Dr. Behnawa Intro Video:

Hi I’m Dr. Susan Behnawa I practice geriatric medicine in our Sun City office here at Rancho Family Medical Group I am born and raised in Southern California I did my undergraduate training at the University of California San Diego in physiology and neuroscience my medical school training was then at Creighton University which is in Omaha Nebraska and then I came back to Southern California to the University of California Irvine where I did my family medicine residency and an additional fellowship training in the geriatric medicine subspecialty under primary care I practice geriatric primary care in Sun City which means my patient panel is age 55 and above my main interests are wellness and a holistic approach to care when I’m not in clinic practicing medicine I enjoy spending time with my husband and our two children we really like to work on being active we go outside do walks and I think that getting the whole family involved is an excellent way to do that come see us at our Sun City office and let us show you how we can be a part of your health care journey I’m Dr. Behnawa, I’d love to partner with you and your health

Dr. Behnawa Promo:

I’m Dr. Susan Behnawa I’m a family medicine physician who has an additional certification in geriatric medicine which is care of the older adult our focus is on lifestyle medicine making sure we’re doing everything we can from exercise your nutrition what your home life looks like looking at any medications we can stop to give you the healthiest life for as long as we possibly can we’re also very fortunate to have exercises on our website www.youcanchoosehealth.com really simple things that you can pull up at home and follow along with our hope is that once we can get our senior center classes started again that’ll be a great option but for now just head over to our website and pull up those classes and follow along from home as your primary care provider our job is to be the center of your medical care communicate with all your specialists making sure that all the care that you’re receiving is appropriate and indicated happening in a timely fashion and that you have all the follow-up you need if you’d like to see us we’re in the Sun City clinic and it would be an honor to be involved in your medical care

Dr. Behnawa Preventative Medicine:

Hey everyone my name is Sienna Boyd and we are back in the Choose Health studio at Rancho Family Medical Group we are actually joined with Dr. Susan Behnawa who is a board certified geriatrician and she practices out of Sun City so today we’re going to be discussing preventative medicine I know that’s a huge topic especially as a geriatrician so can you tell us a little bit about some of the things like the screenings that you’ve heard of you know we talk about mammograms colonoscopies but what are some other things that we should be screening for I think one of the biggest things that tends to be a little bit overlooked because it’s not as mainstream or really advertised or out and kind of general knowledge is a lot of people are really good about getting their breast cancer screening their colon cancer screening and I think that the one of the things that falls by the wayside is bone density screening interesting when you talk about bone density screening this is the dexa scan and it’s such an overlooked part of health that we really are trying to bring more awareness to it okay so what is bone density screening so when you say that what kind of bone density issues is someone having as they progress in age so as you collect more birthdays so your bones are constantly being broken down and built back up so you have the builders and then you have the breakdown component so you have your osteoblasts that are building up your bone and then you have your osteoclasts that are breaking it down and over time there can be an imbalance where you aren’t keeping up to rebuilding the bone that you’ve lost and so the biggest players especially as we get older is just not being as active not as much weight-bearing exercise and so the bones actually need some stress and some force on them to continue to remodel and stay strong and so when we talk about you know one of the most important things you can do for your health as you get older is lifting weights weight-bearing exercise so a lot of people are really good about doing their walks and swimming and you know their zumba or you know all of these things but it’s also really important to not neglect the weight-bearing exercises so lifting weights putting that force on your bones really helps it regenerate and stay strong and so why do we care about the bones staying strong that’s a great question that’s what I was going to ask so the biggest thing is we’re trying to reduce the risk of a fragility fracture so what’s a fragility fracture a fragility fracture is a break in the bone whether it’s you know in a vertebra in the back if it’s the hip or a bone in the wrist that’s sustained as a result of a low velocity trauma so not a high velocity trauma like you’re in a car accident but a low velocity trauma like you trip and fall and you try to catch yourself by you know falling on an outstretched hand and then you end up with a risk fracture or you you’re getting up to go to the bathroom in the middle of the night you trip on something on the floor and you fall and you happen to break your head so these fractures are very debilitating and they’re devastating injuries to have because there’s a lot of recovery that comes hip fractures in general if you look at the mortality several years out there’s you know it’s over a 30 mortality because people can get so many complications from being in the hospital with a hip fracture and so one of the really straightforward things that we like to do as a screening study is we like to send you for a bone density scan so what a bone density scan is is it’s kind of a more sophisticated x-ray we’re looking at the density of the bones in the lower spine and in the hip okay and what we’re looking for is where you fall compared to what would be an average or a zero and so we kind of hold you to this middle marker if your bone is less dense than the standard then you get a negative value for your bone density so we’re talking about the t-score here okay and so if your t-score is you know less than that zero but it’s greater than minus 2.5 you’re in this osteopenia range which is pre-osteoporosis okay if you’re less than 2.5 then you fall into the osteoporosis range and here is where your risk of a fragility fracture is really high if you’re in this osteopenic range which is this pre-osteoporosis then what we do is we calculate your frac score which is your overall risk of fracture given all of your other health markers okay and so if you’re osteopenic with a high frac score or if you’ve ever fractured at any point in time then we treat you as essentially being osteoporotic wow and so what that means is we would want to use medicines to help strengthen your bones to lower the risk of having a fracture down the line now are there specific medications you would prescribe are there supplements or yeah tell us about what one would take right so anybody who is above the age of 65 especially women who are postmenopausal okay the most important thing to understand about bone health is that you your body needs the basic building blocks to be able to restructure and reframe the bone so what are these building blocks we’re talking about calcium vitamin d and magnesium so these are the three main players so for calcium what we’re hoping for is a total dose of about 1200 milligrams that’s combined between your diet and your supplementation wow so if you’re somebody who does a good job with your dairy you’re eating full-fat cheese whole milk or whatever that looks like then you take what you’re eating from your diet and then you supplement to reach the 1200. if you’re someone who can’t really tolerate dairy in any capacity then you would need a higher supplementation dose okay and so calcium is always good a lot of calcium comes formulated with vitamin d because they’re so interdependent on each other wow okay i’ve seen that like on milk it says vitamin d included fortified with vitamin d because it really helps with the overall metabolism and the overall bone health right for vitamin d interestingly enough even though we’re in California a large majority of our population is vitamin d deficient despite the massive amounts of sun exposure that we that surprises me and a lot of it is you know we do take measures for sun protection a lot of our patients have had scares with cancers or pre-cancers of the skin it’s general good health to wear sunscreen when you’re going out longer clothing hats and so vitamin d supplementation is probably your best bet okay we also want to get vitamin d aside from the sun does it come from food a lot of foods are fortified with vitamin d you can find orange juice that’s fortified you had alluded to previously milk is fortified but a lot of the times vitamin d specifically you just do better with vitamin d supplementation okay most of our patients who are vitamin d deficient typically need about 2,000 international units a day if your vitamin d is profoundly low and this is a blood test we can order for you in the clinic and kind of see what dose is correct for you if you’re profoundly know you mean low you may need 5,000 international units per day so a good I think a good general dose just for supplementation for overall bone health is usually about 2,000 international units per day with the calcium it’s also really important to understand that calcium and magnesium are also really important together magnesium is vital for both bone and muscle health and a lot of people are magnesium deficient but they don’t really realize it because it’s not really one of those hype things to check and to kind of look into and so it’s really important to understand with magnesium that there’s different forms of magnesium and it does different things in the body interesting and so magnesium citrate we use a lot for constipation it does cause diarrhea and so when you’re using magnesium citrate that’s not a magnesium form that you want to be using to supplement a magnesium deficiency and that’s the form of magnesium that you’re using to treat constipation you have to be careful okay

