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Want to turn your favorite comfort foods from forbidden to healthy in seconds?
Additional Info
- Segment Number 1
- Audio File clean_food_network/1635cf1a.mp3
- Featured Speaker Missy Chase Lapine
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Guest Bio
Missy Chase Lapine is best known for her game changing Sneaky Chef series of books including her New York Times bestseller, The Sneaky Chef: Simple Strategies for Hiding Healthy Foods in Kids’ Favorite Meals. The Sneaky Chef has transformed the way America feeds its families following her unique method of using “blends” to make every meal more nutritious.
In addition to her seven books, Missy is also the founder of Sneaky Chef Foods LLC, a company committed to developing products that improve children’s health including Sneaky Chef No-Nut Butter (a wildly successful peanut butter alternative) and pasta sauces made with eight hidden veggies. Sneaky Chef Foods are sold nationwide.
Missy has appeared on Today and has made hundreds of national TV, radio and print appearances. She is a regular contributor to the Huffington Post and Daily Meal and is also a member of the Children’s Advisory Council for NewYork-Presbyterian Morgan Stanley Children’s Hospital, where Sneaky Chef meals are served to patients. Missy's fresh, irreverent approach to nutrition can be found on her website, TheSneakyChef.com, and on Facebook, Twitter, and Pinterest.
She lives with her husband Rick and their children in Westchester County, New York.
Additional Info
- Segment Number 1
- Audio File corona/1634cr5a.mp3
- Doctors Armin, Sean
- Featured Speaker Sean Armin, MD
-
Guest Bio
A highly accredited neurosurgeon, Dr. Sean Armin has extensive training and expertise in neurological surgery, advanced spinal surgery with concentration in minimally invasive techniques and interventional neuroradiology.
Fellowship trained in advanced spinal surgery, Dr. Armin has been published in numerous books, abstracts, posters and studies. He has extensive research experience, studying under some of the most prestigious medical experts in the nation. He has received several prominent awards and honors throughout his training in addition to holding leadership positions with nearly every professional organization with which he has been affiliated.
Dr. Armin received his medical degree from UCLA School of Medicine. He completed a residency in neurological surgery from Loma Linda University. Following his residency, he completed a Fellowship in advanced spinal surgery with concentration in minimally invasive techniques from UCLA’s Department of Neurosugery in Los Angeles. -
Transcription
Melanie Cole (Host): Spine surgery has traditionally been done as open surgery, but in recent years, however, technological advances have allowed more back and neck conditions to be treated with a minimally invasive surgical technique. My guest today is Dr. Sean Armin. He is a neurosurgeon and a member of the medical staff at Corona Regional Medical Center. Welcome to the show, Dr. Armin. Tell us about the need for back and neck issues. What are you seeing today as the most common conditions that require some sort of intervention?
Dr. Sean Armin (Guest): Well, I wanted to first say that back and neck issues, specifically involving pain, is one of the most common complains that any patient has to any physician. There are some statistics out there that say it is actually the top reason of adult U.S. residents missing work after the common cold. So, it a very fairly common cause of loss of work time and a lot of mobility difficulty. This is a very common complaint that I have with patients presenting to my clinic. As a neurosurgeon, I treat patients with all types of disorders involving the nervous system, whether it has to do with the brain, the spine or even the peripheral nerve. But by far, the most common complaint involves patients presenting with issues involving their lumbar spine, which is the lower back and the cervical spine which is the neck.
Melanie: So, what are the first lines of defense? If someone comes to you with a pain in their lumbar spine or their cervical spine? What do you do for them first?
Dr. Armin: In general, by the time a patient comes to see me, most of the time they have already been to another physician. In general, it involves their primary care physician. At times, they have seen their chiropractor or a physical therapist and, most of the time, these patients have already had some type of a conservative management. By conservative management, we are referring more to observation which is giving them time to get better. They have had physical therapy. They have had various types of medications, including the anti-inflammatory and other types of pain medication. In order for a patient to really be fully evaluated by a neurosurgeon and a spine specialist, they would definitely need to have some type of imaging of their spine. Nowadays, in modern times, that involves with a gold standard being an MRI of the cervical or the lumbar spine, and, of course, this has to be combined together with a physical examination and a very thorough set of questionnaires and interviewing the patient to make sure that their signs and symptoms match and correlate with the findings on the MRI.
Melanie: So, once you've diagnosed somebody and determined that maybe surgical intervention is necessary. What are you doing? Let's speak about the lumbar discs, first and that type of minimally invasive surgery. What are you doing for people?
Dr. Armin: Before I answer that question, it's always very important in my line of work, for patients to have various options. Not every patient should receive a surgery. There are many times when patients can be treated further with conservative management. This also involves, in addition to physical therapy, interventional pain management, which involves various types of injections. Now assuming these patients are no longer improving or getting better with the standard observation and conservative management, then we start talking about various types of surgical interventions that can help these patients. There are, in general, three different types of surgeries that we do for the neck and the low back. One operation would involve mainly decompression which, basically, means removal of pressure over the neuro element, the nerve roots and all the neuro structure that go to the arms and legs. The other type of surgery involves a fusion type of surgery which, in general, involves the decompression together with some type of a stabilization of the spine. And, the third type of surgery, which is a relatively more recent type of an operation, involves artificial disc replacement, also known as disc arthroplasty, where we are able to preserve a motion in the cervical and lumbar spine. And, really, only a spine specialist can help determine the appropriate type of procedure that would help a patient.
Melanie: So, what are the benefits now to the patient for these minimal invasive types of surgery? Is it less recovery, less pain? Tell us about the benefits for the patient.
Dr. Armin: The basic concept of minimally invasive spine surgery has to do with, as they say, minimally invasive and maximally effective. So, what it refers to is causing a minimal amount of injury and trauma to the soft tissue that surrounds the spinal structure. As various studies have shown, what really causes post-operative pain and agony has to do with amount of trauma that the musculature and the soft tissue endorse during an operation. With minimally invasive spine surgery, we do whatever we can to minimize injury to the soft tissue but, at the same time, we don't want to be taking short cuts or doing less of the actual operation for the sake of doing a minimally invasive surgery. So, with all the advances in spine surgery nowadays, we can effectively do what used to be done via the traditional open operation and get the entire job done while, at the same time, minimizing soft tissue injury. And, what that can end up helping the patient with is minimize the length of hospital stay, it can minimize blood loss during the operation, it can also decrease the amount of post-operative pain. Also, usually the size of the incision is smaller, there is less scar tissue that can form and, overall, patients tend to be much happier.
