Selected Podcast
Dementia Prevention
Dr. Ramanpreet Grewal discusses dementia, including causes, treatment options, and possible preventative methods.
Featured Speaker:
Ramanpreet Grewal, MD
Dr. Grewal completed her bachelor of medicine and bachelor of surgery degree at Manipal College of Medical Sciences, in Nepal. She then completed her family medicine residency at Oakland Physician's Medical Center in Pontiac, Michigan where she served as chief resident in the family medicine residency program. Transcription:
Dementia Prevention
Helen Berdebes: Welcome back to the well within reach podcast brought to you by Riverside Healthcare. I'm your host, Helen Berdebes. And today we've got Dr. Ramanpreet Grewal. one of our Watseka primary care providers here with us to talk about dementia. Thanks for being here, Dr. Grewal.
Dr Ramanpreet Grewal: Thank you for having me Helen.
Helen Berdebes: Of course, before we get into the topic at hand, tell us a little bit more about yourself and your background.
Dr Ramanpreet Grewal: Hello everyone. I'm Dr. Grewal I'm board certified in family medicine, currently practicing as a primary care physician in Watseka. I did my residency from a community hospital. From Pontiac, Michigan. my special interests are women's health and preventative medicine. Hence why, I kind of chose to speak about dementia today.
Helen Berdebes: Then let's get right into it. Let's start with the basic question. What is dementia?
Dr Ramanpreet Grewal: So dementia is a umbrella term used to describe a wide range of neurological conditions that affect the brain over time. It's the loss of ability to think, remember, or reason to the levels that affect day to day activities. Now in the past dementia was thought to be a normal part of aging, but it's not. not everyone develops dementia as they get older and it can happen to anyone at any time of their lives.
Helen Berdebes: That's so interesting. Yeah. That's something that I always thought, once you get to a certain age that that comes, I mean, obviously there are some people who are very sharp all the way up in age, but it does seem like something that most people or a lot of people, face. So what causes that? What causes dementia?
Dr Ramanpreet Grewal: So basically dementia is caused by damage to brain cells. this damage interferes with the ability of the brain cells to communicate with each other. So when the brain cells cannot communicate normally, thinking behavior and feelings can be affected. The brain, in itself has many distinct regions and each of the regions are responsible for different functions. Like some part is responsible for memory. Some part is responsible for judgment and some for movement. So when the cells kind of get damaged and they cannot communicate with each other, that's when dementia occurs. So for example, the most common Alzheimer's dementia.
So it's basically, build up of abnormal protein in and around the cells and it affects the hippocampus, which is kind of the memory center. So, hence you get Alzheimer's dementia. Then there are a lot of dementias. other one would be Louie body dementia, where a patient also hallucinates, and then they also lose their memory. So we call it Louie body dementia, so on and so forth, there are so many examples of dementia.
Helen Berdebes: Do you know, are there like certain things that people do that make that happen? Like that cause that, the damage of the cells?
Dr Ramanpreet Grewal: So sometimes there are treatable causes of dementia. So that's not actually dementia, but it's something like a pseudo dementia, like a patient starts to forget, gets more confused, starts wandering off. In that case, when you take that person to a physician or if the person themselves realizes, okay, I'm, not doing that. Great. Let me just go see my doctor. So the first thing that a doctor is going to do is get some labs. To see if there's an electrolyte imbalance or if there's something that can be reversed, like vitamin deficiencies, especially B6 or B12, or, they'll look at your medications.
Sometimes certain medications can cause that, especially after you turn 65, there's something called the bears criteria that is kind of like a reference we use to see if is this medication an appropriate medication to use in an older. Adult or not. other things could just be emotional problems like depression, anxiety, blood clots in your brain. some history of head injury, thyroid problems can also cause that liver problems can cause that and then drinking too much alcohol is another thing.
Helen Berdebes: Wow. I didn't know that all those things, I kind of thought it was something that just happened over time. I didn't realize that there were so many things that you could actually do to reverse it or that are treatable. That's interesting. So what are some signs to look for or like symptoms, if you think that that might be something that you're gonna face?
Dr Ramanpreet Grewal: So, many people associate dementia with memory loss. this is because memory problems are often one of the early symptoms of any dementia disorder. But they're not the only one. the symptoms of dementia can vary depending on the type of dementia and what areas of the brains are affected. So some symptoms could be, just poor judgment confusion, changes in ability to speak, understand, and express thoughts or words, or be able to read or write, wandering off or getting lost in their familiar neighborhood.
