Inactive (722)

Segment Number 1
Audio File city_hope/1622ch2a.mp3
Doctors Khosravi, Azar
Featured Speaker Azar Khosravi, MD
Guest Bio Dr. Azar Khosravi graduated from medical school from the Shahid-Behesthi University in Tehran, Iran. She moved to the United States in 2000, and first worked as a Research Assistant at San Francisco General Hospital, in the Department of Family Medicine. Dr. Khosravi went on to complete a residency in Internal Medicine at Saint Vincent Hospital in Worcester Massachusetts, followed by a Fellowship in endocrinology at the National Institutes of Health in Bethesda, MD, from 2004 through 2007. She then served as an instructor in Endocrinology and the Associate Director of the Osteogenesis Imperfecta Department within the Kennedy Krieger Institute at Johns Hopkins, where her research focus was on bone and mineral metabolism. She also served as a Clinical Associate, in the Skeletal Clinical Studies Unit, Craniofacial and Skeletal Disease Branch at NIDCR, NIH. She is board certified in Internal Medicine, and in Endocrinology and Metabolism. Her research focuses on metabolic bone diseases.

Learn more about Dr. Azar Khosravi
Transcription Melanie Cole (Host): Metabolic bone diseases are disorders of bone strength and can sometimes be caused by abnormalities of minerals or by other factors. My guest today is Dr. Ozar Khosravi. She’s an endocrinologist at City of Hope. Dr. Khosravi welcome to the show and tell us about your new clinic at the Center for Metabolic Bone Diseases at City of Hope.

Dr. Ozar Khosravi (Guest): Thank you very much. We are launching a new clinic with a focus on metabolic bone diseases in the context of a cancer hospital mostly dealing with bone loss that happens after cancer, whether it’s the cancer itself or treatments or even survivors for a long time after the diagnosis of the cancer and the completion of therapy. We have a department that has trainees. We have endocrinology fellows at City of Hope and also other institutes that come here. Apart from the cancer patients, we also have another focus for general metabolic bone diseases that are usually rare genetic conditions but of interest to endocrinologists apart from cancer patients but the vast majority of the focus is bone loss in cancer patients.

Melanie: Why does that happen, Dr. Khosravi? Bone loss in cancer patients--is this a common occurrence as a result of treatment?

Dr. Khosravi: It’s very common, especially at the onset of diagnosis or as a result of therapy. There are some cancers that by themselves can cause bone loss, even before any treatment is started. Breast, prostate and gastric, thyroid, liver, brain, lymphoma, leukemias. Some of them, like leukemia, can actually present with spine fractures in very, very young patients and could be a presenting symptom. Apart from that, as you mentioned, the treatments also can cause a lot of damage to the bone which could be lasting for a long time. Chemotherapy, especially in pre-menopausal women, are the biggest insult. Radiation therapy – sometimes we think that radiation is focused on one area, it wouldn’t harm the bone in general, which is an incorrect concept. If the treatments affect sex hormones--in women estrogen and in men testosterone--that could be an added insult to the bone. Those are another big treatment strategy that is used for a lot of cancers but it also has a lot of effects on the bone, directly and indirectly. Physical activity changes during treatment for cancers, so that’s also another reason. Immobility, long hospitalizations and changes in diet--these are all things that can affect bone in short-term and long-term.

Melanie: We hear about osteoporosis as we age, Dr. Khosravi, and the media, things about Boniva and keeping your bones strong, do you deal with osteoporosis in these associated patients that are dealing with cancer treatment the same way you would deal with osteoporosis in just an average aging individual without cancer?

Dr. Khosravi: That’s a great question because there are a lot of things that are different. Sometimes you are dealing with very young patients, so the focus in these patients and, basically, in all patients, the first and foremost, is lifestyle optimization and making sure their diet is calcium rich and trying to get them get their calcium from diet rather than supplements. Also, exercises that are bone focused. In our clinic, before the patients even see the physician, they go through nutrition and physical fitness evaluations and then see us and we talk about medications. That’s probably one of the best opportunities to modify a patient’s diet in the right direction. Also, the medications play a very major role and one of the ways it’s different from the general population is that we actually have lower thresholds to start patients on treatment because it has been shown in population studies that women who were on osteoporosis treatment mostly bisphosphonates, Fosamax, Boniva, Actonel, Zemeda – all those medications--had a third less risk of breast cancer in the future. There seems to be some anti-cancer effect from these medications. So, in the right patient that needs medical treatment, we usually have lower thresholds to start them on these treatments. The other thing that is different is that some of these changes in bone are temporary. If you have a younger patient or children, they lose a lot of bone during treatment but they could restore some of that bone structure later, given the right guidance. It’s a very dynamic issue depending on what phase of the treatment you see the patient. As a result, the strategies are going to be different. What is constant is lifestyle optimization.

Melanie: Before we get to lifestyle optimization, do you then routinely check bone density to see if osteopenia has started or if there is developing osteoporosis, even if it’s dynamic and possibly temporary?

Dr. Khosravi: Yes. It is x-ray based but I have to say DEXA scans use very, very low radiation. It’s pretty much equivalent to going to the beach for one day. So, there’s not much of a risk to the patient to be having DEXA scans once a year or every other year. That is usually our tool to gauge the bone loss and also the follow up to see, with whatever treatment that we suggested, if it has been effective and that we are going in the right direction. That’s absolutely one of the first and foremost tools that we have.

Melanie: How do you work with people on diet and exercise while they’re going through treatments for something else to keep track of this and hopefully keep it at bay just a little bit?

Dr. Khosravi: It’s usually not very difficult. The calcium rich diet is not hard to reach unless somebody’s diet is particularly unhealthy. Dairy has a lot of calcium, if patients are inclined to have dairy or can tolerate it, but there are a lot of vegetables, especially dark, leafy, green stuff that have plenty of calcium. Vegetables like kale, chard, collard greens and turnip greens have a lot of calcium. There are some fatty fish like tuna and even tilapia that has a lot of calcium. It is not difficult to get calcium, if they eat the right amount of vegetables, particularly. Some fruits and citrus, also, has a lot of calcium. There are also some fortified sources of calcium in the foods but I think if we stick to the natural foods that we have without fortification, we should be able to get enough calcium. Vitamin D is the other component of bone structure. Sun exposure is a great source of Vitamin D formation but a lot of people end up getting some supplementation depending on the season and where they live, their age and even skin color, it could determine their Vitamin D levels. A good percentage of people end up needing some Vitamin D supplementation.

Melanie: In just the last few minutes, wrap it up for us Dr. Khosravi and tell us about this new center Clinic for Metabolic Bone Disease that you’re starting there at City of Hope and why they should come for their care. Tell us a little bit about your team.

Dr. Khosravi: We have recognized for a long time that every cancer center needs a bone center because a great number of patients, apart from those that get bone metastasis from the cancer have a lot of bone loss, especially immediately after treatment or even during treatment. The consequences of bone loss and osteoporosis could be severe. It could result in chronic pain, loss of lung volume, if it is significant, spine fractures and, unfortunately, even death if it is in elderly and they get a hip fracture. I think, a lot of times, we lose sight of the grave consequences of osteoporosis that remains untreated so we want to raise awareness and also promote a healthy lifestyle, first and foremost, which is important for any condition, including the bone. We think that it is an opportunity to make people aware that not necessarily as we age, we shrink. If we maintain a healthy lifestyle we should be able to go through old age without losing our height and bone density.

Melanie: Thank you so much, Dr. Khosravi. It’s absolutely fascinating and I applaud all the great work that you are doing at City of Hope. You’re listening to City of Hope Radio. For more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole MS

The Latest Treatments for Stomach Cancer

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Segment Number 4
Audio File city_hope/1608ch3d.mp3
Doctors Woo, Yanghee
Featured Speaker Yanghee Woo, MD
Guest Bio Yanghee Woo, M.D., is a surgeon scientist specially trained and internationally recognized in robotic surgery and gastric cancer. She has particular expertise in complex procedures such as D2 lymphadenectomy for locally advanced gastric cancer. Dr. Woo offers her patients completely laparoscopic and robotic surgeries (for stomach and pancreas tumors) with optimal oncologic outcomes while preserving patients' quality of life. She is one of very few surgeons who treat gastric cancer and pancreatic cancer using minimally invasive methods.

Learn more about Yanghee Woo, M.D
Transcription Melanie Cole (Host): If you’ve been diagnosed with gastric cancer or a pre-cancerous condition in the stomach, City of Hope is a recognized leader in stomach cancer treatment and research. Gastric cancer patients receive unsurpassed diagnostic treatment and supportive care from our multidisciplinary team. The primary goal is to ensure that every patient and their loved ones can live a life free of gastric cancer. My guest today is Dr. Yanghee Woo. She’s a world renowned stomach cancer specialist at City of Hope. Welcome to the show, Dr. Woo. Tell us about the incidence of stomach cancer.