choose your magnesium wisely watch the magnesium far and away for magnesium deficiency forms for supplementation that can be really well absorbed by the body and really easily accessed is magnesium glycinate or chelated magnesium but they’re a little bit more difficult to find okay and so a lot of people will either go to a health store or just look specifically for those forms you can order them off of the internet if you’re using magnesium for migraine headache prophylaxis or trying to decrease the frequency of migraine headaches usually magnesium oxide is a good bet around 400 milligrams daily I had a physical medicine and rehabilitation physician at the VA who had put all of his patients on magnesium and so the question is always well what’s the dose and so he would say the dose of magnesium is you start slowly you keep taking it until you get diarrhea then you back off a little bit and that’s fair to magnesium okay so everyone’s gonna be a little bit different in terms of how much magnesium they can tolerate you’re not looking for diarrhea but you’re looking for you know stools that are easy to pass but the magnesium itself if you can’t tolerate it orally you can also do you know epsom salt soaks and gets your magnesium transdermally and so a lot of people like to do that instead they’ll just take a bath and epsom salts and then some of that magnesium is absorbed and then it helps them with that now is magnesium something that you can eat enough of in your nutrition or how would somebody get magnesium it’s really hard to get you know dietary magnesium and I think especially with transdermal or through the skin supplementation with the epsom salt baths even if you can’t tolerate it orally you have a good way to do it okay I love using magnesium for sleep it’s very calming it has very relaxing properties and so there are a lot of calming teas that contain magnesium as well which can be really helpful okay so what I’m hearing is you need magnesium vitamin d and calcium and those three together make this beautiful concoction yeah to aid and maybe hopefully present yeah osteoporosis those are I think kind of stage one when we’re talking about bone health okay then if you truly have osteoporosis or osteopenia or you’re fractured in the past or you have a high frac score then you have to level up to the prescription medications okay and so when we’re talking about the prescription medications there are general classes of them that we use and some may be right for you and some may be not the best fit and so you know class wise we use bisphosphonates which is basically a class of medication that helps slow down the breakdown process your body can catch up there’s um antibodies that we use like you know that are infusions or injectables okay and then there’s parathyroid hormone analog so it’s a lot of shop talk for saying different types of medicines that are right for different types of patients and so talk to your doctor about which one’s appropriate for you given all your other medical conditions but if you’re in that osteopenic range or if you’ve ever had a fracture at any point in time that was a low velocity trauma you’re somebody who should really be thinking about what can I do down the line to prevent fractures in the future so we have you know the supplements prescription medications and then also really really important is working on your balance and your core strength okay and how would you suggest some of your older patients work on their balance or core strength so I think that straight out of the gate the best thing to do is some sort of physical activity whatever that looks like for you at Rancho Family as part of our senior center when we have classes we have balance classes which is great you know we have yoga classes which also work on stabilizing your core and really help with balance when you’re holding those certain positions the other thing that is really important is individualized physical therapy individualized balance assessments and so I have a lot of patients who let’s say they’ve had a fall or something has happened or they’re just not as steady on their feet the value of a good physical therapist who can do a balance and gait assessment and give you strategies on how to transfer how to get up how to move how to walk it’s such a great thing to do and a lot of our patients don’t realize that that’s something that’s available through them just as a physical therapy referral through their doctor and so that’s really important i think overall a lot of patients kind of fall into the trap of I’m having balance problems let me get a cane or a walker there’s actually a lot of thought and evaluation that goes into picking the correct ambulatory assist device wow that is so interesting I know I would never think that I would be one of those people who would say oh I’m not walking that well maybe I should just grab somebody to assist me rather than right hey maybe there’s something I can do to help prevent it getting worse maybe there’s something even better for me that’ll help me walk even better right so that’s where you want to consult your physician absolutely so generally speaking certain types of canes are better for pain than for balance certain types of walkers are better for certain types of imbalances so everybody kind of likes the roll eater walker it’s the four wheel walker with the seat it’s super fancy you can put things in it but you have to have really good balance and core strength to be able to use that safely okay a lot of the times the relator walkers tend to slip away from people especially if they don’t have a good center of balance and it actually can predispose to injury and so part of the functional assessment that you can do with a good physical therapist is they can have you try different types of assist devices and see which one is safest for you before versus kind of just oh my neighbor had an extra one of these and she gave it to me or my son noticed that I was walking more slowly so he picked up a cane for me so we use different things to overcome different boundaries to ambulation and I think it’s really important to have somebody who can really watch you watch the way that you walk and make the recommendations on that basis that I would never have known that was something that you could do or even be referred to from your primary care so that’s pretty awesome well thank you so much just for joining us and educating us even more about preventative health I think that’s something that we all need to just need to know as we get older and especially if we have older parents or older parents and it’s so important to keep up with your preventative health definitely balance and bone density screening is just one of the facets of you know your overall health and so it’s one thing that you know make sure you schedule your annual physical make sure you’re doing your routine visits we can’t do everything in one time but we can slowly build over time to a picture of optimal health definitely thank you so much Dr. Behnawa for being with us today my pleasure thanks for having me