Melanie: Is there any difference in range of motion in what's preserved for the patient and their back afterwards?
Dr. Armin: Well, if patients have less pain, in general, their backs and necks are more mobile. Almost with any type of neck or low back surgery, patients end up getting muscle spasm which tends to tense up their neck and back and the less spasm and less pain that they have, they also tend to have more mobility. And this is often the case with minimally invasive spine surgery.
Melanie: Is this done robotically, Dr. Armin?
Dr. Armin: There are some robotic systems that are being tried out. Most of the systems are not ready for prime time yet but that is just around the corner and we are probably looking at may be a year or two away, but nowadays it is not done robotically. We use various types of neuro-navigation and image guidance systems during the surgery to help improve the precision and accuracy of the operation. That is now being done routinely in many hospitals including Corona Regional Medical Center, but the robotics are not here yet.
Melanie: In just the last few minutes, Dr. Armin; what should people with back issues and back pain and, as you said, this is one of the number one causes for people to miss work and come to see a doctor. What should they think about when seeking care?
Dr. Armin: One very important issue is, number one, for them not to ignore their symptoms, mainly including pain, and even more importantly, having numbness or weakness. Many times, I encounter patients who have ignored their symptoms for quite a while, they come to me with sometimes obvious weakness, difficulty walking, lack of balance. Sometimes I see patients with frozen shoulder where the muscle has atrophied, they are no longer able to move their arm, they are no longer able to bring their foot up, they have various other symptoms such as a foot drop. Some of these can sometimes become irreversible and you may not even be able to fix even with operative intervention. So I think it's very important for them to seek the right specialist which, in this case, would be a neurosurgeon, a spine specialist, soon and not ignore their symptoms. Number two is for them to have a complete evaluation which involves the imaging studies that we briefly mentioned, including the MRI. One other thing that I just wanted to mention since we talked about minimally invasive spine surgery and its benefits, minimally invasive spine surgery is even a better option for the elderly patients. A very large portion of my patients nowadays because of the aging population are elderly. The minimally invasive spine surgery allows these patients to leave the hospital quicker and get back on their feet a lot faster. And, also for obese patients. Many patients with low back pain, especially, because they become less mobile, they tend to put on a lot of weight. Obese patients in general are an excellent candidate for the minimally invasive spine surgery and also there are patients who, for various reasons such as religious reasons, patients being Jehovah's witnesses, they do not even want to receive blood transfusions. Because of the less blood loss that we would expect on these operations, these types of patients would even be better candidates for minimally invasive spine surgery.
Melanie: And, why should they come to Corona Regional Medical Center for their care?
Dr. Armin: At Corona Regional Medical Center, there's a multidisciplinary approach to treatment of patients with spinal disorders. They do have all the surgical equipment that are advanced and they are fully equipped to treat patients with spinal disorders, whether it has to do with the cervical spine, the low back, the mid back and all the various types of surgeries we discussed, including minimally invasive spine surgery, whether it be a decompression operation or a fusion surgery, and whether we are talking about artificial disc replacement. All these types of surgeries can be done very effectively and safely at Corona Regional Medical Center. And, also the use of navigation, using computers and image guidance, during surgery can be done readily at Corona Regional Medical Center.
Melanie: Thank you so much for such great information, Dr. Armin. You're listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to coronaregional.com. That's coronaregional.com. Physicians are independent practitioners who are not employees or agents of Corona Regional Medical Center. 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
Smoothies are a great way to get tons of nutrients in an on-the-go snack.
Additional Info
- Segment Number 5
- Audio File clean_food_network/1634cf1e.mp3
- Featured Speaker Jenna Tanenbaum
-
Guest Bio
Jenna Tanenbaum is the founder of Green Blender, a smoothie delivery service based in Brooklyn, NY. She believes that being healthy should be fun and easy.
Green Blender sends out all the pre-portioned ingredients and superfoods to make healthy, wholesome smoothies at home.
When she's not blending up the latest smoothie recipe for Green Blender, she is trying out new ways to sweat.
The philosophy of naturopathic medicine is to use the most natural methods to achieve optimal health and beauty.
Additional Info
- Segment Number 3
- Audio File clean_food_network/1634cf1c.mp3
- Featured Speaker Pina LoGiudice, ND, LAc
-
Guest Bio
Dr. Pina LoGiudice is a well-recognized expert in the field of natural medicine. She was awarded the Health Care Heroes Award in 2011 along with her husband, Dr. Peter Bongiorno, in the category for Complementary and Alternative Health.
Dr. Pina is the past vice-president of the New York Association of Naturopathic Physicians and an honored member of the American Association for Naturopathic Physicians. She has taught at New York University, Mt. Sinai School of Medicine, and is on the adjunct faculty at the Natural Gourmet Institute for Food and Health. She is a frequent expert guest on the Dr. Oz Show as well as numerous other media.
Clean eating encompasses more than just the foods you put into your body.
Additional Info
- Segment Number 2
- Audio File clean_food_network/1634cf1b.mp3
- Featured Speaker James Smith, Chef
-
Guest Bio
In November of 2014, Chef James Smith was appointed as the first-ever Chair of Culinary Programs and Operations for Centennial College.
James adds over 26 years of culinary, academic and leadership experience to this team.
James joins us most recently from Georgian College where he was the Associate Dean of Hospitality, Tourism and Recreation. James' primary passion has always been the Culinary Arts having worked in leadership positions at several Toronto landmark restaurants including Scaramouche, Truffles at the Four Seasons, Boba and Senator Restaurants. James also brings a wealth of experience in Food Media having worked on Food Network productions such as Cook Like a Chef, Christine Cushing Live, Martin Yan's Chinatowns Series as well as working with Canadian Living Magazine.