Dr. Yanghee Woo (Guest): Stomach cancer is an uncommon cancer in the United States. It’s about 26,000 patients who are diagnosed each year with stomach cancer. However, in the world, there are about a million patients diagnosed each year with gastric cancer and it is the third leading cause of cancer deaths. In the United States it is the eighth leading cause of cancer deaths and less than 25% of patients who are diagnosed with gastric cancer in the United States survive five years. So, it is a deadly cancer for some patients who are diagnosed with late stages. Unfortunately, diagnosing gastric cancer in its early stages is a major challenge.

Melanie: Tell us some of the risk factors. Who is at risk for this type of cancer?

Dr. Woo: Sure. There are two general groups. Only 10% of the patients who develop gastric cancer have a genetic predisposition. The most well-known genetic predisposition is the CDH-1 gene which causes the hereditary diffused gastric cancer. However, other mutations are known like the BRCA 1 and 2 mutation does give you a predisposition to gastric cancer and if you have Lynch Syndrome, you’re also at a genetic risk for gastric cancer. However, 90% of gastric cancer patients do not have a known genetic risk. So, what are the risk factors? Many of the risk factors are modifiable. You can divide it into two categories: modifiable risk factors and non-modifiable risk factors. The modifiable risk factors, obviously, include a long standing infection with H. pylori. H. pylori is a bug that grows and lives in your stomach and can put you at anywhere between 3-12 times risk of developing gastric cancer over a long period of time. Smoking is also a risk factor for developing gastric cancer as it is a risk factor for many cancers. Men are twice as likely to develop gastric cancer or be diagnosed with gastric cancer than women. The average age of diagnosis of gastric cancer in the United States is in the late 60’s, which is different from other countries and, depending on the ethnic minority groups, the incidence actually differs. You are at a higher risk of developing gastric cancer if you are a Korean American, Asian American, African American or Hispanic American compared to other non-Hispanic whites.

Melanie: People hear stomach cancer. It’s a very scary diagnosis. Are there some symptoms? Patients always want to know what symptoms they might pay attention to that would send up red flags, Dr. Woo.

Dr. Woo: Sure. Unfortunately, this is the biggest challenge to detecting gastric cancer in its early stages is its lack of specific symptoms for gastric cancer. In early stage of gastric cancer, 80% of our patients are asymptomatic or have symptoms that are non-specific. For example nausea, abdominal pain, discomfort, or reflux symptoms of heartburn – these are all nonspecific symptoms that you cannot attribute specifically to gastric cancer. Unfortunately, the concerning symptoms of gastric cancer of significant weight loss, persistent abdominal pain, feeling full with eating very little, loss of appetite, feeling like something is getting stuck in your throat like dysphagia--these symptoms do not occur that often. They may persist less than 3 months and it takes, sometimes, up to 3 to 12 months of these symptoms persisting for the patient or even the physician to feel that there is something going on in the stomach. It may be not addressed in an appropriate manner because the symptoms are non-specific.

Melanie: So, how is it diagnosed then?

Dr. Woo: Sure. The gold standard for diagnosing gastric cancer is with an upper endoscopy and a biopsy of any abnormalities in the inner lining of the stomach for analysis of cancer cells. An upper endoscopy is performed by a gastroenterologist with a scope. I think most patients are familiar with a colonoscopy. However, this is a scope that is introduced through your mouth that goes into your esophagus, evaluates the stomach lining and can see any mucosal abnormalities. If there is such abnormality, than the gastroenterologist will take a biopsy of these areas and it will be tested for histological evaluation to look for cancer cells or pre-malignant cells. There is no blood test to diagnose gastric cancer or a serum biomarker for gastric cancer detection. This is one of the limitations that we have. Decreased levels of red blood cells in our body called “anemia” can be a sign of G.I. cancers, including gastric cancer. It may lead our physicians to have our patients get an upper endoscopy. There are no specific physical signs of gastric cancer until its late stages. The diagnosis can be made only by an upper endoscopy and a biopsy.

Melanie: So, Dr. Woo, once the cancer has been diagnosed and staged, there must be a lot to think about when considering these treatments. Speak about the first treatment – first line of defense--and then go into how a listener would, or a patient, would deal with this type of cancer as a different normal.

Dr. Woo: Sure. The diagnosis of gastric cancer for most of our patients and their families can be devastating but there are absolutely treatment options for gastric cancer. Gastric cancer is curable in its early stages and in locally advanced gastric cancer when cancer has maybe gone through some of the lining of the stomach wall and spread to the lymph nodes in the region, is also curable but, at that point, will require a multi-modality treatment. For early stage gastric cancer that is confined to the inner lining of the stomach, it’s surgically curable. I want people to understand that in its early stages, gastric cancer is curable and 95% of the patients can live a normal life without cancer even with the diagnosis of gastric cancer. However, locally advanced gastric cancer that involves the stomach and sometimes its draining lymph nodes will require a multi-modality treatment. This means that, for the best available treatment options we need to combine surgery, the most proper surgery--that is the removal of the stomach, its cancer in the stomach and the lymph nodes that drain the stomach. And then, combine that with systemic treatments such as chemotherapy and, at times, radiation treatment. It is very important that each patient that comes and is diagnosed with gastric cancer be evaluated completely and meet with, not just the surgeons, but the medical oncologists and the radiation oncologists and some of the support staff that we have to create a comprehensive treatment plan from the beginning so that the patient and the family know exactly what is expected in terms of their treatment and what the best strategy is to ensure long life without cancer and the best quality of life. There are many different options that can be provided to the patient and their families in terms of the surgical approach, the different types of chemotherapy and when and how all these are combined to give them the best outcome.

Melanie: What about life after stomach cancer treatments? Is there a big change in diet? What’s the quality of life left? We don’t have a lot of time but speak about the quality of life.

Dr. Woo: Sure. After the stomach surgery that is required for removal of the cancer and for cure, requires that we remove either two-thirds of the stomach or the entire stomach. Many patients ask me “How can I live without a stomach?” and “How will it affect my life afterwards?” People can live without the stomach very, very well.   The stomach function can be eliminated and be taken over by other parts of the G.I. tract. The stomach is not required for life. However it is a major component of the way we enjoy our food and how our nutrition is processed. After surgery, patients will have to change their eating habits. When patients change their eating habits, it also changes the way they think about food and how they socialize with family and friends. Smaller portions must be taken in at each meal. They have to eat multiple meals a day and it will take about 3-6 months up to a year to adjust to the changes that occur. Patients will lose at least 10% of their body weight initially from the stress of surgery but also from having taken in less calories. Much more attention needs to be taken in evaluating what kind of foods that we eat--the calories, the content – higher proteins, higher fat content, less of sugar. Sugar is really bad for cancer. Also, this nutritional support that we give to our patients is necessary in terms of guidance and counseling over time. This is one of the biggest challenges. To maintain your body weight and actually maintain good body weight with higher muscle mass, it also requires that patients exercise and keep up energy because surgery and chemotherapy can make patients very tired and fatigued from the treatments.

Melanie: Dr. Woo, please wrap it up for us. This such important information. Tell us what is exciting at City of Hope and why patients should come there for their care.

Dr. Woo: Sure. Treatment for gastric cancer at City of Hope is amazing as I am a part of a multidisciplinary team. We are here to provide the best available treatment in the most timely manner. It includes personalized treatment, patient tailored, involving all our resources of medical oncology, radiation oncology. All the, research that is being done for gastric cancer on campus, we hope to bring to our patients. In practice there are a couple of things that we do very well here. Other than the multidisciplinary therapy, one of the strategies that we will create for every individual patient and their family members robotic surgery for surgically resectable gastric cancer patient. Robotic surgery is performed in less than 2.5%-5% of the time for gastric cancer in the United States. It’s a novel innovative approach to gastric cancer patients. It affords them the benefit of minimally invasive approach which is early return to normal life, meaning less pain after surgery; early ability to eat faster than open operation; patients go home sooner. There is much less blood loss during the operation. We are here to provide the best surgical outcome for our patients and one of the methods that we are using is new technology and innovation in robot surgical platforms. We have some clinic trials that are going on here at the City of Hope. One is for diagnosis of patients with HER2 positive disease using a novel radio tracer tagged to an antibody for HER2, which is a PET imaging study. Lastly, multiple new targeted antibody therapies for more advanced gastric cancer patients. One of the most exciting things that we are doing here in terms of research is novel treatments using vironcolytic therapy to target gastric cancer advancements--metastatic gastric cancer--or diseases that have spread beyond the stomach to the peritoneum and the liver. These are in pre-clinical studies meaning they’re not in humans right now but we hope in the next couple of years, it will get to helping cure and care for our gastric cancer patients.

