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Additional Info
- Segment Number 4
- Audio File allina_health/1627ah5d.mp3
- Doctors Mooney, Marc E
- Featured Speaker Marc Mooney, LP -Clinical Psychologist
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Guest Bio
Marc E Mooney, LP is a clinical psychologist at Allina Health Mental Health – Abbott Northwestern Clinic with professional interests in anxiety disorder, obsessive-compulsive disorder, and psychotic and mood disorders.
Learn more about Marc Mooney, PhD -
Transcription
Melanie Cole (Host): Obsessive Compulsive Disorder, formerly considered a type of anxiety disorder, is now regarded as a unique condition. How can you tell if OCD tendencies are symptoms that require professional help? My guest today is Dr. Mark Mooney. He's a clinical psychologist with specialties in anxiety disorder and Obsessive Compulsive Disorder at Allina Health Mental Health at Northwestern Clinic. Welcome to the show, Dr. Mooney. So, first, tell us: people have heard OCD; they think hand washing. What really are obsessive compulsive disorders?
Dr. Mark Mooney (Guest): They are disorders that involve both problems with thinking and then, also, with behaviors that are interruptive or troublesome.
Melanie: So, what are some symptoms that--well, first of all, let's ask who's at risk for these? Is there a genetic component?
Dr. Mooney: There is a genetic component to these. It does tend to run in families.
Melanie: Okay. So, if it runs in families, you know that this is something that you might have a tendency toward. What do you look for?
Dr. Mooney: Well, interestingly, you would look more for the compulsions than the obsessions, because the obsessions are thoughts. We can't see them. The compulsions are ritualized, repetitive behaviors that can be things like hand washing, checking or cleaning.
Melanie: So, compulsions are ritualized. So, the difference between those is…because we all have crazy . . . not crazy, but wild thoughts sometimes. It's whether we act on them, correct? Or, how does that work?
Dr. Mooney: Well, so, we all can be compulsive and we all can have obsessions, at times. The distinction between sort of typical stuff that most people have in OCD is really the amount of time that is spent obsessing and compulsing. More than one hour a day.
Melanie: So, the sort of starting point is more than one hour a day? And, what if that's sort of broken up and some people have those thoughts scattered throughout the day?
Dr. Mooney: Well, it's in its totality. If you're spending five minutes here and ten minutes there, if it adds up to an hour or more a day, then that's one rule-of-thumb for deciding whether a person needs therapy and medication.
Melanie: So, are there certain environmental factors that can also contribute?
Dr. Mooney: Well, certainly stress and pressure will make a person more obsessive and more compulsive and this is true for normal people, also.
Melanie: So, when would they start to notice? I mean, is this something that you would start in childhood and takes you through or does it typically start in the teen years or even later?
Dr. Mooney: It can definitely start in childhood and the nature of what people obsess about, the bad thoughts that they have differs, I think, with age a little bit, but it certainly can start in children as young as five.
Melanie: So, what's a parent to look for? Because some kids just want to have clean hands and they're told at school so many times to wash their hands, so maybe they overdo it a little bit at the beginning. How long does it go on before then you say, “Okay, this is definitely something that requires professional help”?
Dr. Mooney: I think when it reaches a point where it's interfering with a child's routines and behavior. Where they're late for the school bus; or they're not going to recess because they're washing their hands; or they're not going out to play sports with others because they're avoiding things that, say, they might think are contaminated. That would be a point where an evaluation would be warranted.
Melanie: Will it go away by itself or does it really need treatment?
Dr. Mooney: It really needs treatment.
Melanie: What's treatment involve?
Dr. Mooney: Treatment involves one of two approaches. There are classes of medications that can help make people have less obsessions and then, in terms of psychological treatment, there is what is called cognitive behavioral therapy which involves finding those things that make an obsessive compulsive person anxious and then having them systematically expose themselves to those things until their anxiety goes down.
Melanie: So, are there certain exercises, per se, that you recommend to your patients that they can do at home? And, if people are starting to have some of these obsessive thoughts, is there some way that you tell them that they can sort of do cognitive behavioral therapy on themselves on the off days that they're not seeing you?
Dr. Mooney: In fact, they do and, really, the majority of the effective treatment that happens in psychotherapy for OCD are the exercises or the exposures that patients do when they're not in the clinic.
Melanie: So, give us an example of what you tell people to do.
Dr. Mooney: An example might be that a person has a fear of contamination. Let's say they're afraid of germs. I might have them go to a public place and touch some door handles or knobs and then sit and not wash their hands for an hour.
Melanie: So, in other words, it's restraint from that feeling. How difficult is that for people?
Dr. Mooney: It can be very difficult. On the plus side, though, it's extremely effective when I can get people to do exposures to the things that make them anxious and make them obsess, whether it's disorder or cluttered things, or if it's contamination. They can enjoy a great deal of symptomatic relief in just a matter of two or three months.
Melanie: And, is this something that, by doing these things and using restraint and training their brain, as it were, and through cognitive behavioral therapy, that you can overcome, or is it something you will be working on the rest of your life?
Dr. Mooney: I think that if a person can do a good course of cognitive behavioral therapy for one type of obsession, say, it's contamination, that they will learn skills to help prevent them from developing an obsession in another area.
Melanie: And, what are the medications intended to do?
Dr. Mooney: The medications simply reduce the intensity and the frequency of obsession.
Melanie: How do they do that? Is this a hormonal thing acting on brain hormones, or what does that do?
Dr. Mooney: They achieve this effect primarily through increasing levels of serotonin in the brain which tends to make people less impulsive and more planful. It makes it easier for them to tolerate the stress.
