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While feeding a baby is a wonderful experience, at times it can be frustrating.
Additional Info
- Segment Number 2
- Audio File clean_food_network/1625cf1b.mp3
- Featured Speaker Jill Hillhouse
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Guest Bio
Jill Hillhouse is a passionate advocate of whole foods eating and nutrition education. She believes that health starts on your dinner plate and she uses diet and lifestyle shifts to mitigate and reverse health conditions. Jill focuses on addressing her clients’ metabolic individuality as a key factor in her functional nutrition protocols and health coaching. A strong voice for self-advocacy, Jill encourages and empowers her clients to be active participants in their own health care. Working as a practitioner since 2001, Jill is part of the integrative health team at P3 Health Clinic in Toronto, Canada. She is also a Trusted Advisor for Zwell.ca, and a PRO with League.com. Jill is the author of The Best Baby Food and her next health book will be published in October 2016. She also writes articles for a number of publications including Blikki, Zwell and Naturally Savvy.
Jill is a Certified Nutritional Practitioner (CNP) from The Institute of Holistic Nutrition and has earned her Bachelor of Physical and Health Education (BPHE) and her BA in Psychology at Queen’s University. She is certified as a First Line Therapist in Lifestyle Medicine by Metagenics and as a Stress and Wellness Consultant by the Hans Selye Foundation and The Canadian Institute of Stress. Jill has been a faculty member of the Institute of Holistic Nutrition since 2005. She is a member of The Canadian Association of Natural Nutrition Practitioners and the Institute of Functional Medicine.
The concept of salads have come a long way. You can be much more creative than a simple lettuce concoction.
Additional Info
- Segment Number 1
- Audio File clean_food_network/1625cf1a.mp3
- Featured Speaker Pamela Salzman
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Guest Bio
Pamela Salzman is a natural foods cooking instructor, certified holistic health counselor and food blogger based in Manhattan Beach, California, outside of Los Angeles.
She is married with three children.
Additional Info
- Segment Number 1
- Audio File virginia_health/1625vh1a.mp3
- Doctors Smith, Ryan P
- Featured Speaker Ryan P Smith, MD
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Guest Bio
Dr. Ryan Smith is fellowship-trained in male reproductive medicine and surgery, and his specialties include male infertility, fertility preservation and testosterone therapy.
Learn more about Dr. Ryan Smith -
Transcription
Melanie Cole (Host): A vasectomy is a surgical procedure for male sterilization or permanent contraception, but how do you decide if this is the right procedure for you? My guest today is Dr. Ryan Smith. He's fellowship trained in male reproductive medicine and surgery and his specialties include male infertility, fertility preservation and testosterone therapy at UVA Health Systems. Welcome to the show, Dr. Smith. People hear that word, men recoil. What is a vasectomy? What is it intended to do?
Dr. Ryan Smith (Guest): Well, you're exactly right, and thank you, again, for having me. So, a vasectomy, just like you said, is meant to be a permanent form of contraception. That is first and foremost something that we reiterate to patients time and again to make sure that this is something that they understand is permanent and they want permanent contraception. The procedure, in itself, essentially what we're doing is that the vas deferens is the tube that carries the sperm, essentially from the testicle and epididymis out through the remainder of the reproductive tract. So, when you do a vasectomy--and there are different modes of performing this--but in its simplest form, you're occluding that vas deferens so that the sperm cannot make the transition from the reproductive tract out the urethra.
Melanie: So, I guess the first question that men would want to know is, is this a painful procedure?
Dr. Smith: So, in general, most men are very comfortable with doing this procedure in the office. We often liken it to going to the dentist in terms of you get a local anesthetic and we're able to do all of the procedure through that. Some patients who may be nervous about it, we will give some oral sedation, whether that's Valium or Xanax, or something like that. On a very rare occasion, would IV sedation be necessary for the procedure. So, in general, patients are very comfortable during it and that's our goal is to maintain their comfort throughout.
Melanie: So, when should a man look at doing this because there is that discussion among spouses; should the woman do it? Should the man do it? And, how do they come to that conclusion?
Dr. Smith: Well, I think, just as you said, for a couple, it's a conversation that's often ongoing for even years. We know from a lot of the studies that multiple couples will have that conversation, but won't commit to something for several years after discussing it. I think one of the biggest conversations when couples are discussing permanent contraception is whether to pursue a vasectomy or a tubal ligation. In general, when you compare those two as options, they're equally effective, but a vasectomy is faster, safer, only requires local anesthetic, and so it's overall more cost effective compared to a woman undergoing general anesthesia for a tubal ligation, which has other risk factors involved.