James began his academic teaching career at the Calphalon Culinary Centre before he transitioned into a full-time position at George Brown College as the inaugural Research and Development Chef at the Centre for Hospitality & Culinary Arts. James went on to teach in Continuing Education and Apprenticeship before he was hired as a full-time faculty member to teach Culinary courses in the Bachelor of Applied Business in Hospitality Operations degree. Once established as an exceptional professor, James moved on to develop and launch an innovative program combining Culinary Management and Nutrition where he fostered many partnerships, participated in many applied research projects and created an active program advisory committee.
James' personal education journey includes obtaining a Culinary Management Diploma as well as his Red Seal Certification before he completed his MBA in Hospitality and Tourism from the University of Guelph.
Additional Info
- Segment Number 2
- Audio File corona/1634cr3b.mp3
- Doctors Khamsi, Babak
- Featured Speaker Babak Khamsi, MD
-
Guest Bio
Dr. Babak Khamsi is a native of California and finished his undergraduate studies in Electrical Engineering at UCLA graduating Cum Laude and inducted into the prestigious honor societies Tau Beta Pi and Eta Kappa Nu. He pursued his medical training at Upstate Medical University in Syracuse, NY. His Orthopaedic Residency was at Rutgers-New Jersey Medical School (formerly UMDNJ) where he served as administrative chief his last year and was recognized with “resident teaching award” by his peers. He completed his fellowship in Spine Surgery under world renowned spine surgeons at UCLA. Dr. Khamsi is board eligible and is a member of American Academy of Orthopaedic Surgeons (AAOS) and North American Spine Society (NASS). He has had several publications in books and peer reviewed journals and stays active in research.
Learn more about Babak Khamsi, MD -
Transcription
Melanie Cole (Host): Many people have occasional neck pain or stiffness. In many cases, it may be due to poor posture, normal wear and tear or overuse. If you do suffer from neck pain, you know how difficult everyday movements and activities can be. My guest today is Dr. Babak Khamsi. He is an orthopedic surgeon and a member of the medical staff at Corona Regional Medical Center. Welcome to the show, Dr. Khamsi. What are some of the most common causes of neck pain that you see?
Dr. Babak Khamsi (Guest): Thank you very much. Thanks for having me. Neck pain can be caused by many, many different problems or as we call, different pathologies. As you know, in the neck you have the bones, you have the discs, you have ligaments and you have muscle, and any one of those can be causing the pain. So, as a doctor, as a surgeon, it's my job to figure out what's exactly causing the neck pain and based on that, there are different treatment options that we can try.
Melanie: People sometimes just have a stiff neck or even stress can affect neck and shoulder pain. What is a red flag, Dr. Khamsi, that would someone to see a doctor in a first place?
Dr. Khamsi: Well, I would say if your pain is persistent for more than a few days and if you have tried some of the over-the-counter medications such as ibuprofen or Tylenol and you don’t get any type of relief, that’s when you probably want to get it checked out. Now, I am not saying that you needed to jump to see a spine surgeon such as myself. You can always see your primary care physician, possibly get some x-rays and be examined by them and, if needed, they can refer to us. The other thing that's important to pay attention to, is if the pain shoots down the arms. If you have neck pain that is associated with tingling or numbness of the fingers or the pain that is going down to your shoulders or all the way to your hands, at that point, that can be some concern and you need to be evaluated by a specialist.
Melanie: Are there certain risk factors for neck pain?
Dr. Khamsi: The neck pain is really multi-factorial. We don’t really know what's causing it, but we know that there is a genetic factor to it. And, also it depends on the people who are working with heavy instruments or are construction workers, mechanics with a lot of physical activities that usually tend to have a higher rate of neck pain.
Melanie: Are you seeing more neck pain, Dr. Khamsi, from kyphotic positions--people looking down at their phones, working at their computers? Is that causing an increase in neck problems?
Dr. Khamsi: Absolutely. People who have their necks hanging, which you see in dentists a lot because their neck is always bent down looking in somebody's mouth; somebody who does a lot of reading, you see in students a lot, they do a lot of reading. They can have neck pain. Usually this type of neck pain is related to the muscle of the neck and treatment options for this type of neck pain are usually a lot of physical therapy, working on strengthening the muscles, especially the muscles in the back that hold the head up. And, the majority of those patients can have very good relief with physical therapy and strengthening of the muscles.
Melanie: Someone does suffer from neck pain. Do you like ice or heat to relieve some of those symptoms?
Dr. Khamsi: That's a great question. I get that question a lot. There is really no good scientific evidence on whether ice is better or heat is better. I always tell a patient, try both, whatever works for you. Some people like ice better, some will like heat better and neither one matters. As long as you get good relief with either one, you can try it.
Melanie: What kind of surgical interventions are available for people who suffer from chronic, very painful neck pain?
Dr. Khamsi: I would say, in general, the main treatment just for neck pain is conservative management, including physical therapy, strengthening and stretching, if it’s just neck pain. Now, if the pain starts radiating down the arms and/or the patient does not really respond to conservative management, then there are different surgical interventions that can be tried. It really depends on the pathology, but I would say most the common procedure that we do on a neck is a fusion surgery. It's called “ACDF,” which is anterior cervical discectomy and fusion. That's ACDF and, basically, what that consists of is the surgeon will go from the front of the neck and will remove the disc that we think is causing the problem and we put a spacer where the disc belongs to, that way we can restore the normal anatomy of the cervical spine. Then we put a small plate with some screws on the front of the spine just to keep everything together. That's probably the most common surgery that we do for neck problems. Of course, there are other procedures that can be done depending on different pathology, but that’s the most common one.
Melanie: What is it like after the anterior cervical discectomy for patients? Is, then, their neck pain gone? Do they feel a little more stiffness? What goes on?