Melanie: So, that's kind of where I was getting, is the serotonin uptake inhibitors that someone might take, and there are certain other therapies that can help increase serotonin levels, like exercise. Do you recommend any of those to kind of help as an adjunct?
Dr. Mooney: I definitely recommend exercise. Meditation practices are also helpful. Anything that decreases the level of stress is going to decrease the frequency of symptoms of OCD.
Melanie: Are there certain movements, repetitions that people can do that don't necessarily say “Yes, they're an OCD”?
Dr. Mooney: This is very true. There are many people who have very orderly routines and patterns of behavior that are not compulsive and they're normal and healthy.
Melanie: So, you can be a very organized person and still not be considered OCD?
Dr. Mooney: Very true.
Melanie: And now, tell us about your group at Allina Health Mental Health.
Dr. Mooney: Our group is an outpatient group that meets weekly and the people who come to the group are adults who have Obsessive Compulsive Disorder and are looking to work on their problems in a group setting.
Melanie: So, wrap it up for us, Dr. Mooney, about OCDs, what you tell people every day about these because this is such a huge problem. Millions of people suffer from them and some people it really, really affects their everyday quality of life. What do you tell people every day about ways to manage them?
Dr. Mooney: I tell them that even though it's a very confusing and disturbing problem to have, that they can get better with treatment and most people will and that it's possible, with a relatively limited amount of effort and time and treatment and with medication, that they can live almost symptom-free lives.
Melanie: Wow. That's great advice, and very hopeful for people suffering with OCDs. Thank you so much for being with us and for more information about Allina Health's Mental Health at Abbott Northwestern Clinic, you can go to AllinaHealth.org. That's AllinaHealth.org. You're listening to The WELLcast with Allina Health. This is Melanie Cole, thanks so much for listening.
- Hosts Melanie Cole, MS
Vitamin D is so essential for optimal health, but many individuals are simply not getting enough and are considered deficient.
Additional Info
- Segment Number 2
- Audio File clean_food_network/1630cf1b.mp3
- Featured Speaker Michelle Dudash, Chef & Clean Eating Expert
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Guest Bio
Michelle Dudash is the creator of CleanEatingCookingSchool.com and a writer whose “Dish with Dudash” column is published in the Arizona Republic. It reaches over 1.5 million readers per week.
She is also a featured monthly guest on KPNX-TV’s Arizona Midday show, and a regular contributor to the Food Network’s Healthy Eats blog, one of the most heavily read columns on the television network’s site.
Learn more about the natural, effective, and safe approach to conserving bone mass and building healthy bones.
Additional Info
- Segment Number 5
- Audio File clean_food_network/1630cf1e.mp3
- Featured Speaker Laura Kelly, DAOM
- Guest Bio Dr. Laura Kelly is a licensed Traditional Chinese Medicine practitioner and Doctor of Acupuncture and Oriental Medicine. She completed her medical training and doctorate at Yo San University in Los Angeles. Her private practice focuses on primary care and chronic disease. She is working with a research group to document the biochemical effects of Chinese herbs on fatigue and is leading the investigation on a nonsurgical treatment for paralysis. On her blog, Case Notes, she writes about her experiences in medical practice. In 2017, she will complete The Institute of Functional Medicine’s Certificate Program (IFMCP). She lives and works in Topanga, California.
Learn some simple tips to make your healthy eating quest more doable.
Additional Info
- Segment Number 4
- Audio File clean_food_network/1630cf1d.mp3
- Featured Speaker Ramona Fasula
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Guest Bio
Ramona Fasula is a Certified Holistic Health Coach and CEO of Wellness by Ramona. She helps busy professionals to feel confident, secure, and in control of their health by designing customized wellness programs. She is a natural health expert, and has dedicated her life to helping others enjoy a better quality of life. With a host of various certifications in the health and wellness field, she will be pursuing a Doctorate in Holistic Nutrition in the near future.
Ramona is also a first time author of A Health Coach’s Guide to Heart Health, recently launched a line of healthy living ebooks and is working on developing healthy living e-courses. She has made several guest appearances on such radio shows as Women to Watch with Susan Rocco, The Mike Siegel Show, Nyghtstorm Radio, OC Radio, Wellness Journey, Live, and most recently, The Ask Bon Bon Show on the Lifestyle Channel for which she was asked to be their health expert.
She has also written for various publications, including South Jersey Mom Magazine, The CEO Magazine, Mom Meet Mom, Proud Working Mom, Urbanette Magazine, Women’s Wellness Over 40, and About Her Magazine. In her spare time, she is a volunteer for the American Heart Association and serves as the lead in the DreamViolet Healthy Lifestyle Initiative. With so much passion and knowledge, it is easy to see why she has achieved the level of success that she has had with her clients.
If you have a sweet tooth, giving up your favorite tweaks for the sake of health may seem impossible.
Additional Info
- Segment Number 2
- Audio File clean_food_network/1630cf1c.mp3
- Featured Speaker Caryn Fine Sullivan
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Guest Bio
Caryn Fine Sullivan is a wife, mother, writer, public speaker, former media executive, and cancer survivor who always finds a reason to smile.
An imperfect perfectionist, Caryn tirelessly seeks wholesome and reputable methods to improve her family’s overall health and well-being. With a storytelling-like style that’s easily consumable for the busy woman, her writing chronicles her enthusiastic search for a more-zen lifestyle.
As a longtime soap opera enthusiast and 17-plus year veteran of the sports and media industries, Caryn brings entertainment and great character to her daily life. She’s been seen dressed in a train costume while reading stories to her son’s class, leaving small notes behind to make her husband smile, and writing silly poems to motivate friends and co-workers.
