Inactive (722)

Segment Number 4
Audio File city_hope/1639ch5d.mp3
Doctors Shapiro, Kimberly
Featured Speaker Kimberly Shapiro, MD
Guest Bio Kimberly Shapiro, MD earned her undergraduate degree from Stanford University, before completing a post-baccalaureate premedical program at the University of Southern California. She went on to receive her medical doctorate from the David Geffen School of Medicine at UCLA. In 2013, Dr. Shapiro completed a residency in psychiatry and behavioral sciences at Los Angeles County + USC Medical Center, Keck School of Medicine of USC, where she was chief resident. After graduation, she stayed on as faculty on the Consultation/Liaison service before pursuing opportunities in private practice and with the Department of Mental Health.

Learn more about Kimberly Shapiro, MD
Transcription Melanie Cole (Host): Getting through cancer treatment can be draining for everyone involved. Handling everyday personal needs, answering others questions about a diagnosis, and dealing with work or home life can suddenly become exhausting and can cause depression and anxiety. My guest today is Dr. Kimberly Shapiro. She's an assistant clinical professor at the Department of Supportive Care Medicine at City of Hope. Welcome to the show, Dr. Shapiro. What are some of the unique challenges when it comes to depression, anxiety, and the exhausting regimens of cancer treatment that you see with cancer patients and their loved ones?

Dr. Kimberly Shapiro (Guest): Thanks so much for having me, Melanie. Depression and anxiety in cancer patients is actually quite common. Up to one in four cancer patients can experience a depressive episode at some point during their treatment, starting from diagnosis all the way into remission. This is a high risk population already undergoing a huge amount of stress, physical stress, and mental stress. If there's already a depressive or anxiety disorder on board, that can even lead to worsening of it. It's a very interesting population and, just like you said, in addition to the patient themselves, they're also dealing with family members, they have to go to a job, they have to take care of their kids, take care of their spouse, and take care of their home life. So, a cancer diagnosis can be devastating on so many fronts and cause a lot of stress at the get go. What's great about my job is that at City of Hope, we’re a specialized center where the psychiatrists here, this is what we see every day. We see that it's common but we also see that these things are very treatable. What I would say to a cancer patient is, it is very normal and very common to experience feelings of depression and anxiety about your diagnosis, about your treatment, and about your prognosis. When a mental health professional would want to be involved is when the depressive symptoms become more of a syndrome where you'll have difficulty sleeping, eating, and feeling excessively hopeless or helpless. Having no energy, no ability to concentrate. This is when a normal depressed mood turns into something a little more serious that we would want to intervene and get treated more quickly. Same goes for anxiety. The patient is feeling nervous about their cancer diagnosis going into a doctor's office that's very common. I would never want to pathologize that. That is very common and normal. When anxiety starts to become an issue is if a patient is persistently worrying, worrying about worrying. Obsessing about things, having difficulty making decisions. Maybe feeling excessively irritable, finding themselves sweating and panicking throughout the day. With both of depression and anxiety, what psychiatrist and all mental health professionals get concerned about is when a patient feels like it's interfering with their life. That could mean anything from getting in the way of your relationships, getting in the way of your ability to take care of yourself, getting in the way of your ability to do your job because of the excess of all these symptoms.

Melanie: Dr. Shapiro, along those lines is it true or this is just strictly your opinion or theory, that the more positive an attitude that if somebody is feeling this incredible anxiety and depression that you're describing can affect the outcome of their treatment?

Dr. Shapiro: That's an excellent question. A lot of patients and their loved ones think that if a patient just adopts a positive attitude or feels that they can just overcome it, then it's enough. And, while I would never discount that, I think it's a wonderful thing to have if you're optimistic and hopeful about your treatment but it's really not enough and that is scientific proven. That's not my opinion. That is proven in the medical literature that a positive attitude is not enough. These symptoms can become incredibly overwhelming and just trying to think yourself out of it or shake it off won't work. It could be helpful to adopt a positive attitude and prayer, and other sort of supportive measures can be very-very useful but when the anxiety and depression become overwhelming to a patient, then it's just not enough.

Melanie: Then give us some working tips that you tell cancer patients and their families every single day about things that they can do to go along with their treatment whether it's getting support, or looking into meditational management, or nutrition and exercise. Give the tips that you give these families every day about dealing with this.

Dr. Shapiro: Very good. I think the first thing is, if these symptoms are becoming overwhelming to patients or family members are noticing patients are withdrawn, they're not interested in things they used to be interested in, they are having feelings of panic and obsessive thoughts, an inability to sleep, an inability to eat, that is the time to go and see a mental health professional and get an evaluation. There are so many treatments that are available. Medications are one of them. Obviously, I believe in that; that's part of my job but they're not everything. Medications, anti-depressants, other things to target like sleep can be very helpful. That's the first thing. The second thing a mental health professional could provide is individual psychotherapy or group therapy, and there is a lot of scientific data actually that shows that therapy can change your brain just as much as medications. So, patients who are very concerned about drug/drug interactions with their cancer treatment or don't feel like they want to be on medications for a variety of reasons, they're not the only thing and therapy can be very, very useful. There's targeted therapy to work on depression and anxiety also. It doesn't need to be the kind of therapy that you see necessarily in the movies, where you're lying on a couch and someone's analyzing you for hours. There can be very short-term therapy that can be very useful. So, that's a mental health professional side. Things patients can do at home are actually incredibly effective, like exercise. It gets your endorphins going. It can actually improve your mood and decrease anxiety alone. Exercise is an excellent treatment for both mood and anxiety and should be part of any comprehensive treatment plan of those two issues. I'm not saying you have to go out and run a marathon but even something like taking a walk a few times a week for thirty minutes. Yoga is an excellent exercise that patients can do. It’s low impact and it has excellent benefit on anxiety and mood. Other things that are maybe a little less mainstream but I think are becoming more popular these days are meditation and breathing exercises can be very useful to calm down panic in the moment and keeping your anxiety down overall throughout the day. Like I said, this is not an opinion. All of these things have scientific data backing them that they're very, very useful and accepted by the medical community. Something that may be a little more alternative but also very interesting is hypnosis, and there are certain therapists that that is their speciality and they can work on anxiety or certain things that are bothering patients. Patients can even quit smoking with hypnosis if they're not interested in other avenues. Also I would say a healthy diet and working with your doctor on a diet, and if patients are doing vitamins or other supplement just to always clear those with your physician.

Melanie: Dr. Shapiro, I'd like to get back to that but, as much as this is for patients, what do you tell their caregivers and their families? And, maybe that's for a whole separate segment but the stress on the caregivers is sometimes just absolutely extreme. What do you tell them about dealing with that stress as well, watching their loved ones go through these treatments?

Dr. Shapiro: That's a wonderful question. Another thing which was the last thing I was going to get to is social support. It is very important for patients and actually outcome data shows that cancer patients do better with more social support. So, it does take a village to take care of a cancer patient and, like you said, families, friends, and caretakers can become very involved and there's a lot of research going on caretaker burnout. That is a real thing where caretakers feel that they not only can't take care of their patients anymore or their family member but stop being able to take care of themselves. There's a very high incidence of depression in caretakers. At your local hospital, there is often information on caretaker support and there are many support groups popping up throughout our region and, I would imagine throughout the country, teaching caretakers how to also take care of themselves and prevent burnout. I think some of the things are just general self-care; making sure that there is time to take care of yourself; getting good sleep; healthy diet and exercise; and doing some of those stress-reducing activities that they enjoy and making that part of their daily plan, like a prescription. If a doctor told you to take a medication, you would do it. If a doctor told a caretaker, “You need to take an hour out to go and play cards with your friends or go to that exercise class that you enjoy. That's a really important part of your day.” Depending, of course, on the severity of whoever they're taking care of--their illness and there are, of course, variables but caretakers should take care of themselves, also, at the same time. We always say in psychiatry, “You can't give from an empty cup. If you have nothing left to give, it's very hard to take care of your loved one as well.”

Melanie: Absolutely and that's such great advice. In just the last few minutes, wrap it up for us. Give your best advice for patients and their families about dealing with that anxiety and depression that can come with cancer treatment, and why they should come to City of Hope for their care?

Dr. Shapiro: The best thing is to communicate it--everything. The patient should communicate their needs. A family should communicate their feelings and get everything out in the open. If you're a patient or even the caregiver starts to notice that the patient isn't doing well. They're not acting the way they normally act and you start to get concerned, don't hesitate. The City of Hope has a very robust supportive care department. There are so many people here to help you, and no one is alone. Patients are not alone, the families are not alone. There are psychiatrists here. There are supportive care physician, social workers, psycho therapist, group leaders. There's a ton of information here at the Biller Family Resource Center, about ways to take care of yourself during and post cancer treatment and also resources for families and caregivers. So, make your needs known and be open to ideas and sharing them, and I think there's a lot of resources available for both cancer patients and their loved ones and their families, and we understand that here. This is what we do. It's a wonderful place. If you happen to be treated here, it's a wonderful place to be treated for patients and families. There's just such a huge push toward taking care of the whole patient and I really enjoy that about working here. I feel that we can make a very positive difference in patients’ lives.

Melanie: Thank you so much, Dr. Shapiro, for being with us today. It's really great and such important information. You're listening to City of Hope Radio. For more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Targeting Cancer Stem Cells

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Segment Number 3
Audio File city_hope/1639ch5c.mp3
Doctors Wang, Leo David
Featured Speaker Leo David Wang, MD, Ph.D.
Guest Bio Leo David Wang, MD, Ph.D. earned his undergraduate degree in Molecular Biophysics and Biochemistry from Yale University, followed by his Ph.D. and medical doctorate at the University of Chicago. He successfully completed an internship and residency in pediatrics at the Children’s Hospital of Philadelphia. Dr. Wang then completed his Pediatric Hematology/Oncology/Stem Cell Transplantation fellowship at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, and pursued postdoctoral research in the laboratory of Dr. Amy Wagers at the Joslin Diabetes Center and Harvard Stem Cell Institute.

Board certified in pediatrics and pediatric hematology/oncology, Dr. Wang is the recipient of multiple honors and awards, including a Damon-Runyon Foundation Cancer Research Fellowship, a St. Baldrick's Scholar Award and an Alex's Lemonade Stand Foundation Young Investigator Award.

