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Barbecuing can be a healthy way to cook, but you have to make sure you're doing it right.
Additional Info
- Segment Number 2
- Audio File clean_food_network/1626cf1b.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.
The busy-bee frenzy in which many people live their lives doesn't always allow for healthy eating.
Additional Info
- Segment Number 1
- Audio File clean_food_network/1626cf1a.mp3
- Featured Speaker Amy Symington, BAH, MSc
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Guest Bio
Amy Symington, BAH, MSc, is a nutrition professor, research associate and chef at George Brown College (GBC), where she teaches nutrition and culinary courses, develops nutrition focused curricula and works on health based research projects.
Amy has a M.Sc. in Applied Human Nutrition with a focus on functional food from Oxford Brookes University, UK. She also develops recipes, does food writing and provides nutrition advise to small and large businesses and magazines in the Greater Toronto Area including the infamous Clean Eating Magazine. In addition to teaching, applied research and recipe development, Amy is also the nutrition and kitchen program coordinator at Gilda's Club Greater Toronto where she runs a bi-weekly supper club program and provides nutrition workshops and culinary demonstrations to those touched by cancer.
Amy is recently the happy recipient of a SSHRC grant for the Community and College Social Innovation Fund to develop a cookbook and guide for cancer nutrition to be utilized by cancer care organizations like Gilda's Club Greater Toronto as well as those touched by cancer.
Whether you're just starting on the vegan path or are upping your vegan game, Jason Wrobel's new cookbook, Eaternity, is a great place to start.
Additional Info
- Segment Number 5
- Audio File clean_food_network/1626cf1e.mp3
- Featured Speaker Jason Wrobel, Chef
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Guest Bio
Detroit-born chef Jason Wrobel (aka J-Wro) is a graduate of the Living Light Culinary Institute with national certification as a Professional Raw Food Chef and Instructor. An ethical vegan for nearly two decades, he's inspired thousands of people worldwide to prepare deliciously easy and satisfying plant-based cuisine. The healing properties and outrageous tastes of his dishes have rendered his recipes favorites among celebrity clients and fans alike.
His popular YouTube channel, The J-Wro Show, features hundreds of vegan recipe videos and vibrant living vlogs. As the first-ever celebrity vegan chef on Cooking Channel, his TV series How to Live to 100 merged healthy, vegan comfort food recipes with a humorous blend of sitcom skits and innovative animation.
He lives in L.A. with his rescued feline companions, Lynx, Clawdia, and Figaro. Eaternity is his first book with Hay House.
Learn the health benefits of grinding your own flour.
Additional Info
- Segment Number 4
- Audio File clean_food_network/1626cf1d.mp3
- Featured Speaker Sue Becker
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Guest Bio
Sue Becker is a gifted speaker and teacher, whose passion is to share the principles of healthy living in a simple and encouraging way. She is the co-owner of two businesses and the founder of a non-profit ministry, Real Bread Outreach, all dedicated to educating others about whole grain nutrition.
Sue is a wife, mother and grandmother, with nine grown children and 10 grandchildren. She and her husband Brad, live in Canton, Georgia.
Through her teaching, countless families have found improved health.
Spiralizers are a fun way to introduce more vegetables, especially to finicky eaters, and reduce carbohydrates.
Additional Info
- Segment Number 3
- Audio File clean_food_network/1626cf1c.mp3
- Featured Speaker Marilyn Haugen
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Guest Bio
Marilyn Haugen is a small business owner, author, mother and passionate food lover. She holds both a BBA and an MBA. Marilyn’s professional career enabled her to travel the world and experience the food cycle from beginning to end, and in many different cultures.
After 30 years as a senior level finance professional working for large multinational corporations, Marilyn decided to become a stay-at-home mom and pursue her passions, many of which relate to food, home and health.
Marilyn has always been passionate about cooking because it brings people together. From her childhood days to present, food has always been a means of celebrating with family and friends.
Marilyn owns her own media company, which focuses on a variety of lifestyle interests, particularly great food and entertaining. You can join her at FoodThymes.com. Marilyn is also a syndicated contributor to the eMJay Media network.
Marilyn and her daughter live in Madison, Wisconsin.
Additional Info
- Segment Number 4
- Audio File allina_health/1620ah5d.mp3
- Doctors Hemmesch, Janel
- Featured Speaker Janel Hemmesch, RD, LD, Abbott Northwestern Hospital Bariatric Center in Minneapolis
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Guest Bio
Janel Hemmesch, RD, LD, is a registered, licensed dietitian with professional interests in bariatrics, cardiac nutrition and nutrition for gastrointestinal health.
Learn more about Janel Hemmesch, RD, LD -
Transcription
Melanie Cole (Host): The labels on the food you buy may look a lot different in the next two to three years and it may help you make healthier decisions. My guest today is Janel Hemmesch. She’s a Registered Dietitian at Abbott Northwestern Hospital Bariatric Center in Minneapolis. Welcome to the show, Janel. When did the labels last change? What has the FDA done recently that's different?
Janel Hemmesch (Guest): The last major change that they made was actually in 2006 when they put trans-fats on the label. But, they really have not had an overhaul since their original version. It has been long overdue and they’re finally going to make some pretty major changes to it, both format wise but then also, a lot of changes that are more of a reflection of the new research that we've had since they were originally made.