Melanie: Wow. Thank you so much for being with us. Such great information, Dr. Woo. Thank you so much. You’re listening to City of Hope Radio and for more information you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole MS

Clinical Trial Tests Treatment for Enlarged Prostate

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Segment Number 4
Audio File virginia_health/1616vh2d.mp3
Doctors Haskal, Ziv J.
Featured Speaker Ziv J Haskal, MD
Guest Bio Dr. Haskal is a tenured professor of radiology and medical imaging in the Division of Interventional Radiology at the University of Virginia School of Medicine. Dr. Haskal received his M.D. at Boston University School of Medicine and completed residency and fellowship at the University of California, San Francisco. As a sought after teacher and educator, Dr. Haskal has given more than 500 invited lectures worldwide and been awarded numerous honorary fellowships, national, international and societal awards for leadership, service and research excellence. He has designed, participated or led more than 40 research trials. Dr. Haskal has also published more than 400 scientific manuscripts, chapters, review, abstracts and editorials in journals ranging from Human Gene Therapy and the New England Journal of Medicine, to Circulation, JVIR, Radiology, Hepatology and more. The AHA Guidelines documented he co-chaired and co-wrote has received more than 2,700 citations.

Learn more about Dr. Haskal

Learn more about UVA Radiology and Medical Imaging
Transcription Melanie Cole (Host): About 210 million men worldwide suffer from symptoms such as frequent or painful urination caused by an enlarged prostate. A clinical trial at UVA is examining a non-surgical procedure for these symptoms called “prostatic artery embolization”. My guest today is Dr. Zeve Haskell; he's an interventional radiologist at UVA Health System. Welcome to the show, Dr. Haskell. First, let's talk about BPH or benign prostatic hyperplasia. What is that and how would a man know if they have it?

Dr. Zeve Haskell (Guest): Melanie, it's incredibly common in half of men aged between 51 and 60 and it increases to about 90% when they hit their 80s. Basically, the prostate is a big gland that sits under the bladder. As we get older, it grows, pushes up on the bladder, and it also squeezes the tube that carries urine outward--the urethra. So, we have symptoms that make it hard to initiate urination—can't start, and hard to empty the bladder, and in some cases, so bad that you're in the emergency room having a catheter placed.

Melanie: Wow. So, this is something that's so common and as we age as a society, you're seeing more and more men with it. What's the first line of defense when you notice someone has an enlarged prostate?

Dr. Haskell: Well, in 2010, we estimate that nearly $5 billion were spent on medications for this. So, the first line of therapy is tablets. Many men get some relief with these over several weeks or months. But, in those that fail, we start looking to more invasive options.

Melanie: So, tell us about some of those and then tell us about the clinical trial that you're doing for minimally-invasive options.

Dr. Haskell: Well, when the medications fail, folks will generally see a urologist who will discuss the various surgical options. In the rarest case, that will be a removal of the entire prostate. But, in most cases, it's something that's done through the urethra itself using a variety of things using lasers, or cutting tools, or even staplers, to push back the prostate or cut it out from the inside in order to make a larger passage. Those treatments are very effective but they do carry some real complications which are naturally a concern to all of us. Those include incontinence--being unable to hold urine; and sexual dysfunction as well--impotence or retrograde. That is reversed ejaculation. In looking for options that are less surgical or have less of these risks of these complications, we've sought, as interventional radiologists, to extend the types of things that we do for a living. We're choosing high-tech imaging to do minimally-invasive non-surgical treatments for almost everything in the body. And in the setting of the prostate, what we're essentially doing is injecting these tiny microscopic particles to reduce the blood supply to the prostate so it gradually shrinks in place.

Melanie: Wow. Now, this particular clinical trial is open so it's a national clinical trial, yes?

Dr. Haskell: Yes, that's right. It's a pilot study that is under the guidance of the FDA. We have it approved by the FDA, so we've chosen to do this rather than simply to offer the treatment to hold ourselves to the highest quality and rigor, to get the best evidence to support the widespread use of this in the US, and at the same time, provide the extremely detailed and high level of service and care when you're involved in a clinical investigation.

Melanie: So, as a potential alternative to other available and invasive surgical treatments, Dr. Haskell, tell us a little bit more about the PA procedure and what it involves.

Dr. Haskell: This was pioneered outside of the US and has been performed over a thousand times but the good, solid clinical information in the US is still lacking. As a patient, what it means is that you meet our team of urologists and interventional radiologists at our clinic. You get screened for the study, and if this is something that makes sense, then the actual procedure is done under light-conscious sedation. We have a tiny tube that is smaller than a spaghetti and more flexible than that. We pass that inside of the arteries and through that, an even tinier one directly to the ones of the prostate. We have some sophisticated imaging that allows us to make sure that we're only injecting this material into the prostate, not into adjacent things that we wouldn't want to block off. We do that to both sides and that usually takes us about an hour and a half. Patients are relaxed and awake and many of them are actually watching it on a black and white screen because you can't actually feel anything that is happening inside of the arteries. There are no nerves to feel with. We discharge our patients the next day and then we see them in follow up as part of our protocol which actually mimics what we'd want to do as best care, anyway.

Melanie: So, how long can they expect to see maybe some symptom relief if the prostate is shrinking from this procedure?

Dr. Haskell: Well, in some cases, men will experience some improvement within a week or two. More typically, it's gradual over several weeks and we have some patients who have had the same extraordinary good results that have been reported outside of the US and in other centers, as well, which is that those inability to hold urine or having to constantly go have really diminished or set the clock back many, many years, in that respect, without an operation.

Melanie: That's absolutely fascinating. What do you envision as the future of this procedure? Would it need to be redone, or is it something that's going to last 10 years as our population ages and men get older?

Dr. Haskell: Melanie, those are fabulous questions, and as a clinical researcher who's been working in this area of interventional radiology and embolization for 20 years, part of my job is to provide the best care but also to provide a beacon for the future of research and for centers elsewhere. So, we're looking to answer those very types of questions while giving our patients the best care. Will this last for 10 or 15 or 20 years? I don't know but we do this for patients with uterine fibroids and have for decades and we're able to repeat for women who grow new fibroids. So, it may be that the same options will be available for men, as well.

Melanie: How cool is that? And in just the last few minutes here, give your best advice for men suffering from BPH and where they can get more information about this clinical trial.

Dr. Haskell: Well, the first step is to make sure it is, indeed, the prostate and not the bladder which means being evaluated by a urologist and understanding what you have. We can certainly do that as part of our team approach at the clinic here in which we work in close partnership with our urologists. Everybody gets seen by everybody on the same day. If this is a good option that may spare you some of the surgical complications or you're looking to avoid being exposed to them, then you can reach us at 434-297-7136 or our email, which is uvaprostate@virginia.edu. That's 434-297-7136.

Melanie: The email is uvaprostate@virginia.edu. Thank you so much, Dr. Haskell, for being with us today. It's absolutely fascinating and we applaud all the great work that you're doing with this clinical trial. You're listening to UVA Health Systems Radio. And for more information, you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Self-Care For Family Caregivers

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Segment Number 1
Audio File allina_health/1620ah5a.mp3
Doctors MacBride, Gayle
Featured Speaker Gayle MacBride, PhD, LP -Allina Health clinics
Guest Bio Gayle MacBride, PhD, LP, has a PhD in psychology and am a licensed psychologist with professional interests in trauma and severe persistent mental illness.

Learn more about Gayle MacBride, PhD
Transcription Melanie Cole (Host): Having a loved one that's dealing with an illness or disease can be very hard on the caregiver. From the moment of diagnosis, your life as a caregiver or spouse or loved one is really changed. My guest today is Dr. Gail MacBride. She's a licensed psychologist with Allina Health Shakopee Clinic. Welcome to the show, Dr. MacBride. So, let's talk about the caregivers because people sometimes are willing to try to take on helping their loved ones but it can be just as hard on this person that is taking care of their loved one dealing with the disease.

Dr. Gail MacBride (Guest): Absolutely and we're looking at people who give care across the lifespan. We see parents caregiving for children as well as adult children caring for aging parents or spouses caring for each other as they go into later years of life.

Melanie: It can be so hard on both people, especially if you're talking about spouses, because it changes the whole dynamic of a marriage. What advice do you give people every day on dealing with that caregiving need because so many of those needs are definitely intimate, different, hard to deal with?

Dr. MacBride: It definitely puts a strain on marriages, in particular, because it shifts that relationship from a romantic, loving one often to just providing those simple activities of daily living kind of cares. And intimacy often drops back and sometimes even the companionship for the caregiver, it's really important to continue to make sure that needs are being met; social needs, staying in contact with friends, having the support needs, whether you're talking to other individuals who have similar struggles and kind of sharing those in sort of a peer support sort of way or even reaching out for professional support and making sure that other people can kind of help meet your emotional needs in a way that maybe your aging or ailing partner no longer can.