A former Hostess Snowballs addict, Caryn now has a plant-based nutrition certification and a new-found love for green juices, avocados and hot yoga. She’s a contributor to the Huffington Post and has been seen on The Dr. Oz Show, HuffPost Live, WTNH-TV News Channel 8, Fox CT and News12 Connecticut as well as on her blog, PrettyWellness.com and YouTube channel.
Caryn lives in Connecticut with her husband and son.
How can you create your own kitchen ecosystem?
Additional Info
- Segment Number 1
- Audio File clean_food_network/1630cf1a.mp3
- Featured Speaker Eugenia Bone
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Guest Bio
Eugenia Bone is a nationally known food and nature journalist and author. Her work has appeared in many magazines and newspapers, including the New York Times, Wall Street Journal, Denver Post, Saveur, Food & Wine, Gourmet, Martha Stewart Living, Wine Enthusiast, Sunset, Metropolis, New York Magazine, and the National Lampoon.
She is the author of five books. At Mesa's Edge was nominated for a Colorado Book Award. She wrote Italian Family Dining with her father, celebrated chef Edward Giobbi. Well-Preserved was nominated for a James Beard award, and was on many best cookbooks of 2009 lists. Mycophilia: Revelations From the Weird World of Mushrooms was on Amazon's best science books of 2011 list and nominated for a Council on Botanical and Horticultural Libraries award. Her fifth book, The Kitchen Ecosystem (October, 2014) was nominated for a Books for a Better Life award, and on many best cookbooks of 2014 lists. Here current project is Symbiotica (Rodale, 2017) a survey of the huge impact of the smallest things… microbes!
Her writing and recipes have been anthologized in a number of publications, including Best Food Writing, Saveur Cooks, and The Food & Wine Cookbook, among others. Eugenia has lectured widely, in venues like the Denver Botanical Garden, Georgia Center for the Book, the Rubin Museum, and the American Museum of Natural History, and many mycological and gardening societies, and has been the featured speaker at a number of mushroom festivals. She has judged food and wine competitions, and appeared on television, radio, and pod casts many times. She is the founder of Slow Food Western Slope in Colorado and is the former president of the New York Mycological Society, which was founded over 50 years ago by composer John Cage.
She writes the blog, kitchenecosystem.com.
Eugenia lives in New York City and Western Colorado.
Additional Info
- Segment Number 2
- Audio File virginia_health/1629vh3b.mp3
- Doctors Adams, Reid B.
- Featured Speaker Reid B. Adams, MD
-
Guest Bio
Dr. Reid Adams is a board-certified surgeon and chief of surgical oncology; as well as the chief of liver and pancreatic surgery at UVA Cancer Center. His specialties include liver, pancreatic and biliary cancers and diseases.
Learn more about Dr. Reid Adams
Learn more about UVA Cancer Center -
Transcription
Melanie Cole (Host): Have you been told that you might have to have spine surgery? That could be a scary thought, although with some new advances in spinal surgery, recovery may be easier than you think. My guest today is Dr. Jeff Gleimer. He’s an orthopedic spinal surgeon with Lourdes Health System. Welcome to the show, Dr. Gleimer. Tell us a little bit about what reasons people would need spine surgery.
Dr. Jeff Gleimer (Guest): Yes. Hi, Melanie. Thanks for having me. Spinal surgery is obviously, as you mentioned, a last resort and a concern for a lot of patients out there. One of the major reasons is pain-- pain in the back, pain in the buttock, pain in the leg, weakness in the leg. These issues, that do not improve after physical therapy, anti-inflammatory medications, modifying activities, the pain that just doesn’t go away. At a minimum of six weeks, potentially no longer as six months, people reach an area where surgery on the spine is appropriate and indicated. And, again, everyone is truly an individual when it comes to these problems and it’s really something that must be discussed and really reviewed with a spinal surgeon in detail before surgery is really, truly appropriate for that given patient.
Melanie: So, people have all kinds of issues with their spine-- scoliosis and stenosis--catch all terms and arthritis and they get that sciatic pain you described; the weakness in the legs and the pain down the legs. What would, then, signal to you, that this is a surgical need? This needs an intervention. When does it come to that?
Dr. Gleimer: It is, unfortunately, all too common. I think it’s rare if any of us have gone through our lives without meeting someone that has either had back or leg pain at some point in their lives. It’s the pain that just won’t go away. I tell all my patients, “This is never an operation that I will have to sell to you or encourage you to have.” These patients will come in and they know full well they have tried everything like physical therapy and medications and maybe they’ve been through pain management injections, things like epidural steroid shots in their spine and they just get temporary relief from these modalities. And, they just reach a point where they can’t live with the back pain or the leg pain and, at that point surgery, is appropriate. Surgery helps a large majority of these patients that have the right type of problem in their back.
Melanie: As we mentioned at the beginning, spinal surgery sounds scary- long recovery. Tell us what’s going on, that’s changing the world of spinal surgery for the better.
Dr. Gleimer: There have been dramatic improvements. As most of us have hoped, with technology there have been dramatic improvements. The goal, always, is to make surgery safer, more efficient, better outcomes in a shorter period of time. One of these advances has been robotic spinal surgery, which really allows for patients to have truly less invasive surgery on their spine. Traditionally, they would need a large incision, a lot of stripping of muscle and tendons off their back. With this new technology, we’re able to make smaller incisions with nearly 100% accuracy in placing pedicle screws, for example, and performing operations to stabilize scoliotic spine and painful spines with degenerative disc disease, arthritis, removing herniated discs. The less invasive our surgeries are, the quicker patients are recovering. The surgery can be done and they can go home the same day.
Melanie: Wow, fascinating. Tell us a little bit about the Mazor Robotics Renaissance Guidance System. Tell us about this Mazor surgery. What does it entail? How does it work?