Melanie: So, for the woman, this is a bigger surgery and for the man, this is something that's just a little bit quicker. How much quicker? What's the recovery like?
Dr. Smith: In general, we tell guys to expect a couple of days of discomfort. So, in general, it's very popular for men to have the procedure say, on a Friday, and by Monday, you can generally return to work for those who maybe don't have an extremely strenuous job. In general, we recommend them you not doing any aggressive or vigorous physical activity, maybe even for upwards of a week, but the recovery time is really just those two days are the crux of it.
Melanie: Is this a reversible procedure?
Dr. Smith: It is reversible. Part of that is dependent on the timeframe from when the individual had the vasectomy, but certainly even within the first ten years, you have greater than a 95% chance, in most cases, of a successful reversal in terms of returning sperm to the ejaculate, if that is what the patient desires.
Melanie: So, what are the odds, I mean, is it an effective procedure? Is there a chance the woman can still get pregnant?
Dr. Smith: Yes. So, one of the things that we talk about, and every patient gets a pre-procedure consultation where we review risks and benefits, and this is one of the things that we discuss is that you know, no contraception, essentially, is 100% reliable. In terms of a vasectomy failure, a repeat vasectomy is required in less than 1% of cases and we define a failure as when a man still has moving sperm present six months following the procedure. And, again, that's less than or equal to 1% of the time. So, the other way to think about failure is a longer-term failure meaning that the patient followed through and had a post-vasectomy semen analysis, which is essential to show that the procedure is effective. If the patient had no sperm present on that post-procedure analysis and then down the road had a pregnancy, that's about a 1 in 2,000 chance.
Melanie: Does it ever have to be re-done?
Dr. Smith: It can be re-done. In the scenario that I mentioned where a patient still has moving sperm at 6 months, at that time, you'd have to have a conversation about potentially repeating the procedure if that was something that the patient desired because that would indicate there continues to be a risk of pregnancy when there's moving sperm at that six month mark.
Melanie: So, Dr. Smith, is there a time when certain men cannot have that? Are there certain men that you just say, “No, this is not the right procedure for you”?
Dr. Smith: Sure. So, any time someone comes in for that pre-procedure consultation and there's some hesitancy there or a great deal of uncertainty, or someone who may be saying "Well, I want to make sure that I can reverse this," or "Can I bank sperm before the procedure?" or something like that that may indicate they're not quite ready for a permanent form of contraception. We generally advise those patient that maybe this is not the right time for them to pursue this as a procedure. The only other time where we may counsel someone against pursuing vasectomy is someone who has chronic underlying discomfort in the scrotum for whatever reason that may be, in which case we'll generally advise them that vasectomy may not be the best choice for contraception for them.
Melanie: So, are there some disadvantages and then, what if you feel, if you as a doctor get the feeling they're being pressured into this?
Dr. Smith: Sure. So, in general, sometimes couples will come together for their consultation visit. If we felt like there was a lot of outside pressure it may be something that we may discuss with the couple together in that regard. I think most of the men we tend to see are there because they want to participate in the discussions and the procedure with their significant other. So, they've already had those conversations like we talked about initially. And if they go back home after our visit and discuss with their spouse or whomever and decide it's not right for them, well, they ultimately don't return for the procedure. But, you know, as with anything, part of our conversation is again, those risks and benefits and there are some potential side effects of the procedure.
Melanie: So, what might some of those be?
Dr. Smith: In general, we talk about hematoma. That would be essentially significant bruising and swelling in the scrotum or a blood clot that forms in the scrotum. There's about a 1-2% chance of that occurring. It generally does not require any sort of secondary procedure, but the patient may be uncomfortable for a longer period of time, even a few weeks for all that hematoma reabsorbs. The infection risk is low--1% or less, and most patients don't need antibiotics for the procedure because of that low infection risk. One other item that we counsel them about is something called “post-vasectomy pain syndrome” and what that is, is kind of chronic discomfort that can linger in the scrotum for even months or a year following the procedure. It's not well-defined but it’s estimated that 1-2% of men may notice that. There's been research done to look at anything that predisposes men to develop that or if there's something procedurally that can be done to alleviate that risk and nothing's really borne out in the literature to show that it's effective in eliminating that risk. It's something that we just counsel patients about so that they're aware of it. You can perform a vasectomy reversal for a patient who had chronic discomfort following a vasectomy and in approximately 79% or more of case, patients will report improvement in discomfort following a reversal.
Melanie: So, in just the last few minutes, Dr. Smith, tell us what you tell patients every single day--couples, men individually, and their spouse--about vasectomy. What you really want them to know about this procedure.