Melanie: So, one of the difficult things, and I've been a caregiver myself, quite a few times, is you're working a job at the same time, sometimes, because you have bills to pay and things that you have to do, so what affect does caregiving, with that stress, have on your health and well-being?

Dr. MacBride: You know as many as 1/6th caregivers are working full-time or part-time and there are a number of different challenges for those individuals. You know, if you're caregiving and working a job in a competitive employment setting, oftentimes, those caregivers are returning to that job and they're often fatigued, they're not sleeping well, they're not taking care of their needs, they're not eating, they're distracted because they're worried about their loved one that they're caregiving for, and it really decreases productivity on the job when you're not able to take care of yourself well. And there can be a huge cost to just your employer if you are not a well caregiver yourself. There's a financial cost, and you mentioned the importance of holding that job sometimes to be able to afford to be the caregiver, and oftentimes, because the care recipient isn't able to hold a job, we find that caregivers are not only just trying to afford their own bills, but they're trying to help afford the bills for the care recipient. Whether it's being able to help for the groceries, or the doctor's appointments, or paying off the hospital bill, they are oftentimes taking their own financial resources and putting it toward that care recipient who may or may not be living in their home.

Melanie: So, what do you want caregivers to know about taking on this role and making sure that they have that support that they need because it can change your life dramatically?

Dr. MacBride: You know, the first and most important thing that you need to know as a caregiver is the thing that you learn when you get on the airplane which is put on your own oxygen mask first before you begin to help others. If you're not taking care of yourself, your own health and wellness is compromised to the extent that you cannot adequately help others, it means you need to nurture yourself, eat well, sleep well, get exercise, and keep your life in as much balance as you can, and keep your own structure and consistency so that you can be there as fully as possible to be a caregiver. You also need to know when to ask for help, to bring in other resources and to know your own emotional and physical limits. I add physical in there, because sometimes as you're going down this road, this marathon of caregiving, we can tend to overexert and cause illness or injury to our own body when we are trying to do this as non-trained professionals, but loving, caring family members. We can overexert and harm ourselves to the extent that we can no longer be a caregiver.

Melanie: What are some signs that we are overexerting? When do you know that you need to just ask for help?

Dr. MacBride: When you see your own symptoms, either worsen or if you notice new symptoms-- symptoms like fatigue or increase in illnesses. You know, you get that cold and then you get the next one and the next one. You get whatever's kind of going around. Your immune system seems to be compromised. If you notice you're short and irritable, or just kind of tired and run down all the time, you find yourself sleeping too much or not enough, if your concentration seems to be shot or you find yourself resenting being in the caregiver role, these are all things that are hints and signs that maybe you need to step back and have someone else help you.

Melanie: That's an important point that you make, Dr. MacBride. Speak about that resentment a little bit. What do you tell people about dealing with that? Doing what you do, as a licensed psychologist about that resentment, about that feeling of "I'm giving up my life to take care of this loved one of mine." How do you help them reconcile that feeling?

Dr. MacBride: You know, a lot of times it's sitting back with a patient and evaluating the reasons they took on these responsibilities to begin with. You know, they did this, oftentimes, because it preserves the dignity of the loved one in their lives, to allow someone to stay home longer, and helping someone kind of come back to the reason that they made that decision is often very useful. If they made it and it's financially driven and it began from a place of resentment and just feeling kind of stuck, then sometimes we try to see if we can't get hooked up with more resources. So, someone who might be of a social work or homecare kind of background that might be able to expand what we, as kind of lay people know, are out there as resources and be able to kind of add to the caregiving network for an individual. And, if it's not in a local community, oftentimes, there are national organizations that can also step in or provide ideas. The American Cancer Society has a good number of just amazing programs that help families and loved ones financially that oftentimes patients and their caregivers don't even know about.

Melanie: So, you mentioned putting on your own mask before you put on the mask of others and what do you recommend for caregivers to make sure that they are taking care of themselves in regard to making time for exercise or meditation or going out with friends?

Dr. MacBride: You know, I often recommend to my patients that they structure it like an appointment. They make appointments with themselves. You know, my patients are really great at making appointments and they do it all the time. They do it for the person that they're caregiving for and we forget because when we're trying to do these things for ourselves, we fit it in and when we fit it in, it's often the very first thing to fall off of the agenda. If you set it as an appointment or a reminder on your phone or a calendar or you begin to structure it in everyday, then it becomes a more part of your normative routine.

Melanie: And that's what's important. What do you want caregivers to know about when they seek help? if they are looking for somebody professional to help them, what should they be looking for?

Dr. MacBride: You know, first and foremost, if you're looking for professional help, you have to feel like you have a really good interpersonal fit. I tell my patients at their first visit with me, that they need to feel like they've met someone they really kind of connected with. That is an important decision for them to make. I can't make that on their behalf. Things like age and gender and life experience and those kinds of things factor out in service of making sure you have a good fit and rapport with your therapist. It's really important for patients to know they're not alone and to know that you can talk with a therapist or a professional on an individual basis, but sometimes, group interventions are extremely helpful because they allow people to talk, interact, build a support system, and know that they are not the only ones going through these really complicated feelings.

Melanie: That's such an important point. In just the last few minutes here, give your best advice for caregivers out there, when to ask for help and some signs that it could be too much for one person to take on.

Dr. MacBride: The signs that it's too much are when you know that your depression--maybe you're prone to depression--is increasing, and it's really not kind of leveling itself back out and you're going two, three weeks or a month and the depression is really getting quite bad, or the anxiety has gotten up. If you notice that you have started increasing your alcohol intake or you've picked up smoking again and these are behaviors that you've had well-managed for a long time, and you notice that these things are kind of getting to be too much for you to handle, they may be signs and symptoms that you need to intervene in a more aggressive kind of way, like seeing a therapist, or even talking to your primary care provider about what the right intervention might be for you. If you find yourself neglecting your responsibilities or you're cutting yourself off because “I just can't handle one more thing. I can't take one more person asking me for something” or “I just don't take enjoyment in the things that I used to enjoy in my leisure time”. Those are all times to say, "I need help before I do any more caregiving."

Melanie: That's so important. Just wrap it up for us for advice for the caregivers on self-care.

Dr. MacBride: Self-care is critical and those things that we've said before like getting good sleep is one of the most key things that you can do. We're not looking so much at quantity of sleep as we're looking at good quality of sleep. Being able to fall asleep and stay asleep; eating healthy, balanced meals every day; getting that exercise in and adequate hydration are the four basic things that you can do for wellness, no matter what the disease or condition. For the caregivers, ask for an advocate, ask for support, ask primary care, ask your therapist to direct you to a treatment that might be best to kind of support you. Don't forget relaxation, mindfulness, prayer, meditation--all of those things carved into your life help create a lot of balance as you go through really stressful times.

Melanie: What great information and so beautifully put. Thank you so much Dr. MacBride for being with us today. You're listening to The WELLcast with Allina Health. And for more information you can go to allinahealth.org. That's allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Significant Advances For The Treatment of Fibromyalgia

Additional Info

Segment Number 5
Audio File allina_health/1620ah1e.mp3
Doctors McAllister, Murray J
Featured Speaker Murray J McAllister, PsyD, LP -clinical psychologist, Courage Kenny Rehabilitation Institute
Guest Bio Murray J. McAllister is a health psychologist specializing in chronic pain rehabilitation. He currently serves as the Clinical Director of Pain Services for Courage Kenny Rehabilitation Institute. Courage Kenny is a leader in providing chronic pain rehabilitation care that helps people with chronic pain learn to live a full and active life.

Learn more about Murray J McAllister, PsyD
Transcription Melanie Cole (Host): Fibromyalgia affects millions of Americans, predominantly women, and is often misunderstood by the medical community. In recent years, however, significant advances have occurred in our understanding of this condition. My guest today is Dr. Murray McAllister. He's a health psychologist and the clinical director of Pain Services for Courage Kenny Rehabilitation Institute. Welcome to the show, Dr. McAllister. First, tell us what is fibromyalgia?

Dr. Murray McAllister (Guest): Well, fibromyalgia is a chronic pain condition that is characterized by a few key symptoms. Those symptoms are widespread pain all over, excessive fatigue, and what might be considered a sensitivity to touch or mild pressure. So, what I mean by that is that people with fibromyalgia, as well as other chronic pain conditions, by the way, will often report that at some time during the course of their condition, they notice that things that are normally not painful have become painful. The classic example for fibromyalgia is that hugs hurt. The pressure to the skin and the muscles that are involved in a hug that shouldn't be painful have, in fact, become painful. We call this “allodynia” or “hyperalgesia”. People with fibromyalgia they report pain all over, the sensitivity to touch and pressure and excessive fatigue. Commonly, though, folks with fibromyalgia also report other symptoms, too. They can report they have light and unrestful sleep, irritable bowel symptoms, poor concentration, short term memory problems, anxiety, depression and these kinds of things.