Trouble handling money, or paying bills, repeating questions, using unusual words to refer to familiar objects, taking longer to complete normal daily task, loss of interest in normal daily activities or events, hallucinations, delusions, paranoia, or sometimes even acting impulsively. So people with dementia and those caring for them can face great challenges, including the person's ability to handle tasks like changes in family relationships, loss of work, and need for more care as the underlying. A disease process progresses. So people in their early stages of dementia may need help with day to day activities.
While people with advanced dementia may need more constant care and supervision. Also, it's very important to note that people with intellectual disabilities or developmental disabilities can also develop dementia as they age. So recognizing the symptoms, can be sometimes difficult because they're maybe attributed to person's disability. It's important to consider a person's existing ability and watch for changes over time that might signal dementia.
Helen Berdebes: So if you, or like a loved one, think that this might be something that is going on with you. How can they get diagnosed and get treated?
Dr Ramanpreet Grewal: To diagnose dementia, your primary care physician will need like a medical history. We'll need to do a physical exam and do some neurological tests that will assess your balance, sensory response, reflexes, and memory, and thinking skills. In addition, your doctor may, order brain scans, blood tests, some genetic tests, or just get a mental health evaluation to help determine the diagnosis. Now sometimes we need help. So we might send you to a neurologist, which is a specialist in the disorders of the brain and the nervous system, or also a psychiatrist, just to see if it's an underlying depression that's just presenting as dementias.
As far as treatment goes, no treatments currently exist to stop or slow dementia that's caused by Alzheimer's or related dementias. There are some medications that may temporarily improve or stabilize memory and thinking skills. People and may help with range of symptoms. And then there are some medications that may help with some behavioral problems like hallucinations or paranoia. So a team of specialists, doctors, nurses, and therapists can help maintaining mobility, addressing speech and swallowing problems.
And new ways to handle, loss of skills with everyday tasks, such as feeding oneself, but medicine is advancing it's a rolling stone. So there are, lots of clinical trials that are going on and you can always find that, resources online to see how to get in touch with people who do run clinical trials and, one day there might be a treatment for dementia.
Helen Berdebes: Absolutely. So while it can't be treated at this time, before you have any symptoms, can it be prevented?
Dr Ramanpreet Grewal: So, there are no proven ways to prevent dementia, but there are things, that seem to help keep brain healthy. So things like trying to be physically active for at least 20 to 30 minutes on most days or all of the days of the week. but be realistic about how much activity you can do at one time. several short mini workouts may be the best. Then aim for a mix of exercises, like to build endurance strength or balance or flexibility.
For example, you could do a mix of walking or dancing, lifting weights and standing on one foot and stretching. Even everyday activities like household chores and gardening may help you stay active. Exercise your brain, try to do at least two days of complex reading. which is not a newspaper it has to actually be some reading and you can play some games on the phone, which is not Candy Crush.
Helen Berdebes: Not Candy Crush. What?
Dr Ramanpreet Grewal: Yeah. You kind of need to do more complex things like, crossword puzzles, find the word Scrabble or things where you use some mats, which could be Sodoku and things like that. other things would just be maintaining a healthy diet, choose nutritionist foods, and fruits and vegetables, whole grains, and lean sources of proteins and dairy products. Always in general, avoid added sugars or saturated fats or excessive sodium. Try to stay social by talking over the phone with family and friends or joining like an online support group or going for a walk in your neighborhood.
Helen Berdebes: Cool. So it sounds like the different ways to keep your brain healthy are really the ways that we learn to keep ourselves healthy as a whole. That's kind of, you know, the things we aim to do. Do you have any other tips for people that might be living with dementia?
Dr Ramanpreet Grewal: Alzheimer's disease and related dementias, just get worse over time. So even simple day to day, activities can become very difficult to complete and to help cope with these changes in memory and thinking. you might want to consider some strategies that can make day to day tasks easier. There's like a huge list of things that can be done. But, just for the sake of the time today, I'm just gonna mention a few. Write down to-do lists, write down. Your appointments and make events in your, notebook or just your calendar that you use.
