (30:58):
I never ever have that anymore.
Speaker 5 (31:01):
I'm happy to go to work. I like what I do,
and I love interacting with patients.
Speaker 6 (31:06):
But I work next to him sometimes and I don't
always see him not having the little blues. So no,
I'm just kidding. Two good friends here, Doctor Singer and
I are very good friends. Hey, you can tell, you
can really tell. What about you, doctor Fellows, I do
as well. I have a different take on it. I
(31:28):
really love what I do for a few different reasons,
but one of the main reasons. And do not take
this the wrong way because people make fun of me
because I tell people that it took me twenty years.
I've been practiced for twenty five years post residency, but
I say it really took twenty years. When I hit fifty,
everything just started to click and I would say, I really,
I just really got great at what I do. That's
(31:50):
what really gives me the best pride and honor that
I'm able to help my patients, help the community, because
I do feel that I'm finally great at something. And
that's really what brings me happiness, is knowing that I
finally achieved a level of greatness, because I don't know
that I've really achieved greatness.
Speaker 7 (32:09):
In many other things in life.
Speaker 6 (32:11):
I think I'm a great dad, I'm a guy of
wonderful children, but like I finally figured out how to
take care of patients, there's always a little snaffoo and
things become difficult.
Speaker 7 (32:19):
Things are hard. We're not saying it's all easy.
Speaker 6 (32:22):
But that's one of my little, my little tidbits that
I can share.
Speaker 4 (32:25):
That's fantastic.
Speaker 3 (32:26):
I love both your answers different and both wonderful because
you feel so fulfilled in what you do.
Speaker 4 (32:32):
It's great, Doctor Singer.
Speaker 3 (32:34):
You guys have provided so much valuable information today. There's
somebody out there who's like, oh my gosh, I really
need need their help. I need to get some more information.
Where might they find it.
Speaker 2 (32:45):
We have four physical locations.
Speaker 5 (32:46):
Our main office in Farmington Hills, and we have offices
in Roseville, in Dearwn Heights, and in Riverview. Conveniently, you
can reach all of them with one phone number, which
is two four eight five to five three red zero
zero one zero, So that's the phone number to make
an appointment at any of the offices. And you can
(33:08):
reach us online at our website which is mind online
dot com, m I N D O N L I
N E dot com.
Speaker 4 (33:17):
Mind online dot com.
Speaker 3 (33:19):
Our guests today have been doctor Jonathan Fellows and doctor
Daniel Singer, neurologists at the Michigan Institute for Neurological Disorders.
Speaker 4 (33:27):
Thank you for joining us today. I sure appreciate you, guys,
appreciate it.
Speaker 2 (33:30):
Thank you.
Speaker 1 (33:31):
This has been light up the d A community, a
fairs program from iHeartMedia Detroit. If your organization would like
to get on the program, email Colleen Grant at iHeartMedia
dot com. Here are all episodes on this station's podcast page.
Welcome to Light Up the D, a focus on what's
happening in our community from the people who make it happen.
Speaker 2 (00:07):
Here's your host.
Speaker 1 (00:09):
IHeartMedia Detroit Market President Colleen Grant.
Speaker 3 (00:13):
Good morning, and welcome to another episode of Light of
the DA. I'm your host, Colin Grant, and I'm joined
today by two gentlemen from the Michigan Institute for Neurological
Disorders also known as MINE. We have doctor Jonathan Fellows
and Daniel Singer. They are both Board certified neurologists at
the Michigan Institute for Neurological Disorders, Michigan's largest and most
(00:34):
comprehensive private neurological practice. Doctor Fellows leads the Mind Alzheimer's
Disease and Memory Disorder Center, discussing World Brain Day, the
rise of neurological disorders, and recent advancements in neurological treatments.
Please join me in welcoming from Mind, Doctor Jonathan Fellows
and doctor Daniel Singer.
Speaker 4 (00:53):
Thank you guys for joining me today.
Speaker 2 (00:55):
Pleasure to be here.
Speaker 4 (00:56):
Hey, doctor Singer, let's start with you.
Speaker 2 (00:58):
What is MIND so?
Speaker 5 (01:00):
Mind is a large, the largest private practice neurology group
in Metro Detroit. We like to say from in the
neurology world that we see all comers. So we people
often ask what you specialize in, although we do have
some specialty centers that will well mention. We sort of
pride ourselves that you know anybody who has any kind
(01:22):
of neurological disorder, whether it be something you know more
mild or some severe, real scary stuff.