Dr. Khamsi: Again, great question. I would say in general, ACDF or anterior fusion of the spine, is good successful surgery. A lot of you ask about stiffness. They think because we have fused one or two levels of their neck, they can be more stiff. Actually, there have been some studies done looking at that and, surprisingly, we see a better range of motion after fusion of the neck and the reason for that is that when you fuse the bad levels, the patient actually has less pain in their neck so they are actually able achieve more range of motion without pain. So, the stiffness is usually not a problem after this surgery. The majority of people do very well after this surgery. Some of the more common side effects that we see are that a lot of you have some problems swallowing after such procedure, but that's usually transient and it goes away after about a week or so. But, I would say that's the biggest complication of this surgery--difficulty of swallowing--but the results are phenomenal.
Melanie: What about neck braces?
Dr. Khamsi: I recommend neck braces sometimes on, what we call “PRN basis” or “as needed” basis. I see some patients who wear the neck brace as soon as they wake up and wear it throughout the day. That is not a good idea. As I said, a lot of times, the reason you would have neck pain is because the muscles are weak and that’s causing the pain. When you wear a neck brace at all times, what happens is, your muscles become lazy and they depend on that brace. So, this actually has the exact opposite effect of doing physical therapy. So, even though you may feel good while wearing the brace, it actually has a bad effect on the muscles. It makes the muscles weaker, which is exactly what we don’t want. So, I don’t recommend wearing a brace at all times, but if someone wants to wear it, if they are doing something hard, strenuous and they feel like they need that extra support for a few hours or if they are going for a long drive and they want to wear that because they feel more secure--that I don’t have a problem with. Wearing it on a persistent basis, it’s not a good idea.
Melanie: Are there some lifestyle modifications, Dr. Khamsi, that you can recommend? People don’t know if they can exercise their neck or what they should be doing to make their neck stronger.
Dr. Khamsi: Well, I would say if you do have neck problems, I really encourage you to be trained by a physical therapist. There are different exercises that can be done, but you should really be evaluated and be trained by a professional, by someone who is trained to do this, whether it’s a physical therapist or sometimes a chiropractor. What they do, they usually come up with a whole exercise program where they train you on what to do and in a safe manner where you can see the best benefit from it.
Melanie: In just the last few minutes, Dr. Khamsi, what should people with chronic neck pain think about when seeking care?
Dr. Khamsi: Well, the way I always tell my patients is that you should see…Pain is very subjective and different people have different demands in life. Before you see a surgeon, you should really think about it hard. As I always say, surgery is injury. So, surgery should be saved for those people who have tried everything else and they just come to this conclusion by themselves that, “I just cannot live like this anymore.” We take every surgery very seriously, even though the risk of complication from surgery is very, very low, usually less than 1%, we still take it very seriously and I don’t like jumping into surgery. But if someone with chronic neck problems who has tried everything else is thinking about surgery, the question they should ask themselves is “Can I or can’t I live like this for the next 10, 15, 20 years.” And if the answer is “No. You know what? This is making me miserable. It's affecting my activities of daily living. I cannot enjoy doing what I enjoy on a regular basis because of my neck problems, then those should really consider surgery and see a specialist.”
Melanie: And, why should they come to Corona Regional Medical Center for their care?
Dr. Khamsi: Well, here at Corona Regional Medical Center, we are very well trained. My partner, Dr. Cramer and I, we do only spine. I am an orthopedic surgeon, he is a neurosurgeon but we are both fellowship trained in spine and we can really tackle any type of problem that a patient can have. As I said before, we are very conservative. We try to reserve surgery as the very last solution, but if it comes down to surgery, we do any type of spine surgery all the time and we have very good results.
Melanie: Thank you so much for being with us today, Dr. Khamsi. It's such great information. You are listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to coronaregional.com. That's coronaregional.com. Physicians are independent practitioners who are not employees or agents of Corona Regional Medical Center. 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
When you make the decision to start eating clean, you must start to think about what you put into your body and be more mindful of the choices you make.
Additional Info
- Segment Number 1
- Audio File clean_food_network/1634cf1a.mp3
- Featured Speaker James Smith, Chef
-
Guest Bio
In November of 2014, Chef James Smith was appointed as the first-ever Chair of Culinary Programs and Operations for Centennial College.
James adds over 26 years of culinary, academic and leadership experience to this team.
James joins us most recently from Georgian College where he was the Associate Dean of Hospitality, Tourism and Recreation. James' primary passion has always been the Culinary Arts having worked in leadership positions at several Toronto landmark restaurants including Scaramouche, Truffles at the Four Seasons, Boba and Senator Restaurants. James also brings a wealth of experience in Food Media having worked on Food Network productions such as Cook Like a Chef, Christine Cushing Live, Martin Yan's Chinatowns Series as well as working with Canadian Living Magazine.
James began his academic teaching career at the Calphalon Culinary Centre before he transitioned into a full-time position at George Brown College as the inaugural Research and Development Chef at the Centre for Hospitality & Culinary Arts. James went on to teach in Continuing Education and Apprenticeship before he was hired as a full-time faculty member to teach Culinary courses in the Bachelor of Applied Business in Hospitality Operations degree. Once established as an exceptional professor, James moved on to develop and launch an innovative program combining Culinary Management and Nutrition where he fostered many partnerships, participated in many applied research projects and created an active program advisory committee.
James' personal education journey includes obtaining a Culinary Management Diploma as well as his Red Seal Certification before he completed his MBA in Hospitality and Tourism from the University of Guelph.
Additional Info
- Segment Number 1
- Audio File corona/1634cr3a.mp3
- Doctors Cramer, Dennis
- Featured Speaker Dennis Cramer, MD
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Guest Bio
Dr. Steven Cramer comes to us from our very own Riverside County, having grown up in Norco. After obtaining his bachelor's degree from U.C.L.A., he completed his neurological surgery residency at Arrowhead Regional Medical Center in San Bernardino, CA. He continued his education at the University of Cincinnati-Mayfield Clinic & Spine Institute where he completed a Complex Spine Orthopedic & Neurosurgery Fellowship, learning the most up to date skills for the treatment of adult and pediatric spinal pathology. In 2008, Dr. Cramer joined the Haider Spine Center. He also volunteers with the Children's Spine Foundation, allowing him to actively help underprivileged children who suffer from spinal ailments. He gained vast experience in evaluating and treating pediatric spinal issues while working at Cincinnati Children's Hospital in Ohio. In addition to his clinical experience, Dr. Cramer's fellowship research project was selected for the international American Association of Neurological Surgeons/Congress of Neurological Surgeons Mayfield Clinic Science Award of 2008, presented in Orlando, FL. He became the first osteopathic surgeon to receive the award. When not at work , Dr. Cramer enjoys spending time with his family and gardening.