Melanie: Dr. McAllister, do we know what causes fibromyalgia?

Dr. McAllister: That's a great question. In fact, we do. For many years, though, it was thought to be an idiopathic condition. Idiopathic means that we didn't know what causes it. But, recently, I would say in the last decade-and-a-half, basic science has come to find that fibromyalgia is caused by a condition called “central sensitization’ and to explain what that means, I have to first talk about how pain works in the body. In our society, we oftentimes think that injury or illness is the most important thing when it comes to pain and, of course, it is important, but no matter what the source of pain is, we also need a nervous system in order to have pain. The nerves in the body detect some kind of problem, like an injury, and they send those signals up the spinal cord and brain, which is also part of the nervous system. The brain processes those signals and creates pain in the body. So, for example, if I had a four inch nail sticking in my foot, I'd feel pain in my foot, of course, but it's only because the nerves in my foot are sending signals up the spinal cord and brain and the brain is processing those signals into the experience of pain in the foot. So, that's how normal pain works. Now, in normally functioning nervous systems, it takes a certain amount of stimuli to cause pain. So, for example, usually it would take a slug in the arm to cause me pain in my arm; whereas, a gentle pat on my arm typically isn't a sufficient amount of force to cause pain. Now, if we got back to fibromyalgia here, what happens in fibromyalgia is that the nervous system becomes excessively reactive. So, it takes less and less stimuli to cause pain. So, the nerves in the body and spinal cord and the brain come to communicate to each other in such a way that the whole system gets stuck in this heightened state of reactivity. It's like it's stuck in this hair-trigger mode that any amount of stimuli can cause pain--for example, just sitting in a chair. Now, that amount of stimuli that occurs when sitting in a chair or having a grandchild sit on my lap shouldn't be painful, but for folks with fibromyalgia it is because those nerves are sending up the signals to the brain and the brain is processing it into pain. So, when the whole system gets stuck in this high state of reactivity, it's called “central sensitization”. That's what we know now is the cause of fibromyalgia.

Melanie: That's fascinating and so well explained. How do you diagnose it?

Dr. McAllister: Well, you know, it's basically based on the patient's self-report of symptoms. We all would love to have a reliable test for the condition, some kind of litmus test for it, but we also, unfortunately, don't have that. In the health care system what the providers does, essentially, is a checklist of possible causes for this widespread pain all over. So, they're going to rule out first, like rheumatoid arthritis, or lupus, or other rheumatological conditions. They'll rule out orthopedic conditions like bone fractures or ligament tears or sprains, things like that. They'll rule out cancer and making sure that somebody doesn't have cancer, but once all those tests come back negative, then, basically, the diagnosis is on the self-reported symptoms of the patient. Specifically, that would be the widespread pain all over and it has to be kind of pain below the waist and above the waist, on the right side, on the left . Of course, the pain typically moves back and forth from day to day, but it has to be on all four quadrants of the body at some time. Then, also, I should add, that it has to be for at least three months, which is the typical, common time for marking something as chronic. Now, just up until about a few years ago, health care providers diagnosed the condition by slightly palpating, or pushing on certain areas of the body called “tender points”. So, if the patient reported pain upon mild pressure at a sufficient number of these sites, they were considered to have fibromyalgia. In the last few years, we've realized that that's not a very reliable test and the field has come to recognize that we're just going to base the diagnosis on self-reported symptoms once everything else has been ruled out.

Melanie: So, Dr. McAllister, I would like to ask you, because there seems to be some stigma around the condition of fibromyalgia. Why do you think that is and why are more women involved in this? Do you think there's something stress related? Talk about that correlation for just a minute.

Dr. McAllister: Yes. Well, first we take the issue of stigma. That's such a big issue for folks with fibromyalgia and for other chronic pain conditions, for that matter, too. You know, people in society without pain, they just don't understand how someone can have pain all over without an injury or, even if there was injury way back when that's maybe been a couple of years ago and it's all since healed up. So, people don't understand how pain can last for that long. They also don't understand that heightened sensitivity, so they don't understand when a hug can hurt and for most of us, hugs feel good. So, when a person says with fibromyalgia says that it hurts, it's hard to understand. I think in that lack of understanding and the difficulty in understanding, people, unfortunately, can turn to judge them. They can kind of think, "Oh, they must be crazy or a hypochondriac" or something. Unfortunately, in our society, mental health problems like that are really stigmatized. So, if a patient is mistakenly put into that category of conditions, they too get stigmatized and it's really unfortunate. You asked about the correlation with women. Yes, that's an interesting question. Studies have suggested that probably upwards to 90% of folks with fibromyalgia are women. We actually don't know why that is. I think most experts would suggest that it's probably due to a combination of multiple factors like biological and psychological/social factors. When we think about it, our health is super complicated. When we consider most common chronic health conditions today like, say, not only fibromyalgia or chronic pain, but, say, diabetes or heart disease, there's a result of many factors. They’re biological and genetic. There are also lifestyle and behavioral factors that come into play as well as societal. The societal factors--the times in which we live--the common health problems that we deal with today like I was just mentioning, they're very different than what we or what our grandparents dealt with.

Melanie: Oh, they certainly are and we are seeing some more of these autoimmune type diseases now. In just these last few minutes, tell us how it's treated, Dr. McAllister.

Dr. McAllister: Well, yes, that's a great question. So, basic science and applied science has really found four categories of things that really work. Historically, fibromyalgia was thought to be something there was really nothing that could be done about it but in the last decade or two, we've really found that there are some effective things that could help. Now, I should add, though, that effective doesn't mean curative. There's no pill or procedure that can cure fibromyalgia but it's so effective in the sense of helping patients to get incrementally better. So, they have less pain over time or more energy over time and are more able to do those activities of life that they want to do. So, what are those four categories? First would be some form of mild aerobic exercise. So, for example, walking, or pool therapies, exercise bike when done on a regular basis over an extended period of time. So, once a patient can get to the point where they're able to do some kind of mild aerobic exercise for 20, 30, 40 minutes, three to five times a week--when they're able to do that, over time they're going to see less and less symptoms. The second thing would be cognitive behavioral therapy, which is having an expert coach who essentially coaches folks on how to make these kinds of healthy lifestyle changes as well as learn some specialized cognitive and emotional coping strategies. Third category would be some kind of relaxation therapy. So, this is diaphragmatic breathing, progressive muscle relaxation but also things like meditation and mindfulness, tai chi, yoga--all of these have been shown in clinical trials to be helpful for chronic pain of all kinds, but fibromyalgia, in particular. And then, the fourth thing that's been helpful are medications. There are essentially two classes of medications: the tricyclic antidepressant and then anti-epileptic medication. Now, I should add just real quickly, because folks are oftentimes wondering, "What medications I should take?” and while they have been shown to be helpful in clinical trials, they're not the most helpful thing to do. The most helpful things are these mild aerobic exercises, the relaxation exercises done on a regular basis, as well as CBT. Now, by all means, folks should maybe take a medication if it's helpful, but it's in the combination of all four strategies that's really been shown to be the most helpful over time.

Melanie: So, in just the last minute, what's your best advice with fibromyalgia and who they should seek for care?

Dr. McAllister: I would say that my best advice would be to be open to understanding the cause of fibromyalgia and how the nervous system gets stuck in that high state of reactivity called “central sensitization”. So, if you understand that, and accept it, it becomes clear as to why you should be doing those four strategies of effective therapies because they all target the nervous system and reduce its reactivity over time.

Melanie: Thank you so much. It is really great information. You're listening to The WELLcast with Allina Health. For more information, you can go to allinahealth.org. That's allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Cancer Biomarkers and Early Cancer Detection

Additional Info

Segment Number 3
Audio File city_hope/1608ch3c.mp3
Doctors Seewaldt, Victoria L.
Featured Speaker Victoria L. Seewaldt, M.D
Guest Bio Victoria Seewaldt, MD., is an accomplished clinician and researcher who's devoted to improving the lives of her patients and the community at large. She has led community outreach education efforts on cancer prevention through personal wellbeing and directed research aimed at finding biomarkers that can be used for early cancer detection, particularly triple-negative breast cancers that are especially resistant to treatment.

At City of Hope, Dr. Seewaldt will direct efforts to provide breast cancer education, free breast cancer screening and treatment, mentorship of young minority scholars, and a forum for community partnered trials. Clinically, Dr. Seewaldt aims to empower women at high breast cancer risk to be full partners in developing wellness strategies to promote personal health.