Dr. Smith: Sure. So, there's a very good guideline that we use as urologists that's put out by the American Urologic Association and so some of the points that we stress in that consultation visit are that this is meant to be a permanent form of contraception; it's not immediate; that patients need to use another form of contraception until they're cleared by a post-vasectomy semen analysis, which is done approximately 8-16 weeks following the procedure. They must do that semen analysis. Only 50% of patients ultimately follow-through in doing it, but without that semen analysis, we can't provide them with any sort of reassurance that the procedure was effective. I also tell them that the procedure is not 100% reliable, just as I mentioned before, and that a repeat vasectomy is necessary in 1% or less of cases; and that there's still a 1 in 2,000 chance of pregnancy even when a semen analysis has shown no sperm or just a few non-moving sperm following the procedure. And then, just the general procedural complications that we talked about: , the risk of hematoma, infection, and chronic pain are things to be noted, as well. There’s not been any substantial risk in terms of to men's health in general like cancer risk, or heart disease. There have been studies in the past that have called some of that into question; however, those have been reviewed by the American Urologic Association and no substantial risks have been shown to men's health overall.
Melanie: And, Dr. Smith, why should men choose UVA for their urology and men's health care needs?
Dr. Smith: Well, UVA is very unique in that we have two fellowship-trained providers who do vasectomies and also male infertility care and we have an andrology lab here that does a lot of research as well. So, we have a very unique sub-specialized, multi-disciplinary approach at UVA that's only available at a handful of centers around the country. So, our patients and we are very fortunate to work in an environment like that.
Melanie: Thank you so much for being with us today, Dr. Smith. It's really important information. 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
Energy bars can be a great option for providing an easy pick-me-up. But, many of them are loaded with sugar and artificial ingredients.
Additional Info
- Segment Number 5
- Audio File clean_food_network/1624cf1e.mp3
- Featured Speaker Camilla V. Saulsbury, PhD
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Guest Bio
Camilla V. Saulsbury is a freelance food writer, recipe developer and cooking instructor. Her culinary focus is translating food and flavor trends into fresh, innovative, and delicious recipes for the home kitchen.
Camilla has been involved in the world of food for more than 16 years, including catering specialty desserts in the San Francisco Bay Area, writing cookbooks and freelance food articles, and developing recipes for national food companies. Further, she has won several of the country’s top cooking competitions, including the $100,000 National Chicken Cook-Off, the $50,000 Build a Better Burger Contest, and the Food Network’s $25,000 Ultimate Recipe Showdown (Cookies Episode).
Camilla’s interest in food is also academic. She holds a Ph.D. in sociology from Indiana University with a specialization in food studies, and her doctoral dissertation was a multi-faceted study of the contemporary meanings of home cooking in American culture. Following completion of her Ph.D., Camilla made food writing, food research, and recipe development her primary occupations.
She has been featured on the Food Network, Today, Good Morning America Health, QVC, Katie, and in multiple publications including New York Times, Dr Oz’s The Good Life, Women’s Health, Runner’s World, Men’s Fitness, Southern Living, Clean Eating, Cooking Light, Food Network Magazine, and Pilates Style magazine.
The Fitness Factor
Camilla has a second professional passion: fitness. For almost two decades she has been teaching a wide range of fitness classes, including, but not limited to, pilates, yoga, spinning, kickboxing, strength training and step aerobics.
Camilla has taught fitness in multiple settings, including universities, spas, private gyms, and private resorts. She has trained countless other fitness instructors to teach, and has led a variety of fitness workshops.
In addition, Camilla has spent many years as a personal trainer, designing unique fitness programs for a diverse clientele. She holds certifications in both personal training and fitness instruction through the American Council on Exercise (ACE) and is a STOTT® certified pilates instructor.
Camilla’s fitness philosophy mirrors her cooking philosophy: balanced, practical and simplified. She loves motivating and encouraging people to find fitness activities that help them lead happy, healthy, productive lives—and that foster an appetite for great food! A native of the San Francisco Bay Area, Camilla currently resides in Texas with her husband and son.
Whether you're suffering from something like celiac disease or just don't feel "well" when eating gluten grains, there are plenty of great options you can turn to instead.
Additional Info
- Segment Number 4
- Audio File clean_food_network/1624cf1d.mp3
- Featured Speaker Camilla V. Saulsbury, PhD
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Guest Bio
Camilla V. Saulsbury is a freelance food writer, recipe developer and cooking instructor. Her culinary focus is translating food and flavor trends into fresh, innovative, and delicious recipes for the home kitchen.