Melanie: Let's start with the format change, because people are just learning how to read those labels and understand what the different departments mean. What’s going to change with the format?
Janel: We know that if you’re going to look at anything on the label, the two things that are the most important are noting the serving size and how many calories. So, they have made the fonts bolder and larger for those two things so that people are drawn to those two. For most people, that might be the initial thing to look at but I eventually want them to go a little deeper and looking up the other things on the label.
Melanie: So, what’ else is changing that’s important that people do understand? The serving size and the calories per serving, because that sometimes can be a little bit confusing. What else is going to come out?
Janel: Very confusing. This is actually new information for me. What I thought was manufacturers were deciding what the serving sizes were, but I learned that there’s actually legislation that mandates that the serving sizes are a reflection of what we’re actually typically eating. So, those have not been updated since 1993 and we know that what we are eating, typically our serving sizes are a lot different than what was eaten in 1993. So, for a lot of foods the serving sizes might be going up and for some they’re going down. Overall, if you look at the fact that we have an obesity epidemic, we know that we're eating too much of a lot of not good choices and not enough of some good choices. So, there’s the danger of looking at those serving sizes as something that we should be eating because, obviously, that could just perpetuate the obesity epidemic if we continue to do that. So, I really try to encourage people not to look at serving sizes as a suggested serving size but to know what they should actually be eating for themselves.
Melanie: That’s great advice.
Janel: For instance, ice cream is going from half a cup serving to two-thirds a cup serving and that does not necessarily mean any of us should be thinking now we should eat two-thirds a cup rather than half a cup.
Melanie: That’s a little bit misleading, Janel. I agree with you there. So, your advice there as a Registered Dietitian is don't follow the serving size as a suggestion but only use it as a tool to understand how much of what you’re eating has these things in it.
Janel: It’s truly nothing more than a reference to all of the other information on the label. That’s it.
Melanie: So, important to understand. What about the sugar indicators? We're learning more and more about sugar and its contribution to diabetes and obesity, so what are the sugar indicators telling us?
Janel: Right. We definitely know that our biggest concern around sugars is the added sugar and up to this point, we haven’t been able to easily know by looking at the label what’s natural versus added sugar. They finally are going to add a line item that listed just added sugar right under the total sugar. So, people will no longer have to be investigators to try to determine what of the sugar listed might actually be natural versus added. It’s going to be listed very clearly.
Melanie: What about the updated daily values? Is that changing for what they expect us to get every day?
Janel: Some of them are changing, some of them are not. For instance, the recommended amount of dietary fiber is going up, so that’s going to impact what the percent daily value is going to be. The thing about the daily values that can be confusing to people is that it’s really designed around people who need 2000 calories. Most of us need around 2000 and that’s why they picked that number but you may or may not need that much. You might need more or you might need less than that. They’re trying to allow it to be a little bit clearer for most of the population as a generalization. So, some of those daily values are changing depending on what recommendations have been recently put out. Sodium levels are recommended now to eat less than what we used to in the past. Those are some of the main areas. Vitamin D, we’re now suggested to eat more now than what we have in the past. So, your daily values are going to be impacted by those new recommendations.
Melanie: There’s one part where it is fat, cholesterol, sodium, protein--these things. Then, there’s the nutrients required, your vitamins and minerals, and these are not necessarily required in food but they’re on the label to let us know where do the daily value of your nutrients come in.
Janel: Right. So, if you actually eat that serving size, how much of that nutrient for you day are you going to get in? They took off some of those vitamins that we really don't see deficiencies in anymore, like Vitamin C, which is going to be taken off, and they're adding vitamin D, and potassium is the other one that they’re adding because we know most of the population is not getting enough of those. So, again, it’s more of a reflection of what our current state is in nutrition rather than what it was when it was originally made over 20 years ago.
Melanie: So, they’re taking, as you say, the current state of nutrition and figuring out what we need to prioritize. Do you think this is going to-- because I'm glad they're putting potassium and vitamin D, calcium and iron, these things that we need. I’d like magnesium to be on there.
Janel: I agree.
Melanie: Do you think that this is going to make people make healthier choices or is it just another thing to look at food and people don't want to be bothered?
Janel: I think people are on a continuum in their journey for nutrition. I think people start out a lot of times maybe not caring about anything on the label but when they start label reading they’ll maybe look at the calories. That’s typically the first thing they look at. But, eventually, usually in our life journeys, there comes a point where people have to start thinking about nutrition more and, at that point, the information is there and just making those numbers actually means something to you.
Melanie: This updated label--when can we expect some of these improvement to show up on our food?
Janel: Just as most things with government, everything takes a really long time to progress along. They’re giving manufacturers a lot of time to come up with some of these numbers. So, they have two to three years, depending on the size of the manufacturer, to actually implement these changes. I think some of the larger food manufacturers will step up and we'll start seeing things like added sugar on the label much sooner than that. But, they certainly do have a pretty decent time frame here to move forward with it.
Melanie: Give us your best advice for label reading and how we can use these new labels to help ourselves understand the nutrition in the food, if we’re eating food with labels at all.
Janel: Right. Usually, when people are ready to go beyond just thinking about calories, I tend to then suggest really looking at them under the context of heart health. We know that heart disease is the number one killer of Americans and so, if you’re going to look at anything else beyond calories, I think looking at those in relation to heart health. As the big hitter has been our hearth health, looking at saturated fat, trans-fat and sodium. So, I usually have people start there and once added sugars are on that label, I would then suggest looking at added sugar as the other thing that we really newly have discovered is more related to heart disease than we thought. So, those are usually the four that I really want people to try to look at and do less of.