Speaker 2 (01:28):
We're happy to see that.
Speaker 5 (01:29):
We over the last several years have grown our footprint
around Metro Detroit. We have four offices now and so
with our large team of physicians and advanced practice providers
nurse practitioners in pas, we are able to take care
of a very large population that seemingly is in ever
(01:51):
need of neurological care.
Speaker 4 (01:53):
And what you had.
Speaker 3 (01:54):
Mentioned, you know the services, what specific services do you provide,
and what conditions do you treat?
Speaker 5 (01:59):
So we treat, you know, the whole host of neurological
conditions from Alzheimer's and memory disorders, migraine and headache disorders,
movement disorders like Parkinson's disease, multiple sclerosis, migraine, low back pain,
muscle and nerve problems, so the whole host of anything
to do with the nervous system, which would include the brain,
(02:21):
the spinal cord, the muscles, and the nerves. And we
you know, do that with you know, I guess first
and foremost, you know, sort of service with a smile.
You know, we like to feel like we're a pretty
affable group of people and want to help care for patients.
And then we pride ourselves in having you know, high
level of diagnostics and technology as well. So we have
(02:45):
an imaging center, we have two MRI machines, We do
nerve and muscle tests and brain wave tests, and we
sort of try to fancy our practice as a one
stop shop where you could you can come and see
the doctor and get yours and get your results all
right on the spot.
Speaker 3 (03:02):
And doctor Singer Mind has five centers of excellence. Can
you tell us what is the center of excellence? Describe
it and what does it mean for patients and families
seeking treatment.
Speaker 2 (03:12):
In today's world?
Speaker 5 (03:13):
You know, people want to see sort of subspecialists and
people who see a lot of one disorder, and there
are certain areas in neurology that require not only just
some sub specialty, but in order to sort of keep
up on the latest advances and so we've broken our
practice up to some extent into these specialty centers which
(03:35):
I mentioned previously. Actually, so we have the Alzheimer's a
memory care center. We have a very large and active
Multiple scrossis center where we take care of patients and
do clinical research. We have a migraine and facial pain center,
a movement disorder center with predominantly that's Parkinson's, but other
movement disorders as well. We have a pain center with
(03:58):
interventional pain doctors.
Speaker 2 (04:00):
And that's the five.
Speaker 3 (04:02):
And that's what gives you the opportunity to serve so
many clients in so many different areas and nervous system
issues they might be having.
Speaker 4 (04:09):
Yes, correct, Doctor Fellows.
Speaker 3 (04:11):
World Brain Day was on July twenty second, and it
was aimed at raising awareness and offering brain health tips
in all stages of life. What tips would you offer
to achieve brain health? What are some some like what
you say, essential tips for keeping a person's brain health,
am preventing or delaying dementia.
Speaker 6 (04:29):
There's a lot of things that we can do that
we actually have complete control over. Some of them are
rather obvious. The first would be things like smoking and
drinking and what we call just habits. We know that
there's a direct correlation between tobacco use and heavy alcohol
use with the earlier onset or more robust sort of
progression of dementia. So first and foremost, who want to
(04:50):
counsel our patients to quit smoking. And then the literature
is a little bit confusing in terms of alcohol because
we use the term moderate, but then some people have
different deaths phoenicians in general, you know, we'd say one
drink per day for women, two drinks per day for men,
but again the jury is still out in terms of that.
Now there's also some other interesting information in that, because
(05:13):
when it comes to certain Mediterranean diets, some will promote
a certain amount of red wine to go with that
in terms of slowing down the aging process. So alcohol
is a little tricky in terms of that, but certainly
smoking cessation would be paramount. Another one that's really important
would be weight loss in controlling things like type two
diabetes melodis. Those two things have absolutely been linked to
(05:35):
again quicker onset of dementia and degenerative brain disease, cardiovascular
health and blood pressure management. The new recommendation would be
again not one twenty five, not one thirty but below
one twenty over eighty in terms of blood pressure control.
In terms of delaying the onset or slowing the progression
of dementia, sleep is a big one. We want to
focus on good quality sleep, you know, keeping blue light
(05:57):
out of the bedroom, working on good sleep. That's an
our podcast in and of itself. In terms of sleep management,
we want to work on things like social engagement and
cognitive engagement. We know that patients do better when they
are actively involved with other people, when there are maybe
lectures that they can attend. And it's interesting, you know,
(06:18):
we have a lot of patients that we see and
sort of individuals in their seventies, eighties and beyond. They
want to stay in their home as long as possible.