Dr. Gleimer: So, it is a state-of-the-art technology that has been around now for quite a few years and it’s really catching speed here on the East coast. What it is, in essence, is a tiny robot. So, truly good things come in small packages. This is a very small robot that is placed just over the patient when they’re under anesthesia and through a computer system as well as CT scans or a Computed Tomography scan, which is a very, very detailed x-ray, we’re able to see, in detail, the patients spine--the bones in their back. This robot then aligns a special type of drill to perfectly place pedicle screws, specifically. Pedicle screw is a large screw. It looks like a drywall screw for any of the construction folks out there or contractors. And, this gets placed into the spine. This robot that is about the size of a soda allows for nearly perfect trajectory to place these screws into the spine, avoiding all the big, scary concerns people have such as being paralyzed, damaging a nerve, or having a severe amount of pain after surgery. So, the robot really guides the surgeon’s hand. The surgeon is still needed, so we haven’t become obsolete yet, but the robot really has perfected this portion of spine surgery to really make pedicle screw placement nearly perfect.
Melanie: And, what’s it like for the patient, Dr. Gleimer, in terms of recovery and after-pain?
Dr. Gleimer: That’s one of the best things, Melanie. Traditionally, spinal surgery is exceedingly painful because of the dissection. What we need to do traditionally to see the right area of the spine to, in essence, place these pedicle screws freehand which takes a high amount of skill, without a doubt, which I’ve been doing for years. So, you can really appreciate using the Mazor Robot that you now can do it through a small stab incision in the patients back, maybe about a centimeter. That’s about it. And the guide is about the diameter of a pencil, that’s placed in the right position. You then drill with a high-speed drill and then you place the pedicle screw directly down this channel and these screws end up in just the right spot much more rapidly and the patient has less surgical time which is always better for the patient . It allows them to recover much more quickly. They don’t have that pain that is typically present from all the dissection that’s needed to put these screws in traditionally. Furthermore, one of the biggest things for myself, who has been doing less-invasive spine surgery, is the robot allows you to minimize the amount of radiation that the patient is exposed to during the surgery. Otherwise, we have to use a lot of x-rays, for the patient, for myself, for any surgeon that’s performing this, there’s a lot of x-ray that has to take place in order to place these screws in an otherwise less-invasive way. And, this robotic technology really negates the need for all these x-rays. We take one x-ray to start, one x-ray at the end and the rest of it is without x-ray.
Melanie: Are there any people that might not be a candidate for this type of surgery?
Dr. Gleimer: One of the great things, no. Anyone that meets those indications to have a spinal surgery done that requires screws in their back, what is commonly referred to as a “fusion” operation for that nagging low back pain that just won’t go away with everything that they’ve tried. This allows for near perfect placement of the screws. So, no. There’s no patient that is not a candidate to have this technology for them, if they need the surgery to begin with, of course.
Melanie: Wow. That is absolutely fascinating information, Dr. Gleimer. In the last few minutes, wrap it up for us about spinal pain, when surgical intervention is needed and the latest technologies--why you’re so excited about these types of procedures.
Dr. Gleimer: It really allows patients to undergo an otherwise horrifying type of surgery from the stories we’ve heard from our grandparents to our aunts and uncles that have had a friend or a neighbor that has had spinal surgery and was never the same again, I can assure you that there are far more good outcomes from spinal surgeries these days than without. And now, with this Mazor Robotic surgery, it allows it to be that much better. Patients feel better quicker, they get better quicker, and, if I can leave the audience out there with one concept to remember it is that patients that have spinal surgery with the Mazor Robotic technology, they get better and they don’t just get better, they get better quicker than they would without it.
Melanie: What great advice. And, just tell us Dr. Gleimer about your team at Lourdes Health System.
Dr. Gleimer: My opinion, one of the best in the country and I’ve been everywhere from Los Angeles and back. They are top notch. There’s a dedicated team that only does spinal surgery. The consistency is key. You have the same team, the same nurses, and the same anesthesia providers that are in the room that just make everything so smooth and perfect, you couldn’t ask for a better place to have the Mazor Robot utilized to get people better, quicker, with less pain.
Melanie: Well I’m sure they couldn’t ask for a more amazing doctor than you. What a doll you are and thank you so much for being with us today, Dr. Gleimer. You’re listening to Lourdes Health Talk and for more information you can go to LourdesNet.org. That’s LourdesNet.org. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 1
- Audio File florida/1630fl1a.mp3
- Doctors Tolat, Mihir
- Featured Speaker Mihir Tolat, MD
-
Guest Bio
Mihir Tolat, MD is a pediactric specialist at Florida Hospital Memorial Medical Center.
Learn more about Mihir Tolat, MD -
Transcription
Melanie Cole (Host): Childhood obesity has more than doubled in children and quadrupled in adolescents in the past thirty years, reaching what experts are now calling epidemic proportions. My guest today is Dr Mihir Tolat. He's a pediatrician with Florida hospital. Welcome to the show, Dr Tolat. Tell us what's going on with children today and the obesity epidemic that you are seeing as a paediatrician and what are your theories on some of the causes?
Dr Mihir Tolat (Guest): Melanie, childhood obesity has become not only a national but a global health epidemic. In the US, nearly one third of the children that are aged two years to nineteen years are overweight or obese according to the 2014 statistics by CDC, and worldwide nearly 41 million children under the age of five are either obese or overweight. It is very concerning to me as a pediatrician and to parents because these children who are obese tend to become obese and overweight as adults, putting them at higher risk for heart disease, for Type II diabetes, for dyslipidemia and also for social and emotional difficulties such as stigmatization and low self-esteem. So, it's really important, as a pediatrician and as a parent, that we deal with this epidemic as early as we can and as young as they are, before it get to manifest it’s ugly head as an adult.