Learn more about Leo David Wang, MD, Ph.D.
Transcription Melanie Cole (Host): City of Hope researchers are working to uncover how cancer stem cells grow and what can be done to stop them from multiplying. My guest today is Dr. Leo Wang. He is an Assistant Professor for the Department of Immuno-Oncology and Department of Pediatrics at City of Hope. Welcome to the show, Dr. Wang. I would like you to clear up a little confusion for listeners about stem cells and specifically cancer stem cells versus the good kind of stem cell.

Dr. Leo Wang (Guest): It’s a very confusing and complicated question, Melanie. Stem cells, basically, I think of as seeds. Just like you have seeds in your garden, stem cells are seeds in your body and they can grow into whatever they're the seed for. Just as a tomato seed will grow into a tomato, the stem cells that are in your body will grow into any kind of tissue. There are stem cells like embryonic stem cells that are what are called “pluripotent” so they can grow into any tissue within the body. I'm focused more on hematopoietic stem cells that can only grow into any kind of blood cell in the body, and they can also self-renew. Cancer stem cells, as the name suggests, are capable of both self-renewing and growing into cancer. So, they don't grow into normal tissues but they do grow into cancer. The way that I talk about it with my patients is to think of them is as weeds. So, if you're a gardener and you have a garden that's overgrown with weeds, you can take a weed whacker or scissors or whatever and cut off the tops of the weeds but if you don't treat the roots or the seeds of the weeds, then they’ll just grow back when you're done.

Melanie: Excellent explanation. How do you identify early that a stem cell is going to be a cancer stem cell versus growing into something positive?

Dr. Wang: That is the crux of the issues and that is one of the biggest questions that has dogged the field for many years. It is not so much that stem cells can grow either into cancer or healthy tissue, it's that there are cancers and cancers have stem cells, and there are normal tissues and normal tissues have stem cells, and sometimes normal stem cells turn into cancer stem cells that are then only capable of growing into cancer. We need to figure out how to identify and eliminate those cancer-causing stem cells as quickly as possible.

Melanie: That would seem to be an amazing goal in the future of immunotherapy T cell cancer medicine. So, when you're targeting these cancer stem cells, Dr. Wang, are you looking to stop their growth or to kill them, or both?

Dr. Wang: Ideally, we would like to kill them. To go back to the garden analogy, I think of chemotherapy as a very harsh and toxic but effective treatment, but it kills both cancer cells and normal cells. So, it's a little bit like putting some sort of pesticide or herbicide on your garden that kills the weeds but it also kills the normal plants. The most extreme form of that would be a bone marrow transplant, where you're essentially burning the field down so that you can give it a chance grow back. Unfortunately, that often will not kill the cancer stem cells. The seeds that grow into weeds are still there and you need to figure out a way to specifically kill those to make a room for the healthy seeds to grow again.

Melanie: So, if they have this pluripotent capacity, this self-renewable ability, and you stop one but it has already ordered another one, how does it move forward? People think of cancers, Dr. Wang, like leukemia or some of the blood-borne cancers, as being able to sort of remake themselves and continuing and that's why people are so scared of those. Explain how you would stop that forward progression.

Dr. Wang: That’s exactly right. The stem cells have amazing proliferative capacity, and the most rapidly dividing ones are often not the stem cells. Those are responsive to chemotherapy and conventional therapies but we also need to kill the stem cells so that they don't, as you say, grow back and cause leukemia relapse, which ultimately can be fatal.

Melanie: Do you more typically see these cancer stem cells in solid tumor cancers, or are they more in systemic cancers, or both?

Dr. Wang: The cancer stem cells are much better characterized in the so-called liquid tumors like leukemia but there's mounting evidence that they exist in all cancers, and people have identified cancer stem cells in multiple solid tumors as well, including breast and lung, colon and brain cancer. We think that targeting stem cells in any tumor is going to really vastly improve how these cancers are treated in the future, and the goal is, as you said at the outset, to try to identify these stem cells and to try to figure out what makes them different, with their Achilles heel is, and how to use that to treat them.

Melanie: Are there certain biomarkers you look for?

Dr. Wang: There are certain characteristics that these cells all share and trying to figure out more of those and how to use those therapeutically is one of the main challenges that the field faces right now. Unfortunately, they don't often raise their hand, so to speak; they don't wear bright colors that say, “Hey, look at me. I’m a stem cell. They’re a little bit trickier than that.” So, we need to devise ways of identifying them diagnostically and of treating them therapeutically that take advantage of their unique properties of stemness, but we can’t always identify them on priority using the techniques that we have already available in the lab.

Melanie: Tell us about some of your current therapeutic strategies against these cancer stem cells. What are you doing right now?

Dr. Wang: The first step is to, as you said, figure out better ways to identify them because you can’t always tell the difference just by looking. Certainly, when we had microscopes, that was our primary way of diagnosis. It was impossible to tell if it's a stem cell or non-stem cell. Now, we have much more advanced techniques, molecular and flow cytometrics techniques. Even those are not very effective at identifying stem cells. It turns out that most of the functions in cells are executed by protein. And so, there are many protein passwords that get activated that are responsible for the stemness of cells; their ability to resist chemotherapy; their ability to proliferate and to self-renew. We're trying to identify those pathways using a technology called mass spectrometry, which is a way to look at the actual protein molecules in each cell, figure out whether they’re activated or not in a way that discovers new protein pathways in addition to just confirming protein pathways that have already been identified. The hope is that once we identify protein pathways that are specifically activated in stem cells, we can then figure out how to turn those pathways off.

Melanie: Dr. Wang, is there a communication or a connection between immunotherapy and targeted stem cells? We hear about T-cell therapy and this team fighting ability of certain cells. Tell us if there is an interaction there.

Dr. Wang: Melanie, that’s a fascinating question, and one of the things that I have come to City of Hope to study. As you know, and you're listeners probably know, immunotherapy has taken the world by storm, and it's this really that this innovative idea that's been around for a while but hasn't really been brought to the clinic until the past five years, that you can actually train the body's own immune system to fight cancer. One of the most innovative ways to do that, one that we are excellent at at City of Hope, is using what are called chimeric antigen receptor T cells or CAR T-cells. These are T-cells that have been genetically engineered to attack cancer cells specifically. When we put these cells into patients they're amazingly good at killing cancer cells and pretty much only cancer cells. One of the big remaining challenges with these cells is that, especially in solid tumors, they tend to disappear after a while. It’s not entirely clear why that is. It probably has a lot to do with the fact that a solid tumor has a very complex environment that has a lot of immunosuppressant properties to it. It turns out that cancers are pretty good at protecting themselves and hiding themselves and they make it so that the immune system sort of goes to sleep when it enters into the vicinity of a cancer. So, one of the things that we want to do, that I want to do at City of hope, is to figure out how to make T-cells, specifically CAR T-cells last longer and work better. One way to do that is to borrow from the stem cell. We know that stem cells actually are really good at persisting and really good at surviving. So, can we identify, as I said before, protein pathways that are specifically activated in stem cells and introduce those into T-cells or help enable those in T-cells so that our now therapeutic T-cells are more persistent.

Melanie: That's absolutely fascinating. Dr. Wang, in the last few minutes, give us your horizon picture. Where do you see the future of targeting stem cells for cancer and why people should come to City of Hope for their care?

Dr. Wang: I think that the field globally is now realizing the importance of cancer stem cells and how important it is to develop cancer stem cell targeted therapies in treating all kinds of cancers. Unfortunately, although we’ve realized the importance of this, there has not been a lot of progress made to date in actually targeting these cells. It is not for lack of effort, it's just it’s a difficult problem. City of Hope is unique in that it brings together the best possible research, the most innovative and far-reaching research in this field with a very innovative and nimble clinic, so that we can bring some of these very interesting and innovative therapies into patients as quickly as possible.

Melanie: Thank you so much, Dr. Wang, for being with us today. You’re listening to City of Hope Radio, and for more information you can go to www.CityofHope.org. That’s www.CityofHope.org. Thanks so much for listening.
Hosts Melanie Cole, MS

How to Prevent, Identify and Treat Infections in Young Children

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Segment Number 3
Audio File virginia_health/1642vh5c.mp3
Doctors Grossman, Leigh B.
Featured Speaker Leigh B. Grossman, MD
Guest Bio Dr. Leigh Grossman is the medical alumni endowed professor of pediatric infectious disease, and the associate dean for international programs at the UVA School of Medicine. She has edited and authored five books; her newest book, The Parent’s Survival Guide to Daycare Infections, was released in October 2016.

Learn more about Dr. Leigh Grossman

Learn more about UVA Health System
Transcription Melanie Cole (Host): Minor infections are a normal part of childhood but they can be puzzling and concerning for parents. My guest today is Dr. Leigh Grossman. She's the Medical Alumni-endowed Professor of Pediatric Infectious Disease and Associate Dean for International Programs at the UVA School of Medicine. She's also edited and authored five books including her newest book, The Parent's Survival Guide to Daycare Infections. Welcome to the show, Dr. Grossman. So, a question that parents always seem to have is, “Does getting sick in daycare or school help kids build up those immunities”?

Dr. Leigh Grossman (Guest): That’s a great first question, Melanie, and I appreciate it because I think many people who send their children off to daycare, preschool, kindergarten, are very concerned that the health, not only of their child, but what they bring home, just ratchets up immediately. And it does, in fact, because they're exposed to germs of all varieties from all the other kids they are in close contact with. Having said that, each one of those infections endows them with immunity, or an ability to prevent future infections with that germ. So, this is an absolutely normal part of childhood, and whether you do this at two or you do it at four, whenever you enter the larger pool of germs, you're going to get sick, and you're going to get sick with organisms that you need to see in order to develop normal immunity.

Melanie: So, what are some of the most common infections that you see, that children in daycare have?

Dr. Grossman: Well, the classic colds, coughs, runny noses, ear infections, are the usual and customary that plague parents most of the way through the winter. And, if you accept that the normal, healthy child, with the normal robust immune system is going to have five to seven of these infections per year--that's an average; many have more, some have less--but the average is five to seven a year and most of those are clustered in the winter months when these kids are in close quarters. And so, that's every month, every other month? So, it is constant, and if you have two or three kids in the house that are bringing these bugs home, everybody is sick for prolonged periods of time during the winter months.

Melanie: Isn't that the truth?

Dr. Grossman: Yes. So, the other common infections are, obviously, is the stomach flus, the vomiting, diarrheal illnesses, and, additionally, common viral rashes. None of these infections are life-threatening in and of themselves, so they are just a huge toll on the family. Sleepless nights; can I take my child to daycare the next day? Can I go to work? Am I going to be sick with this germ? All of the above questions continue on a regular basis.