But when we talk about some of these senior living arrangements,
there's so many vibrant activities that they can become involved with,
and there's lots of data, lots of studies to prove
that that's actually highly beneficial in terms of preserving brain
health and preventing the onset of dementia. Diet, again, we
(06:41):
could talk for hours on that, but in terms of
you know, there's the Dash diet, there's mind diet, there's
Mediterranean diet, but in general, we want to look for
low fat, low red meat, low processed foods, fried foods,
things like that.
Speaker 7 (06:55):
Eliminate those as much as you can from your diet.
Speaker 6 (06:57):
More fish and omega threes if you're going to eat
quote unquote meat, heavy on the plant based diet, heavy
on berries, blueberries, strawberries, things like that, fruits that are
high in antioxidants and things like that. The last two
are really important in these we have complete control over.
First would be hearing loss. There's a lot of interesting,
very new studies that link hearing loss to an earlier
(07:20):
onset of dementia. So we want to be really cautious
and counsel our patients in terms of seeing the NT,
seeing the hearing specialist, and getting fitted for hearing aids
because there's a direct correlation with hearing loss and onset
of dementia. Some of that could be if you're not hearing,
you're not able to engage. That goes with some of
the social stuff we just talked about. The exact ideology
(07:41):
isn't completely known, but we know that's a direct correlation.
And the last, which is absolutely the one we have
the most control over, and at the most important would
be physical activity. So we know that patients who are
more active that exercise have a lower incidence of again
onset of dementia and slowing of progression of disease. And
the recommendation would be aimed for about one hundred and
(08:04):
fifty minutes per week of moderate intensity aerobic exercise and
then couple that with resistance training or weightlifting. You know
patients will often ask, oh, which one's better, and the
answer is both, it's a combination of both.
Speaker 3 (08:16):
Well, those are great tips and anything we can do
and that we can control to try to prevent the
onset is worthy of trying to add into our daily routine.
Can you give us a status on the like on
the status on the aging population with regard to neuro
neurological disorders? What is the status today with the aging population?
Speaker 4 (08:38):
Is it growing?
Speaker 3 (08:38):
Is it getting better? Are people taking better care of
themselves in these ways that might be reducing the onset
of dementia?
Speaker 6 (08:47):
So I think it's a combination of a lot of
those things you just said. So part of it is
we are taking better care of ourselves of ourselves which
means we are living longer, which also means that the
incidence of overall or pure number of cases of dementia
are absolutely on the rise, and these numbers are staggering.
Right now, the state of Michigan has about two hundred
thousand patients with alzheimer disease. If we look at the
(09:08):
whole United States, there's seven point two million Americans with
living with dementia, of which these are over age sixty five.
And when we talk about dementia, dementia's the umbrella term,
and underneath that umbrella lies Alzheimer's disease, which, by and large,
at any age group, Alzheimer's is still the most common
form of dementia no matter what age group you're talking about,
but especially as you get sixty, seventy eighty and beyond,
(09:29):
we're talking about ninety plus percent of all cases our
Alzheimer's disease. The economic burden is massive. We've got a
big problem with caregivers. We've got a big problem with
how to care for the aging population.
Speaker 3 (09:42):
Now.
Speaker 6 (09:42):
We have newer therapeutics on the that we're using now
that require intense monitoring.
Speaker 7 (09:47):
So this is a problem that isn't going away.
Speaker 6 (09:50):
But in fact, we have to come up with some
big solutions in terms of how to manage these folks
as we age.
Speaker 3 (09:55):
Yeah, like you said, the aging population is just going
to require more recent sources as the years go on.
What does MINDS Alzheimer's Disease and Memory Disorder Center offer
with regard to trying to help our aging population? And
can you tell us about the progress and promising new
drug therapies that are out there.