Melanie: That’s great advice, Janel. Thank you so much for being with us. It’s really important and you’ve put it forth so succinctly and clearly. Thank you again for being with us today. You're listening to The WELLcast with Allina Health and for more information you can go to AllinaHealth.org. This is Melanie Cole.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 1
- Audio File florida/1626fl1b.mp3
- Doctors Rosenbaum, Corey
- Featured Speaker Corey Rosenbaum, DO
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Guest Bio
Corey Rosenbaum, DO is a Fellowship-trained orthopedic surgeon who specializes in the treatment of foot and ankle conditions and injuries.
He received his medical degree from Lake Erie College of Osteopathic Medicine and completed his residency at the University of Florida Health Science Center in Jacksonville. He then went to complete his fellowship at the University of Texas in Houston.
His areas of interest include ankle arthroscopic surgery (minimally invasive), fusions, total ankle replacements, reconstructive foot surgery, deformity correction, tendon transfer/foot drop, and treatment of achilles tendonitis/ ruptures, sports related injuries, foot and ankle disorders, flat feet, neuromas and bunions.
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Transcription
Melanie Cole (Host): Total ankle arthroplasty, also known as total ankle replacement, is a surgical procedure that orthopedic foot and ankle surgeons use to treat ankle arthritis. My guest today is Dr. Cory Rosenbaum. He’s an orthopedic surgeon with Florida Hospital. Welcome to the show, Dr. Rosenbaum. So, people hear about shoulder replacements and knee replacements and hip arthritis, and all of these things, but we don’t always think so much about the ankle. Tell us about what could typically go wrong with the ankle. What do you see most often?
Dr. Cory Rosenbaum (Guest): The most common thing that I see is actually post-traumatic arthritis. Patients come in and they maybe had an injury, even in their early teens or twenties and then have been dealing with ankle pain or instability, repeated ankle sprains. And then over time, due to that repetitive malfunction of the ankle, they start developing really bad arthritis and, basically, a bad wear and tear of the ankle. They come in to get evaluated now with severe arthritis. That’s what I most commonly see in this area.
Melanie: So, the ankle is a smaller joint when we’re looking at the size of the hip or the knee. What predisposes somebody to this? Is it for athletes? Women who wear high heels? Are there certain things you would like us to know that might contribute to that?
Dr. Rosenbaum: Yes. That’s a good question. In hips and knees, a lot of times that just seems to be a general arthritis, a general wear and tear. The ankle is a little bit more complex and we see it more after some sort of subtle injury or if you have bad rheumatoid arthritis. There’s really no way to prevent it once you have bad arthritis. But, if you have an injury, it’s better to get that treated as early as possible to hopefully prevent some of these longer term complications.
Melanie: We are going to get to some treatments but is there anything you like people to do if they do have arthritis or rheumatoid arthritis to work on their ankle? Are there any sorts of preventions or things they can do to help it along?
Dr. Rosenbaum: Yes. I think the best thing is to try to stay as active as possible. Keep your weight down. The ankle sees anywhere from five to seven times the amount of weight on your body. So, if you just gained ten pounds, the ankle thinks it’s fifty but also if you lose ten pounds, the ankle thinks you lost fifty pounds. So, keeping that stress off your ankle joint, staying active, keeping the ankle mobile by doing a lot of stretching on your Achilles tendon seems to prevent further pain.
Melanie: Are there minimally invasive things we can do first if we do have arthritis in the ankle? When we think of arthroscopy with the knee or the hip, people say, “Oh, I did it and it’s no big deal.” What about the ankle? It is such a complicated smaller joint.
Dr. Rosenbaum: Yes. That’s a good point. Now our technology and instruments are a lot better than they were even ten, twenty years ago. So, if you don’t have bad arthritis where it’s already so severe, or just have a minor injury, doing something like ankle arthroscopy through a minimally invasive small incision that allows us to go in there with a camera and some tools to fix some smaller cartilage injuries or issues with instability, really help prevent long term arthritis and the recovery is a lot quicker.
Melanie: So then, when does it require a replacement? Explain about what an ankle replacement even is.
Dr. Rosenbaum: An ankle replacement is very similar to what you hear with hips and knees where there are two metal components and a plastic piece in between. So, it’s really just the same thing except now we do it in the ankle. The ankle is a more complex joint because it has a lot more areas of motion with rotation, flexion, extension, inversion, eversion. When you get severe pain and deformity, that’s when that procedure could potentially be very helpful.
Melanie: So, what is it like for the patient?
Dr. Rosenbaum: If we determine that the patient has severe arthritis where they failed all conservative treatments and some of the minor procedures can’t be done, that’s when they’d be a candidate for a total ankle replacement. What’s good about the ankle replacement is it really keeps a lot of the motion in tact in the joint as opposed the old standard procedure which was an ankle fusion. That sort of locks the joint in place. With the ankle replacement, again, you keep that mobility and the biggest thing we are finding out is by keeping the normal kinematics and motion of the foot and ankle complex, you prevent arthritis in the other joints. If you fuse the main ankle joint, the other joints that surround the ankle, that are smaller, suddenly have to pick up the slack to try to keep you moving. So, their normal motion which is pretty small in what they can do, now gets very excessive. So, those joints start to wear out really quick and now you have bad arthritis in multiple joints around the fused ankle, and then, you’re still left with chronic pain, limp, and disability.