Camilla has been involved in the world of food for more than 16 years, including catering specialty desserts in the San Francisco Bay Area, writing cookbooks and freelance food articles, and developing recipes for national food companies. Further, she has won several of the country’s top cooking competitions, including the $100,000 National Chicken Cook-Off, the $50,000 Build a Better Burger Contest, and the Food Network’s $25,000 Ultimate Recipe Showdown (Cookies Episode).
Camilla’s interest in food is also academic. She holds a Ph.D. in sociology from Indiana University with a specialization in food studies, and her doctoral dissertation was a multi-faceted study of the contemporary meanings of home cooking in American culture. Following completion of her Ph.D., Camilla made food writing, food research, and recipe development her primary occupations.
She has been featured on the Food Network, Today, Good Morning America Health, QVC, Katie, and in multiple publications including New York Times, Dr Oz’s The Good Life, Women’s Health, Runner’s World, Men’s Fitness, Southern Living, Clean Eating, Cooking Light, Food Network Magazine, and Pilates Style magazine.
The Fitness Factor
Camilla has a second professional passion: fitness. For almost two decades she has been teaching a wide range of fitness classes, including, but not limited to, pilates, yoga, spinning, kickboxing, strength training and step aerobics.
Camilla has taught fitness in multiple settings, including universities, spas, private gyms, and private resorts. She has trained countless other fitness instructors to teach, and has led a variety of fitness workshops.
In addition, Camilla has spent many years as a personal trainer, designing unique fitness programs for a diverse clientele. She holds certifications in both personal training and fitness instruction through the American Council on Exercise (ACE) and is a STOTT® certified pilates instructor.
Camilla’s fitness philosophy mirrors her cooking philosophy: balanced, practical and simplified. She loves motivating and encouraging people to find fitness activities that help them lead happy, healthy, productive lives—and that foster an appetite for great food! A native of the San Francisco Bay Area, Camilla currently resides in Texas with her husband and son.
It can be challenging to eat healthy on the road, but being prepared can make a huge difference.
Additional Info
- Segment Number 3
- Audio File clean_food_network/1624cf1c.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.
Is your thyroid broken?
Additional Info
- Segment Number 2
- Audio File clean_food_network/1624cf1b.mp3
- Featured Speaker Nikolas R. Hedberg, DC
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Guest Bio
Dr. Nikolas R. Hedberg is a Board Certified Naturopathic Physician, Chiropractic Physician, and he is Board Certified in Nutrition by the American Clinical Board of Nutrition and a Board Certified Chiropractic Internist by the American Board of Chiropractic Internists. Only a small number of Chiropractic Physicians have achieved both of these board certifications. He has a Bachelor of Science in Exercise Science from the University of Florida and a Doctor of Chiropractic from Texas Chiropractic College.
Dr. Hedberg is the founder of the Immune Restoration Center located in Asheville, North Carolina, where he treats patients worldwide with a variety of health problems. Dr. Hedberg uses a variety of state-of-the-art diagnostic tests to determine the actual cause of a patient's health problem and holistic treatment methods including nutrition, naturopathy, herbal medicines, supplementation, and natural hormone replacement to help patients get well. He sees many individuals with thyroid disorders, autoimmune diseases, chronic fatigue, hormone imbalances, depression, weight gain, digestive system problems and many more.
Dr. Nik, as he is affectionately called by his patients, knew early in life that he wanted to be a doctor and help people. He was fascinated with the human body and its remarkable ability to heal. Convinced that true healing was and is possible if an individual is given the correct tools, he has brought his lifelong dream to fruition and has treated thousands of patients with success.
Dr. Hedberg is an avid speaker with regular speaking engagements presenting to doctors on a variety of topics including thyroid disorders and the connection between infections and chronic illness. He is a researcher and author with publications in journals and the book Thyroid Alternative (2011).
Dr. Hedberg has served as adjunct faculty at the University of Bridgeport teaching advanced functional medicine diagnosis and at Hawthorn University on a variety of advanced topics. He serves as a member of the North Carolina Integrative Medical Society, American Clinical Board of Nutrition, American Chiropractic Association, The American Chiropractic Association's Council on Diagnosis & Internal Disorders, and the American Board of Chiropractic Internists. He also consults with conventional and alternative medicine physicians on their most complex cases.
Dr. Hedberg became interested in thyroid disorders early in his career after seeing many patients who were taking thyroid medication but were not feeling better. This sparked his interest in this misunderstood and neglected aspect of health care today.
In his spare time, Dr. Hedberg is a professional opera singer, bodybuilder, martial artist, computer geek and he loves hiking and camping in the mountains of Asheville, North Carolina.
Are you ready for Clean Eating Academy?