Melanie: So, then let's continue with that question, Dr. Grossman. When do you keep them home? What do you tell parents about the symptoms that they might see? Whether it's a stuffy nose or cough or watery eyes; when do you keep a child home and when do you say "Okay, they're all right to go to daycare" ?

Dr. Grossman: Great question. The real truth for me is whether that child can carry on normally. So, if they're well enough to continue with normal activities, whether they have a runny nose, or a mild rash, they acquired this infection at the daycare or the preschool and so to think that keeping them home is going to shelter the rest of the children from that infection--there's no way. They are all spreading around these germs in a normal fashion. However, at the point where a child has a fever, is too fatigued to participate in normal activities, has diarrhea that cannot be contained, is vomiting, has symptoms that do not allow them normal participation in the school activities, then they need to stay home. Above and beyond that is a child who has a fever above 101.

Melanie: So, what should you look for in a daycare center for your child in terms of infection prevention best practices? Are there certain things when you're walking around, looking at a daycare center, that you should be looking for?

Dr. Grossman: At the point where you're looking for a new daycare or a daycare for your child, it's a dicey time, and you can go in and you can look at colors on the wall and great school materials and pleasant environment and wonderful, nurturing people, but from an infection control standpoint, decreasing the risk of serious infectious disease, not the things we've been talking about previously, I am very interested in what they're doing for their infants, because that's a high-risk group, and so, I want to make sure that there are less than three or four per each caretaker in the infant spaces. Are there separate rooms and caregivers for diapered and non-diapered children? They should be different caregivers; they should not be all grouped together. Are food preparation and feeding areas separated from where you change diapers? Do you have proper hand washing facilities and procedures? There should be policies on bedding and toy and play equipment cleaning. They should have policies on when children must stay home and they must have policies on how parents are notified if they're children become ill at daycare. I want to know if they have a sick room for children who have minor illnesses or become sick at school until their parents can pick them up. I also want attendee policies. So, I want policies for children entering that daycare center that include a healthy child or documentation of what the child has that the daycare center needs to worry about, and what are the vaccine policies for each daycare center? In addition, the personnel or staffing policies are extremely important to know that the staff is healthy and does not have a communicable disease, and staff vaccines so that the staff are also immunized against the usual childhood illnesses so they're not further spreading around illnesses. And, lastly, you want pet policies, because some daycare centers encourage having animals and pets in the daycare center and you want policies to insure that they're not spreading a disease that can be prevented.

Melanie: So, how can one prevent infection in their children, if at all possible, and what do you think of the use of sanitizers all over the place? Do you want us teaching our children, of course, to wash our hands, Dr. Grossman, and to teach them proper hand washing, but what about using sanitizers after playing with communal toys or any of those kinds of tips? What do you think?

Dr. Grossman: Well, as we started, I have accepted that I am not going to prevent the usual and customary viral illnesses in this age group and I don't really want to, because I do want to boost their immunity with these illnesses, as unpleasant and difficult as they are to manage for the parents for this age child. Having said that, the organisms that I would like to decrease the spread of are things like strep throat, which we can treat with antibiotics, but if we could decrease the amount of that and that requires sanitizing the common use tables and using hand sanitizers after or before eating. You cannot stop a child from touching their eyes, their nose, their face in the way you might be able to educate adults. And so, I think the hand sanitizers in this setting would be before eating, and before and after using the bathroom.

Melanie: In just the last few minutes, tell us about your book, The Parent's Survival Guide to Daycare Infections.

Dr. Grossman: So, this is a book that was born out of a previous book that was written for pediatricians and public health care providers and nurse practitioners and daycare providers, and that book is in its eighth edition. And this current, new book was written because the professional guide was being picked up by parents and utilized, so we changed that book; I've edited this book with thirty-nine infectious disease authorities from around the country, on what to do with specific infections, how to choose a daycare center, what vaccinations are recommended, what policies are recommended for, let's say, a higher-risk child, such as an infant or a child with cardiac with disease or a child with cerebral palsy, so there might be other things that you would do for those children that we would recommend. So, it is a reference guide, hopefully user-friendly It's just out and so we don't have too much feedback, yet, but I'm looking forward to seeing parents' response to this new book.

Melanie: And, where can they find it?

Dr. Grossman: On the web, and it's The Parent's Survival Guide to Daycare Infections; Amazon has it on-line.

Melanie: Thank you so much for being with us today, Dr. Grossman. It's such great advice for parents and the book is called The Parent's Survival Guide to Daycare Infections, by Dr. Leigh Grossman. You're listening to UVA Health Systems Radio and for more information, you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

What is a Pathologist?

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Segment Number 2
Audio File city_hope/1639ch5b.mp3
Doctors Chang, Sue
Featured Speaker Sue Chang, MD
Guest Bio Dr. Chang graduated cum laude from Harvard University in Cambridge, MA, then went on to receive her medical doctorate from New York Medical College in Valhalla, NY. Later, she completed an anatomical/clinical pathology residency at UCLA Health where she was honored as chief resident, and a resident informaticist. She furthered her training with a cytopathology fellowship at UCLA Health and a surgical pathology fellowship at Brigham and Women's Hospital in Boston, MA. During her academic and professional training, Dr. Chang exhibited leadership qualities as resident champion of UCLA’s CareConnect Initiative, resident delegate of the UCLA Graduate Medical Education Committee, steering committee member for the UCLA Institute for Molecular Medicine (IMED) Seminar Series and board member of the Medical Student Research Forum at New York Medical College.

Board-certified in anatomic pathology and clinical pathology, Dr. Chang is the recipient of many honors and awards including the selection to the Harvard College Dean’s list during four years of undergraduate work, research awards from UCLA, and the Association for Pathology Informatics Travel Award. She has published several articles in the peer-reviewed literature, and has been invited to present her work nationally. Dr. Chang’s professional interests include surgical pathology and cytology, as well as pathology informatics. In her free time, she enjoys collecting rare and vintage medical textbooks, reading biographies and historical fiction, traveling abroad, karaoke, personal finance/investment, and fantasy football.
Transcription Melanie Cole (Host): Led by pathologists renowned for diagnostic excellence, the Department of Pathology at City of Hope combines state-of-the-art laboratories equipped with the latest diagnostic techniques and advanced instrumentation with superior investigative skills to accurately and rapidly identify even the rarest and most complex diseases. My guest today is Dr. Sue Chang. She's Assistant and the Clinical Professor in the Department of Pathology at City of Hope. Welcome to the show, Dr. Chang. People don't always know what a pathologist is. Tell us what you do.

Dr. Sue Chang (Guest): So, I think what we mostly think about is what we see on television, which is a forensic pathologist who performs autopsies, but, in reality, there's a lot more to that. There are two sides of pathology: there's the anatomic pathology and the clinical pathology side. The anatomic pathology side involves examining tissues under a microscope, usually for disease or infection causes and giving an answer as to what is happening within a patient's body. And, the clinical pathology side relates more with the laboratory testing and so has a lot to do with blood work, with microscopic, excuse me, microbiology cultures, and a lot of testing that gets done sort of in the background.

Melanie: So, do you work with doctors, or do you work with patients, or both?

Dr. Chang: Most of the time, we work with doctors. The cool girl phrase is that we're the “doctor's doctor”, so there's a lot of nuance and a lot of complexity to a lot of the medicine that we're practicing these days and most of the time, we consult with what we call “clinical physicians”, so your internal medicine doctors, your pediatricians, your oncologists, and we help guide them with decisions and what's really going on. Occasionally, pathologists will interface with patients, sometimes if we're taking biopsies, or we're checking to see if a specimen being obtained is adequate for diagnosis.

Melanie: And, then, how do you relay that information to the doctors? Is it via a report and then, does the patient see that or does the doctor work it up, re-work it up, and then give it to the patient so they can understand it?

Dr. Chang: Right. So, the report that we generate is given to the treating physician and then the treating physician passes it on to the patient, and that's probably the most common way that you see a pathologist's name, which is on paper. But, really, behind the scenes, there's a lot of phone calls, there's tumor board, there' face-to-face interaction with the treating physicians to make sure that what we're writing down on paper is clear and that the nuance of every case is described adequately.

Melanie: So, tell us a little bit about pathology at City of Hope. What are you doing that's really exciting there?

Dr. Chang: Our department is expanding and it's very dynamic. What we are doing currently are three different really aspects of it, which, the first is that we review a lot of the cases that come from the outside. A lot of our patients have seen many other doctors and they come here for either definitive care or for a second opinion and, at the same time that they're seeing a new oncologist, or a new surgeon, we're also reviewing their pathology slides from outside hospitals. Another thing that we do is that when the patients come here for surgery, we're examining the actual tissue that gets resected from them during the time of surgery and this is also extremely important, especially since so many patients receive neoadjuvant therapy, or treatment before they even go to surgery. So, it's a way for us to examine whether or not that treatment is working; whether or not we should stay the course; or we should shift to something else, what its effect is on the tumor. And then, the third thing is that it's very exciting here that we're leading the charge with molecular testing. So, a lot of our knowledge from the past has been what it looks like, but now we're able to see what kind of mutations are within the tumor and what the tumor is capable of doing or about to do.

Melanie: Do you sometimes, if someone is coming in for a second opinion, and as you stated, you get the information from another hospital, then do you sometimes want to take your own tests as opposed to just checking those? How does a second opinion even work?

Dr. Chang: So, the second opinion can come in two different ways. Either a treating physician at City of Hope would like to double-check or a different pathologist is asking for help on their own cases and the patient may or may not even come to City of Hope. And, that's more of a pathologist consultation. Sometimes we do undertake more testing, especially if the diagnosis is in question. I would say the majority of the time, though, the pathologists that I've worked with from other hospitals have been extremely diligent and very smart, and for the most part, we agree on our diagnoses unless there's that 10% of cases, maybe 5-10% of cases, where the diagnosis is very difficult and it requires a lot of study, even consultations on our own, showing our case to lots of other pathologists to make sure that we have all considered all of the possibilities out there.

Melanie: People hate waiting for test results. It's one of the worst things about being a patient. What do you tell them when they ask you why do some tests take longer than others?

Dr. Chang: Yes. I definitely understand that, especially if you're waiting to hear if a biopsy is benign or malignant, the level of anxiety in that every minute can feel like a lifetime. Part of it is that we have to take this fresh tissue, what we call fresh tissue, which has just been taken out of the patient and we have to preserve it so that we can run tests on it and preserve it for future testing. There's a number of different ways that we can convert this tissue into what we call “permanent” or “fixed tissue” and those processes take some time and if we rush it, it actually ends up hurting our testing in the future. So, a lot of times, the waiting is the hardest part. For us as well.