You can set up automated bill payments and consider asking someone you trust to help, with managing finances, especially, since it's gonna get worse with time, have your groceries delivered to your home. Manage your medications using a weekly pill box. So, a pill box with reminders, like an alarm can also help or just a medication dispenser that we can just buy online or simple drug stores have them usually, follow a regular schedule by going to sleep and getting up at the same time. Other than that, just some home safety tips would be just simplify the amount and layout of her nature at home.
Remove small drugs, because there's just risk of, tripping and falling. Have a sturdy handrail on, stairways and also in your bathroom, so that you don't slip and fall. Other things would be, just make sure that you have a smoke alarm. You have carbon monoxide detectors at home, or consider other safety devices like fall monitors or emergency call buttons. Now, I do want to mention one very integral part of life, which would be just planning for future. So, as much as you want to put off difficult decisions about future. Now is the time to think about your health and your finances, and to make sure you have a say and you're prepared.
So start, discussing things early with your family members while everyone can still help you make decisions together. There are several areas you want to consider, including legal and financial matters and options for in-home care, long-term care and even funeral and burial arrangements.
Helen Berdebes: Sounds good. I've heard the word also mild cognitive impairment kind of floating around when you're doing research about dementia and things. How does that differ from dementia itself?
Dr Ramanpreet Grewal: MIld cognitive impairment, is basically a condition that causes a slight noticeable change in memory or thinking skills, but not severe enough to affect a person's day to day activities. So individuals with cognitive impairment may have consistent memory problems, but they can still keep working and still keep socializing without. So the risk of developing a cognitive impairment increases as someone gets older and conditions such as diabetes, depression, and stroke may increase a person's risk of developing the cognitive impairment.
Helen Berdebes: How is that diagnosed, differently from dementia or how do you know that you don't have dementia when you have that?
Dr Ramanpreet Grewal: Family and friends may notice some memory lapses, and the person with cognitive impairment may worry about, losing, their memory. So these worries usually. Prompt a person to see a doctor about their memory problems. So we go through the whole thing like we do for dementia. We do some labs, we'll just do a neurological exam to just make sure how, your reflexes are, your sensory system is we might wanna do, some head scans and things like that. It just depends on basically how your symptoms project at that time.
Helen Berdebes: Okay. Is that managed the same way as dementia or do you manage it in a different way?
Dr Ramanpreet Grewal: So it's very similar to dementia actually. again, there is no standard treatment or approved medication, but there are things a person can do that may help them stay healthy and deal with changes, in their thinking. Which would be again to maintain a healthy life, watching your diet, exercising, exercising your brain every day and things like.
Helen Berdebes: Okay. And so does this mild cognitive impairment lead to dementia or do they stay totally separate?
Dr Ramanpreet Grewal: So some researchers have found that more people with cognitive impairment than those, without it go on to develop Alzheimer's disease or related dementias. So there's an estimated 10 to 20% of people above the age of 65, with cognitive impairment that do end up developing dementia. A period of time. However, not everyone who has cognitive impairment will develop dementia. And in many cases, just managing your blood sugars, appropriately having like an optimal, blood pressure goal can even reverse the cognitive impairment.
Helen Berdebes: interesting. That's good to know. What kind of resources can patients use to learn more about this if they think someone might be struggling with this or they might be?
Dr Ramanpreet Grewal: There are a lot of resources, but some trusted resources would be, Alzheimer's Association. So it's alz.org, then National Institutes of Health. So that's nih.gov, Family Caregiver Alliance. So that's caregiver.org. And I also wanna mention, there are a lot of help lines, for people to call, if they have dementia, if they have Alzheimer's and even, people to talk to when you have, these conditions. and also for caregivers, there's a lot of help.
There's an increase in caregiver, depression, because you go through a lot when you're taking care of somebody who does have dementia. And especially if they are a family member, then there's a fear of turning into that person you're taking care of once you get older, that can also lead to some PTSD, just a lot, of anxiety. Again, depression. So, there's help out there. all you need to do is pick up your smartphone, pick up your computer and just look up dementia and lots of resources will just be available.
Helen Berdebes: Thank you. Yeah, it's good to know. People are not alone. I'm sure all of this information, would be really useful to someone. And then, the resources that you gave also be really helpful, to people who are dealing with this. So thank you so much for being here today. Dr. Grewal.
Dr Ramanpreet Grewal: It's a pleasure, Helen.