Melanie: But, because this maintains that range of motion, it helps contribute to an even distribution after the surgery, yes?
Dr. Rosenbaum: Correct. You’re basically trying to keep the same normal motion of the ankle or at least have some of it. Now, if you have bad arthritis you probably already experience a lot stiffness. So, you’re never going to get back to 100% motion of a normal ankle without pain. Just keeping a little bit of motion, whether it is a 20-30 degree arc of motion, that’ll keep you walking with a nice smooth gait without a severe limp.
Melanie: How long is recovery, Dr. Rosenbaum? Is that something that takes a lot of physical therapy or can you get walking and doing rotation exercises pretty quickly?
Dr. Rosenbaum: So, one of the things I really love about the total ankle replacement is the recovery. With the fusion, it’s really hard on patients, especially as we get older, and it’s weaker and it’s harder for us to use assist devices like crutches or walkers. With a fusion, you really have to be off your foot for a minimum of 10-12 weeks of really not putting weight on a leg. Again, a thing I like so much about ankle replacement is that the recovery is actually quicker. Patients get back quicker because they’re really only not putting weight on the ankle for the most part for anywhere from just two to four weeks being off of it and then we have them walking in a boot. So, that part is really exciting and changing the way our post-operative course goes for a lot of these extensive ankle procedures.
Melanie: Is arthritis likely to develop again even though it’s a new joint? What about the surrounding area?
Dr. Rosenbaum: No. That’s the biggest thing is that it’s really preventing severe arthritis in the other joints. Obviously, if we have now replaced your ankle joint, you’re not going to get arthritis because you basically have an artificial joint there.
Melanie: That’s amazing. Now, give us your best advice, Dr. Rosenbaum, in just the last few minutes, about keeping a healthy ankle and what you want people to know about shoes and activity, and prevention.
Dr. Rosenbaum: So, again, the biggest things I think are staying active, keeping your weight down to help prevent any sort of foot and ankle issues. Keeping that Achilles tendon nicely stretched out. You don’t want to get a lot of stiffness there because then you’re going to put a lot of pressure on your mid-foot and other areas of your foot and ankle that will start to cause pain and then it’s just like a bad revolving cycle. It’s hard to get back to good mobility. So, doing just those little preventive things are good. Also, if you have an injury or start to develop even a little bit of pain, swelling, locking, or clicking, that is bothersome, I would get it evaluated sooner rather than later because if you do have just a minor issue--something that we can treat--that would be more preventative than you developing severe arthritis later down the line where then you may need one of these bigger procedures, which although are good and helpful. They’re bigger surgeries that do have more risk.
Melanie: Why should patients go to Florida Hospital for their care?
Dr. Rosenbaum: Well, I think the biggest reason to come here now for the care, especially if you’re a good candidate for the ankle replacement, is that we actually do these here. Before I got here, this procedure wasn’t done anywhere in this area. The closest place to us here was—you’d have to go up to Jacksonville at Mayo Clinic. There’s a physician there that’s doing them that I actually trained under. Also, Orlando, or even farther south, in Tampa. Now, we have the ability to do this procedure here. We have a good team and we have physical therapists in the area that are now familiar with this procedure and that help us once you do start physical therapy, which really isn’t for a least six weeks anyways and it’s not that much. But now, you can get all your care here without having to drive a minimum of two hours just for surgery and follow up appointments.
Melanie: Thank you so much doctor. What a fascinating topic. You’re listening to health chats by Florida Hospital. For more information, you can go to FHFOrtho.com. That’s FHFOrtho.com. This is Melanie Cole. Thanks so much for listening!
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 3
- Audio File allina_health/1620ah5c.mp3
- Doctors McKenzie, Melody
- Featured Speaker Melody McKenzie, MD-Family Medicine with Obstetrics
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Guest Bio
Melody McKenzie, MD, is a board-certified physician, specializing in family medicine. Her professional interests include preventive health, pediatrics and pregnancy.
Learn more about Melody McKenzie, MD -
Transcription
Melanie Cole (Host): Chlamydia is a common sexually transmitted disease with nearly three million cases reported each year. My guest today is Dr. Melody McKenzie. She is a Board certified physician specializing in family medicine at Allina Health. Welcome to the show, Dr. McKenzie. Tell us what is Chlamydia?
Dr. Melody McKenzie (Guest): Chlamydia is a sexually transmitted infection that is very common and often doesn't have symptoms and that’s why we're here to talk about it today.
Melanie: If it doesn't have symptoms, how does somebody know if they have it?
Dr. McKenzie: Often women don't have any symptoms. They say up to 85% of women have no symptoms. If they do, it’s often mild symptoms. They might have some vaginal discharge, a little bit of bleeding after intercourse or between their periods but most of the time they have no symptoms at all. And even men, three-quarters of them have no symptoms and that’s the problem with trying to diagnose women with it.
Melanie: So, is this something that you should be screened for regularly if you’re a sexually active person?