Melanie: It certainly is. And, where do you see the field of pathology going in the future? What's on the horizon?

Dr. Chang: My hope is that in the future, we'll have targeted therapy and that the type of tumor that a patient has isn't just based on what we can see and what we think it looks like, but rather a molecular signature or a DNA change and that there's a drug that can treat that specific, targeted change and so things like chemotherapy can become less toxic to other parts of the body that are sort of in the way, or are collateral damage to the therapy we do that's really intended for the tumor.

Melanie: So, in just the last few minutes, Dr. Chang, just wrap it up for us about the pathology department at City of Hope and why you really want listeners to come there for their first or second opinion.

Dr. Chang: I think that you have here a collection of physicians who are up-to-date with the current practices of pathology, who are extremely dedicated to the clinical care of our patients, and though you don't really see us in the background, we're trying very hard to make sure that everything that comes through the door is looked at with a critical eye. Especially because the field is changing so fast, it's really important for all of us to be on the same page with regards to what we can do, what we can do in the future, and possible avenues that perhaps have not been pursued yet.

Melanie: Thank you so much for being with us today. You've really cleared up a lot of good information. You're listening to City of Hope Radio, and for more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole, thanks so much for listening.
Hosts Melanie Cole, MS

The Importance of Prenatal Care

Additional Info

Segment Number 3
Audio File doctors_laredo/1643dl2c.mp3
Doctors Benavides, David
Featured Speaker David Benavides, OB/GYN
Guest Bio Dr. David R. Benavides is an obstetrician gynecologist and a member of the Medical Staff at Doctors Hospital of Laredo. He is a native Laredoan who received his medical degree from the University of Texas Medical Branch in Galveston, Texas. He completed his residency training at Parkland Hospital in Dallas.

Dr. Benavides’ mission is to provide the highest quality of comprehensive healthcare for women of all ages. In his spare time, he enjoys playing the guitar, helping out with the youth ministry at his church, and spending time with his wife and four children.
Transcription Melanie: (Host): According to the US Department of Health and Human Services and the National Institutes of Health, having a healthy pregnancy is one of the best ways to promote a healthy birth. Getting early and regular prenatal care improves the chances of a healthy pregnancy and this care can begin even before pregnancy with a preconception care visit to a health care provider. My guest today is Dr. David Benavides. He's an obstetrician gynecologist and a member of the medical staff at Doctors Hospital of Laredo. Welcome to the show, Dr. Benavides. What do you tell women is the most important bit of information you like them to know about the importance of prenatal care?

Dr. David Benavides (Guest): What I like to tell them to always start thinking about pregnancy and your child, as we all care for our children, and to get early prenatal care because it could definitely improve any adverse outcomes that we try to avoid during pregnancy, and frequent early care is definitely important to all women seeking pregnancy or definitely who are pregnant.)

Melanie: What's meant by prenatal care?

Dr. Benavides: Prenatal care is basically to seek medical care to identify any kind of medical condition that can affect a pregnancy, to avoid any adverse outcomes to the pregnancy, to develop a close relationship with your physician to identify any problems that could arise or that do arise, to treat and formulate a safe pregnancy for the patient.

Melanie: What steps do you want a woman to take if she was just starting to think about getting pregnant? What is it you want her to do, Dr. Benavides? Do you want her to start taking folic acid, prenatal vitamins, or is it too soon for that? Would you like her to try and get some exercise, get her body in shape? What steps do you want her to take?

Dr. Benavides: Well, definitely if they're starting to think about pregnancy, those are all the good recommendations. You were speaking of pre-conceptual care as opposed to prenatal care and it's never too early to do that for women. You have to make sure that a healthy woman leads to a healthy pregnancy. So, it helps you develop a plan for your reproductive life. We do talk about increase their daily intake of folic acid, at least 400 mcg, make sure that their immunizations are up to date. If the patient has any medical conditions such asthma, diabetes, or hypertension, we can address those and get early treatment and optimize the treatment for that because optimal treatment for any of those conditions will lead to a healthier pregnancy. Also, talking about avoiding things like smoking, drinking, or the obvious use of drugs. Also, we could speak of attaining a healthy weight through an exercise program because those are definitely think that could lead to adverse outcomes in pregnancy, and just to learn about their family history or their partner to identify any potential diseases that could be carried to their infant and try to counsel appropriately or visit genetic counselors when needed, and those are all definitely the things that we can do at a pre-conceptual visit.

Melanie: That's great pre-conceptual advice for women who are thinking about getting pregnant. Now, once they are pregnant then what do you want them to do right when they first find out because women are never sure what's the most sensitive time of their pregnancy. What do you want them to know about all of those things that we're just speaking of when they're actually pregnant?

Dr. Benavides: The first evidence of pregnancy is a missed menses and you can definitely visit your physician if you're thinking that you're pregnant, or if you're late on your menses or, obviously, any at-home pregnancy test through the urine can tell you. Nowadays the tests are almost as sensitive as the ones I have here at the office. Obviously, we can elaborate on that with serum blood tests, but once that woman finds out that they are pregnant, they need to come in to the office for their prenatal visit and that should happen immediately because we can start, like we've mentioned before with pre-conceptual, we can start identifying any kind of diseases or factors that could affect the pregnancy. It's just something as simple as when we obtain a history, we talk about family history of hypertension, diabetes, things like that. With the first visit, when you do come in, the earlier the better. Different things that we need to know like blood work, blood type, screening for infection, anemia. Something as easy as a blood test can identify a lot of factors that could potentially contribute to adverse outcomes in the pregnancy. We also need to establish the health of the pregnancy by doing ultrasound, making sure that we have a developed fetus. We want to see the heartbeat and different things like screening for sexually transmitted diseases that could definitely have adverse outcomes on pregnancy.

Melanie: Dr. Benavides, what about if a woman does have diabetes when she's pregnant, or asthma, or any of those things you've mentioned? What about medications and what do you tell women when they ask you can they stay on their medications while they're pregnant?

Dr. Benavides: That's a very good question because there are some patients that have these medical condition that are being treated by family physicians or internal medicine but, unfortunately, some of these medications for high blood pressure can have adverse outcomes on the infant's. So, when they come to me and they say they have high blood pressure and, “I'm on this type of medication,” we have to make sure that the classification of the medication will not harm the baby because definitely you do not want to get off of these medications because you're on them to optimally control these diseases which will improve the pregnancy but, at the same time, if we have to change the medication for your hypertension to medication that is safe in the pregnancy, that is definitely what’s warranted. As far as diabetes, we can talk about the adverse outcomes of diabetes like having an infant that's heavier than normal, increased risk for a cesarean C-section. Unfortunately, with diabetes that's uncontrolled, you also are at an increased risk for cardiac defects, and ultimately a higher risk or stillbirths which would be the ultimate adverse outcome that we want to prevent. We would definitely speak of those, pick a treatment for those, and what we could do to improve the outcome of the pregnancy.

Melanie: Speak about exercise in pregnancy for a minute, Dr. Benavides. Women are not sure what they're allowed to do and, if they were an exerciser before they got pregnant, are they allowed to continue their exercise right through their pregnancy? What do you recommend for them?

Dr. Benavides: Yes, exercise in pregnancy is definitely allowed and it's actually encouraged. I know that the American College of Obstetrics and Gynecology just came out with a new article that does encourage patients who are pregnant to continue their exercise program. So, basically, what we tell patients is just because you're pregnant does not mean that you have to be on bed rest or cannot do the things that you normally could. What we recommend is that if you were doing it before pregnancy, you could probably continue doing it during pregnancy no matter what gestational age. Obviously, with this prenatal care, once we establish that it's a healthy pregnancy, that you do not have multiple pregnancies, that there's no conditions like, for example, something called “placenta previa” in which the placenta attaches in front of the cervix where exercise would contradicted. Once we have ruled those things out, then your physician can tell you that now you can continue your exercise program, you can continue to jog, or whatever it is, lifting weights, aerobic exercise--all of that is definitely indicated and encouraged in pregnancy. Obviously, there has been studies that show that a healthier baby, a decreased admission to NICU when women exercise, healthier size of the placenta and blood flows through the baby. So, those are definitely all indications that women can exercise and should exercise during pregnancy as long as there are no contraindications that you can discuss with your physician.

Melanie: How much weight should a woman gain during their pregnancy and what can they do during their pregnancy to make sure that they have a child that's a healthy weight? Do those two things connect?

Dr. Benavides: Yes, they do. The current recommendations are the amount of weight that you gain is dependent on the weight that you're starting, and there are different recommended weight gain based on a simple formula that we can do when you come in for your first prenatal visit. We calculate your body mass index and based on the body mass index, your physician will tell you need to gain as much as 35 pounds, if you're below weight. If you're at a normal weight, between 25 and 35; or, if you're overweight, less than or at 15 pounds. So, it depends on how much that you're weighing during your prenatal visits, and if you stay within those recommended weight gains, your infant will be at a better weight and adverse outcomes like diabetes in pregnancy will be eliminated, and they will be less likely to have any indication to go to neonatal intensive care unit.

Melanie: Dr. Benavides, what do you tell women about ultrasound and amniocentesis during prenatal care?

Dr. Benavides: Definitely ultrasound is a great tool nowadays to identify many risks to the pregnancy. Usually all physicians will start out with ultrasound in the first prenatal visit to establish many things like multiple pregnancies, the location of implantation, the risk for any threat, miscarriage sign, and it definitely has become a vital tool for any physician that is taking care of women who are pregnant. We also use it for rate of growth in infants and identifying any kind of anatomical defect that we might see. It's not one hundred percent but it definitely, by far, has decreased many adverse outcomes that we have seen in the past like intrauterine growth restriction, and it does not harm the infant. Many patients asked me is there some sort of radiation risk, the more sonos that we do, can that harm the baby? Through the use of the ultrasound, which is sound waves, there are no studies that show that they harm the baby. Then, there are other prenatal tests that we can do to identify genetic problems. Nowadays, we have a lot of blood tests that can identify things like Down's syndrome, Edward’s syndrome, different genetics problems that could affect the pregnancy. Amniocentesis is one way of evaluating that. It's actually the only way that you can prove those genetic studies one hundred percent of the time. Albeit, amniocentesis does have its risks to it, and your physician, if it were indicated, should talk to you about the risk of rupture, the risk of infection and things like that. Not every pregnant woman would need something like the amniocentesis but if you are at increased risk, if something were to happen, if we see something on ultrasound that might indicate that the infant might have a problem, we might suggest that. Women who are above the age of 35 have a slightly higher risk of having infants with genetic problems like Down's syndrome and would warrant those things. Not every pregnant patient needs something like that but definitely ultrasound is a vital tool that every physician is using in obstetrical care.