Learn more about Victoria Seewaldt, MD
Transcription Melanie Cole (Host): Sometimes hereditary or genetic factors can increase your risk for cancer. City of Hope’s cancer screening and prevention program is designed to help you understand more about your personal cancer risks and armed with this knowledge you can learn how to minimize you risk and stop cancer from developing. My guest today is Dr. Victoria Seewaldt. She’s the Ruth Ziegler Professor and Chair of the Department of Population Sciences at City of Hope. Welcome to the show, Dr. Vickie. Let’s talk about early detection because I think everybody wants to know “can we catch cancer early so that I have a better chance of living a long, high quality of life”. Tell us what’s going on in the world of early detection.

Dr. Victoria Seewaldt (Guest): I think that we’re making some progress but there’s more progress to be made. Right now, at this time, we think about cancer as one size fits all when we do our screenings. We tell, “Everybody go get your mammogram once a year” and for some women, we recommend things like MRI. What’s happening now is that there is a recognition that we have different types of breast cancers and we really need to individualize how we screen for breast cancer in a particular women. One size fits all doesn’t really work.

Melanie: It certainly doesn’t. We all hear about getting our mammograms or, if you have dense breast tissue, maybe going for 3-D or an ultrasound after. What else can we do? We learn about colonoscopies. Tell us what else, Dr. Vickie, we can do for early detection.

Dr. Vickie: I think we need to go and take another look at breast self-examination. This is a cheap, easy tool that every woman could do. Unfortunately, I think we have taught it incorrectly and the data that was generated saying that breast self-exam didn’t provide any benefits was generated in China in 1989. I think that, first of all, we need to simplify our breast self-exam so it isn’t so scary. Secondly, I think we need to redo the trials but in the context of U.S. medicine. What we teach in our clinic – and this is what we would like to take to national trials – is instead of a woman using her fingertips, which are really sensitive, just use the flat hand. What we tell women is, “Give your breast a high five” because what happens is, when a woman touches her breast with her fingertips she gets all kinds of information. She gets all of the ligaments, the lumps and bumps. If you go with your flat hand you can actually do a very good job in finding lumps but it averages out all the stuff that makes the exam really difficult. We also think that the connection with your physician is paramount. A lot of times, women will find lumps and nobody will listen to them. We want to develop a trial which automatically gets a woman scheduled for an ultrasound if she finds a lump so there isn’t that lack of communication.

Melanie: Do you want women to lie down while they’re doing that or be sitting up? What position? That’s one of the best tips I’ve heard in a very long time to “give yourself a high five and use a flat hand”. Should we be lying down or sitting up?

Dr. Vickie: I think that either position is okay. What we try to do is reframe the breast self-examination. Breast self-examination is not finding the micro mini little bit in the breast. That’s for imaging. That’s for your mammogram and your breast MRI. What breast self-examination, I think, does very well--and has done very successfully in our clinic – is it finds the fast growing cancers, the interval cancers, that occur between screening. We tell women do it like you’re brushing your teeth. Put your bra on. Don’t make this a cancer-finding expedition. Just say, “I’m brushing my teeth. I’m putting my bra on.” Do it in whatever position feels comfortable. You can even do it with your clothes on, with your bra on. Usually, cancer lumps that are growing rapidly are easily found by the woman. It’s figuring out what’s normal that’s really difficult for us as women. So, if you do a flat hand in whatever position makes you happy with your clothes on, that really can be very helpful in finding the fast growing cancers but filtering out all of the normal stuff that’s part of a normal woman’s breast.

Melanie: That’s really great information. Now, tell us a little bit about prevention. Are there certain bits of advice that you give, doing what you do for a living and in the Department of Population Sciences, seeing the statistics and what people do, what is your advice for prevention?

Dr. Vickie: I think first of all, women in my clinic tell me something which is very important – we’re not just breasts. As a woman, I’ll tell you I’m not just breasts. I’m a whole person. Prevention has got to make the whole woman healthy. One of the things that we focus on is exercise. Exercise has been shown to be effective in preventing breast cancer recurrence, preventing the initiation of breast cancer and also is important in preventing Alzheimer’s disease, cardiovascular disease, stroke. We think exercise is whole woman medicine. We also screen for something called “insulin resistance”. In the past, what we did is we waited for women to develop diabetes. Diabetes is where the pancreas burns out. We treated diabetes very different than we treated heart disease. With heart disease, we do prevention. The equivalent of what we’re doing with diabetes is we’re saying, “We’ll just wait until somebody has a heart attack and they have heart failure and then we’ll treat it.” Nowadays, the American Diabetes Association has become a lot more proactive. What they try to do is identify women who are pre-diabetic so the pancreas can be treated and the woman doesn’t develop diabetes. What that involves is a three step approach. What the woman does is, she’s identified as having an increased hemoglobin A1C. That’s just the normal thing you do at your doctor’s office. If a woman has a hemoglobin A1C of greater than 5.7 or less than 6.3, then she’s pre-diabetic. In that case a woman is given Metformin, which is a drug to help control blood sugar. It’s a very cheap drug. It’s used universally. It can be used during pregnancy. It helps women breast feed. And then, try to design a diet that’s lower in carbs. That doesn’t mean you have to do a 19 carb Atkins diet, but just to be able to reduce some of the sugar sources that you have in your diet and also just to do some walking. This is the three-prong approach. The reason that treatment of insulin resistance is so important is when a woman becomes insulin resistant, when she eats, what happens is you get this huge spike in insulin and insulin makes you hungry. What happens is the woman, instead of feeling full when she eats, wants to keep on eating and eating and eating. I became insulin resistant and my thought was, “I’m not full. I’m starving. I want to eat the tablecloth. I just want to eat everything.” It wasn’t a matter of will power, it was just that I was getting this huge insulin spike. The other thing that happens if you have huge insulin spikes is, it starts to burn out the pancreas because it’s working too hard. Also, it becomes impossible for the woman to break down her fat sources. Using Metformin helps a woman to break down fat and also helps to end these really huge insulin surges. I think what’s being proposed right now by the American Diabetes Association is really important but it’s also cancer fighting because insulin is the thing that stimulates a lot of the bad cells in the breast to become worse. Insulin will make cancers aggressive but we also think it plays a role in starting cancers.

Melanie: People hear the words “immunotherapy” and “treatment” and they hear “genetics” and “genomics”. Now, we’re hearing the word “biomarkers”. What does that mean and how does that help us detect cancer earlier?

Dr. Vickie: Biomarkers are proteins or messenger RNA, so different components that make the building block of cells that are used to test cells to figure out how bad or not bad they are. When a pathologist looks at cells under the microscope, they can look at kind of how they look but they don’t know what their biology is. They don’t know if they have nice benign biology – meaning that the cells will just sit there and not do anything--or they don’t know if the cells have really aggressive biology. We know that there are some cancers with aggressive biology and some that will just kind of sit there. The same is true for some of the early changes in the breast. What biomarkers help us do is start to sort out what cells have the bad biology and have the potential to turn into something bad and what do not. This is important particularly with things like DCIS—ductal carcinoma in situ or atypias--some of the early pre-cancerous legions. We know that some we over treat – we do too much surgery, too much radiation and we know that maybe some we undertreat. This is going to help us sort out who are the bad actors and who are the ones that we don’t have to be so aggressive with.

Melanie: Wow, such great information. Absolutely fascinating and, in just the last minute here, Dr. Vickie, give your best advice for early detection of cancer and what you really want people to know and what you tell patients every day and why they should come to City of Hope for their care.

Dr. Vickie: I think the first thing is keep your body healthy and the second is don’t miss your screening appointments.

Melanie: That’s very good advice. What about City of Hope? Tell us about your team.

Dr. Vickie: City of Hope is awesome. I love being here. There’s a huge group of very kind and decent people who are dedicated to making people healthy. We have geneticists. We have surgeons. Everybody is there acting to help women. I think everybody here sees the woman as a whole person. We look at the whole body, the spirit, the mind and we look at the family as well. I’m just very excited to be here and part of the City of Hope team.

Melanie: Thank you so much, Dr. Vickie for being with us. I applaud all the great work that you do at City of Hope. You’re listening to City of Hope Radio and for more information you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole MS

Managing Anxiety Before Surgery

Additional Info

Segment Number 4
Audio File allina_health/1620ah1d.mp3
Doctors Hopperstad, Barbara
Featured Speaker Barbara Hopperstad, MA -Penny George Institute for Health and Healing
Guest Bio Barbara Hopperstad is an integrative health and wellness coach who works with patients preparing for surgery. She also helps individuals working on a variety of health and wellness issues, including healthy eating, motivation, stress management and life balance.

Learn more about Barbara Hopperstad
Transcription Melanie Cole (Host): Do you have to go into the hospital for a procedure? It can be scary and you might feel more anxiety than you need to. My guest today is Barbara Hopperstad. She's an integrative health and wellness coach who works with patients preparing for surgery at Abbott Northwestern Hospital. Welcome to the show, Barbara. Does everyone experience pre-surgical anxiety?