Dr. McKenzie: The Center for Disease Control currently recommends that all women under 25 get screened yearly, even if they have no symptoms. That's because 65-70% of cases of chlamydia are in that age group. So, we really encourage women, once they become sexually active, either as young as 12 or 13, or as old at 24, if they're under 25, they should be checked every year. The nice thing is now it's not as onerous to women and not as scary. Before, teenagers were told that they had to have something similar to a pap smear and their cervix had to be tested. Now, we can just do a simple urine test and it has really helped us diagnose more of these women and treat them.
Melanie: Are there some complications from not being diagnosed?
Dr. McKenzie: Yes. That's a great question. A lot of women can have this bacteria for years and years and not know and then they have symptoms years later. They can have lower abdominal pain, what we call chronic pelvic pain; they can have problems getting pregnant; they can have pregnancies that are called “ectopic: pregnancies. That's where the embryo, instead of implanting in their uterus, ends up in their ovarian tube. So, it's really important that we try and diagnose these women young instead of when they have complications years later.
Melanie: If you do diagnose them and they come out positive, is there a treatment?
Dr. McKenzie: Yes. The treatment is very simple. For most people, it's a one-dose antibiotic and that will cure almost all of people that have chlamydia. We also recommend that any partners they’ve had in the last two months also get tested or even just treated. The nice thing is, if we can treat those people we don't even have to test them, we just treat their partners to try and prevent the spread. In Minnesota alone, last year there were over 21,000 reported cases of chlamydia. So, we’re not talking about something that’s uncommon. It's very common. It's just people don't know they have it.
Melanie: So, Dr. McKenzie, if they've been sexually active and had multiple partners, and they test positive for chlamydia, do you recommend, as with some other sexually transmitted infections, that they contact any of those even if they're not still together?
Dr. McKenzie: That’s right. That's the difficult thing. So, the Department of Health will contact people who test positive for chlamydia and they will ask, or we will ask, sometimes people don't want to give names and we will just, depending on the ability to, sometimes we will just give a prescription for them to treat their partners. But, it's very important. Then, sometimes we have to test them for other sexually transmitted diseases as well. So, the hardest thing is encouraging patients to be honest with their provider and come in and actually tell us what's going on.
Melanie: Can this be spread through oral sex and other means just besides normal sexual intercourse?
Dr. McKenzie: Yes. People can have it orally. They can have it rectally. So, any sexual activities or sexual contact can spread chlamydia. So, it is recommended that people use condoms. It is recommended that people get screened, especially if they have multiple partners. Even if they're over 25, if they have multiple partners, they probably should be screened every year.
Melanie: What do you tell people, Dr. McKenzie, every day about preventing sexual transmitted infections and the importance of knowing what's going on?
Dr. McKenzie: I think knowledge is power, so I always tell anyone that if they're sexually active, especially women, they’re always at risk for sexually transmitted disease and unplanned pregnancy. So, they have to be honest with their partner; they have to ask questions; they should consider maybe even testing for sexually transmitted diseases before they have new partner; they should limit how many partners they have; and they should always use condoms.
Melanie: What about the treatment? Can they have sex during the treatment or what do you tell them about that?
Dr. McKenzie: The best thing to do is actually wait seven days after the start of treatment. If they use the one-day treatment, if they use one of the other treatments which can last up to seven days, again, they should wait till that’s done, so seven days they should actually not be sexually active.
Melanie: Dr. McKenzie, people hear that you can get it from oral sex, as you’ve said, but they don't typically think of using condoms during oral sex.
Dr. McKenzie: Right, they don’t. There are oral barriers that can be used. And, again, testing partners is another important way to try and prevent this because most women and most men have no symptoms.
Melanie: Tell us just a little bit about some of the other sexually transmitted infections that you see on a regular basis and what you would like people to know about them?
Dr. McKenzie: Obviously, chlamydia is the one that we diagnose the most. We don't see a lot of people with classic symptoms. Other things that we do see, we see some gonorrhea, not as prevalent, we see trichomonas, we see mycoplasma, we see a lot of herpes relative to some of those other ones. So, again, it’s knowledge and it’s protection. People always need to be thinking of protecting themselves and they always need to be thinking about what they're doing.
Melanie: Just to switch around topics just a little bit for a second, what do you tell parents that ask you about the HPV virus and this vaccine?
Dr. McKenzie: I love that question because I have young men, boys who are now young men, and one of my obstetricians that I used to work with, she asked me actually that same question. We were at a conference talking about HPV and I found it very interesting that a lot of doctors weren't promoting it then. And she looked at me and sent me this little note, “Would you vaccinate your boys?” And I said, “Absolutely. Why wouldn't I?” So my boys are vaccinated. We know that this is the first vaccine that actually can prevent cancer and I think that's wonderful when you think of it that way. This is a new thing in medicine where we are actually preventing cancer through a vaccine. Unfortunately, once the word ‘sex’ becomes involved, people get all upset about it and think that it promotes promiscuity and will encourage teenagers to be sexually active. We know that's not the case. We can actually prevent cervical cancers, rectal cancers, oral cancers, throat cancers with this vaccine. So, I’m one of the biggest proponents. My patients all know, the mothers when they come in, they all know that as soon as their child is 12-years-old, I'm promoting that vaccine.
Melanie: Dr. McKenzie, in just the last few minutes your best advice for the prevention of the spread of all sexually transmitted infections. What do you tell people every day?