Melanie: In just the last few minutes, what should people think about when seeking prenatal care?

Dr. Benavides: What women should be thinking about is, as with any parents, I think we all are thinking of the health and safety of our child and when they seek prenatal care, they should seek to formulate a relationship with their physician to avoid any kind of adverse outcome to their infant, and to be forthcoming with the information and medication that they're on, smoking history, drinking--any of those issues that can affect the baby. They should be thinking that whatever they're doing is, obviously, for their health and the benefit of the baby, so that doesn't come when the baby is born that starts from what we've talked about from the very beginning, even before pregnancy.

Melanie: Why should they come to Doctors Hospital of Laredo for their care?

Dr. Benavides: They should come to Doctors Hospital because they provide good quality prenatal care. They have excellent staff, and will make your prenatal, and labor and delivery part of the pregnancy very comfortable. We all have to think about different conditions in pregnancy that could affect the infant and at Doctors Hospital we allow you to take the worry out of pregnancy and allow it to be a happy and excited time.

Melanie: Thank you so much for being with us today. You're listening to Doctors Hospital Health News with Doctors Hospital of Laredo. For more information, you can go to www.doctorshosplaredo.com. That's www.doctorshosplaredo.com. Physicians are independent practitioners who are not employees or agents of Doctors Hospital of Laredo, the hospital shall not be liable for actions or treatments provided by physicians. Doctors Hospital of Laredo is directly or indirectly owned by a partnership that includes physician owners including certain members of hospital medical staff. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Are You at Risk for Diabetes?

Additional Info

Segment Number 1
Audio File florida/1644fl4a.mp3
Doctors Melo, Haroldo D.
Featured Speaker Haroldo D. Melo, MD
Guest Bio Haroldo D. Melo, MD is an expert in the diagnosis and treatment of acute and chronic illnesses.

Learn more about Haroldo D. Melo, MD
Transcription Melanie Cole (Host): According to the CDC, more than 29 million Americans are living with diabetes and 86 million more are living with pre-diabetes, a serious health condition that increases a person’s risk of Type II diabetes and other chronic diseases. My guest today is Dr. Haroldo Melo. He’s an Internal Medicine physician with Florida Hospital. Welcome to the show, Dr. Melo.

Dr. Haroldo Melo (Guest): Hi.

Melanie: So, first, give a little explanation of what is diabetes.

Dr. Melo: Diabetes is a disease of the carbohydrate—carbohydrate is a fancy name, a five-dollar word for sugar—basically, elevated sugar, uncontrolled. The main organs associated with this problem are the pancreas and it affects the production of insulin.

Melanie: So, how would somebody know if they are at risk for diabetes?

Dr. Melo: The main thing would be look at your weight on a scale. Nowadays, those little scales are really easy to find. They’ll give you your body mass index, which is BMI. And, if you don’t exercise frequently, if you are overweight or obese, you are at risk. If you are eating highly processed foods, highly processed sugars, you are at risk of getting diabetes. Also, if you have family members that have diabetes, especially Type II diabetes (that’s the most hereditary form of diabetes), you are at risk and you may want to speak with your doctor.

Melanie: Are there some symptoms if somebody is overweight or obese or they don’t exercise, have a sedentary lifestyle? Would they notice anything if they were pre-diabetic or actually have Type II diabetes?

Dr. Melo: That’s a good question. Not always. There are the typical symptoms of diabetes. Someone comes into your office and says “You know, doctor, I’ve been eating a lot, I’m hungry all the time. I’m thirsty all the time and I’m drinking too much, and I can’t stop urinating. I have a lot of urine coming out; it’s mostly white.” So those are the typical symptoms of diabetes. That’s the first thing that we think about but it’s definitely not a disease that will reveal itself through symptoms. It’s basically, you know, you are at risk, we check you, and then it turns out that you’re becoming diabetic, your blood sugar is going up slowly. Usually, when someone presents with symptoms to the doctor’s office, it’s usually, I don’t want to say too late, but it’s already a pretty advanced diabetes and your blood sugar’s really, really out of control. But, for most people, they will come to your office. They’re completely asymptomatic and then you give them the news, and it’s a big shock for most of the patients.

Melanie: And, how is it diagnosed?

Dr. Melo: Well, there are very simple things that can be done. The first one and the easiest one is getting a hemoglobin A1C. Hemoglobin, we all know, is the amount of red cells in your body, so the content of the red cells. So we have a certain amount of sugar that attaches to your hemoglobin, to that red part of your blood. If it’s less than 5.8, if it’s 5.7 and below, 5.7% and below, then you should be fine; you don’t have diabetes. If the amount of sugar on your hemoglobin is anywhere between 5.8 and 6.5, then you are what’s known as a pre-diabetic. You’re not able to metabolize the carbohydrates or the sugars adequately. If you’re anywhere over 6.4 or 6.5, then you are a diabetic. That’s the easiest one. The other one is getting a fasting blood sugar. You go to the lab to check your cholesterol. Your doctor checks your blood sugar. You haven’t had anything to eat for 8 hours. You’re blood sugar is over a 126 mg/dL. That’s just a random number; you don’t have to learn it. But if it’s over that number, you’re diabetic. Also, there’s 2-hour glucose where you can drink something that for some people in the past, that used to be a very common way of diagnosing it. You have to drink a liquid that really doesn’t taste that well but it’s very sugary, and they check your blood sugar in 2 hours. If it’s over a certain limit, you are a diabetic. And, I would say, not the most common, but the frequent reason why people show up is that “Hey, I have a friend that has a blood sugar machine because he’s a diabetic. I checked my blood sugar, it’s 240.” We call that a random blood sugar and any random blood sugar over 200, you can consider yourself a diabetic, especially if you’re having symptoms.

Melanie: So, then, what treatments are available for a Type 2 diabetic? People hear the word “insulin”, and with Type I diabetes, Dr. Melo, that’s an insulin-dependent diabetes. The pancreas is damaged or destroyed. But, in Type I, it’s a resistance. Do they have to go on insulin? They hear that and they think right away that’s what they’re going to have to do.

Dr. Melo: No, definitely not. It depends on where you are with your blood sugar when you’re first diagnosed and everything. But I would say, the cornerstone of diabetes treatment is, first of all, weight loss, a healthy diet, and exercise. That is the first thing that we need to get in line, and usually, a lot of people stumble in that area. And the cornerstone, which is these three things: weight loss, diet, and exercise, is very patient-driven and patient-dependent; it doesn’t really depend a lot on the doctor. Now, the next step would be medications and there are a bunch of them, several. The most common ones are Metformin; most diabetics will know the Metformin. Insulin is really, especially on a Type II, on a Type 1, as you said, it’s an insulin-dependent. There’s no way around it. You need the insulin, period. But on a Type 2, insulin, it’s kind of a, you know, “We’ve exhausted all the pills; we’ve exhausted all the other possibilities, your blood sugar is still uncontrolled, then, you know what? We need to use the insulin.” That’s kind of a last step. And, finally, I think, I’d say the most drastic one to treat Type II diabetes is the bariatric surgery--you know, the weight loss surgery. That’ll reshape the form of your intestines; maybe a sleeve. It depends on what kind you’re getting. And, that also, I wouldn’t say cures it, but it definitely puts it under control for a lot of people, especially if you maintain the low weight after bariatric surgery.

Melanie: So, that was going to be my next question, Dr. Melo, is can you reverse it? If you’re told that you’re pre-diabetic or that you are diabetic, and you do all of these lifestyle modifications that you’ve just mentioned; you lose weight, you change your eating habits, you get some exercise, can you then reverse it and be somebody that does no longer have diabetes?

Dr. Melo: Definitely, yes. I advocate a plant-based diet but you can definitely do it just the way you described it. I’ve seen it happen. It’s happened for a few of my patients. I don’t want to say a lot because not a lot of people have the willpower to do it. But it’s definitely something that’s possible. I have seen people go from 3 medications, from insulin-dependence, to becoming completely one pill at the most and some of them actually no pills at all. And followed them for the next one, two, three years and the blood sugar is well controlled. Now that being said, once you develop the problem, you don’t want to be, you know, you have to pay attention all the time because if you gain the weight again, if you start eating the way you used to, it’s just going to revert back. It’s not a “you cured it, then it’s gone.” It’s not like a skin infection where the doctor gave you an antibiotic; you stop taking the antibiotic after the recommended time; and it’s gone, you know? You don’t have the problem anymore. Diabetes is there; if you stop paying attention, it will come back. Your blood sugar will be uncontrolled again and it’s something that you’re going to have to pay attention to for the rest of your life. You need to pay attention but it is definitely possible, people can do it. As I said, the cornerstone is weight loss, a healthy diet, not just extreme diets that will change temporarily and will lower your blood sugar, but healthy changes to the way you feed yourself to the way you consume calories and exercise. There’s no question about that.

Melanie: Thank you so much, Dr. Melo, for being with us today. It’s such great information. You're listening to Health Chats by Florida Hospital. For more information, you can go to www.hcpphysicians.org. That's www.hcpphysicians.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Lung Cancer: Screening Can Save Your Life

Additional Info

Segment Number 2
Audio File virginia_health/1642vh5b.mp3
Doctors Hanley, Michael
Featured Speaker Michael Hanley, MD
Guest Bio Dr. Michael Hanley serves as the medical director of UVA's comprehensive lung cancer screening program.

Learn more about Dr. Michael Hanley

Learn more about UVA Health System
Transcription Melanie Cole (Host): Lung cancer counts for about 27% of all cancer deaths and is the leading cause of cancer death among both men and women. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. My guest today is Dr. Michael Hanley. He’s the medical director of UVA’s Comprehensive Lung Cancer Screening Program. Welcome to the show, Dr. Hanley. How common is lung cancer? Are you seeing a rise in it these days?

Dr. Michael Hanley (Guest): Thanks for having me. Yes, as you mentioned, lung cancer is the leading cause of cancer related death. We have seen an increase in the patients that we see for lung cancer, both partly because of our growth but also because of the region that we’re in. The rates have been coming down for men but they’ve actually been increasing for women, which is concerning.

Melanie: So, then, tell us a little bit about lung cancer and the risk factors that you look for.