Barbara Hopperstad (Guest): Well, thanks for having me, Melanie, and that's a good question. I would say that anxiety is a natural, human response to the idea of having surgery performed on your body; however, the intensity and the reasons for the anxiety vary widely from person to person. Some of that is due to the personality of the individual and some of that is due to the specific situation related to their surgery.

Melanie: So, what do you tell people about that anxiety when they come to you? Do they relay it to you? Do they let you know that they're that anxious or do they try to hide it a bit?

Barbara: Oh, some people really literally say that they don't have any anxiety. That's a very small percentage, and other people, it's all they can talk about. What I like to tell people is that there are actually many parts to each of us, and as a person preparing for surgery, most likely, a part of you is going to be anxious. But, another part of you made the decision to have that surgery, most likely because that part of you knows that this is really the best course of action for you to take. So, for example, if you're having surgery to deal with chronic pain, I'm sure there's a part of you that really can't wait to get relief from that pain and if you're having surgery to remove cancer, you really, really want to get that cancer removed from your body. So, when we think about these very parts that all come together in this experience of planning for surgery, it's important to understand that each part of us is simply trying to protect us and keep us safe. So, the part of you that's anxious before surgery is trying to alert you to the fact that you're preparing to face some danger. While there's risk associated with surgery, we now know something about anxiety. Feeling anxious is part of our "fight or flight" response which also known as the "stress response". If you can think of the stress response like a light switch that's flipped on, it causes all sorts of physiological reactions and all of them are designed to allow us to run faster--flight--or punch harder--fight. When the light switch is turned off, our body's in the opposite response and this is called the "relaxation response". The body becomes a better healing environment when we're in the relaxation response. So, for the science behind this, the research shows a couple of really powerful things about the relaxation response. When we're in that response, our immune system functions at its peak. The reason that matters to someone coming in for surgery is you do not want to get an infection, catch a cold, or the flu that will complicate your recovery process. There's also evidence that medications that we take work better, more effectively, when we're in the relaxation response. So, I like to tell people that one of their jobs as the patient undergoing surgery is to figure out how they're going to relax as much as possible heading into and following their surgery because this is something they can do to have as quick and easy a recovery as possible.

Melanie: What an excellent explanation. That's absolutely fascinating. Now, so what is pre-hospital coaching?

Barbara: So what we focus on in our prehospital coaching program is, we want patients to walk into this hospital, on the day of their surgery, consciously aware of their own strengths, abilities and the resources that they're going to call on to get them to their surgery and their recovery. We also teach tools and techniques that are going to complement the conventional medicine tools that are going to help them manage their pain, anxiety, nausea and those kinds of things. We do some education, including what I just described to you, about understanding anxiety and the relaxation response. It just helps them kind of have the context for why doing the things that we're suggesting they do will be effective and help them have that quick and easy recovery.

Melanie: So, can family members also get in on this pre-hospital coaching and be helped with surgical anxiety, because sometimes, they're worse than the actual patient?

Barbara: Yes, that's a great question. We always encourage family members to attend, as well as the patient if they are so inclined. It's important for them to get this education about how powerful the relaxation response in helping their loved ones have that quick and easy recovery. Medications work better, their immune system is boosted, and so, one of the things we talk about with family members is having a handle on their own anxiety and managing it when they are around their loved ones. One of the things that happens--it's a natural thing--it's actually called "entrainment" and it's a fancy word for what happens, but when we're around another person, we tend to match their breathing pattern. So, if, as a family member, you're with your loved one in the hospital room and you're breathing in an anxious way, it's probably going to ratchet up your family member's breathing to that same quick and shallow breathing that we do when we are anxious, and the anxiety in the room is going to get bigger. So, a family member needs to work on their own breathing pattern and making it calm and slow when they're around their loved ones. Now, how do we do this? How do we address that in a bigger sense? If someone in the family, or the patient themselves, is really focusing, as they're preparing for surgery, on all the things that could go wrong, we call this "awfulizing". You're thinking about every awful thing that can happen.

Melanie: You sure are.

Barbara: Sometimes, people need to go through that process, so what I suggest they do is that they write down a list of every single thing that could possibly go wrong and then they choose a point in time prior to heading into the pre-op area of the hospital when they're going to somehow get rid of that list. They can decide at what time point. It could be the night before surgery; it could be right as they're heading out of the garage in the car; it could be walking into the hospital. So, pick a time that you're going to get rid of this list. You could do it in a ritualistic way: burn the list, you can tear it up into little pieces and put it in the trash can in that garage before you get in the car, throw it in the first trashcan you see in the hospital. At that point, you make the decision that from now on, you're going to focus on a successful surgery and a quick and easy recovery.

Melanie: Wow. That is such great advice. So, what do you want people to know, also, about before they go in and what they can expect after?

Barbara: Okay. So, what I want them to know before they go in is, again, to become consciously aware of their own strengths and abilities. We might talk about, for example, if people have a meditation practice, a prayer practice; if they have some information and wisdom about their breathing. Breathing in a calm, slow fashion is the simplest entry point we have into the relaxation response. So, before heading into the surgery, if they've got some information about calm, slow breathing, I want them to practice that maybe every night before they go to sleep in bed. Practice calm, slow breathing.

Melanie: So, in just the last minute, Barbara, give your best advice for people that are going into surgery and their families, and how they can manage that anxiety and how you can help them.

Barbara: Okay. I like to remind people that even though their surgical experience is new to them, the people taking care of them chose this as their profession and they do this every day. So, if they can ask the part of them that's anxious to step back, to allow them to relax as much as they can, they are doing their part as the patient, and as the family members, to allow the patient to have a quick and easy recovery. I also just really encourage the personal support system to spread that message far and wide that the best thing they can do for that patient is to help them relax as much as possible during their recovery.

Melanie: What great information, and I applaud all the great work that you do. You sound like you are very, very good at your job. You're listening to The WELLcast with Allina Health. For more information, you can go to allinahealth.org. That's allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Acupucture/Chinese Medicine During Pregnancy

Additional Info

Segment Number 2
Audio File allina_health/1620ah1b.mp3
Doctors Beniek, Stefanie
Featured Speaker Stefanie Beniek, L.Ac., MaOM, Dipl. OM -Allina Health, Family Tree Acupuncture
Guest Bio Stefanie Beniek, L.Ac., MaOM, Dipl. OM is a licensed acupuncturist and practitioner of Chinese Herbal Medicine. Stefanie is board certified as a Diplomate of Oriental Medicine by the National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM) and is licensed by the MN Board of Medical Practice. She holds a Masters of Acupuncture & Oriental Medicine from the Minnesota College of Acupuncture & Oriental Medicine.
Transcription Melanie Cole (Host): The question of “is Chinese medicine safe in pregnancy” is one of the most commonly asked questions of traditional Chinese medicine practitioners by pregnant women. My guest today is Stephanie Beniek. She’s a licensed acupuncturist with the Penny George Institute for Health and Healing. Welcome to the show, Stephanie. First, let’s talk about what types of traditional Chinese medicine practices can be used during pregnancy.

Stephanie Beniek (Guest): Thanks, Melanie, for having me on the show. I just love talking about pregnancy and acupuncture. The types of practices that can be used during pregnancy are all of the same things that we can use when you’re not pregnant. We can use things like acupuncture, traditional Chinese herbs, moxibustion which is a heat therapy, cupping, tui na, which is Chinese medical massage and diet therapy. We just use these things in a different way which is why it is important to choose a licensed acupuncturist who specializes in pregnancy to go to. Similar to when you get pregnant, you choose a new doctor or a midwife to see you through your pregnancy and delivery, you want to choose a licensed acupuncturist who has master or doctoral level training and has experience and additional training in the treatment of pregnant women.

Melanie: Chinese medicine has been around for thousands of years. Do you find that people are a little bit wary of what you do and especially with pregnant women? Clear that up for us.

Ms. Beniek: Chinese medicine has a long obstetric history in using acupuncture, not only in pregnancy, but in fertility care and post-partum care as well. Acupuncture is a safe and drug-free natural way to get well and stay healthy through your pregnancy. There are certain herb that we do not use in pregnancy and there are certain points and ways in which we use our treatment methods during pregnancy and there are certain things we wouldn’t use in pregnancy because it wouldn’t be safe for the baby. We just need to make sure that we’re using all of our modalities in a safe and effective way during pregnancy.

Melanie: Tell us about acupuncture and some of the benefits of it for pregnancy.

Ms. Beniek: During pregnancy, some of the benefits of acupuncture are that it really helps to provide both physical and emotional support during your pregnancy. We can work on things like anxiety and depression; any pain like sciatica or back pain that you’re having; headaches, nausea and vomiting like with morning sickness and then we can work on it for labor preparation treatment, like the months leading up to your estimated due date.