Additional Info
- Segment Number 1
- Audio File clean_food_network/1624cf1a.mp3
- Featured Speaker James Smith, Chef
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Guest Bio
In November of 2014, Chef James Smith was appointed as the first-ever Chair of Culinary Programs and Operations for Centennial College.
James adds over 26 years of culinary, academic and leadership experience to this team.
James joins us most recently from Georgian College where he was the Associate Dean of Hospitality, Tourism and Recreation. James' primary passion has always been the Culinary Arts having worked in leadership positions at several Toronto landmark restaurants including Scaramouche, Truffles at the Four Seasons, Boba and Senator Restaurants. James also brings a wealth of experience in Food Media having worked on Food Network productions such as Cook Like a Chef, Christine Cushing Live, Martin Yan's Chinatowns Series as well as working with Canadian Living Magazine.
James began his academic teaching career at the Calphalon Culinary Centre before he transitioned into a full-time position at George Brown College as the inaugural Research and Development Chef at the Centre for Hospitality & Culinary Arts. James went on to teach in Continuing Education and Apprenticeship before he was hired as a full-time faculty member to teach Culinary courses in the Bachelor of Applied Business in Hospitality Operations degree. Once established as an exceptional professor, James moved on to develop and launch an innovative program combining Culinary Management and Nutrition where he fostered many partnerships, participated in many applied research projects and created an active program advisory committee.
James' personal education journey includes obtaining a Culinary Management Diploma as well as his Red Seal Certification before he completed his MBA in Hospitality and Tourism from the University of Guelph.
Additional Info
- Segment Number 2
- Audio File florida/1623fl4b.mp3
- Doctors Bautista, Joel O.
- Featured Speaker Joel O. Bautista, MD
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Guest Bio
Dr. Bautista is a general surgeon who lives and practices in DeLand, Florida. He received his medical degree from Washington University in St. Louis, Missouri. He fulfilled his general surgery residency at the Charity Hospital System of Louisiana State University Medical Center in New Orleans, Louisiana. Dr. Bautista is board certified in general surgery by the American Board of Surgery, and he is a fellow of the American College of Surgeons.
Learn more about Dr. Bautista -
Transcription
Melanie Cole (Host): The gallbladder isn't an organ that gets a lot of attention unless it's causing you pain. My guest today is Dr. Joel Bautista. He's a general surgeon with Florida Hospital. Welcome to the show, Dr. Bautista. Tell us a little bit about the gallbladder. People don't even know what this organ does.
Dr. Joel Bautista (Guest): Well, good morning. Thank you for having me. The gallbladder--consider it like a bag in the abdominal cavity underneath the liver. It's connected to the bile duct, which connects the liver to the bowels and what it does is, it stores the bile that the liver produces so that when you eat, it squeezes that bile down into the bile ducts and into the bowels so the digestion of the food--typically fatty foods--is more efficient.
Melanie: So, it's basically a storage organ for bile until it needs to be excreted?
Dr. Bautista: Yes. Yes.
Melanie: What can go wrong with the gallbladder?
Dr. Bautista: Well, this bile is composed of several components and one of them is cholesterol. Sometimes, some of this bile can very thick and you get sludge which can become problematic. Sometimes, crystals will form out of this; they'll precipitate out, as we say, and they'll coalesce, come together and they form gallstones. The most common type of gall stones are actually cholesterol stones. Now, the sludge and stones, by themselves, may not cause any problems, and if they're not too problematic, they could probably be monitored. Obviously, they can cause symptoms that may warrant treatment.
Melanie: What would be some of those symptoms? Would people experience severe episodes of pain? What would they experience?
Dr. Bautista: There are classic symptoms. Typically, those are sharp abdominal pain in the right upper portion of the abdomen; the area where the liver, below the liver would be. Sometimes, this pain may radiate to the back, to the shoulder. Typically, this pain will be exacerbated, or made worse, when you eat. Again, remember the gallbladder is stimulated when you eat, so it may result in the discomfort or spasm of the gallbladder and the symptoms. The symptoms also may elicit more vague symptoms of nausea, vomiting, maybe loose stools, and, in more complicated cases of gallbladder disease, you could have progressive infection that could cause fever, chills, and even jaundice--yellowing of the skin and--eyes because of possible blockage of the biliary system.
Melanie: Dr. Bautista, are there certain people that are more predisposed to gallbladder disease? Excessive alcohol use or obesity? Are any of these lifestyle type behaviors something that can contribute to problems?
Dr. Bautista: Well, we learn in medical school there's a group of patients most commonly, classically that could develop gallbladder disease. Fair, fat, in their 40’s, but it, obviously, could occur in a lot of other people. In this area of Florida, we often see it in the Hispanic population. People with blood disorders like sickle cell may have gallstones and not from cholesterol stones but from the breakdown of their hemoglobin and those stones are typically darker, as well, too.