Learn more about Dr. Cramer -
Transcription
orthMelanie Cole (Host): Low back pain is one of the most common reasons people visit their doctors every year. My guest today is Dr. Dennis Cramer. He is a neurosurgeon and a member of the medical staff at Corona Regional Medical Center. Welcome to the show, Dr. Cramer. Low back pain is one of the main reasons people stay out of work. What are some of the causes for low back pain?
Dr. Denis Cramer (Guest): I'll tell you that one of the most common causes is just age related wear and tear. Someone goes out, does some exercising or just bends over to lift something up and they feel a strain in their low back and, by and large, most of the time that resolves within a few hours. But, sometimes it could take a little longer and, unfortunately, there are those times that it doesn’t go away and that's the time where they are sent to a spine surgeon or neurosurgeon, such as myself.
Melanie: So, can people, if they start to feel those pains in their low back in the morning, what can they do for themselves before they would visit a doctor to try and stretch it out a little to get rid of some of that pain?
Dr. Cramer: No, you said exactly what I was thinking. First thing I would do is stretching in the morning. Just gradual standing and flexing over and getting your hands as far down to the ground as you can to the floor and some slow twisting of the spine. That's where I would start. Most of the back pains can be managed without any prescribed medications. So, I am talking use of Tylenol or some type of NSAID, such as Advil or Ibuprofen and maybe even some rest. I am not saying strict, laying in a bed or laying on a couch but probably holding off on going or doing any of your exercises such as at the gym or a long walk. I would probably wait a few days until the pain subsides.
Melanie: Do you like ice or heat for a sore back?
Dr. Cramer: I don't think there is any data that says one is better than the other and, in my patients, I tell them to use ice and if that doesn’t work, I'll tell them to put heat on their back and, many times, I tell them to alternate. I found through my experience that what works well for one group of individuals works a lot different for others. And so, if it does work, if ice works for a certain patient, I'll tell him to keep doing that and, if not, then try something different but, like I said, I don’t think there is any one type of treatment that you can use for everybody. It has to be tailored.
Melanie: We hear the word stenosis a lot, the sort of catch all term for kinds of all back pain. What is stenosis? What kinds of conditions do you see in the back that would require seeing a doctor?
Dr. Cramer: Well, I'll tell you, you are right. Stenosis is a phrase or medical terminology phrase that is frequently thrown out there. You see it a lot on MRI reports so forth and primary care doctors like to talk about it. But, basically, stenosis is when the canal or the spinal frame where the nerves exit the canal become pinched, meaning from a disc herniation or you get a lot of arthritis that is starting to block the exiting of the nerves and, in that way, and that’s actually called “stenosis”. Now, it’s the degree of stenosis that people eventually refer to a surgeon for and, depending on that degree, someone may need to have that operated on to open up and relieve the compressed nerve.
Melanie: What kinds of tests would you order if somebody suffers from chronic low back pain?
Dr. Cramer: Well, as a spine surgeon, we typically like to divide pain into basically into two different categories. Number one is just pure, straight back pain and the second type is back pain which effects the exiting nerves in the lumbar spine and results in pain in the legs and we often refer to that as “sciatica”. If someone has straight back pain, we start off by getting some x-rays of the lumbar spine. And, a lot of the times, I’ll have the patient lean forward and lean back and get an x-ray to see if there is any abnormal movement of the bones in the spine because that itself--abnormal movement itself--can result in the pain. Once the x-rays are done and we prescribe treatment based on that--it might be a short course of physical therapy. If they're still having issues or having sciatica like symptoms then probably the next test I would order is an MRI scan. MRI scans are really good for looking at soft tissue and when I say soft tissue, what I am looking for are the discs itself. I am looking to look at the nerve roots in the spinal cord itself as well as the amount of ligamentum and nerve pinching. Because those kinds of things, the soft tissue structures, you can't really see on x-rays. X-rays are more to look at spinal alignment and to look for fractures or any other type of a boney pathology.
Melanie: When we are looking at some treatments for low back pain, people hear about epidurals, they hear about steroid injections, either orally or injected. Tell us, when do those come up?
Dr. Cramer: Well, I typically order quite a few epidural steroid injections. They are mostly indicated for people that have sharp shooting pains into the legs, also known sciatica or the other word that is kind of interchangeable with that is radiculopathy. Basically, radiculopathy means that there is pressure on the nerves and is sending pain down the leg. Since there is a lot of inflammation around the nerve itself, we'll go ahead and take a needle, put the needle right where the nerve is being pinched, right where it’s been inflamed, and inject a small amount of steroid medication. As people may know or may not know, a steroid is a very powerful anti-inflammatory medication. It reduces the amount of swelling and irritation around the nerve itself. So, most of the time a patient will experience a significant reduction in the amount of pain after an epidural steroid injection. Now the thing is that you can only have so many injections because it’s a steroid, so you don’t want to keep going and getting injection after injection because of the drawbacks and side effects of steroids. Sometimes, some steroid injections don’t last as long as we want them to. Steroid injections are typically only indicated for someone with a more acute or sub-acute pain, meaning someone might have sciatica, but if it’s been over three or four or six months, a steroid injection might not provide enough long-term treatment than more than for a few days or a few weeks. So, you have to weigh the risks and benefits and pros and cons of epidurals.
Melanie: What can they do prevention-wise? While it may not be possible to prevent low back pain, are there some life style modifications you'd like to recommend to help with that sort of pain?