Helen Berdebes: Yes. So memories matter, to stay on top of your cognitive health schedule, a wellness visit with your Riverside primary care provider to schedule you can call 855-404-DOCS. Visit Riversidehealthcare.org or use the, My Riverside app.
Dementia Prevention
Helen Berdebes: Welcome back to the well within reach podcast brought to you by Riverside Healthcare. I'm your host, Helen Berdebes. And today we've got Dr. Ramanpreet Grewal. one of our Watseka primary care providers here with us to talk about dementia. Thanks for being here, Dr. Grewal.
Dr Ramanpreet Grewal: Thank you for having me Helen.
Helen Berdebes: Of course, before we get into the topic at hand, tell us a little bit more about yourself and your background.
Dr Ramanpreet Grewal: Hello everyone. I'm Dr. Grewal I'm board certified in family medicine, currently practicing as a primary care physician in Watseka. I did my residency from a community hospital. From Pontiac, Michigan. my special interests are women's health and preventative medicine. Hence why, I kind of chose to speak about dementia today.
Helen Berdebes: Then let's get right into it. Let's start with the basic question. What is dementia?
Dr Ramanpreet Grewal: So dementia is a umbrella term used to describe a wide range of neurological conditions that affect the brain over time. It's the loss of ability to think, remember, or reason to the levels that affect day to day activities. Now in the past dementia was thought to be a normal part of aging, but it's not. not everyone develops dementia as they get older and it can happen to anyone at any time of their lives.
Helen Berdebes: That's so interesting. Yeah. That's something that I always thought, once you get to a certain age that that comes, I mean, obviously there are some people who are very sharp all the way up in age, but it does seem like something that most people or a lot of people, face. So what causes that? What causes dementia?
Dr Ramanpreet Grewal: So basically dementia is caused by damage to brain cells. this damage interferes with the ability of the brain cells to communicate with each other. So when the brain cells cannot communicate normally, thinking behavior and feelings can be affected. The brain, in itself has many distinct regions and each of the regions are responsible for different functions. Like some part is responsible for memory. Some part is responsible for judgment and some for movement. So when the cells kind of get damaged and they cannot communicate with each other, that's when dementia occurs. So for example, the most common Alzheimer's dementia.
So it's basically, build up of abnormal protein in and around the cells and it affects the hippocampus, which is kind of the memory center. So, hence you get Alzheimer's dementia. Then there are a lot of dementias. other one would be Louie body dementia, where a patient also hallucinates, and then they also lose their memory. So we call it Louie body dementia, so on and so forth, there are so many examples of dementia.
Helen Berdebes: Do you know, are there like certain things that people do that make that happen? Like that cause that, the damage of the cells?
Dr Ramanpreet Grewal: So sometimes there are treatable causes of dementia. So that's not actually dementia, but it's something like a pseudo dementia, like a patient starts to forget, gets more confused, starts wandering off. In that case, when you take that person to a physician or if the person themselves realizes, okay, I'm, not doing that. Great. Let me just go see my doctor. So the first thing that a doctor is going to do is get some labs. To see if there's an electrolyte imbalance or if there's something that can be reversed, like vitamin deficiencies, especially B6 or B12, or, they'll look at your medications.
Sometimes certain medications can cause that, especially after you turn 65, there's something called the bears criteria that is kind of like a reference we use to see if is this medication an appropriate medication to use in an older. Adult or not. other things could just be emotional problems like depression, anxiety, blood clots in your brain. some history of head injury, thyroid problems can also cause that liver problems can cause that and then drinking too much alcohol is another thing.
Helen Berdebes: Wow. I didn't know that all those things, I kind of thought it was something that just happened over time. I didn't realize that there were so many things that you could actually do to reverse it or that are treatable. That's interesting. So what are some signs to look for or like symptoms, if you think that that might be something that you're gonna face?
Dr Ramanpreet Grewal: So, many people associate dementia with memory loss. this is because memory problems are often one of the early symptoms of any dementia disorder. But they're not the only one. the symptoms of dementia can vary depending on the type of dementia and what areas of the brains are affected. So some symptoms could be, just poor judgment confusion, changes in ability to speak, understand, and express thoughts or words, or be able to read or write, wandering off or getting lost in their familiar neighborhood.