Melanie: So, Dr. Tolat, as far as health effects of childhood obesity, you are seeing even things that used to be just adult diseases, like diabetes Type III, which used to be called “adult onset”--it's not anymore. High blood pressure--you're seeing these things in children now, yes?
Dr Tolat: Yes, it's becoming more prevalent especially with poor dieting and lack of exercise that's been going on in society today. Now these diseases that we saw only in adults are also happening in adolescents.
Melanie: So, what are you as pediatricians doing if a parent comes into your office, are we taking BMIs of children now? Is this a standard thing to do? And then, how do you talk to parents about what the results of a BMI are?
Dr Tolat: By definition, the BMI are calculated in children that are two years and older. Under the age of two, like from babies until about twenty three months, we take what we call weight for height values, and above 95 percentile, even in this age group, is somewhat concerning. So, if they are at that level, we try to follow them more closely than we would otherwise. We take BMI every health care visit for ages two years and beyond and any BMI that's between 85th percentile to 94th percentile is considered overweight, and above 95th percentile or a BMI of 30 is considered obese. Once we have these values, we take further actions into finding out what are reasons of their BMI’s are so high and what we can do as pediatricians, as parents, as society to help them lose weight and overcome these challenges.
Melanie: Do you ever run into resistance from parents when you tell them that their child has a weight issue, and sometimes you would see that the parent has a weight issue as well?
Dr Tolat: To be honest with you, a lot of times, most of the obese that we do see have parents that are also obese. And, there are a lot of racial and ethnic disparities in groups on what healthy is by definition. A lot of Hispanic communities feel that having rolled on babies or chubby cheeks on a child is what is claimed as healthiness as opposed to other ethnicities which view them as “my kid is overweight” or “my kid is obese”. And, I've also seen that a lot of times it's a family oriented approach. So, many times the practice of the parents in terms of their diet and exercise, the kids also have a similar kind of lifestyle because they look up to the parent as a role model for what is ideal and what is appropriate in terms of diet and exercise and they kind of follow the same trend, making them also obese, like the parents.
Melanie: What do you tell parents who say to you, "But, my kid is a picky eater. He won't eat vegetables and he doesn't really like to eat healthy food, he just likes his junk food"?
Dr Tolat: We counsel parents on the harmful effects of unhealthy foods and what it can lead to later in life but, to be honest, education and counselling can only go so far. There has to be some structured behavioural modification that has to take place if we are to see any changes. Like, we have to make sure we tell parents that there are several culprits of obesity that have been identified, such as intake of sugars in beverages, like soda, ice tea, sweet tea, sports drinks, energy drinks, and juices that are advertised as juices but they only contain 10% juice. We really tell parents that we want to minimize that because that's a lot of excess calories which are of no use. So, AAP actually recommend that juice only given in amounts of four to six ounces in children that are one to six years, and no more than twelve ounces for those above the age of six years. So, no more than that. Not only do these foods and beverages lead to excessive weight gain but also can lead to tooth decay. The other thing we also recommend for parents is to minimize the foods that are increased energy dense, such as fattened rich meat, fried foods, fast foods, sweets, cheeses. On contrary, we tell them to go for healthier options. So, it's always important because kids want options. It's not like you can be an authoritative parent and say, "You must eat this, this, and this." You want to give kids options but you want to make them choose from the healthier options. You have the veggie sticks, you have the fruits, and you have the greens. Try to help them choose from a healthier version of a plate as opposed to unhealthy foods. The other culprit that has been big in obesity is television viewing The American Academy of Pediatrics recommends that children under the age of two years should not be watching TV and the ones that are above two years limited to no more than two hours a day. TV viewing, or any kind of games, computers or laptops, are all sedentary forms of activities which takes away from the time that they can actually utilize to do physical activity and, also, a lot of the commercials on TVs promote unhealthy things. There are a lot of commercial about fast food restaurants and unhealthy juices and foods. So, it promotes those as opposed to promoting healthy food. We also recommend that they eat age appropriate content, like each age has certain amount of calories that they need to grow. There's no need for access calories beyond that because obesity is basically an equation of how much energy you take in and how much you put out. It's believed that it's easy to control what we can put in and the amount we take in, as opposed to burning it off That is a much more rigorous process to actually burn and do physical activity to burn all the excess calories we put in. So, it’s really important that the foods we eat are low in calories and are low in energy. They're healthy and we have portion control in terms of how much we eat. Besides the nutrition aspect of it, the other aspect that we push on is physical activity. The American Academy of Pediatrics recommends that kids at least need to do sixty minutes of moderate to vigorous activity per day. Hopefully, some of that could be done in school with gym or other activities but a lot of the stuff could be done as the family. You don't have to be enrolled in the gym. You can go for hikes and go for a walks. You can walk the dog and roller skating. You can use stairs as opposed to using the elevators. You can walk to school, if it's feasible. We try to promote all these things to help work on this whole obesity epidemic.
Melanie: That's great advice, Dr. Tolat. Limiting screen time as the AAP recommends and offering that healthy choices as opposed to a choice between a banana and maybe something that's very unhealthy like a piece of candy. Those are all great advice. Now what about the schools because this is a bigger problem than we even realize. The schools are cutting gym and recess in favor of academics but kids need to run around, get their beans out. What do you tell parents about community involvement and getting their children more active to prevent childhood obesity when the schools sometimes have to cut some of that activity time?
Dr Tolat: Yes, I understand the academic portion of schools but, as a community, we need to work with the schools to promote these kinds of activities. Like I said, it's not only about running around. A lot of the stuff that can also be done without an official recess or gym class, or something, but we should promote a gym class, that helps build self-esteem and it helps promote healthy habits. The other thing with school that is important is that a child spends a lot of their hours of the day in school. It's important to know what they're feeding in school. So, parents should inquire about the menu at school, at lunch cafeteria, that they're offering healthy options because you don't want at home to promote healthy eating while at school they're getting pizza and other kind of unhealthy foods.