Dr. Michael Hanley: Sure. Smoking is attributable to about 90% of lung cancer. There are other environmental risk factors: radon exposure, occupational exposure, things you may have been exposed to in the environment but, again, 90% are about smoking. The reason that the risks for men are coming down is because of very aggressive anti-smoking campaigns but the risks for women are increasing because we see a little bit of a lag from in the late 70’s and early 80’s when there was a lot of targeted advertising to women.

Melanie: So when you’re speaking about the lung cancer risk factors, is there a genetic component to lung cancer?

Dr. Michael Hanley: There certainly is. It’s not one of the cancers that we know an exact gene and we can’t test for it, much like we can test for the breast cancer gene. We know that it does run in families so while we don’t know the gene exactly, we do assume there is some genetic component.

Melanie: Is there a screening tool available for lung cancer?

Dr. Michael Hanley: People have been looking at how to catch lung cancer early for years. One of the major problems with lung cancer is that about 80% of patients diagnosed with lung cancer get diagnosed in later stages where surgery is not curative. There have been people that have looked at a variety of different things. They started out looking at annual chest x-rays. So, if you just come in for your annual exam to see your doc you would get a chest x-ray. They looked at that very carefully and they found that actually wasn’t very helpful. They’ve looked at things where you would spit in a cup and they would look at that under a microscope and see if they could detect cancer early. That didn’t really pan out. There are blood tests in development and a few other things that are kind of in development, but what really came out of the last couple years is should we use CT scans to detect early cancers? We know that CT scans do an excellent job of taking up early nodules. We see nodules on quite a high percentage of studies that we look at for other reasons, but what we are trying to look at is should we use that tool to look at very high risk patients? That’s what the lung cancer screening trials have shown us in the last couple years--that annual low radiation dose CT scans are helpful in detecting early lung cancers.

Melanie: Who is a candidate for this type of screening?

Dr. Michael Hanley: Generally, looking at heavy smokers between 55 and 77 years old and heavy smokers are really defined as a 30 pack year history. So, if you take someone who smoked one pack a day for 30 years that would equal 30 pack years, or two packs a day for 15 years, or some equivalent thereof. We also want people to be free from symptoms of other cancers. If patients are having severe symptoms where they and their doctor think that they’re worried about something and they need a CT scan, they may need a CT scan but probably don’t want to be part of our screening process.

Melanie: So, then, the screening takes place how often?

Dr. Michael Hanley: It’s an every year low radiation dose CT scan. It takes just a few minutes to have it done but here at UVA we also couple that visit with a visit with our nurse practitioner. What our nurse practitioner will do is talk about smoking cessation for patients that are still smoking. They could prescribe cessation medications, if needed, and really be a great resource for patients going through what could be one of the hardest things they’ve ever gone through. As many smokers know, it is very, very hard to quit.

Melanie: Dr. Hanley, do insurance companies recognize this particular type of screening?

Dr. Michael Hanley: They do. It’s all insured. Because of the Affordable Care Act, all insurers must provide this coverage without co-pay.

Melanie: Now, if somebody is worried about lung cancer, are there some symptoms – people think of coughing, they think of sputum, any of these kinds of things – are there any symptoms to watch out for?

Dr. Michael Hanley: There are. One of the things that is kind of tricky with lung cancer is that many smokers have a chronic cough. So, you don’t want to say, “Well, if you cough then it must be cancer,” because there’s a lot of other reasons to have a cough. But, if that cough gets worse or doesn’t go away and is worse than the normal smoker’s cough, that is something that could be worrisome and you should see your physician about. Other things like coughing up blood or chest pain and shortness of breath are other things that we would ask about. Weight loss is also something that’s concerning for cancer and a lot of different cancers share those symptoms.

Melanie: So, if you do diagnose somebody, that can be the most scary diagnosis to hear. What do you tell them to give them some hope and what are some treatment options available?

Dr. Michael Hanley: Sure. Again, the reason that we want to catch cancer early is because that’s when there are curative cancer treatments. Say, for example, a patient comes and they have a cancer that’s the size of a dime that we detect on a CT scan, they would be able to undergo resection of that. They could see a surgeon, have that cut out, and they would effectively be cured, and that’s really what we’re going for. We want to avoid what is the current state most of the time – again, 80% of the time – when we diagnosis people with lung cancer, it’s done at a state where it’s already spread to other areas, which then just leaves chemotherapy as effective treatment options.

Melanie: So then if people go through this, and what do you tell them about obviously life style modifications, is there anything else besides quitting smoking that you like them to do after treatment?

Dr. Michael Hanley: Actually, quitting smoking-- they’ve actually been looking at quitting smoking even after someone’s been diagnosed because there’s a lot of sentiment of our patients that they say, “Well, it’s a stressful time when they get diagnosed and they’ve already been diagnosed with cancer so why should I quit now?” And they’ve actually done a lot of research looking at patients who quit smoking at the time of their diagnosis and patients that don’t quit, that continue to smoke during their treatment, and patients who quit smoking after they get diagnosed do much, much better through their treatment. Really, that’s something that we definitely focus on. Again, it’s a very, very hard thing to quit so we want to make sure that we give the patients all the support that we can to not only to physically get through and emotionally get through a diagnosis of cancer, but also the smoking component.

Melanie: Dr. Hanley, tell us about UVA’s Comprehensive Lung Cancer Screening Program and tell us about your team.

Dr. Michael Hanley: Sure, we’re very lucky to have a team that-- what our real goal is, is to try to provide a full service for patients that are undergoing this exam. The CT scan is really just a part of it. We’ve partnered with the cancer center to hire a nurse practitioner. She’s really the focus of our program where she sees the patients; she develops lasting relationships with our patients; she can help them quit smoking, as I mentioned; and then, also, when patients are due for their annual study, we work on making sure that we get in touch with those patients. We don’t want anybody falling through the cracks, so having someone that can help coordinate the program is really essential. We also have a great team including thoracic surgeons, thoracic oncologists, and all of our other treatment specialists who, when patients are identified, we can make sure that they’re seen quickly and with great specialists.

Melanie: Thank you so much, Dr. Hanley. It’s great information. For more information on UVA’s Comprehensive Lung Cancer Screening Program, you can go to www.uvahealth.com. That’s www.uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Mindful Moms: Complementary Approaches to Managing Anxiety During Pregnancy

Additional Info

Segment Number 3
Audio File allina_health/1642ah4c.mp3
Doctors Welke, Tina
Featured Speaker Tina Welke
Guest Bio Tina Welke is a perinatal social worker and therapist with Allina Health.
Transcription Melanie Cole (Host): Are you a woman who is pregnant, has a history of anxiety or emerging anxiety in your current pregnancy, and want to learn complementary approaches to managing that anxiety? My guest today is Tina Welke. She is a perinatal social worker and therapist with Allina Health. Welcome to the show, Tina. What’s normal and abnormal? very new mother or pregnant woman to be is always nervous. We always have anxiety anyway, so what’s normal? And then, how do you determine what’s abnormal?

Tina Welke (Guest): Hi, Melanie. Thanks for having me. That very true. It’s incredibly normal and quite appropriate for moms and their partners to be very anxious about pregnancy or bringing a baby into the world and they’re worried about safety, making sure developments are on par. Those things are very normal. But, what we’re talking about here is anxiety during pregnancy or postpartum periods that become a little bit more abnormal or more of an anxiety disorder. And, that’s when it’s severe enough to cause distress, or it gets in the way of functioning with family, with work, or at home with your partner, things like that, where the worry becomes so big it’s hard to manage.

Melanie: Okay. Then, what do you tell women of what they should do when they do sense that? Or, is it the loved ones who are sensing it first?

Tina: That’s a good question. Oftentimes, partners will say, “Something is going on with my wife or my partner since she’s had the baby. She doesn’t sleep as well, she’s been talking a lot about his safety and weight.” Breastfeeding is oftentimes a huge source of anxiety or distress for moms just to make sure they’re doing it well or right. But, oftentimes moms will bring it up, like, “I just can’t settle. I’m not sleeping well. I’m always focused on is the baby breathing? Is the baby okay?” Things like that. What I really like to talk to my patients about and women about when I’m teaching or educating them or supporting them is about their overall emotional health and welfare. Like, if you really think about that whole being, and having moms just feel incredibly supported, having them understand what to do with stress, giving them the coping mechanisms or thinking about ways to manage stress, because bringing a baby into the world are having a pregnancy with other children is very, very stressful. So, talking about their emotional health and well-being is really, really important, and how they orient themselves to problems and how they are figuring out managing stress. I also talk to moms a lot about their history of anxiety or history of perfectionism or thinking they have to do it one right way or the right way when there really is no right way to do this. And, I also talk to moms a lot about being kind of a good enough parent. So, thinking about breastfeeding and thinking about the delivery and afterward, what looks like good enough--not perfect, not all or none--but good enough parenting at home with your partner, and so the baby is well and so are they.

Melanie: That’s great bit of information there, Tina, because it is certainly true that we feel that need as women to be perfect, to be super moms, to be able to do it all, and none of us really can do it all. We all need help sometimes. So what are some complementary and holistic approaches to that healthy and balanced well-being that you’re discussing?

Tina: Yes, Melanie, that’s so true. So many times moms prioritize kids or family or partner first and then they come last. So we talk about this all the time, I practice with a physician and she and I talk about this all the time, not only with medical professional but with patients also, just about self-care, coping, different complementary approaches outside of medicine at times before women get to that point of needing to take medicine or before they’re seeing therapist. Many of my patients do yoga, prenatal or postnatal yoga, seeing an acupuncturist, doing massage therapy, working with an integrative medicine person, to understand aromatherapies. I talk to patients all the time about sleep and nutrition. If you get up in the morning and, certainly, moms deserve and need coffee, but if you’re drinking coffee throughout the day and your body is exhausted and you just keep putting coffee in your body, it’s really important to think about when your body gets to rest, when it gets good nutrition and water, and if you can sleep when the baby sleeps, or at night when your partner is in, can he or she help, so that you can get some rest or unhook from the day or the baby or breastfeeding or whatever that looks like, so that she can be well and get a little bit of a down time. So, thinking about a balanced approach to parenting.

Melanie: If a woman does have clinical depression and she is diagnosed that way and she looks to medicational intervention, whether she’s pregnant or this is a postnatal thing, what do you tell them about that need and where they should seek help?