Dr. McKenzie: The first thing I tell parents is that they need to talk to their children and doctors need to talk to their young adults and women about this. People need to ask questions. People need to be thinking; people need to think about protecting themselves and think about getting tested; and minimizing partners, if they can. If they do have multiple partners, they need to be honest with their doctor so that their doctor can help keep them healthy and keep them safe.
Melanie: What great information. Thank you so much for being with us today. You're listening to The WELLcast with Allina Health. For more information you can go to AllinaHealth.org. This is Melanie Cole.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 3
- Audio File virginia_health/1625vh1c.mp3
- Doctors Huff, J. Stephen
- Featured Speaker J. Stephen Huff, MD
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Guest Bio
Dr. Huff was born in Carbondale, Illinois and grew up in Midwest Illinois and Indiana. He attended Butler University for his undergraduate degree. In 1979, he graduated Indiana University School of Medicine. Dr. Huff completed a flexible internship at Methodist Hospital of Indiana and a neurology residency and emergency medicine residency at the University of Cincinnati. He started at UVA in 1995. Outside of work, Dr. Huff's special interests include jazz and improvisational music. He contributes to UVA’s community radio station (WTJU 91.1) on Monday evenings.
Learn more about Dr. Huff
Learn more about UVA Neurosciences -
Transcription
Melanie Cole (Host): UVA will be part of a unique national trial examining the best medication for treating epileptic seizures. My guest today is Dr. J. Steven Huff. He's board certified in neurology and emergency medicine at UVA Health System. Welcome to the show, Dr. Huff. Tell us a little bit about this ESETT trial. What is it and what is it seeking to determine?
Dr. J. Steven Huff (Guest): Sure. ESETT stands for Established Status Epilepticus Treatment Trial. It's a nationally-run study. Jaideep Kapur of neurology here at UVA is the overall coordinating investigator. I'm the site investigator here at the University of Virginia. Lea Becker is the clinical research coordinator. This is being employed and looked at at more than 20 sites across the US. Our goal, as always, is to do excellent, ethical research, compliant with regulations. The basic research question is we don't know what drugs work best for prolonged seizures. We know what class of medications are the diazepines--medications like Valium and others--are good first-line drugs, but if the patient doesn't respond, that is if a seizure continues, we don't know the best second-line drug to be used. So, this is a randomized perspective trial of three drugs that are known to be effective for seizures. There are no experimental agents in this study. The goal is to get enough patients, enough sites together, and enough data so that perhaps physicians will have the good idea to know which drug works best for prolonged benzo-diazapine refractory seizures.
Melanie: So, what's considered a prolonged seizure?
Dr. Huff: Generally, for status epilepticus, the definition has changed to the recent years. It's one seizure lasting longer than five minutes. One generalized seizure lasting more than five minutes, a convulsion, or several convulsions without the patient gaining full responsiveness in between.
Melanie: So, typically, these patients have been treated with benzo-diazapine, like Valium, as you said, and it's not fulfilling what it needs to do at that point?
Dr. Huff: That's correct. So, typically, rescue squad is summoned. EMS may give medicine like valium or Midazolam or another medication and often that stops the seizures. Then the question is, as I said, if the seizures continue, we physicians just don't know which drug is best after that.
Melanie: So, how is this trial different than normal clinical trials we discuss?
Dr. Huff: A couple of ways, basically. This has been a question--study question--that has been present for many years. A cornerstone of clinical research is informed consent. By the nature of this emergency, patients are unable to give informed consent, so we're employing something called EFIC—“Exception From Informed Consent”. This is an FDA-approved research technique. it complies with human research regulations and allows research to be conducted without consent if the life is at risk; if the best treatment is not known and the study might help; and if it's not possible to get instantaneous or contemporaneous permission. When the patient recovers, or when family or a legally authorized representative arrives, then a normal consent process will take place.
Melanie: Is emergency department care of this established status epilepticus the same everywhere, typically? Do you all kind of follow the same course of action?
Dr. Huff: It isn't. We know that a second-line drug needs to be given, whether that's Fosphenytoin, whether that's Levetiracetam, or Keppra, or whether that's valproic acid is just not known. There are many causes of seizures. Many times the cause of a seizure, even after extensive investigation isn't discovered, but of these three drugs, they're commonly known, but it hasn't been possible to get any high-level of evidence to give an idea which one is preferred. So, it's been a question that's been present for several years.
Melanie: So, if the study is looking at different medications to stop these seizures, what are you intending for these medications to do? Are there a few different ones you're going to try and are they going to be able to stop the seizure, hopefully, right away? What's the intention?
Dr. Huff: So, the idea is to halt the ongoing seizure activity. So, again, there are three drugs that will be studies: Fosphenytoin, Valproic, and Levetiracetam. These are all FDA-approved treatments for seizures and these drugs are prepared in an investigational pharmacy so that the physicians, the other caregivers providing the care won't know which drug is being given. Randomization for this study for the drug takes place before the patient arrival. So, the person arriving will get one of the study drugs and it won't be known until one hour. At one hour, unblinding is possible. Outcomes for this study are at 20 minutes and at one hour. Are seizures continuing? Is the patient improving with their level of consciousness? So, it should provide a high level of evidence because of what's called a “blinded study”. The treating providers don't know which drugs are being given. That's desirable in research because it's thought to avoid bias. Again, these are all drugs that are approved for seizure treatment.