Trouble handling money, or paying bills, repeating questions, using unusual words to refer to familiar objects, taking longer to complete normal daily task, loss of interest in normal daily activities or events, hallucinations, delusions, paranoia, or sometimes even acting impulsively. So people with dementia and those caring for them can face great challenges, including the person's ability to handle tasks like changes in family relationships, loss of work, and need for more care as the underlying. A disease process progresses. So people in their early stages of dementia may need help with day to day activities.
While people with advanced dementia may need more constant care and supervision. Also, it's very important to note that people with intellectual disabilities or developmental disabilities can also develop dementia as they age. So recognizing the symptoms, can be sometimes difficult because they're maybe attributed to person's disability. It's important to consider a person's existing ability and watch for changes over time that might signal dementia.
Helen Berdebes: So if you, or like a loved one, think that this might be something that is going on with you. How can they get diagnosed and get treated?
Dr Ramanpreet Grewal: To diagnose dementia, your primary care physician will need like a medical history. We'll need to do a physical exam and do some neurological tests that will assess your balance, sensory response, reflexes, and memory, and thinking skills. In addition, your doctor may, order brain scans, blood tests, some genetic tests, or just get a mental health evaluation to help determine the diagnosis. Now sometimes we need help. So we might send you to a neurologist, which is a specialist in the disorders of the brain and the nervous system, or also a psychiatrist, just to see if it's an underlying depression that's just presenting as dementias.
As far as treatment goes, no treatments currently exist to stop or slow dementia that's caused by Alzheimer's or related dementias. There are some medications that may temporarily improve or stabilize memory and thinking skills. People and may help with range of symptoms. And then there are some medications that may help with some behavioral problems like hallucinations or paranoia. So a team of specialists, doctors, nurses, and therapists can help maintaining mobility, addressing speech and swallowing problems.
And new ways to handle, loss of skills with everyday tasks, such as feeding oneself, but medicine is advancing it's a rolling stone. So there are, lots of clinical trials that are going on and you can always find that, resources online to see how to get in touch with people who do run clinical trials and, one day there might be a treatment for dementia.
Helen Berdebes: Absolutely. So while it can't be treated at this time, before you have any symptoms, can it be prevented?
Dr Ramanpreet Grewal: So, there are no proven ways to prevent dementia, but there are things, that seem to help keep brain healthy. So things like trying to be physically active for at least 20 to 30 minutes on most days or all of the days of the week. but be realistic about how much activity you can do at one time. several short mini workouts may be the best. Then aim for a mix of exercises, like to build endurance strength or balance or flexibility.
For example, you could do a mix of walking or dancing, lifting weights and standing on one foot and stretching. Even everyday activities like household chores and gardening may help you stay active. Exercise your brain, try to do at least two days of complex reading. which is not a newspaper it has to actually be some reading and you can play some games on the phone, which is not Candy Crush.
Helen Berdebes: Not Candy Crush. What?
Dr Ramanpreet Grewal: Yeah. You kind of need to do more complex things like, crossword puzzles, find the word Scrabble or things where you use some mats, which could be Sodoku and things like that. other things would just be maintaining a healthy diet, choose nutritionist foods, and fruits and vegetables, whole grains, and lean sources of proteins and dairy products. Always in general, avoid added sugars or saturated fats or excessive sodium. Try to stay social by talking over the phone with family and friends or joining like an online support group or going for a walk in your neighborhood.
Helen Berdebes: Cool. So it sounds like the different ways to keep your brain healthy are really the ways that we learn to keep ourselves healthy as a whole. That's kind of, you know, the things we aim to do. Do you have any other tips for people that might be living with dementia?
Dr Ramanpreet Grewal: Alzheimer's disease and related dementias, just get worse over time. So even simple day to day, activities can become very difficult to complete and to help cope with these changes in memory and thinking. you might want to consider some strategies that can make day to day tasks easier. There's like a huge list of things that can be done. But, just for the sake of the time today, I'm just gonna mention a few. Write down to-do lists, write down. Your appointments and make events in your, notebook or just your calendar that you use.
You can set up automated bill payments and consider asking someone you trust to help, with managing finances, especially, since it's gonna get worse with time, have your groceries delivered to your home. Manage your medications using a weekly pill box. So, a pill box with reminders, like an alarm can also help or just a medication dispenser that we can just buy online or simple drug stores have them usually, follow a regular schedule by going to sleep and getting up at the same time. Other than that, just some home safety tips would be just simplify the amount and layout of her nature at home.