Melanie: That's great advice for parents to really make sure they inquire at their schools about the menu that the kids are getting. So, wrap it up for us, Dr. Tolat, with your very best advice for parents in this epidemic of childhood obesity and the dangers of children's health and what you want them to know about prevention or working with obese children?
Dr Tolat: Alright. So, basically, I would encourage parents to buy fewer food associated with obesity and, if they buy these foods—like, if it's a birthday or something like that--it should be bought right before that event happens and it should be disposed right after the event is over. If you were to store that in the fridge, it should not be very visible on the front. It should be maybe in the back of the fridge where it's not visible, and it should be preferably covered in aluminium foil or something that's not a see through thing because lot of the times when some stuff is closer to us we are more prone to utilize those foods as opposed to ones that are further from our reach or further from our sight. I also recommend limiting the serving size of meals, use smaller size plates, bowl, spoons for foods that are higher in calories versus bigger sizes for these items, if the food that we're giving are lower in calories and healthier food. Decrease that sedentary lifestyle options by removing televisions from the bedroom and areas where food consumption is done. I would limit the use of video games and computers for sleep time and physical activity. This whole thing basically, I'll be honest with you, is a family based interventions. So, they're more effective than if we just spoke with a child, the family has to work together like I said, because children look up to parents as role models, so what the parents do, the children generally tend to model. If the parents themselves want their children to become healthy adult, the parents have to take that initiative now themselves to also start living a healthier lifestyle.
Melanie: Thank you so much for being with us Dr Tolat, it's really important information. You're listening to Health Chat by Florida Hospital, and for more information you can go to fhpediatricians.com. That's fhpediatricians.com. This is Melanie Cole, thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 3
- Audio File allina_health/1627ah5c.mp3
- Doctors Osborne, Jan
- Featured Speaker Jan Osborne, APRN - Gerontological Clinical Nurse Specialist
- Guest Bio Jan Osborne is a gerontological clinical nurse specialist at Unity Hospital in Fridley. She is the nursing coordinator for the Nurses Improving Care of Healthsytem Elders, NICHE, program working to improve geriatric care housewide. She was influential in establishing Allina's first Acute Care for Elders, ACE, unit at Unity. Her practice includes patient consultation for patients with delirium, dementia and management of geriatric syndromes, and site lead for fall prevention.
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Transcription
Melanie Cole (Host): As our parents age, chances are good that we'll find ourselves switching roles. We're no longer just their child, we're now the caregiver. This change in roles can be confusing for both the parent and the child. My guest today is Jan Osborne. She's a gerontological clinical nurse specialist at Unity Hospital in Fridley, part of Allina Health. Welcome to the show, Jan. What's the most important thing? What do you tell people every single day about aging, that can help us better care for our parents?
Jan Osborne (Guest): Well, thank you, Melanie on having me on this show today. I'm very excited to talk about the older adult and aging. I think the number one thing that most people don't understand is that as we age, older adults don't show the same symptoms of illness that a younger adult may show. The first sign of an illness may be a fall, or a new confusion, or just forgetting to take their medication. So, I think sometimes that gets it's overlooked as a sign of an illness. It's called “atypical presentation of disease” and older adults may have that type of symptom instead of a high fever, instead of a cough. They may have a fall or a confusion as the first sign of an illness.
Melanie: So then, if you're dealing with your parents, one of the things that people run into on occasion is that resistance of their parents to let them help if they fell or if now they maybe need the bathroom to be redone and bars in the shower. There's a resistance there, Jen. What do you tell people about dealing with that resistance?
Jan: I think that it's very important to let your parents have control and show to them that they're in control of their life and their health, and you are there to help them. I think many older adults feel that if you tell someone that “I've fallen or I've forgotten to take my medications” that they're going to put you in a nursing home, and there's a big fear of that. We don't want to put our older adults in nursing homes; we want them to age in place. Part of that aging in place is keeping their home safe for them, having someone to come in and look and see if their home is safe by picking up loose rugs, giving them a bar in the shower to hold on to. If we focus on that and have open conversation with our parents to let them know that we're on their side. I think that goes a long way with the older adult.
Melanie: Another thing people run into is the big driving thing, Jen. So, you know, your parents and you get to be middle-aged, so you're that sandwich generation, and all of a sudden now, maybe your parents shouldn't be driving any more. How do you start that conversation with them?
Jan: Yes. I think that conversation has to start with your parents because you want to let them know that they're still in control of their lives. Ask them if they have any concerns about driving. I think one of the things that older adults can do proactively is to have their vision checked annually to make sure that they are seeing properly when they drive. Older adults may limit their driving when they know that they're having problems. They may just stay in their neighborhood. They may just only go to the grocery store and back, another way that we can tackle this is talk to the primary care physician about, “Do you think I should be driving?” So many times, the daughter or the son may send a letter to the physician saying, "I have concerns about my parents' driving," and that physician could perhaps do some type of testing with them or send them to a driving evaluation and have that done. Many times it's become quite a tug of war between the children and the parents about taking away the keys. So, that's a very tricky situation and it’s not a very easy one to take care of.
Melanie: Jan, parents' personalities start to change and we've heard that sort of old myth that if you were a sweetheart in your younger days, you turn a little bit meaner as you get older and vice versa. Is that true and what do you tell people about the changes that happen in personalities as people get older?