Dr. Cramer: Well, yes, there are. And, we talked about one of those. I think that stretching is very important and to do stretching, even if you don’t have pain, I think that helps. But, I think one of the biggest risk factors for low back pain and degenerate changes are smokers. So, when I have a patient that comes in, the number one thing I'll tell them is that, “You've got to stop smoking” because not only is it very important for someone's overall health, but studies have shown how smokers have very bad backs. And what I mean by that is, as we get older we get degeneration and bone spurs and arthritis in our joints in the back and that's just a normal process of age-related wear and tear, but smokers seem to have accelerated degenerate changes. That's what we try to stay away from. So, that's the number one thing about people that smoke that really is hard on the spine itself. Another treatment to help prevent is the type of activities you do. If you are doing a lot of activates where you are twisting your spine such as a sport, particularly in golfers, it’s really hard on the joints and the back and many times when I see these long standing golfers that come in and their backs show severe degeneration. So, I just try to counsel them on the need to be very careful with the type of activities they do.
Melanie: What about proper lifting techniques?
Dr. Cramer: Yes. I go over that with my patients about the way to lift and more to bend the knees and kind of bend the pelvis so much, not so much hump over and bend over your back when you are lifting a heavy objects because when you are in a bent over or forward bent position and you try to lift a heavy object, that puts an immense load on the pressure in our joints and in our discs in the lumbar spine and repetitively doing that over a long period can cause some serious damage and a reason why patients are finally referred to their family doctor or their family doctor refers them to their local neurosurgeon for evaluation.
Melanie: In just the last few minutes, Dr. Cramer, what should people with low back pain think about when seeking care?
Dr. Cramer: I think the first thing that they should seek is that they need to find a doctor that if you are comfortable with, that is going to treat them in a very logical, methodical way and starting from A and then finishing at Z, just go step by step.
Melanie: And, why should they come to Corona Regional Medical Center for their care?
Dr. Cramer: Well, I think the physicians at Corona do exactly that. They start off with behavioral techniques that we talked about, proper stretching, proper lifestyle changes. If that doesn’t work, the next step would, we see if the patient is a candidate for epidurals or for physical therapy or chiropractic manipulation and if that doesn’t work there's still ongoing pain and pathology, then that’s when you start doing x-rays and imaging studies such as an MRI scan and possibly the nerve studies. By that time, if they have been down that trail and they are still not getting better, then many times the primary care physician will go ahead and send them to myself or for evaluation.
Melanie: Thank you so much for being with us today. You are listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to coronaregional.com. Physicians are independent practitioners who are not employees or agents of Corona Regional Medical Center. The hospital shall not liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 5
- Audio File virginia_health/1629vh3e.mp3
- Doctors Harvey, Jennifer A
- Featured Speaker Jennifer A Harvey, MD
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Guest Bio
Dr. Jennifer Harvey trained in Arizona, receiving her BS degree in zoology and chemistry at Northern Arizona University and her Doctorate of Medicine degree at the University of Arizona. She also completed her residency training in diagnostic radiology at the University of Arizona, where she served as chief resident. She was certified by the American Board of Radiology in 1993. Dr. Harvey has been the head of the Division of Breast Imaging at UVA since 1994, and director or co-director of the UVA Breast Program since 2000. She is a fellow of the Society of Breast Imaging and the American College of Radiology. Her primary research interest is mammographic breast density and the association with breast cancer risk. From mammography and tomosynthesis (3D mammography), to ultrasound and breast MRI, Dr. Harvey is involved in all aspects of breast imaging. She also performs image-guided breast biopsies including stereotactic, ultrasound, MRI guided biopsies and radioactive seed localization procedures.
Learn more about Dr. Harvey
Learn more about UVA Cancer Center -
Transcription
Melanie Cole (Host): If a recent mammogram showed you have dense breast tissue, you may wonder what this means for your breast cancer risk. My guest today is Dr. Jennifer Harvey. She's the head of the division of breast imaging at UVA Cancer Center. Welcome to the show, Dr. Harvey. So, doctors know that dense breast tissue makes breast cancer screening a little more difficult. What does that phrase "dense breasts" mean?
Dr. Jennifer Harvey (Guest): So, women with dense breast tissue, that means that there's a lot of white on the mammogram and that white tissue is composed of breast tissue, you know, the part of the breast that makes milk, as well as fibrous tissue, which is just a sort of dense fibrous tissue.
Melanie: So, how does a woman know if she has dense breasts?
Dr. Harvey: So, in Virginia, we have a law that requires us to tell you in your letter if you have dense tissue. If you do not have dense tissue, there won't be anything about breast density in your letter of your mammogram results.
Melanie: So, this is a law in some states and the woman gets it, and then, what does she do with that information?
Dr. Harvey: Well, that's the big question and it is somewhat under debate with breast imagers. I think the most important thing to know about dense breast tissue is that mammography is less sensitive and so, you know, you hear back and forth "Oh, maybe I should wait more years between screenings," and things. If you have dense tissue, you need to come every year. So, don't skip a year and you should also consider sort of optimizing your screening. And that could be either with tomosynthesis, which is 3D mammography or getting an ultrasound of your breasts. Either of those will give us a better opportunity to see breast cancer at an earlier stage.
Melanie: So, how does dense breast tissue differ when you're looking at the screening--and you mentioned 3D tomosynthesis--how does it differ for what you see?
Dr. Harvey: Yes, so, cancers are white, typically, on mammography. So, we're trying to find a white cancer in a background of white tissue. So, you can see why it's harder for us to find them on regular mammograms. The 3D, those are pictures that are taken sort of in an arc over the breast and then, those get reformatted in slices, kind of like a CT scan, and so, basically, that allows cancers to be sort of uncovered, if you will. They can be obscured by clumps of dense tissue, so we can sort of see behind the clumps. So, that helps us see more cancers. But, for women with very, very dense tissue, where it's completely white, the extremely dense category, which is about 10% of women, the tomosynthesis may not be enough, so ultrasound gives us a different way to look at the tissue. On ultrasound, cancers are dark and the breast tissue's white. So, then we're looking for dark masses in a sea of white tissue. So, it's a different way to look at the tissue.
Melanie: When do we have to go to an ultrasound?