Melanie: So, each of you doctors are going to like, flip a coin. You're going to just be taking one of these three medications and since there's not the exception from informed consent, what if there's an allergic reaction or any of those kinds of things going on?
Dr. Huff: Well, certainly, if there's an allergic reaction or an adverse reaction, the infusion would be stopped. It would be very unusual for any of these drugs to have an allergic reaction. There is a method for adverse event reporting which is pretty standard with literature. It's not really flipping a coin. I mean, it's more sophisticated than that in that through a central statistical service, the next drug up is determined. It's given to the different study sites. The physicians at the point of care do not know which one of these three drugs will be given, but it's not like I have a choice between one or three. It's the next drug up--the next investigational packet up will be given. At the moment of treatment, the physicians will not know which drug. But, like I say, this is desirable in research to try to avoid bias.
Melanie: That's fascinating. How common are these type of seizures or epileptic seizures, in general?
Dr. Huff: Well, epileptic seizures are pretty common. It's thought that somewhere around 1% of emergency department visits are seizure related. Continuing seizures, continuing generalized status epilepticus, is less common and even less common are seizures that don't respond to benzodiazepines. When given early, benzodiazepines are very effective drugs. So, this is of 20 sites. We're hoping the study's going to accumulate over 500 patients over a couple of years and that number is thought to be necessary in order for good evidence, in order for good statistical interpretation.
Melanie: Is this something that happens to both adults and pediatric patients?
Dr. Huff: It does happen to adults and children and many children’s' hospitals are participating in that. We've opted, just for simple logistical reasons, not to use it in patients less than 18 years old here at UVA at this time.
Melanie: So then, in just the last few minutes, just kind of summarize it for us and tell patients and listeners--this is an emergent situation, so how can they get more information about the trial, as well?
Dr. Huff: More information about the trial and, in fact, the entire study protocol is posted up at a website that's ESETT.org or you can send an email to seizure@virginia.edu and we'll be happy to provide more information individually. Again, a lot of information about the study is at the ESETT website.
Melanie: And would you give that website one more time?
Dr. Huff: Sure. That's www.esett.org.
Melanie: Thank you so much, Dr. Huff. That is fascinating information, really, and we wish you all the best and applaud all the great work that you're doing. Thanks for being with us today. You're listening to UVA Health Systems Radio. 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
Additional Info
- Segment Number 2
- Audio File virginia_health/1625vh1b.mp3
- Doctors McLaren, Nancy M.
- Featured Speaker Nancy M. McLaren, MD
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Guest Bio
Dr. McLaren trained in general pediatrics at Emory University in Atlanta. She has been in Charlottesville for over 12 years and has worked at the Teen Health Center at UVA during that time. She has been fortunate to focus her time and energy on the care of the adolescent patients whom she loves. She's a clinical assistant professor of pediatrics in the UVA Children's Hospital. She also serves on the community-based obesity task force and has been active in pioneering programs that reduce obesity in childhood and adolescence. She also has a special interest in sports medicine that probably developed from the injuries her own children received during their years in competitive athletics. In her spare time she enjoys skiing in Colorado and spending time with her husband and three children (who have taught her so much about adolescents).
Learn more about Dr. McLaren
Learn more about UVA Teen and Young Adult Health Center -
Transcription
Melanie Cole (Host): It's so important to continue working to reduce the teen pregnancy rate. How and when should parents discuss this with their children? My guest today is Dr. Nancy McLaren. She's board certified in pediatric medicine and specializes in caring for adolescent and teen patients at UVA Health Systems. Welcome to the show, Dr. McLaren. Why is it so important to work with teens to reduce this pregnancy rate?
Dr. Nancy McLaren (Guest): Well, we want to give them a chance at having a better life and the cycles certainly have shown as with teen pregnancy, if someone gets pregnant as a teen, then the possibility is that their child will also have children in their teenage years. It's important really, to give them a better chance at succeeding at other goals that they may have in education and really advancement and really sort of break the cycle of poverty that teen pregnancy can put someone in.
Melanie: So, what are some of the best ways to reduce? Are we looking at media outlets or are we looking directly to the parents and the loved ones of these teens to be the ones involved reducing this rate?
Dr. McLaren: Well, the most important person in the teenager's life, or persons in their lives are their parents or their guardians that they're close to. The importance of parents starting to talk to teenagers starts when they're really quite young--when they're 9, or 10, or 11. Really encouraging them to be active in other things in their lives, in school, in sports, in music, and other things that make them feel positive and strong about their lives and really getting them involved. Being involved in the community and their schools and family is a very large protector against teen pregnancy. The other thing is to talk to them also about sexuality and what they feel about their bodies and what's involved with sex, basically—to have the sex talk but start it when they're quite young so that it's not an uncomfortable thing at all when you have to sit down at age 11 or 12 and have this puberty talk. Really start with them when they're quite young, learning about their bodies, and what their bodies do, and feeling good about their bodies and wanting to take care of their bodies. And, again, I say that conversation can happen in the pediatrician's or the adolescent physician's office but it's really important that it happens at home with the parents and having them involved so that the teens get comfortable, the young people get comfortable feeling that they can go to their parents and ask questions.