Speaker 6 (10:12):
Sure, so we mentioned a little bit before, but in general,
you know again that mind we have a lot of
neurologists that can care for the aging population, in particular
any what we call degenerative brain disease, of which Alzheimer's
disease would be by far the most common, the first
and foremost. We would do what's called a history and
physical examination. We talk to the patient and really we
(10:32):
want to talk to the caregiver as well. We want
to really understand. You know, I always tell patients I
want to hear what you have to say, but I
also want to see what others are saying, you know,
seeing about you, you know, what the outside is looking in,
so to speak. So it's really important that family or
caregivers come with the patient to the appointment and then
there's a host of like diagnostic testing that we do
something as simple of blood work to look for certain
(10:53):
vitamin levels, look for other what we call metabolic causes
for confusion or memory problems, things like that. We always
want to do some sort of a brain imaging procedure,
preferably an MRI of the brain. There's no radiation with
an MRI of the brain, and we can glean a
ton of really good information about why cognitive problems could
be going on from that. Sometimes we do what's called
an EEG where we look at the electrical brain waves
(11:14):
and we want to see if there's any asymmetry side
to side or what we call slow waves, looking for
any slowing of the brain waves. And then ultimately, if
we're really on the right track and we do some
like bedside cognitive testing, what we want to do then
is we want to look for what's called amyloid. And
amyloid is that bad sticky protein that gets into the
brain and is responsible for Alzheimer's disease. Amoloids what cause
(11:37):
us plaques. People hear about plaques all the time. You
can't see a plaque. Plaque is something you can see
under a microscope, but with certain tests like a spinal
tap or even a blood test, or probably the most
sensitive would be what's called an amyloid PET scan. That's
a certain type of nuclear medicine test. And if the
patient gets that test, then we can say with nothing's
one hundred percent, but with nearly one hundred percent certainty
(11:59):
that this patient has amyloid in the brain and with
the right clinical picture that equals Alzheimer's disease. And once
we do this onboarding process, which usually takes about four
to six weeks to get that done in terms of testing,
then we go on to discuss maybe one of the
new therapeutic medications, which are called monoclonal antibodies. And there's
two different drugs that are FD approved right now for
(12:20):
the treatment of Alzheimer's disease. And in a nutshell, what
they do is we infuse these drugs either every two
weeks or once a month, and what they do is
they stimulate the body's own inherent immune system to basically
make our own immune system eat away at the amyloid
that's in our brain or our blood vessels. These drugs
are not without side effects, but if we want to
just summarize it, in one sentence. These drugs can slow
(12:43):
the progression of disease by about twenty five to seventy percent,
depending on what stage of Alzheimer's disease the patient's in.
So we tell people all the time, these are very good.
We're not at great yet, we're at very good, but
it's certainly a wonderful first step in terms of treating
these folks.
Speaker 4 (12:57):
And this is the newly FDA approved blood.
Speaker 5 (13:00):
So the blood test was Yes, there is a new
FDA proof blood test that was FTA approved in May.
It thus far is not covered by medicare or insurers
to get it done yet.
Speaker 2 (13:14):
But the blood test is what's called a biomarker.
Speaker 4 (13:16):
Okay, so doctor Fellows, you were talking about a.
Speaker 6 (13:19):
Treatment, right, So Doctor Singer can relate to some of
the biomarkers. That's something that will actually look for amyloid.
That's one type of biomarker. And then the treatments are
two different drugs that are given as infusions to get
rid of the amyloid.
Speaker 3 (13:32):
Okay, got it all right, Please continue, doctor Singer.
Speaker 5 (13:35):
So the new blood test, which we're hoping to be
able to use clinically very soon, it's available clinically right now.
But it's a cash pay on a cash paid basis,
is a blood test to take. It's aimed at patients
or people who are fifty five years and older who
have some sort of cognitive concern with potentially a family history.
(14:00):
It's a pretty it correlates pretty decently. So they did
a study where they look to see the correlation of
the blood test and they compared it to the pet
scan and or spinal tap, and what they found was
that if a patient had a negative result, meaning they
didn't have this blood biomarker, there's about a ninety seven
percent chance that they did not have Alzheimer's disease. And conversely,
(14:24):
if they were positive, there was about a ninety two
percent chance that they did have it. So it's a
pretty relatively inexpensive and easy literally just a blood test
way to screen a lot of individuals. Because it's not
really commercially available yet. You know, we as the neurologists
are going to have to learn how to counsel patients
(14:45):
because there are you know, some things to be concerned about.
You know, take somebody who's fifty five years old, fifty
six years old, who's asymptomatic. But let's say both parents
had Alzheimer's disease. On one hand, if there was something
to do because we found out they were super high
risk other than all those lifestyle management things that we
already spoke about, then it would be great. And that's
(15:07):
sort of hopefully where all the research is going to go.
Take somebody that we say you're super high risk. Maybe
there's going to be a vaccine in the future, Maybe
there's going to be a pre clinical treatment to give
these patients, to say, your high risk. We know that
by the time you're sixty five, your risk is this,
and seventy five it's higher, and eighty five it's higher.