Dr. Harvey: So, in many states, all women with heterogeneous, or very dense breast tissue, are offered screening ultrasound and I think it's a good idea for most women to at least consider it. Insurance may or may not cover it, but I think it's a really good idea, again, because it's a different way for us to look for cancer. For women with that very dense tissue, that's probably the best option to have a screening ultrasound in addition to the mammogram. Now, the downside of screening ultrasound is that we find a lot of things that we think are going to be cancer, that are benign. So, I think it's really very individual what you decide. If you're somebody who is a minimalist, you know, I definitely don't want to have any extra biopsies or follow ups, then I would recommend the 3D mammography. If you're somebody that wants to do everything and have every opportunity to find cancer earlier, even if it means having more biopsies, then I would do a mammogram and an ultrasound.
Melanie: Do dense breasts put us at a higher risk for breast cancer?
Dr. Harvey: Yes, they do and it kind of makes sense. So, women who have denser tissue that likely indicates that the breast tissue is more active, and the more active the tissue is, sort of the more cell turnover it has, and every cell turnover, there's an opportunity to sort of have our DNA make a mistake, if you will, and increase the risk of cancer. So, women who are very dense are about twice as likely as the average woman to develop breast cancer. It doesn't put anybody at high risk on its own, but it definitely does increase the risk.
Melanie: Will it change our ability to do a self-exam if we're somebody who has dense breast tissue?
Dr. Harvey: You know, that is a great question and it often does because women with dense tissue often have a very firm breast, but it's not always that way. In my 20 years of practice, I've been surprised sometimes that women with dense tissue can very have soft breasts and can feel lumps easier, but, in general, women with denser tissue, it is going to be harder to feel lumps and they often have lumpy breasts to begin with. So, just doing self-exam alone is not going to be enough to supplement your mammogram. But, if you do feel something, please come and see us.
Melanie: And if you have dense breasts, are there some lifestyle choices that you can make to help keep your risk a little bit lower?
Dr. Harvey: Yes, there are. So, you've probably heard that women in developed countries have a higher risk of breast cancer. So, some of the things that increase our risk are things that we can't control as well, like having children at a later age and things like that, but hormone therapy increases the risk, not hugely, but it does increase risk after menopause. Weight gain after menopause increases the risk as well, and alcohol increases risk as well. So, try to minimize your alcohol use. Exercise and breastfeeding are both protective against breast cancer. So, if you can do those, that does make a difference.
Melanie: In just the last few minutes, give us your best advice. What do you want women to know about the laws regarding dense breast tissue and even where they don't have these laws, what's your best advice for women about getting screened and really taking charge of their own health?
Dr. Harvey: I think if you have dense breast tissue, you need to know that mammography is imperfect for you. That it is going to be harder for us to find things. So, make the most of your opportunities. Show up every year for your mammogram, don't skip a year, get the 3D, and definitely at least consider ultrasound. You know, if you end up having to have a little needle biopsy or something like that, that may be a small price for us to be able to find cancers early. I would definitely consider that.
Melanie: Tell us about your team at the Breast Imaging of UVA Cancer Center.
Dr. Harvey: Oh, we have a great team. So, everybody who works here, we do just breast care. So, for example, all of the radiologists, we do breast care. We don't look at gallbladders and things like that. We are dedicated to what we do, and very passionate about what we do.
Melanie: Thank you so much for being with us. What great and such important information for women. You're listening to UVA Health Systems Radio and for more information, you can go to uvahealth.com. That's uvahealth.com for more information on breast imaging at the UVA Cancer Center. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 4
- Audio File virginia_health/1629vh3d.mp3
- Doctors Perry, Mary Lou
- Featured Speaker Mary Lou Perry, MS, RD, CDE
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Guest Bio
Mary Lou Perry, MS, RD is a registered dietitian and a certified diabetes educator.
Learn more about Mary Lou Perry, MS, RD -
Transcription
Melanie Cole (Host): Do you know what the key components of a heart healthy diet really are? My guest today is Mary Lou Perry. She’s a Registered Dietician Nutritionist and a Certified Diabetes Educator at UVA Health System. Welcome to the show, Mary Lou. What are the seven simple steps outlined by the American Heart Association to avoid cardiovascular disease?
Mary Lou Perry (Guest): Well, thanks, Melanie. I appreciate being on. The Life’s Simple 7, actually, Seven Small Steps to Big Changes, is the American Heart Association’s call to action for the population to decrease cardiovascular risk and there are seven small steps that people are encouraged to do. One is to manage blood pressure; secondly, to keep blood cholesterol at or near normal; manage blood glucose, not smoking, and if you do to quit smoking; increasing your physical activity to at least 150 minutes a week; losing weight if you are overweight or obese; and then, finally, the one that’s near and dear to my heart, eating well. So, those are all those things that can go into a heart-healthy lifestyle and reducing the risk of cardiovascular disease or cardiovascular death.
Melanie: What’s involved in eating healthy? People see so much Mary Lou in the media and all around and it can be a bit confusing when they’re hearing about carbohydrates are not good for you or fats are not good. You should eat more protein, less protein, clear some of this heart-healthy eating up for us.