Melanie: If the parents don't discuss it, the children are going to learn about these kinds of things from other sources, which may not be reliable. So, how do you tell uncomfortable parents, Dr. McLaren, how to start this conversation? What do you tell them about the fact that some of them believe that if they start this conversation, they're opening the door to permissive sex for their children?
Dr. McLaren: Well, first of all, what we try and do when parents are coming in with their young ones, even at 8, 9, and 10, is to give them some tools to have. That can be books, reading with their children. There are some great books out there to talk about how your body is changing and what's going to happen and having the conversation even earlier on before the young people get where they're sort of more reserved and withdrawn and more quiet about things. Then to continue that conversation going through the teen years and telling parents, "It may be an uncomfortable conversation, but it's really an important one to have." Otherwise, they are going to get information from their peers and from the media, from the internet, and the information they get from there may not be as reliable or as factual as what they could get from their parents and from their doctors. I think they can—and if the parents are uncomfortable, we'll say, "Why don't we have the conversation together in our office?" and that can be another way of helping with it. And starting it, again, when they're younger, and not waiting until they're 12 or 13 and no one's ever had the conversation.
Melanie: Well, one thing I appreciate that you pediatricians do is when the teens come in for their well visit, now they get to fill out a form that discusses with them about drug use and that the parents don't get to look at it unless the teen says it's okay so that they feel like they can trust their pediatrician, which is a great resource for them to get some of this information. Now, when the parents are beginning this discussion, do they come at it as "I don't want this to happen"? How do they discuss protection and “if you are going to have sex, you must protect yourself from pregnancy and sexually-transmitted infections”?
Dr. McLaren: Well, I think you can almost say it in just the way you said it. In the sense that we do know that teenagers are having sex as they go through middle school and high school and the goal would be first to talk to them about the risks of having sex at an earlier age, so if that is going to happen, talking about protection and what ways can they find out and learn about protection, whether it's condom use or whether any of lots of different birth control methods that are out there. Even to say, if you're not comfortable talking with me, let's go to the doctor's office and talk to the doctor. We do give, once they're 11 or 12 years old, we do always want to have a time of privacy with the adolescent to give them freedom to talk about some things. Maybe to help them figure out how to talk to their parents about some of these issues, too, and letting them know that the parents really want to protect them and take care of them and help them through this time and have them see their parents as resources, also.
Melanie: Is there a role for those after-school specials and scare tactics showing 14-year-old girls with babies and kids that have had to drop out of high school? Do you agree with that kind of way of going about it?
Dr. McLaren: I think it's--I mean, we certainly in our clinic use humor and information in that way, not as scare tactics, but just to have them think about things. I think that it's better to talk about "if this does happen," and certainly after-school, having young people in activities after school. The time for highest risk for pregnancy with an adolescent is between the 3: 00 - 6: 00 time because people are not around and they have more time alone, so getting them involved in other things. But it's really talking more about what their hopes and dreams are and what they want to be doing. I think it puts it in a different way of having them look that way rather than what's going to happen if you get pregnant. Really trying to get them to think beyond just the moment and what they want to accomplish and how to go about doing that and that preventing pregnancy--teen pregnancy--can make a big difference in helping them accomplish that.
Melanie: So, in just the last few minutes, give us your best advice for parents about discussing this with their children, when the appropriate time is, and how to begin. Parents don't even know, Dr. McLaren, how to start that conversation.
Dr. McLaren: Well, it's not an easy conversation to have. I've had to do it with my three kids, and it's just a matter of sitting down and saying, "You know, I have something we need to talk about, I'm concerned about this or that. We want to make sure that you have all the opportunities that you can. We would encourage you not to have early sex but we also understand this may happen. We want you to get the right information from us or from your doctor. So, let's talk about it." And they can even say, "I'm uncomfortable talking about this, too. Let's talk about it now and then we can certainly go to the doctor's office and get more information." And also, I think they do need to bring up contraception and say, "There are really effective methods of contraception and if this is something that is a possibility that is going to happen, let's go and talk to the doctor or the clinician about contraception and what's going to be the most effective method for you to use."
Melanie: It's so important--that open line of communication—and to know if your child has a boyfriend or girlfriend and then you can discuss those things. And so, now, tell us about your team at the UVA Teen and Young Adult Health Center.
Dr. McLaren: Well, the Teen and Young Adult Health Center actually was started 21 years ago to prevent teen pregnancy in Charleston and the surrounding area. We have evolved into a full adolescent and young adult health center so that we do total adolescent and young adult care, which can be sports physicals, it can be care for asthma, it can be care for sexually transmitted infections. We do a lot of contraception. In fact, we're probably one of the leaders in this part of the country in providing long-acting contraceptives for adolescents. We also do mental health care. We are developing an eating disorder program. Then, we also have a program for transgender youth and young adults. So, it's really trying to meet a lot of the different needs and issues that come up for adolescents. It's a place that they can come and feel safe and feel welcome. We have a small staff and we get to know them very well. We try and have them see the same provider when they come back. And so, it really is a great, great location. We also do community outreach. We have a person--a health educator who works with peers in the schools and actually gives the peers the right information. So, if a young person goes to a peer, they are getting the right information. We work with Boys and Girls Clubs in the community and with different youth groups. So, it's really a full, comprehensive health center for teens and young adults.
Melanie: Thank you so much, Dr. McLaren, what great information. We applaud all the great work that you're doing on behalf of teens and young adults. You're listening to UVA Health Systems Radio. 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