Speaker 2 (15:27):
So because your high risk, we're.
Speaker 5 (15:28):
Going to give you a treatment that as of this
moment doesn't exist yet. Without that, other than the lifestyle changes,
there are some medical ethical discussions to have with patients.
I hate to say it this way, but do you
want to know, right if there's nothing really to do,
would it cause somebody. There's some psychological things that go
along with that that we're still trying to navigate, but
(15:50):
as a general rule and patients who are symptomatic, it'll
end up being a great first step and may in
the long run, reduce the cost of working in a
patient up for therapies because we can say with pretty
good certainty with just a blood test that they have
amyloid in the brain, and therefore these amyloid targeted therapies
(16:10):
that doctor Fellows was mentioning would be a good choice
for them.
Speaker 3 (16:13):
That gives you a chance to manage them as early
as as early as possible. Correct, got it, Doctor Fellows,
can you describe the importance of like you know, we
were talking about how important it is for early detection
specifically with Alzheimer's, but with the detection of any neurological condition,
and what types of exams, tests, imaging and other assessments
you guys have available at mind that are used.
Speaker 6 (16:36):
Sure, so, one of the most important things that we
that we do in terms of patients with a memory
problem is we look at a brain imaging procedure and
the most commonly order test would be a brain MRI scan.
And when we do a brain MRI, which we are
able to do at our office, this test would be
done without contrast, so you don't need an IV or
anything like that, and we're able to get a great
(16:57):
deal of information, And the reason why it's important is
because we want to first exclude other causes for memory problems.
Has there been a previous stroke, Is there a lot
of what we call white matter disease. Is there what's
called hydrocephalus or extra fluid on the brain? Could there,
god forbid, be a brain tumor. Is there evidence of
previous brain trauma what we call subdural hematoma, and things
(17:17):
like that. So there's a lot of things that we
do to exclude sort of another structural ideology. And then
we go forth and say, is there an atro free
pattern atrophy justice a fancy word for shrinkage. Is there
a certain shrinkage pattern of the brain. Is it more
in the front part of the brain. Is it more
in the temporal lobes? Is it more in the bridal lobes.
And that can sort of help us sort of whittle
away at what we call the differential diagnosis, or we
sort of make a list of different things in our
(17:38):
head of what we think could be going on to
the patient, and then we sort of try to come
to some conclusions of the next sort of diagnosis for
the patient.
Speaker 3 (17:45):
So, and what's so exciting is that you guys now
have four locations. You just open a river View location
so you can do more to serve more people across
our community. Talk a little bit about the new Riverview location,
doctor Singer. It's like I said, your fourth and why
there and are there different services that you provide there
as opposed to your other locations.
Speaker 5 (18:04):
You know, we've been trying to sort of get down River,
and one of the reasons is that we've been in
I'll say kind of we're mid to southern Wing County
in Garden City for many years and then in Dearborn Heights.
What we found was that a lot of patients from
the Downriver community they were driving north to get to
us in those other communities, so we thought it was
a good opportunity to expand into that area. We're really
(18:28):
excited about our Riverview office. We have two neurologists that
are full time rousers there. We have one of our
nurse practitioners who is full time there, and we are
getting busier and busier. One of the things that is
most exciting about that office is in the multiple scrossest world.
So one of the doctors who's there full time is
(18:49):
multiple scrosses subspecialists and in the MS world, really the
most what we call highest efficacy or strongest treatments in
today's day and age are in few usion therapies, and
so as part of our office, we have a infusion
center that is there where we'll be able to service
patients both the infusion. The medications that we were mentioning
(19:11):
for Alzheimer's disease are infusion. And then also in the
multiple scrossiest world, we do a lot of infusion therapies
and so to be able to offer that service those patients,
we're driving from Downriver out to our Farmington office in
order to do that, and so to sort of bring
it closer to home to them, I think has been
a real plus.
Speaker 4 (19:28):
And how often would they have to do something like that?
Speaker 2 (19:31):
Is that?
Speaker 4 (19:31):
What's the regular cadence of that?
Speaker 5 (19:32):
Yes, So in the multiple scrossest world, there are a
few different infusions we use. Some of them are every
six months, some of them are once a month. And
then in the new Alzheimer's medications, the two that are
out now is one is once a month and one
is twice a month.
Speaker 4 (19:47):
Oh so that's great to have a little.