Jan: Well, usually as we get older our personalities stays the same. That is consistent throughout the lifespan. But, if you notice a distinct personality change, then I think it could be due to many reasons. It could be due to chronic pain that they're suffering from and that they're not mentioning to anyone and they're suffering underneath their personality. Or, it could be just changes in the brain which could be a sign of a mental health issue. So, I think it's something that you'd want to go and have their primary care physician check out. Just have a visit and talk about things like maybe anger or paranoia or fear, something that they can talk about with their primary care physician. They may not want to talk to their children about it, but they may want to talk to a mental health professional.
Melanie: What about sleep? Does that change as we age? Do older adults really need less sleep?
Jan: Well, sleep does change as we age, but the one thing about sleep that does not change is the amount of sleep we need. We definitely need 7 to 8 hours sleep as we get older. When we do get older, our sleep becomes more light. It becomes a little bit more difficult to fall asleep and then stay asleep. We may wake up in the middle of the night more easily. We don't have that deep sleep as we age. One of the things that impedes our sleep as we age is the amount of time that we need to get up to urinate during the middle of the night. For some reason, older adults produce more urine over the nighttime span than younger adults do. And so, we want to limit our fluids just a couple of hours before we go to bed, maybe put our feet up on the lounge chair at that time, too. Then, try to urinate before bedtime and then try to get a good night's sleep. When you get up 1 or 2 times a night during your sleeping time to urinate, that can really impede your sleep and really makes you feel crummy the next day.
Melanie: When the time comes when you feel your parents need either a caregiver or to move into assisted living, tell us how to begin that conversation.
Jan: Well, that conversation should be probably started well before that process ever happens. I think it's always good to talk about, as we get older with our parents, when they're starting to get older, not when they probably need to move the next week. So, having that open conversation, saying, “What would you like to see as you get older? Where would you like to live when you feel that you no longer can work this out yourself?” I think it's that process of communication and talking to your physician and knowing the resources in your neighborhood. We have a Senior LinkAge Line that is a 1-800 number that you can call, and it can really connect you to all kinds of services in Minnesota from home care to housekeeping to meals delivery. So, that can be a very helpful free service provided by the Minnesota Board on Aging.
Melanie: that Senior LinkAge Line is 1-800-333-2433. That's 1-800-333-2433. So now, tell us about some of the things at Allina that can help people who have aging parents.
Jan: Well, Allina has a very good website on health issues. You can go to AllinaHealth.org and listen to different podcasts, look at different diseases and issues. Allina Health hosts a Stepping On program, which is an outpatient or “open to the public” falls prevention program for older adults. It is for older adults to prevent falls by teaching them how to walk in the community, the types of shoes that are best for support for adequate walking, teaches them what medication side effects may impair with their walking. It's a very good, proven, research-based, program to reduce falls in older adults.
Melanie: So, that's called the Stepping On program, yes?
Jan: Yes.
Melanie: What a wonderful service that is. So now, wrap it up for us. Give your best advice when people come to you and their parents come to you, maybe they're starting to get a little forgetful and the son or daughter is concerned that it's Alzheimer's or dementia. What do you tell families when they come to you every day about this aging process and what they can expect?
Jan: I tell my patients' families that they should keep a close eye on their older adult relatives and keep asking questions, keep following up with them, monitoring what is going on and talking with them every day. When you see a change, report it to the physician, call that physician's office, make an appointment to see them, make sure that they're being safe, first of all. There are all kinds of resources out there on the web, there's the WWWAALZ.org for Alzheimer's. They provide a lot of support for our patients and family members who have loved ones with dementia. You can find out a lot of information there that can show you the top 10 signs of dementia and how to get help. There's always help out there and Allina Health is here to help with that aging process and realizing that we're all getting older every day. The more we know about our aging body, the better we can take care of ourselves.
Melanie: What great information. Thanks so much, Jan, for being with us. I applaud all the great work you do with families. You're listening to The WELLcast with Allina Health. For more information, you can go to AllinaHealth.org. That's AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 1
- Audio File virginia_health/1629vh3a.mp3
- Doctors Brayman, Kenneth L
- Featured Speaker Kenneth L Brayman, MD
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Guest Bio
Dr. Kenneth Brayman is a board-certified surgeon and the division chief of transplant surgery at UVA.
Learn more about Dr. Kenneth Brayman
Learn more about Charles O. Strickler Transplant Center at UVA -
Transcription
Melanie Cole (Host): If your child needs a liver transplant, you’ll have a team of specialists at UVA. This team approach ensures that your child receives the best therapy during this highly complex process. How will the new partnership between UVA and Children’s Hospital of Pittsburgh expand access to pediatric liver transplants in Virginia? My guest today is Dr. Kenneth Brayman. He’s a board certified surgeon and the Division Chief of Transplant Surgery at UVA. Welcome to the show. Dr. Brayman, tell us why did UVA and Children’s Hospital of Pittsburgh establish this partnership?
Dr. Kenneth Brayman (Guest): The partnership was established in an effort to improve access to high quality liver transplantation for pediatric age patients in the Commonwealth of Virginia that require liver replacement. Arguably, the University of Pittsburgh has the premier pediatric liver transplant program in the United States and, in fact, in the world. They have a large number of patients that come to their center seeking liver transplantation. For us in Virginia, we don’t have that high concentration of patients but we have some and we were able to create a win-win situation with the group at Pittsburgh in an effort to increase access to care and quality of care for pediatric age patients that require liver transplantation.
Melanie: So, how does this partnership work?
Dr. Brayman: Well, patients that are either referred to the University of Pittsburgh or patients from Virginia are evaluated for transplantation at the University of Virginia and then are transplanted here at the University of Virginia with organs that are procured locally.
Melanie: So, patients don’t have to go to Pittsburgh to receive their care?