Melanie: Tell us a little bit about acupuncture because right away, people think needles and they’re not sure if it hurts and especially a pregnant woman is concerned for the safety of her baby.

Ms. Beniek: Absolutely. Generally, during pregnancy we do not do any points on the abdomen. I just like to put that out there right away because moms are like, “Where are you going to put the points?” We might do some on the upper abdomen really early in the pregnancy but we don’t do anything that is directly into the abdomen during pregnancy. Acupuncture is the insertion of these really tiny disposable, sterile needles that are placed very gently into specific points on the body. During the insertion, some people feel nothing at all while others may experience a little quick twinge like a mosquito bite and it might be followed with some light tingling or some heavy sensation or warmth feelings but all these responses are completely normal as some points of the body can be more sensitive than others. Points are generally retained or remain in place for about 20 minutes and patients generally feel relaxed and often most of my patients take a little nap during their treatment and they often wake up feeling revitalized and rested after their session.

Melanie: How often do you recommend that they come in?

Ms. Beniek: During pregnancy, I generally recommend for all pregnant women monthly prenatal acupuncture treatment. However, if there is something – a health concern or issue going on--we generally recommend coming in on a more weekly basis until those symptoms are a little bit more manageable and under control. That can be anywhere from two weeks to four to six weeks of weekly treatments. In the last month of pregnancy, it’s very helpful to come in, again, weekly starting around 36 to 37 weeks gestation with one baby or like 34 to 35 with twins. I like for them to come in weekly, again, for acupuncture because it helps to prepare your body for labor and delivery and to have a more efficient and effective labor and delivery.

Melanie: What can they expect after the treatments? Are there residual feelings? Do they feel a sense of euphoria and well-being? Tell us about what’s after the treatment.

Ms. Beniek: Immediately following the treatments, oftentimes people feel very relaxed. A lot of people like coming in the evenings because they go home and take a nap or in the afternoon when they can go home and take a nap. Sometimes people, like I said, feel kind of revitalized and kind of get this burst of energy again to finish throughout their day. It kind of depends on the symptoms that you’re having and the reason that you’re coming in. For example, with morning sickness or with nausea and vomiting, oftentimes people will find that they get relief after their acupuncture treatment for anywhere from two to four days and their symptoms, because their pregnant, then that doesn’t go away and their symptoms come back a little bit which is why they need to come in again for a weekly treatment. For things like pain or headaches, most people can feel immediate symptom relief from the acupuncture.

Melanie: At the beginning, you mentioned that there are some precautions and with herbal medicine as well that you want pregnant women to know about. Speak about some of those.

Ms. Beniek: For acupuncture, there are just certain points that we don’t use throughout your pregnancy because of they can potentially stimulate uterine contractions. However, they have tried to do studies on this to stimulate uterine contractions with these points early in pregnancy and it is unsuccessful. However, we still don’t use these points early in pregnancy. As far as herbs are concerned, there’s just a small amount of Chinese herbs that are safe to use during pregnancy. It’s similar with medications. There’s just a large number of medications that you just don’t use during pregnancy because of the risk to the fetus. It’s the same with Chinese herbal medicine. There’s a large number that we don’t use during pregnancy because of the risk to the fetus.

Melanie: What do you tell women that say they were at their local health food store and there were things that said can help morning sickness and pregnancy? What do you tell them about being cautious about some of these things they can buy over the counter?

Ms. Beniek: I generally tell them to not buy those things over the counter and to talk with, if they have an acupuncturist, to talk with their acupuncturist about it. A lot of midwives do know a lot about different herbs. Some OB’s do as well. I always encourage them to check in with their healthcare providers first before taking anything over the counter. With that said, there are some things like some teas over the counter--like pregnancy teas--that are totally safe and fine. They’re very small amounts. Things like ginger tea or peppermint tea – those are fine. Anything that’s like a pill in a health food store, that I would say check in with your healthcare provider before you take it.

Melanie: In just the last few minutes, Stephanie, give your best advice for pregnant women that are considering traditional Chinese medicine during pregnancy and why they should come to the Penny George Institute for health and healing because it is a question so many of them have and it can be so beneficial. Give your best advice.

Ms. Beniek: My number one thing is just to find a licensed acupuncturist who specializes in pregnancy. We do have some wonderful people at the Penny George Institute that have lots of experience with pregnancy. Just make sure you’re going to that licensed acupuncturist. Don’t just find kind of anybody out there because in pregnancy it is this unique time in a women’s life and you want to make sure that you’re creating the best healthcare team that you possibly can find. I really encourage every pregnant woman to seek out regular acupuncture throughout their pregnancy because it really does help to set a foundation for a positive, healthy labor and delivery and post-partum recovery.

Melanie: What great information and so important for pregnant women to hear. Thank you so much, Stephanie, for being with us today. You’re listening to The WELLcast with Allina Health. For more information on the Penny George Institute for health and healing you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Positive Effects Clean Eating Has on Other Areas of Your Life

How can clean eating affect your career success and relationships?

Additional Info

Segment Number 5
Audio File clean_food_network/1620cf1e.mp3
Featured Speaker Leanne Jacobs
Guest Bio Leanne Jacobs is an internationally recognized author and holistic wealth expert who takes a mindful approach to money. Through her website, books and podcast Leanne shares tips, insights, strategies and guidance for creating wealth in an authentic, joyful and mindful way. She also works with clients around the world, helping them to cultivate the daily habits that lead to optimal wealth and wellbeing. Her newest program, The Beautiful Money Course, uses her expertise in finance and leadership to teach people how to achieve their goals, find fulfillment in their work, and align themselves with what they truly value in life - all while creating more cash flow and financial freedom than ever before. Her upcoming book, Beautiful Money, will be released in January 2017 (Penguin).

Before launching her own business in 2004, Leanne worked for numerous Fortune 500 companies in sales and marketing roles, including Johnson & Johnson, Nike, DuPont, and L’Oreal. She has a MBA from Wilfrid Laurier University and a Bachelor’s of Science degree in Biomedical Toxicology from University of Guelph. In addition to her academic credentials, Leanne is also certified as a clinical nutritionist, yoga and Pilates instructor.

Leanne’s guidance and programs have been featured in media throughout North America. Internationally recognized as a top direct selling expert, Leanne also mentors clients working in that industry helping them to create global six and seven figure businesses.

Leanne resides in Toronto, Canada with her husband and four children.

Divine Organics: Life from Life, Energy from Energy

Divine Organics educates and informs consumers to optimize and simplify their lifestyles.

Additional Info

Segment Number 4
Audio File clean_food_network/1620cf1d.mp3
Featured Speaker David Kaplan
Guest Bio David Kaplan was born and raised in New York City. He has over 50 years of business experience, and has been a leader in the health and wellness industry for nearly 40 years.

During the 60's and early 70's David helped his father a lot who was in the food business, this is where he learned the basics about gourmet food. In the 80's David's focus was gold and numismatics. Being successful after some years he brought two pieces of property on Maui, HI, and developed them as organic sustainable farms growing everything from tropical fruits to macadamia nuts and coconuts. The intention over the years was for sharing "healing and learning sustainable agriculture, meditation and a healthier and more fulfilling lifestyle. I was determined to use the money I made to help set up spiritually secure, sustainable and self-sufficient farms that would weather the storms to come.”

In 1977 he produced the largest nutrition expo of its time with 30,000 people in the NY Coliseum. It has been considered one of the most successful consumer health expos in the U.S. From 1977 on, after being introduced to a yoga adept, he studied and taught Hatha Yoga for 10 years. Then in 1987 he had the good fortune to meet a true Saint: Saint Thakar Singh Ji Maharaj. He was taught the Path of the Masters and learned the Holy Meditation (Science of Light & Sound ). From 1988 until 2005 he was authorized by the Master to teach the Science and Way of The Saints. In the 80's David had one of the top wine collections in the U.S. though gave up that interest and all flesh foods after beginning the meditations. David was fortunate to be able to meditate many hours a day for many years at the feet of a true Master Saint.

In 2003 he started educating people about the benefits of Himalayan Crystal Salt and soon after started his company Transition Nutrition. The focus of TN is to help people purify and tune-up through proper diet and nutrition so at some point people could be ready to feed the soul through meditation on the inner light and sound.

Transition Nutrition is now a thriving superfoods distribution company with over 70 premium, unique and organic raw food products under three brands including Divine Organics and Royal Himalayan. The company motto is: “LIFE FROM LIFE, ENERGY FROM ENERGY.”

The company has projects and works closely with organic sustainable food farms and processors around the world in South America, Turkey, Thailand, Indonesia, Philippines, and Hawaii. David has sponsored the Raw Spirit Festivals, Best of Raw and Pure Living Expo as a way of raising organic raw food and health consciousness.

More...

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Juice It to Lose It

A New Way to Detox for Wholistic Health

Avoiding Painful Performing Arts Injuries

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