Tina: That’s a really good question. There is so much emphasis placed on harm to pregnancy or to a woman and the developing baby through breastfeeding, about medicine harming the baby, but what we really need to think about is this more holistic approach about mom, her physical health, her mental health is just as important as her physical health. So, if we have a mom who has a history of depression or anxiety or both, and she goes into the pregnancy without any medicine and she is incredibly stressed and not sleeping and worrying constantly, we know that impacts her, how she is functioning. And we know that it impacts—through a lot of data and science and studies—it impacts the developing fetus. So, it’s really important for moms to think about talking to their trusted provider. I tell moms the first step is to talk to their OBGYN. Moms prefer to get their care from a trusted provider, which is usually an OBGYN or family practice doc, sometimes a midwife, and talk to them about “I’m feeling all of these symptoms”, or “I’m struggling this way”, or “I can’t sleep”, or “I can’t turn off worry”, or “I’m still afraid of contracting this”, or “I’m so afraid of eating all of the right things”. So, it’s important to talk to their trusted provider first and foremost. Many times doctors can talk with them about starting medicine, if that’s indicated, or maybe seeing a therapist and starting there as a first-line approach and talking with a therapist about their worries or their sadness or depressed mood. And then, many times the OBGYN or the doctor/provider will reach out to a person like me and say, “I think this depression is way bigger than I can manage”, or “I think this anxiety is getting worse, can you give me some ideas about what would be helpful for this patient throughout her pregnancy or postpartum period so that she is well and her symptoms are treated?”

Melanie: Tell us about the goal of Mindful Moms Group and the shared medical visit.

Tina: Mindful Moms is a group, it’s a shared medical visit between myself and Dr. Elizabeth LaRusso, who is a perinatal psychiatrist. This is a two-hour group and our focus is really on complimentary approaches to treating anxiety during pregnancy. So, patients are going to be able to meet one to one with a reproductive or perinatal psychiatrist Dr. LaRusso, talk about symptoms, talk about their functioning, talk about whatever is on their mind as far as their anxiety and their pregnancy and how they’re managing it. We are having a yoga instructor come in and teach a gentle flowing yoga to moms and Dr. LaRusso and myself. And women are going to be then meeting with me and talking about psycho-education and basics of perinatal anxiety, or anxiety during pregnancy and what that looks like after they’ve had the baby. And, then, we’re looking at guest speakers or clinicians coming in and talking about acupuncture and Chinese medicine, nutrition and the role of nutrition, aroma and massage therapy. We’re having an integrative medicine physician coming in and talking about kind of more natural approaches to anxiety like supplements and teas and things like that. Also, having another therapist come in and talk about mindfulness and meditation and how important that is in managing a worried thoughts. And then, we’re also having Dr. LaRusso speak to patients when complementary approaches aren’t enough and when psychiatric medicine is indicated and what that looks like for women with their pregnancy.

Melanie: What are program, Tina. Wrap it up for us and give moms, listening moms-to-be, even women who are thinking about getting pregnant your best advice about that anxiety that we all suffer from when we are thinking about having children or if we’ve just had a new baby and what you really want them to know about the best ways to take really good care of themselves throughout that process.

Tina: Good question, Melanie. What we know is that anxiety during pregnancy and after delivery is quite common, and we know that women are at a higher risk of it if they’ve had a history of it. I will say that there are many anxieties and worries that are very common and valid about pregnancy and bringing a baby or babies into this world and those kind of things you can talk about with your partner, other moms or women that you know that are trusted, or talk about with your OB about these other things I’m worried about. When it gets a little bit too big or hard to manage, it’s really important that a woman is adequately supported and so that she can talk about her mental and emotional health with a therapist. Sometimes that’s indicated and that’s an okay thing. And, then, if you’re anxious I really encourage you to think about being brave and courageous as a woman and a patient to talk about with your OB and just say, “This has really been hard for me.” Starting the conversation there is important so your trusted provider or OB can then refer you on to someone who could be helpful to you during pregnancy or after you have had the baby. Anxiety poses a risk for mom and their wellbeing, but also the baby and family, so it’s really important to get it treated. And, again, coming from a holistic perspective, looking at mind/body, mom/baby attachment and looking at the whole family, it’s really important that women are well supported throughout their pregnancy and are able to talk about some of the more normal worries and the worries that are getting bigger and harder to manage. And, that’s why we exist and that’s why we’ve created this group Mindful Moms.

Melanie: Thank you so much, Tina, for being with us today. It’s great information. For more information on Mindful Moms, Complementary Approaches to Managing Anxiety During Pregnancy, you can go to www.AllinaHealth.org. You’re listening to The WELLcast with Allina Health. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

The Epidemic of Childhood Obesity

Additional Info

Segment Number 1
Audio File doctors_laredo/1643dl2a.mp3
Doctors Cervantes, Francisco
Featured Speaker Francisco Cervantes, MD
Guest Bio Dr. Francisco Cervantes is a pediatrician and a member of the Medical Staff at Doctors Hospital of Laredo.
Transcription Melanie Cole (Host): According to the Centers for Disease Control, the CDC, childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. My guest today is Dr. Francisco Cervantes. He’s a pediatrician and a member of the medical staff at Doctor’s Hospital of Laredo. Welcome to the show, Dr. Cervantes. What is the state, as you see it, of childhood obesity? What are we seeing happening to our children today?

Dr. Francisco Cervantes (Guest): Okay, what we are talking about here in Laredo, Texas, is mostly Mexican-American population chiefly, and we have a big problem with obesity. By the time the kids finish high school, 2 out of 3 are overweight. That’s a big number, which goes along with the numbers of 2 out of 3 Americans in the United States in general, adults who are overweight. So, that’s a big problem and all of the problems that come with being overweight. We see children here, we have a walk-in clinic, and we check the height and the weight. In general, we see they grow and they change height and weight with the years. A general rule is if your weight percentage is higher than your height percentage, very likely you are either at risk of being overweight, or overweight. So, it places you into the higher bio-mass index for your weight, and once you’re in a risk area or in an overweight area, you are exposed to problems like higher fatty liver, hypertension, cholesterol problems, which mainly produces in low, good cholesterol, the HDL, the high-density. And the other one is triglycerides. Once you lower HDL or high triglycerides, you are at risk of diabetes, eventually. If you are overweight within 10-20 years, you may develop diabetes, the risk you are exposing yourself. And so, we have kids who are, at three years, they are overweight, or one year, so by three or four years, we have one of three kids who are overweight, so that’s a very big problem. And the problem gets worse when they enter school and stay there. It doesn’t get any better after they get to school despite the physical education programs and the change in diet in school, they get a lot of starch. We are a very highly diabetic population. The kids I see here in the office, 80% of them have a close relative with diabetes. 10-20% of them have either one of the parents with diabetes, and 1-2%, both parents with diabetes. We’re talking about young parents especially between 20-40 years of age. So, it’s a big problem, diabetes, it’s a main concern for the future in the United States in children and adults and we are also looking at the size of the liver and the size of the kidneys get bigger and the hypertension starts from every age. We wrote paper on hypertension and diabetic patients at three or four years of age. So, we are committed to detect, to work with them and every visit to remind them that they are overweight and they need to do something; they need to exercise they need to change diet; they need to cut the carbohydrates since with clinic in 2001, we knew the problem was the carbohydrates. We do eat a lot of carbohydrates in our diets. Very little veggies, and very little red meat. So, we eat starch or fat, in other words.

Melanie: So, Dr. Cervantes, when you’re working with a high population of Hispanics, and you see that the parents are also overweight, how do you work with them as a family to get the whole family to eat healthy, because it would seem that the only way you can get the children to be more active, to eat healthier foods, and to make better choices, is to get the parents to do the same. How do you do that?

Dr. Cervantes: We approach the problem. We let them know that they are overweight. It is worse when both parents are overweight. It’s a little bit better when one of the parents is overweight, but we’re talking here that people are pre-diabetic and we have it. So, you have to confront the problem directly to the family that they cut down on the carbohydrates, do more exercise, and try to eat more veggies. It is hard. It is hard when we see them every day. The good thing is, we see them on periodic visits, periodic yearly exams, and we see them again and again, and we tell them. We do lab work, and we follow them, and we watch for them fatty liver; we watch for alcoholic and non-alcoholic hepatitis, which is very common, and the cholesterol. We have a lot of kids on medication for low HDL and high triglycerides and it’s really not a cholesterol problem. The problem is the HDL and the triglycerides which we have to put them on medication, and it works. It works. We follow these kids for 15 years, and when we compare initial and the BMI at the follow up, at least they are not worse, so something is good for the families. Eventually, some of them, they lose weight. Some of them, at least they don’t gain any more weight, or they stay the same BMI and we try to keep them informed on what the changes are with the blood pressure. So, that’s what we do. We remind them, keep track of the progress we have and stay with them.

Melanie: So, do you think that the cultural food is part of the issue, that it’s a high carbohydrate diet and that it’s hard to incorporate fresh fruits and vegetables? And then, also, Dr. Cervantes, touch on activity. Kids today play a lot of video games. And the screen time--you’re a pediatrician—and the screen time has totally changed from what it used to be. So, first talk about the cultural foods, and how that can be changed and what you tell parents and then, also, the activity level of children, and changing the screen time requirements, so that they get out and they are more active.

Dr. Cervantes: Okay, Laredo has a peculiar situation. It’s mostly Mexican-American population, okay, which has high propensity for diabetes. It’s very hard. There are very few places to exercise. Even schools don’t have the whole year, physical education programs. So, we encourage them to exercise. We advise them about the carbohydrates, excessive carbohydrates, and that’s the only thing we can do. They are supposed to be preparing food which is good, but we don’t see the change with different diets and food and they just change the carbohydrates. There’s not really much we can do about the food they get a school, but we remind them. Every time you see them, you remind them and it pays off because at least they are not worse and we have the numbers to prove it, that just by staying on top of them, it makes a difference. It’s not the same as if you see an overweight kid and you don’t say anything and you don’t do anything or you don’t do any lab work. And, so, you have to do it. You have to approach the problem, and you have to tell them, you know, the kid is overweight, especially when they stop growing, it gets worse. So, you tell them, you know, “Watch out! Watch out! And, keep on watching your weight and exercise.” Exercise is for everybody. We didn’t come here to rest, okay?

Melanie: Good point.

Dr. Cervantes: If you don’t do anything, you’re not going to stay sitting in a chair the rest of your days, so you need to move. You need to do something and no matter how old you are and especially in young kids. They need exercise. Either swimming or walking. We don’t ask them to run or jump fences – just walk. They need to walk at least half an hour and to find the best time. And, stay away from carbohydrates and that’s the only thing we can do. We do eat a lot of carbohydrates. We’re very susceptible to diabetes. So, we tell them: watch your weight, watch your exercise, and watch what you eat. Cereal. In the afternoon. If you have cereal in the morning, that’s it. It’s breakfast. You don’t continue eating cereal, because it’s carbohydrates. The same with milk, the same with juice, the same with soda. Two sodas make you diabetic, eventually. Two sodas a day will make you diabetic. It’s a fact.