Mary Lou: There’s no doubt about it, there are lots of mixed messages out there and depending on someone’s ability to communicate, you might hear one louder than the other. But, here’s what we do know. People do not eat in nutrients. People don’t think about, “Well, I’m going to have two carbohydrates today and one fat today.” People think in terms of food and so we have to start talking to people about eating healthy, not with nutrients but eating healthy with real food. So, what does that actually look like? The big players here for heart healthy eating are always going to be fruit and vegetables. Across the board, no matter what study that you read, no matter what study population or what kind of conditions, what seems to really get filtered through one time and time again is the benefit of consuming lots of fruit and lots of vegetables. So, I would just say to somebody I’m working with, if they’re only eating, and most of us or very few of us are getting the recommended amount of fruits and vegetables. So, first, just start with that, by adding more fruits and vegetables to the way that you eat. Now, what that will mean is that you’re actually increasing healthy carbohydrates and, in doing so, you’re decreasing saturated fat, cholesterol, and total fat. But, the patient hears it or the person hears it as something that they can do--an actionable step that’s relatively simple. I can eat more fruit and vegetables. So, I get why there’s a lot of confusion but we can clear that up by just some basic, simple steps. I already talked about the benefits of fruit and vegetables and we also know that fish and regular consumption of fish is associated with decreasing cardiovascular risk and having real benefit. What’s now recommended for the population is at least two fish meals a week and, if that fish could be some kind of Omega-3 rich or rich in Omega-3 fatty acid, all the better. So, something like salmon, mackerel, or tuna, but even if it isn’t, the fact that you’re consuming seafood or fish means that you’re getting significantly less fat and significantly less saturated fat. So, we know fruits and vegetables are good; we know that consuming more fish, especially about two servings per week; we also know that there are certain kinds of fat, not so much the how much but it’s really about the what kind when it comes to fat. And, this is also where a lot of the confusion comes from. Many people have probably heard the Mediterranean diet or heard of the Mediterranean style of eating. That is what we think about when we think about a heart-healthy diets because one of the things that they do really well in the Mediterranean is eat well because they eat locally and they don’t eat processed foods. They also use lots and lots of olive oil for flavoring and for cooking. So, that’s a real important component of eating healthy and decreasing the amount of saturated fat and increasing the amount of healthy fat. That would be in the form of using olive oil when you can. Additionally, it is important to decrease saturated fat as well as cholesterol. Now, what does that look like? What’s the real food recommendation? That would be increase the amount of chicken, turkey, and lean cuts of beef that you’re eating. Decrease the amount that you’re eating and then, finally, keep the style of cooking bake, broiled or grilled so that you’re decreasing total fat, not only in the cooking but total fat in the type of meat, as well as the amount of meat. Generally, what we tell patients as a good rule of thumb is to use a deck of cards. A deck of cards is the perfect portion for a serving size of meat. So, far you’ve got eating more fruits and vegetables, consuming healthy fats such as olive oil, eating more fish, and using leaner cuts of meat or types of meat. And then, what we also know is that decreasing fried foods becomes important. That will decrease the total fat and the amount of saturated fat, and finally the calories. One of the things that we also know is that two thirds of our population is struggling with weight issues and that means that the majority of the people that we come across probably could lose some weight. To lose some weight, you want to do that slowly and you want to cut back on calories. The way to do that is to decrease high calorie foods like fried foods and snack foods. Another thing that has come about, Melanie, quite interestingly or more recently in the last couple of years, is the whole area of sugar. It used to be that sugar wasn’t recommended because of the extra calories or the impact it has on dental cavities, but now we know that sugar is probably a bigger culprit in cardiovascular disease, diabetes, and other kinds of metabolic type syndromes. If we look at population studies, we know that Americans across the board are consuming too much sugar. In fact, the average sugar consumption in a teaspoon a day, now this just isn’t added sugar but what’s contained in food, average sugar consumption for most Americans is 22 teaspoons of sugar. What the American Heart Association is saying, as well as the US Dietary Guidelines says, “Let’s cut that in half.” Cut that down to about ten teaspoons a day or approximately 100 calories coming from simple sugars or added sugars. So, that’s a very interesting thesis, something people can start thinking about. I think that the way that that would work in a meal plan is look at the beverages that you’re consuming and are you consuming regular soda pop? Are you consuming sugar-containing beverages? Cut back on those and even cut back on fruit drinks that aren’t always 100% fruit but they do contain added sugar. So, watch the beverage intake and try to limit your beverage intake to mostly water, coffee, and tea that’s unsweetened. But, again, I think we can sometimes make it more complicated than it needs to be by focusing on a micronutrient or a macronutrient. By picking on B12 or B6 or picking on carbohydrate, protein, and fat, but it really makes sense to take a couple steps back and look at it in terms of, how to I make sense of this and what do I put on my plate and how do I do this day after day? So, using those general guidelines will help people navigate a confusing world around food and nutrition when it comes to cardiovascular health. Melanie, does that answer your question?
Melanie: It certainly does Mary Lou. What an amazing guest you are. I have one last question for you, what do you want people to do? Give us your best advice when they dine out to follow these bits of information that you’ve given us today, and they were such great bits of information, but when they dine out, they look at that menu and they don’t know whether one thing is healthy or not. They see avocados. They think that’s going to be healthy but some people say that’s very high calorie, high fat food. What do you want them to know about dining out?
Mary Lou: Great question and I do want to just, as a side bar, when it comes to avocados, avocados are very healthy foods and so very high in these monounsaturated fats. Avocados, though, high in calories, they also pack a punch. So, I would say avocados on the whole are healthy because of their healthy fats. But, let me get to the real question was, what do we do when we go out to eat? How do we know how to maneuver these dietary guidelines or these dietary recommendations when we eat out? I think first and foremost, just remember, when you eat out, most serving sizes are much too large or way too big for most people. So, ask for a doggy bag, even before you order just say I want to get a doggy bag or simply split the entrée with a friend. That way you’re cutting back on literally half the calories and half the fat. Additionally, with that you want to watch out for fancified types of foods, if you will. Those are things with heavy sauces and gravies and stick with plain things. So, like a plain steak, not a sixteen ounce rib eye, but maybe a four ounce sirloin which is not covered in bleu cheese or not covered in some kind of special sauce. So, the things you want to look for words like “plain” or not fried. And then, another thing is just ask questions. Many times in a restaurant you can make wonderful substitutions that aren’t always listed or clear in the menu. So, if you’re looking at decreasing total calories or decreasing total fat, and on the menu French fries are served, ask your server if you can substitute a steamed vegetable in place of those French fries. You’re going to get healthy carbohydrate, you’re going to get a lot less calories, and you’re going to get a lot more fiber, all of which are heart-healthy. So, I would say just kind of go armed with a healthy curiosity, ask questions of your server and some restaurants are now partnering with the American Heart Association for heart-healthy entrees. So, sometimes you can even look for that as a shortcut to making healthier choices. The one piece of advice that I would give people when they’re getting fast food is to think small. So, when I say that, think like a kid. Get the kid’s meal. Most times, you can ask the fast food restaurant for the kid’s meal. That way, you’re getting much smaller portions of what’s being offered. So, I think, as a rule of thumb, when you go for fast food, think small and also ask the same questions about making some of those healthy substitutions.
Melanie: Thank you so much for being with us today, Mary Lou. It’s really great information. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