Dr. Brayman: That’s correct. They don’t have to go to Pittsburgh and, for patients that are based in Roanoke and Richmond and in the Tidewater area, that’s a lot easier for them to be closer to their families to have their transplants done in Charlottesville as opposed to having to go to Pittsburgh.
Melanie: Tell us why a child might need a liver transplant. What sorts of conditions come up that would require this?
Dr. Brayman: Well, there are conditions that we’re born with called “congenital liver diseases” such as biliary atresia where the bile ducts are malformed, and that results in progressive fibrosis in the liver, and then liver failure. That is a condition which is not easily treated with anything but liver transplantation. Other conditions would include various types of genetic conditions such as metabolic diseases. There are diseases called “maple syrup urine disease” where there are metabolic conditions that the liver requires replacement. There are other conditions that result in abnormalities of liver resulting in scarring and cirrhosis. So, there are diseases that are peculiar to childhood that have nothing to do with alcohol or hepatitis, which are the primary reasons for adults to receive liver transplants. But, in children, the spectrum of diseases is different but equally life threatening.
Melanie: Tell us about some of the options for liver transplants for children. We hear in adults that a living donor can donate a part of a liver. Is that the same for children?
Dr. Brayman: Yes, it is. Adults can donate part of their liver. Usually, it’s what we call the left lateral segment, to a child. It’s very difficult to size match for liver transplants with children because of the requirement for having a donor that’s about the same size as the recipient. So, if you have very small children, there aren’t that many donors that are in that small size range. So, taking part of an adult liver and transplanting it to a child, is a very effective way of providing a new liver in a more timely fashion. And that, of course, can come from a living donor.
Melanie: Is it very tough to find donors for children’s liver transplants?
Dr. Brayman: Well, it is challenging. I think that’s one of the reasons why Pittsburgh was interested to collaborate with us because we, obviously, have access to a different donor pool than they do up in Pittsburgh. There is a national system for sharing but it’s regionally based and trying to find livers in a timely fashion for patients with rapidly advancing liver diseases is a national problem. So, in an effort to better serve their patients and also the patients of the Commonwealth, we struck up a partnership with them. And, for the University of Virginia and the citizens of the Commonwealth, we have the great fortune of being able to tap into their expertise and 40-year history of experience with liver transplantation. So, it really catapults the status of our liver transplant program for children from being a very small program to being a national player.
Melanie: Do children get priority for livers on a waiting list over adults?
Dr. Brayman: Well, they do get some priority but livers are pretty much distributed on the basis of how ill the patients are. So, there are some factors which will allow children to get some additional points, so to speak. In general, they do compete with adults for transplants.
Melanie: Tell us about your liver transplant care team at UVA.
Dr. Brayman: Well, we have a fabulous liver care team. We have very experienced pediatric hepatologists and gastroenterologists that are integrated with our local transplant surgeons as well as a variety of different nurse practitioners. The surgeons and the anesthesiologists from Pittsburgh will be coming down to the University of Virginia to participate in the actual surgeries themselves. There are nurses that are coming down to participate in the post-operative care of the patients that receive liver transplants here. University of Virginia has done a number of pediatric liver transplants successfully but having the collaboration with Pittsburgh is really wonderful because it will increase the volume and the complexity of the patients that we can take on as liver recipients.
Melanie: Doctor, what’s life like for a child that’s received a liver transplant? What happens afterwards as far as growth factors and nutritionally? What happens for a child?
Dr. Brayman: Well, it’s amazing. The patients that receive liver transplants, they will resume, essentially, a normal existence. Their liver, if they receive a segment, will grow in size to take up the area in their right-upper abdomen where the liver is situated. They will have normal clearance of toxins, normal production of bile, normal clearance of drugs, and they will grow and develop normally. There are many patients now that have received liver transplants in childhood since the mid-1980s that have gone on to grow up and have normal adulthoods, normal families, normal offspring. It’s remarkable. It basically takes individuals who have very little medical options and completely restores and rehabilitates them with the goal of achieving and living a long, normal life.
Melanie: Because you’re dealing with parents who, we all know, can worry about the smallest thing--and this not the smallest thing--what do you tell parents every single day about the hope for their child to live this nice, long, normal life?
Dr. Brayman: Well, it’s very challenging to have individuals that are in the hospital or as outpatients with families that are waiting for that very special call with the message that, “We have an organ for you--a gift of life.” So, we do our best to try to support families both that are here locally within the hospital and long distance, by being available to them and keeping them up to date as to the likelihood of receiving a transplant. We work very closely with the families and families appreciate the availability of our coordinators and our physicians. We offer a very satisfying experience for patients that do require a liver transplant.
Melanie: In just the last few minutes, Dr. Brayman, how do patients and families benefit from this partnership? Wrap it up for us. And, why should they come to UVA for their transplant care?
Dr. Brayman: Well, University of Virginia is the only comprehensive transplant program in the State of Virginia meaning that we offer all transplants: heart, lung, liver, kidney, pancreas, adult, pediatric. We offer a very high quality liver transplant and transplant experience. We have a very experienced team of physicians, surgeons and nurses. Our hospital is a premier institution which is very patient-centric. It takes the tension and minimizes it as best as possible, creates a very healthy environment for individuals to undergo a very stressful experience, which is to obtain a transplant. I think that it’s not just about the operation itself, it’s about the whole process--from the evaluation to the support from social workers, financial coordinators, to the ability to arrange for local housing and transportation. The excellent care and surgery that they get, obviously, is important, also; but it really is a very supportive environment to receive complex care.
Melanie: Thank you so much. What great and such important information. Dr. Brayman. Thank you so much for being with us. You're listening to UVA Healthy Systems Radio. For more information on the new partnership between UVA and Children’s Hospital of Pittsburgh, you can go to UVAhealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