Speaker 5 (19:48):
Yeah, So some of that I'll be and I spend
time on that side of town. And you know, I
have patients that I've been seen in my Dearer Heights
Heights office for a long time, and there's this barrier
to get them just from a trap standpoint, you know,
to do the cadence of the treatment they need. And
therefore some things we have to pick other treatments not
my first choice as the physician, but I go to
(20:11):
my second choice because it's what's convenient and what makes
more sense for their lifestyle. And that certainly is part
of the part of the discussion. Now, I think that
we open this up, you know, more opportunity for them
with more treatment options, so that we can really try
to cater to a patient's needs on an individual basis.
Speaker 7 (20:28):
That's great.
Speaker 3 (20:28):
Do you guys see more growth in your future like
that serving a wider portion of the metro area.
Speaker 5 (20:34):
Yes, and we are, you know, we are constantly looking
to grow where We're always looking at new great neurologists
to hire and people to join our team. We have
been looking at other communities actually as we speak right now,
just nothing to announce.
Speaker 4 (20:51):
Yeah.
Speaker 3 (20:51):
Well, as doctor Fellows said, with the aging population, the
need is going to be even greater and being able
to serve people in wider area across the metro will
will be certainly.
Speaker 4 (21:01):
Be needed and valued.
Speaker 3 (21:03):
Many many people are fans of Billy Joel and you
know he was diagnosed with normal pressure hydrocephalus or NPH,
which is most common in people over sixty five. Can you,
guys describe what is it that he has? What is
NPH and the main symptoms and the causes of the condition,
the diagnosis and treatment.
Speaker 4 (21:22):
What's in for him.
Speaker 5 (21:24):
NPH or normal pressure hydrocephalus in Layman's terms, is water
on the brain. It's a really important diagnosis not to miss.
And part of that reason is because one of the
reasons we do MRI scans when we see patients with
the memory problems is it can present with memory problems
and be misdiagnosed as Alzheimer's disease, and yet the treatment's
(21:44):
very different, so especially caught early, it's a very treatable disorder.
We teach medical students that it has a triad of symptoms,
and the way we have medical students remember it as
we say wet, wacky, and wobbly, which stands for urinear
incontinence or trouble with your bladder, difficulty walking, specifically difficulty
(22:08):
initiating gait, some shuffling and initiating gait, and then the
and then memory problems. When that's caught early, because it's
it's an accumulation of fluid on the brain, it can
be treated and quite frankly reversed with a neurosurgical procedure
called a shunt where they put a basically a drain
(22:29):
from the fluid filled cavity in the brain and they
drain it down into the chest and it takes that
excess fluid and continuously drains it off, and the symptoms
are it's what we consider a reversible cause of dementia
if caught early. Interesting specifically, I'm Billy Joel, and I've
tried to look, you know, both as a fan and
just as a neurologist. There's not a lot of information
(22:51):
that I've seen about you know, treatments as far as
like sort of where it was caught for him or
what his doctors are doing or recommending for him. So
it's uncle year whether he's going to go through a
you know, a neurosurgical procedure or not. But there used
to be you know, back in the television days, there
was a public service announcement PSA commercial that said, you know,
(23:13):
were you diagnosed with Alzheimer's, But do you have these symptoms?
Ask your doctor about NPH And it really is is true.
It's kind of easy to miss and and something really
important to find because it's treatable and reversible if caught early.
Speaker 3 (23:29):
How long has the Michigan Institute for a Neurological Disorders
been around serving our community?
Speaker 6 (23:35):
Got the exact year? I don't know that I know
the exact nineteen sixty nine. Okay, wow, that's why we
brought out to your singer with he knows that year
nineteen sixty nine. Wow, and a number one. Where we
love where we work. We're there more than we're home,
so it's our either our first or our second home.
We're not really sure, and we're also really proud that
we often say it's We are now on our third
generation of doctors. So either folks have retired or unfortunately
(23:59):
they've since passed a way. But those are the first
generation of doctors at MIND, some the actual founders of Mind,
and they help build the initial practice. Doctor Singer and I,
we are, you know, sort of entering into the older
range of doctors. So we are now the second generation
and now we have some young thirty something doctors, so
they are are sort of getting closer to our children's
so they're the third generation of MIND. So we're exciting, Yeah,
(24:21):
really exciting, and we're particularly proud of that. And you know,
like we said before, we're going to continue to grow
and expand our footprint as well.