Melanie: How do you know if something is going wrong if someone is experiencing some of those symptoms? Do they rush themselves off to the emergency room? What do you do there?
Dr. Bautista: It depends on the intensity of the symptoms. More often than not, people will have some discomfort, they'll have recurrent episodes, they'll progress, and, at some point, depending on their threshold, they may seek medical attention. That's the typical pattern that we will see. Sometimes, the pain can become so intense that you're not able to wait to make it to your appointment to your primary care physician; you may go to the emergency room. But, obviously, if you're having those symptoms in addition to having fevers and the jaundice, then that would probably require more a urgent evaluation through the emergency department, for sure.
Melanie: Can the gallbladder get cancer?
Dr. Bautista: Yes. It's not a common cancer but when it does occur, it can be potentially very aggressive. Part of the reason for that is, we often don't find these cancers until much later because we don't typically identify symptoms related to gallbladder cancer until they're much larger and they're causing other problems maybe to the bile duct and surrounding structures. Sometimes, when people are evaluated with imaging, CAT scan, or ultrasound, it's not uncommon to find polyps in the gallbladder and the patient may not have any symptoms. If the polyp is typically less than 5-10 millimeters, or about a quarter inch, those can be usually monitored and followed, especially if they're not having any other symptoms or significant risk factors. Larger than 10 millimeters size, which is about 1/3 of an inch, then that's the time you might want to consider having something done about it at that point before it becomes more problematic.
Melanie: So, what are some treatments for gallbladder diseases or some of these things we've been discussing? Is it always to remove the gallbladder, or are there other interventions?
Dr. Bautista: Well, there are always options. Obviously, doing nothing is an option, but depending on their symptoms and their actual pathology what's causing their problems, that might not be reasonable. Usually, the most common thing is an operation to remove the gallbladder. There are some situations where, most commonly, when patients aren't going to be able to tolerate the operation and the anesthesia associated with it, like an older patient with significant heart disease, sometimes, we may do a dissolution therapy, or medication that will help dissolve the stones. But, they have to be a certain type of stone and sometimes you're taking medicines for an extended period of time and you can continue to have problems and even if the medicine works and the gallbladder is still there and it shows that it can make more stones in the future. So, typically, the best option, if you have problematic gallbladder disease, is an operation and this is done laparoscopically, or minimally-invasive, as we say, is the most common technique. It is the standard of doing it surgically that way with the understanding that we may have to convert to an open operation, if there are any issues.
Melanie: What would you like listeners to know about lifestyle behaviors and dietary adjustments that they might have to make if they've had gallbladder surgery or if they're at risk for gallbladder issues?
Dr. Bautista: Well, if they do have problematic gallbladder disease and they want to try to manage it conservatively, the best with regards to diet is maintaining a low-fat diet. Again, it's the fat and the greasy foods that are the ones that are most likely going to release the hormone that stimulates the gallbladder to contract, so if you can minimize that. After an operation for gallbladder, called a “cholecystectomy”, typically patients won't have any significant restrictions with their diet. After they're healed from that operation, there's really no restriction with their activity, as well. There is a small percentage of people that will have chronic loose stools from not having their gallbladder, but that's probably less than 2-3% of people.
Melanie: Some people have heard in the media about gallbladder cleanses. Is there anything to this?
Dr. Bautista: I've had people approach me with that and I really don't feel comfortable to say that I would advocate that. I think it's best maintaining a good, healthful diet, exercise; everything that you would do maintaining your body's health and fitness for the gallbladder, you would do maybe for your colon, for your heart, and all those things. I would think maintaining a healthy lifestyle is the best option.
Melanie: So, in just the last few minutes, Dr. Bautista--it's such great information--give us your best advice about maybe when to call your doctor for symptoms you're not sure of, how to keep a healthy gallbladder, and why they should come to Florida Hospital for their care.
Dr. Bautista: Well, if you should have any symptoms that I've mentioned, I think the first step is going to see your primary care physician, or internist, or family practitioner, and they can help navigate and try to discern what kind of problem are there. Then, based on that, then they may order additional evaluation, typically with lab work or some type of imaging, usually an ultrasound. Sometimes they do a nuclear scan study. If that does confirm gallbladder disease, then the next step may be referrals to a surgeon to discuss that. Sometimes, with complicated cases, you may require a gastroenterologist to help clear the bile duct of any complicated stone. With the need for all these sub-specialties the Florida Hospital Healthcare partners is always a reasonable and good choice because we provide all those specialties to be able to care for the whole patient.