Remove small drugs, because there's just risk of, tripping and falling. Have a sturdy handrail on, stairways and also in your bathroom, so that you don't slip and fall. Other things would be, just make sure that you have a smoke alarm. You have carbon monoxide detectors at home, or consider other safety devices like fall monitors or emergency call buttons. Now, I do want to mention one very integral part of life, which would be just planning for future. So, as much as you want to put off difficult decisions about future. Now is the time to think about your health and your finances, and to make sure you have a say and you're prepared.
So start, discussing things early with your family members while everyone can still help you make decisions together. There are several areas you want to consider, including legal and financial matters and options for in-home care, long-term care and even funeral and burial arrangements.
Helen Berdebes: Sounds good. I've heard the word also mild cognitive impairment kind of floating around when you're doing research about dementia and things. How does that differ from dementia itself?
Dr Ramanpreet Grewal: MIld cognitive impairment, is basically a condition that causes a slight noticeable change in memory or thinking skills, but not severe enough to affect a person's day to day activities. So individuals with cognitive impairment may have consistent memory problems, but they can still keep working and still keep socializing without. So the risk of developing a cognitive impairment increases as someone gets older and conditions such as diabetes, depression, and stroke may increase a person's risk of developing the cognitive impairment.
Helen Berdebes: How is that diagnosed, differently from dementia or how do you know that you don't have dementia when you have that?
Dr Ramanpreet Grewal: Family and friends may notice some memory lapses, and the person with cognitive impairment may worry about, losing, their memory. So these worries usually. Prompt a person to see a doctor about their memory problems. So we go through the whole thing like we do for dementia. We do some labs, we'll just do a neurological exam to just make sure how, your reflexes are, your sensory system is we might wanna do, some head scans and things like that. It just depends on basically how your symptoms project at that time.
Helen Berdebes: Okay. Is that managed the same way as dementia or do you manage it in a different way?
Dr Ramanpreet Grewal: So it's very similar to dementia actually. again, there is no standard treatment or approved medication, but there are things a person can do that may help them stay healthy and deal with changes, in their thinking. Which would be again to maintain a healthy life, watching your diet, exercising, exercising your brain every day and things like.
Helen Berdebes: Okay. And so does this mild cognitive impairment lead to dementia or do they stay totally separate?
Dr Ramanpreet Grewal: So some researchers have found that more people with cognitive impairment than those, without it go on to develop Alzheimer's disease or related dementias. So there's an estimated 10 to 20% of people above the age of 65, with cognitive impairment that do end up developing dementia. A period of time. However, not everyone who has cognitive impairment will develop dementia. And in many cases, just managing your blood sugars, appropriately having like an optimal, blood pressure goal can even reverse the cognitive impairment.
Helen Berdebes: interesting. That's good to know. What kind of resources can patients use to learn more about this if they think someone might be struggling with this or they might be?
Dr Ramanpreet Grewal: There are a lot of resources, but some trusted resources would be, Alzheimer's Association. So it's alz.org, then National Institutes of Health. So that's nih.gov, Family Caregiver Alliance. So that's caregiver.org. And I also wanna mention, there are a lot of help lines, for people to call, if they have dementia, if they have Alzheimer's and even, people to talk to when you have, these conditions. and also for caregivers, there's a lot of help.
There's an increase in caregiver, depression, because you go through a lot when you're taking care of somebody who does have dementia. And especially if they are a family member, then there's a fear of turning into that person you're taking care of once you get older, that can also lead to some PTSD, just a lot, of anxiety. Again, depression. So, there's help out there. all you need to do is pick up your smartphone, pick up your computer and just look up dementia and lots of resources will just be available.
Helen Berdebes: Thank you. Yeah, it's good to know. People are not alone. I'm sure all of this information, would be really useful to someone. And then, the resources that you gave also be really helpful, to people who are dealing with this. So thank you so much for being here today. Dr. Grewal.
Dr Ramanpreet Grewal: It's a pleasure, Helen.
Helen Berdebes: Yes. So memories matter, to stay on top of your cognitive health schedule, a wellness visit with your Riverside primary care provider to schedule you can call 855-404-DOCS. Visit Riversidehealthcare.org or use the, My Riverside app.