Speaker 3 (24:28):
Yeah, and the learnings upon learnings and upon learnings that
you guys can share and supporting each other and then
new generations. It's so exciting and it's understandable that you
would be able to expand with all of the years
and years you have of experience.
Speaker 4 (24:40):
That's great.
Speaker 3 (24:41):
So with that said, with those years and years and
years of experience, what types of advanced on site diagnostic
tests do you offer at MIND? Do you have all
of those advanced tests at all of your locations? Are
different advanced tests at different locations.
Speaker 6 (24:55):
So at our main office in Farmington Hills, we have,
you know, everything that we've talked about. We have on
site imaging, including MRI. We have diagnostic studies such as EEG,
which is used for memory dysfunction as well as epilepsy seizures.
Speaker 7 (25:11):
And epilepsy.
Speaker 6 (25:12):
We have EMG testing, which is nerve and muscle testing
sort of a We call it EMG, but it's really
two part tests where you do the nerve conduction velocity.
That's where we give you little electric shocks and measure
how well your nerves conduct electricity. And then one of
the doctors will take a little tiny almost like an
acupuncture needle, put it in the muscle, and we're able
to measure how well the nerve and muscle communicate with
one another. And with that test we can diagnose things
like what's called peripheral neuropathy. We can diagnose primary diseases
(25:34):
of the muscle and even more commonly things like carpal
tunnel syndrome, pinch nerves throughout the body as well as
pinch nerves in the neck and the back, stuff like that.
We have an active pain management department when you talk
about testing, so they do things called fluoroscopy, which where
they can actively find the exact area where a.
Speaker 7 (25:52):
Therapeutic like steroid or a.
Speaker 6 (25:54):
Lytokane something like a numbing medicine can go right to
the exact area where the patient is having a pro problems.
That's another sort of diagnosis, therapeutic all sort of wrapped
up into one. And then we have our whole infusion
center at MIND in the Farmington Hills location, and we
also have infusion centers at two of our other locations
at Dearborn Heights and at Roseville. No, I'm sorry, Roseville
(26:19):
and Riverview. See I get confused. They don't let me
out of Farmington Hills very often, so I don't have
as much insight into that all the time. In terms
of other testing, some of the EEG, e MG, those
can be done at any of our offices, but the
imaging is really done at our Farmington Hills office.
Speaker 3 (26:37):
And how do most people find out about you? Are
they referred from their doctor or are they like, there's
an issue, I need to make a phone call. How
does it come about that somebody ends up in your offices?
Speaker 7 (26:46):
I think it's both.
Speaker 6 (26:47):
So a lot of our referrals come from our colleagues
that are primary care doctors, whether they be internal medicine,
family practice, things like that. But quite frankly, we get
a lot of patients that a great example would be
you have more most grossis for example, well, the MS
community is a very tech savvy, tight knit group. So
they have Facebook groups and social media groups and they're say, oh,
(27:09):
I have this great physician at mind, you should get
a you should get an opinion from them. So a
lot of them is word of mouth from individuals who
have a similar disorder. And then also we see you know,
family members like say, for example, oh mom has migraine.
For example, it's not uncommon for us to see all
the kids with migrain because migrain has a genetic component,
much like a lot of other neurological diseases.
Speaker 4 (27:32):
That's interesting. How is AI going to affect your business?
Speaker 6 (27:36):
AI will affect every business, and medicine not excluded. I
would say, you know, medicine were a little bit probably
more behind on that. Interestingly, we just had some folks
come to our office and they had sort of like
an add on module to our imaging suite, and it
was very interesting they what they were showing us, and
an AI model could sort of take the information or
(27:58):
the data that an MRI machine is able to sort
of give us an image, and they can dive in
even deeper and look at an MS lesion and give
us more information. They could look at a brain that
is being treated with one of the Alzheimer medications, and
they could help us sort of understand if there's an
early side effect associated with the with the therapeutic that
(28:19):
we're using. Lots of things in terms of early detection
of disease. Other things that AI can be helpful with
would be just just managing your business and sort of
evaluating all the vast amounts of data that's that's that's
sort of crammed into our what's called e m R
or electronic medical record. So there's a great opportunity there.
Do you have anything else on the AH end.
Speaker 5 (28:41):
Well, I think, you know, patients often get frustrated in
today's day and age that you know, doctors are often
looking at their keyboards more than they're looking in the
patient's eyes. And where I think that AI is going
literally in an office setting, is there's going to be
an AI microphone just recording and docum manning the conversation,
(29:01):
which will allow for especially doctors who are necessarily great
typists per se in order to you know, have a
little more of face to face human interaction so the
patient can feel that the doctors engaging with them instead
of just engaging with their computer.