Melanie: Thank you so much for being with us today. You're listening to Health Chat by Florida Hospital. For more information, you can go to fhsurgery.com. That's fhsurgery.com. This is Melanie Cole, thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 1
- Audio File florida/1623fl4a.mp3
- Doctors Grove, Christopher
- Featured Speaker Christopher Grove, MD
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Guest Bio
Dr. Grove is a board certified general surgeon who lives and practices in Daytona Beach, Florida. He received his medical degree from the University of Alabama School of Medicine in Birmingham, Alabama. He fulfilled his integrated general surgery residency at Wright State University in Dayton, Ohio. He is a fellow of the American College of Surgeons and fluent in all aspects of general surgery. Dr. Grove believes in “a personal touch” and makes it a point to contact his patients directly after surgery in case they have any questions or concerns. In his spare time he enjoys computers, scuba diving, camping, and racquetball. He is also an active member with the Boy Scouts of America and recently received the Outstanding Eagle Scout Award from the National Eagle Scout Association.
http://www.hcpphysicians.org/index.php/physicians/christopher-grove-md -
Transcription
Melanie (Host): If you’ve been diagnosed with breast cancer, your doctor may recommend surgery and can help you determine the kind of surgery that’s most appropriate for you. My guest today is Dr. Christopher Grove. He’s a board certified general surgeon with Florida Hospital. Welcome to the show, Dr. Grove. What a scary thing when women hear they have to have surgery and breast cancer surgery or surgery on their breast for any reason. Tell us what about the different types of surgeries out there to give them a little reassurance.
Dr. Christopher Grove (Guest): Thank you. I appreciate the opportunity to be on your show today. There are several types of breast cancer surgery now. It used to that a woman would lose her entire breast if they had breast cancer but now we certainly have much better options than that. The first option is to do breast conservation therapy. That basically means that you go in and you take out the breast cancer itself, take out the lump, so to speak, and then from there, we actually go and take out a sample of the lymph nodes. The other option is a modified radical mastectomy and that means that we go in and take out all of the breast tissue overlying the muscle which is obviously a much bigger surgery and much more disfiguring. Now we can offer something that’s much more cosmeticly pleasing to the patient and offers a lot less pain and a lot quicker getting back to work with much less chance of complications.
Melanie: Let’s start with the lumpectomy because we’re going to work our way through some of these and even cover breast reconstruction during surgery if you’re having a mastectomy. If you’re having a lumpectomy what can a woman expect? Is this a minimally invasive type procedure?
Dr. Grove: My favorite saying is that the only minor surgery is surgery on somebody else. With that said, it’s a fairly minor procedure when we go in and take out the lump and we don’t have to take out any extra breast tissue. We try to get just around the cancer, get negative margins around it so that the patient, hopefully, will not have to come back and have anything else take out. It’s an outpatient surgery. They come in, have it done and go home the same day and sleep in their own bed that night. It takes about a week to ten days to completely recover from that.
Melanie: Why would a woman not be able to have a lumpectomy and have to do a mastectomy?
Dr. Grove: There’s several factors that a surgeon will look at when the patient comes into the office. We have to look at the size of the tumor and that’s, not only just the size of it, but the size relative to the breast as well as they type of cancer that it is and any other mitigating factors that the patient may have. We do our best to try to offer breast conservation therapy in patients that meet all the criteria which is becoming more and more patients are meeting that criteria. We don’t like to do a mastectomy if we don’t have to but, certainly, some women prefer to have a total mastectomy just so they don’t have to worry about it anymore.
Melanie: That’s a good point right there. If you have a lumpectomy, is that still a concern for women that breast cancer could come back? If they have a mastectomy is that no longer a concern?
Dr. Grove: The studies show that the two operations are actually equivalent in five year survival. So, if you go with a lumpectomy or with a mastectomy, five years down the road you stand the same amount of chance of being alive from your breast cancer. There’s a slightly higher chance of a local recurrence, meaning the cancer coming back at the breast with a breast conservation therapy because you’ve left breast tissue there. Certainly, if the tumor comes back we can always go back and do a mastectomy and, like I said, the five year survival from that is the same. If we do a mastectomy, even though we take out all the breast tissue there’s still always some breast tissue remaining. It doesn’t reduce the risk of recurrent cancer to zero but it certainly is low.
Melanie: If the cancer is localized to the breast itself, you can do your lumpectomy or mastectomy. What if it’s spread out into the lymph nodes? Do you prophylactically remove some lymph nodes? Tell us about lymph node removal.