Melanie: It’s really great information. In just the last few minutes, Dr. Cervantes, what should parents with children that are over the recommended healthy BMI think about? What do you tell them every day?

Dr. Cervantes: When you see them, these kids come also from slim parents, and they’re active. They swim, they cross country, and you tell them, “Even though you are exercising, stay away from pizza.” I’m sorry. I have to say it. Eat the top of the pizza, okay? So, eat the meat of the pizza and stay away from cheese, especially spicy cheese, because we have a lot of gall bladder problem, too. We also have a propensity to have gallbladder problems. So, you eat spicy cheese, you have gastritis and you develop cholecystitis and you end up with surgery that you didn’t need to have – in every age. We have kids here with gall bladder surgery at 12 years of age or six years of age because of the spicy cheese. So, it’s just another problem that we have.

Melanie: And, why should they come to Doctor’s Hospital of Laredo for their care?

Dr. Cervantes: We do send them for lab work. We do send them for detection of fatty liver and the liver size, and gallbladder findings, and we feel confident that it’s a very reliable laboratory that we’ve been working with for the last ten years and we can reproduce the information and you know that it’s very, very precise and I’m very happy with the laboratory.

Melanie: Thank you so much for being with us today, Dr. Cervates. You’re listening to Doctor’s Hospital Health News with Doctor’s Hospital of Laredo. For more information, you can go to www.doctorshosplaredo.com. That’s www.doctorshosplaredo.com. Physicians are independent practitioners who are not employees or agents of Doctor’s Hospital of Laredo. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Parkinson’s Disease: Advancements In Treatment Options

Additional Info

Segment Number 2
Audio File allina_health/1642ah4b.mp3
Doctors Vaou, Okeanis
Featured Speaker Okeanis Vaou, MD- neurology
Guest Bio Okeanis Vaou, MD, is a board certified neurologist with Noran Neurological Clinic and Abbott Northwestern Hospital. She is fellowship training in Parkinson’s disease, dystonia, essential tremor, autonomic nervous system disorders and sleep-related disorders.

Learn more about Okeanis Vaou, MD
Transcription Melanie Cole (Host): Parkinson's disease is a neurological condition that affects about 1 million Americans. Even if you don't know someone with Parkinson's, you've probably heard of some famous people with this condition, such as Michael J. Fox or Muhammad Ali. While there isn't a cure for Parkinson's, there are number of ways to treat or manage it and researchers are learning more every day. My guest today is Dr. Okeanis Vaou. She's a board-certified neurologist with Noran Neurological Clinic at Abbott Northwestern Hospital. Welcome to the show, Dr. Vaou. Let's start with a little bit about Parkinson's. Explain to the listeners what it is.

Dr. Okeanis Vaou (Guest): Well, thank you for having me to the show. Parkinson's disease is a chronic neurodegenerative neurological condition which affects movement, coordination, balance and also some other symptoms of what we call “non-motor symptoms” - blood pressure, mood, sleep, and many more others.

Melanie: Do we know what causes Parkinson's disease?

Dr. Vaou: We don't really know what causes Parkinson's. We do certainly know that there are some triggers or some environmental factors that may cause Parkinson's, such as pesticides. Genetics can be part of it, only it's quite rare. If you see a young patient develop Parkinson's, then definitely we're thinking or suspecting genetic causes. We really don't know what might cause Parkinson's.

Melanie: The symptoms of Parkinson's are often difficult to diagnose. They kind of go together. Speak about the symptoms and the diagnosis based on those symptoms.

Dr. Vaou: The symptoms of Parkinson's disease, what we call the “cardinal symptoms” are tremor, rigidity, bradykinesia and unsteady gait. Unfortunately, we do not have a test to diagnose Parkinson's at the moment. So, there is no serum test or blood test or any imaging that can diagnose Parkinson's disease. We have to rely on the clinical appearance of the patient, the clinical symptoms.

Melanie: Do you get a detailed description of the symptoms as the family explains it to you or the patient?

Dr. Vaou: Clinical history is very important, so yes. We want to know when it started, how it progressed, and also when the patient is examined in the clinic or in the office, we can tell if they have a resting tremor, whether they're slow in their movement, when they're stiff--their muscles are stiff--and if they're unsteady in the gait. We add these things up, these symptoms up, and make a diagnosis of Parkinson's disease. Like I said, it's a clinical diagnosis, meaning we examine the patient and make a diagnosis. We don't really have a good test as of yet to diagnose Parkinson's. However, the scientific community is really working on trying to find a test and we're much closer now than we ever were before.

Melanie: Depending on the person's symptoms, is there a standard of treatment? What is your first line of defense when you have to tell somebody they have Parkinson's disease?

Dr. Vaou: That's a very good question. Basically, every patient with Parkinson's disease is different in terms of how they present with their symptoms. Some have more tremor. Some might be slower with their movement. Some may be more stiff with their muscles. You don't always get the same symptoms in one patient. Age also plays a role as to what medication you want to choose; how you want to treat the patient. We're talking about individualizing treatment for someone with Parkinson's disease. There are also side effects of medications that may need to be taken into account because if the patient, for example, is sleepy you don't want to give him medication that will make him more sleepy. You want to choose another medication. There is no gold standard of first line medication that you would go to. It's really customizing the treatment for a person with Parkinson's disease.

Melanie: And these medications are intended to deal with the symptoms, yes? They do not slow the progression of the disease.

Dr. Vaou: Correct. What we have now basically treats the symptoms. Parkinson's disease is a lack of dopamine. The cells that are producing dopamine in the brain decrease and, therefore, we have a decreased level of dopamine. So, we're basically supplementing that level of dopamine in the brain, and that's what the medications do. They only treat the symptoms. It's symptomatic treatment and there is no cure or anything to slow down the course of the disease. Having said that, exercise is the only proven treatment that slows down the progression of the disease.

Melanie: That's fascinating. Is this a new development?

Dr. Vaou: Not so much. It is recent but I wouldn't say it's new. Just this year alone there were 5,000 publications about the benefit of exercise in Parkinson's disease and it has been picking up. It was first introduced about 5 or 10 years ago and there's more and more evidence about the importance of exercise in Parkinson's disease. Mostly, it's motor symptoms and their progression.

Melanie: When people have the tremors and these motor symptoms, is there a surgical treatment for Parkinson's? Tell us a little about deep brain stimulation.

Dr. Vaou: Deep brain stimulation improves the quality of life for patients with Parkinson's disease and it also helps them move. It is just another treatment option when medications alone are not as effective any more or there are side effects to them or patients can't tolerate them for one reason or another. If the patient develops dyskinesias, which are basically involuntary dance-like movements, we see in patients caused by one of the treatments for Parkinson's. That's when we usually start considering deep brain stimulation. What deep brain stimulation is, is it’s basically a continuous electric stimulation of the brain with electrodes which are surgically placed in certain targets of the brain and basically treat the symptoms similarly to what medications do, only deep brain stimulation doesn't have side effects. So, that's the benefit. Once you have someone have DBS, then you may decrease the medication that they're already on and provide much better and controlled relief and treatment of the symptoms.

Melanie: Is DBS FDA-approved? And, reassure the listeners about the fact that it is safe and effective.

Dr. Vaou: Right. It's definitely FDA-approved. The history of DBS goes back in the late 1980s when it was first discovered that electrical stimulation of the brain can help with tremors and the motor symptoms of Parkinson's. It was FDA approved for Parkinson's disease in 2002, and in 1997 reapproved for essential tremor. It's mostly safe. Of course, there are some very rare complications of brain hemorrhage and infection and these are only 1%. It's very well-tolerated and recovery is very fast. Like I said, in combination with medication, it improves quality of life and really provides very good control of motor symptoms. Having said that, it doesn't treat all symptoms of Parkinson's. For example, it doesn't treat dementia; it doesn't treat depression; it doesn't directly improve sleep or some of the sleep complications that some of the patients with Parkinson's have, but it definitely improves the stiffness, the tremor, the slower movement and the patient feels better overall.

Melanie: Are there some people for whom this is not an option? Are there some people that are not candidates for DBS?

Dr. Vaou: Yes. Patients who have dementia are not candidates. Patients who are severely depressed are also not candidates. Also patients who do not respond to dopaminergic medications like Levodopa, which is one of the most common medications taken for Parkinson's disease. If the patient does not respond to this medication, then they are not candidates for deep brain stimulation, because you might want to think dopamine controlling the same symptoms as deep brain stimulation will. So, if dopamine is not controlling it, then deep brain stimulation will not, so that patient is not a candidate.

Melanie: Dr. Vaou, what about the caregivers? Because Parkinson's can be quite a devastating disease, both for the patient and for their loved ones, what do you tell their loved ones about dealing with things like the depression and the insomnia and the facial masking and the things that go on when someone is progressing with Parkinson's?

Dr. Vaou: What I usually say, first of all, at this point is just to point out, Parkinson's is not just tremors, not just about feeling stiff or slow, it's about all the other things that come along with it: depression and sleep problems and dementia, other things such as constipation and frequent urination. It involves a lot of other systems in one's body. What I usually tell the caregiver is: first of all, education is key. I want both the patient and their caregiver to get as much education about Parkinson's as possible, for two reasons: one, to identify their symptoms as a result of being from Parkinson's and address them with a neurologist; two, by knowing these symptoms, to really know how to deal with them and to know whether there is treatment or not. You mentioned depression, for example. There are antidepressants medications that can help and treat those symptoms. With every individual symptom that the patient might have, there is also treatment that goes along with it that overall improves the patient's quality of life.

Melanie: Wrap it up for us, Dr. Vaou, if you will, about Parkinson's and what you tell patients and their loved ones everyday about this disease.

Dr. Vaou: I know it's hard when someone is newly diagnosed with Parkinson's disease but, like I said, education is key. They should not forget that exercise is very important and is the only thing that slows the progression of the disease. They should be very hopeful because there are a lot of treatment options to this day and we know that there are many more medications in the pipeline that seem very promising and I feel that a cure is not very far away.

Melanie: Thank you so much for being with us today. You're listening to The WELLcast with Allina Health. For more information you can go to wwwallinahealth.org, that's www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

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