Speaker 4 (29:17):
Yeah, No, that's a huge advantage doctor singer. Do you
love what you do?
Speaker 2 (29:21):
I love what I do?
Speaker 4 (29:22):
What do you love about it?
Speaker 5 (29:24):
You know, I grew up my dad was a doctor,
and I love interacting with people, and unfortunately in neurology,
actually speaking of AI. In preparation for a lecture that
I'm giving in a few weeks, I was working on
this weekend and I asked chat GPT, what are the
top three medical diagnoses that people are afraid of? They
(29:48):
actually gave me the top three, and then they gave
some honorable mentions two more and of the top five,
neurological disorders were four of the five. So number one
was cancer all all told. Number two was Alzheimer's disease,
Number three was als Louke gerrig syndrome neurological, and then
(30:09):
in that honorable mention was multiple scrosis. So we often,
unfortunately have to navigate with patients and families through really
difficult discussions and difficult diagnoses. And I enjoy that part
of it. I enjoy sort of being there for the
patient and the families. And you know, there's all this
(30:32):
stuff that we as doctors complain about with electron and
medical record and billing and all of that stuff, but
the true you know, when I'm in a room with
a patient, that's really what I love to do. And
I can put up with the other stuff because I
really you know, back in school, I used to have
what I called the Sunday night blues, right, so on
(30:54):
Sunday nights you didn't sleep well because you had to
go back to school the next morning.
Speaker 2 (30:58):
I never ever have that anymore.
Speaker 5 (31:01):
I'm happy to go to work. I like what I do,
and I love interacting with patients.
Speaker 6 (31:06):
But I work next to him sometimes and I don't
always see him not having the little blues. So no,
I'm just kidding. Two good friends here, Doctor Singer and
I are very good friends. Hey, you can tell, you
can really tell. What about you, doctor Fellows, I do
as well. I have a different take on it. I
(31:28):
really love what I do for a few different reasons,
but one of the main reasons. And do not take
this the wrong way because people make fun of me
because I tell people that it took me twenty years.
I've been practiced for twenty five years post residency, but
I say it really took twenty years. When I hit fifty,
everything just started to click and I would say, I really,
I just really got great at what I do. That's
(31:50):
what really gives me the best pride and honor that
I'm able to help my patients, help the community, because
I do feel that I'm finally great at something. And
that's really what brings me happiness, is knowing that I
finally achieved a level of greatness, because I don't know
that I've really achieved greatness.
Speaker 7 (32:09):
In many other things in life.
Speaker 6 (32:11):
I think I'm a great dad, I'm a guy of
wonderful children, but like I finally figured out how to
take care of patients, there's always a little snaffoo and
things become difficult.
Speaker 7 (32:19):
Things are hard. We're not saying it's all easy.
Speaker 6 (32:22):
But that's one of my little, my little tidbits that
I can share.
Speaker 4 (32:25):
That's fantastic.
Speaker 3 (32:26):
I love both your answers different and both wonderful because
you feel so fulfilled in what you do.
Speaker 4 (32:32):
It's great, Doctor Singer.
Speaker 3 (32:34):
You guys have provided so much valuable information today. There's
somebody out there who's like, oh my gosh, I really
need need their help. I need to get some more information.
Where might they find it.
Speaker 2 (32:45):
We have four physical locations.
Speaker 5 (32:46):
Our main office in Farmington Hills, and we have offices
in Roseville, in Dearwn Heights, and in Riverview. Conveniently, you
can reach all of them with one phone number, which
is two four eight five to five three red zero
zero one zero, So that's the phone number to make
an appointment at any of the offices. And you can
(33:08):
reach us online at our website which is mind online
dot com, m I N D O N L I
N E dot com.
Speaker 4 (33:17):
Mind online dot com.
Speaker 3 (33:19):
Our guests today have been doctor Jonathan Fellows and doctor
Daniel Singer, neurologists at the Michigan Institute for Neurological Disorders.
Speaker 4 (33:27):
Thank you for joining us today. I sure appreciate you, guys,
appreciate it.
Speaker 2 (33:30):
Thank you.
Speaker 1 (33:31):
This has been light up the d A community, a
fairs program from iHeartMedia Detroit. If your organization would like
to get on the program, email Colleen Grant at iHeartMedia
dot com. Here are all episodes on this station's podcast page.
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