Dr. Grove: The lymph node evaluation has come a long way over the last several years. We used to go in and take out all the lymph nodes which meant that women would get swelling in the arm; they would have increased risk of injuring the nerves that innervate the muscles surrounding the arm and into the back. Now we use something called “single lymph node biopsy”. The patient will come in and have a radioactive tracer injected into the breast. Then, we take them to the operating room and use a radioactive gamma counter to find those lymph nodes that light up. That allows us to take out one or two lymph nodes instead of multiple lymph nodes which greatly reduces the amount of swelling they have and nearly eliminates the risk of nerve injury but not totally eliminate it.
Melanie: What are some of the after effects of lymph node removal for the women? They hear about lymphedema and things along those lines. Tell us a little bit about what happens after.
Dr. Grove: The side effects of a lymph node dissection are mainly a fluid collection or a seroma up under the arm as well as some numbness and tingling under the arm. The worst case scenario is what we call “lymphedema” which is swelling of the arm. Again, for women that develop that, there are even now physical therapy sessions that are available for that called “lymphedema clinics” where we can even reduce the side effects of lymphedema. The goal with single node biopsy is that we’ve greatly reduced that risk and so we’re seeing this less and less. Certainly, there’s still always that risk. If it does develop, there are at least some treatment options now.
Melanie: Dr. Grove, as a general surgeon, tell us what’s going on in the world of breast reconstruction during mastectomy and how women can feel a little bit better about themselves post-surgery.
Dr. Grove: The idea of reconstructing the breast right after surgery is one of those things that have kind of come and gone in waves. The reason for that is that we certainly would like to reconstruct every breast that we can at the time of surgery so that when you do wake up cosmetically, it’s more pleasing to you; you feel whole again and women are a lot happier if they have immediate breast reconstruction. The problems that we face and have to make a decision on each individual basis is to whether a patient is eligible for that has to do with the size of the tumor, whether they’re going to need chemotherapy and radiation therapy afterwards; as well as whether it’s moved into the lymph nodes or not. Our problem is that if we reconstruct a breast immediately and we have to radiate that area, then we can either lose a breast flap or contract a breast implant capsule. There are a couple different types of breast reconstructions and one of those is a saline implant and the other is a flap reconstruction. Certainly, if a woman would like to have her own tissue there, then we’re able to do a tummy tuck, so to speak, at the same time. We bring tissue up from the belly and place it up under the chest wall and it allows a woman to have actual live tissue up in the breast. The other option is to do the saline implants and they usually start with tissue expanders to expand that area. Both of those can be done either immediately during surgery or, most commonly now, after they have undergone treatment for their breast cancer and are then ready to proceed.
Melanie: What do you tell women that ask you about the BRCA gene and prophylactic mastectomy?
Dr. Grove: I highly recommend that anybody that is under the age of 40 or who has a significant family history of breast cancer to undergo BRCA testing first. The studies are very definitive that prophylactic mastectomy in somebody who is BRCA positive is very worthwhile to at least consider. I don’t push anybody to absolutely have the bilateral mastectomy if they are BRCA positive but I certainly think that they need that information ahead of time. They’ve come a long way with gene testing and we can have the answer on the BRCA test fairly quickly now. You used to have to wait two or three weeks and now we can have it within a few days so that we can help make that decision prior to going to the operating room.
Melanie: What great information. in just the last few minutes, Dr. Grove, give women listening and the spouses that love them, your best advice and information – what you tell people every single day when they are considering breast surgery for a myriad of reasons.
Dr. Grove: The first thing I always want to reassure women about is that breast cancer used to be a death diagnosis. If you got it, you were not going to live from it. We very much have some good tools in the toolbox now and much less deformative surgery and much better options in order to treat breast cancer. Breast cancer, in my opinion, is a treatable disease and we do our best on every patient to go for a cure, if at all possible. I let them know that I’m going to be with them throughout the process. We have a medical oncologist and surgical oncologists. We have radiation oncologists. So, it’s a whole team approach to approaching breast cancer now. They certainly will not be alone on that path.
Melanie: Why should they come to Florida Hospital for their care?
Dr. Grove: Florida Hospital is a wonderful hospital. I think that they not only take care of the patient medically but spiritually and emotionally and offer that support. We have breast cancer navigators that are with the patient from the time that they go in for their biopsy through the time that they are in our office for follow up and all the way through their oncology follow ups. That person is with them and can answer questions and guide them through the process. I think it adds a lot to the patient experience and takes away a lot of the fear. Certainly, many hospitals can do a good job of taking care of the patient with the medical aspect but I think that we add that extra component to it.
Melanie: Thank you so much for being with us today. You’re listening to Health Chat by Florida Hospital. For more information you can go to fhsurgery.com. That’s fhsurgery.com. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
