Inactive (722)

Audio File southwest/sw005.mp3
Doctors Gorski, Yara
Featured Speaker Yara Gorski, MD
Guest Bio Yara Gorski, MD is a Vascular Surgeon and a member of the medical staff at Southwest Healthcare System.
Transcription Melanie Cole (Host): Your body relies on healthy blood flow to carry oxygen to your legs, feet and other parts of your body. When problems develop in your circulatory system, painful and sometimes serious health issues can result. One example is peripheral arterial disease, which can occur when plaque builds up in the arteries and restricts blood flow to the legs. My guest today is, Dr. Yara Gorski, she’s a vascular surgeon and a member of Medical staff at Southwest Healthcare System. Welcome to the show, Dr. Gorski. So, when we’re talking about peripheral vascular disease, what exactly is that?

Dr. Yara Gorski (Guest): Good morning, thank you for having me. Yes, I’ll be happy to speak about the peripheral artery disease. It builds up in the arteries, blockage in the arteries. It’s usually caused by a variety of reasons, most importantly it’s hereditary. A lot of patients carry a genetic disposition for atherosclerosis, hardening of the arteries.

A second important cause is the smoking. Smoking is one of the major reasons why patients develop plaque in their arteries. Smoking can make the blood thicker, produce blood clots, and also increase the deposits of plaque in the arteries.

After that, there are risk factors like diabetes, high blood pressure, high cholesterol. Those are the main causes for buildup of plaque in your arteries.

Melanie: So, how would anybody even know? If you go in for your annual physical, and maybe you have your cholesterol levels checked, that doesn’t really check for that atherosclerosis, Dr. Gorski. So, how would somebody know?

Dr. Gorski: Well, it’s very important, as you said, that you have your annual checks, that you follow-up, that you take care of your health issues with your primary care physician, but a lot of times, it takes to be asked the right questions, to understand if you have atherosclerosis or not. And a simple test in the office where the primary care doctor check for your pulses, ask for symptoms of peripheral vascular disease, like for example, you have pain when you walk, or you getting your legs are feeling tired, or are you having wounds in your legs that are not healing? Those are symptoms that might trigger your primary care physician to consider ordering a further testing to identify if you have peripheral vascular disease or not. In case you have decreased pulses, and a lot of times it’s just a blood pressure check on your legs, and a sonogram.

Melanie: Okay. So, who would they go to see to get those kinds of tests?

Dr. Gorski: They will be sent to a vascular surgeon, who’s a specialist, who can evaluate the circulatory system and identify if they do have peripheral vascular disease or not, and offer them treatments.

Melanie: So, we hear about, for heart disease, in general, Dr. Gorski, how great exercise is to help with that, but in peripheral vascular situations, exercise could be a limiting factor because it could hurt claudication in their legs. So, what do you tell patients that say, “Well, I really want to exercise or ride a bike or go on the treadmill and help myself, but it hurts.”

Dr. Gorski: That’s a great question. A lot of patients with peripheral vascular disease decrease, they exercise, they have this kind of limitation, and they don’t know that there’s treatment for that. So, essentially the same causes for peripheral vascular disease will cause blockages in other arteries. So, patients that have peripheral vascular disease, they are diagnosed with blockage in their leg arteries. They actually at risk for having blockages in their coronaries, and also their carotid arteries. So, technically they are at risk for having heart attacks and strokes. So, it’s very important of both to be diagnosed, to understand the disease process, to understand the risk factors, and find especially if they can offer you treatment.

And how do we treat peripheral vascular disease? Peripheral vascular disease most of time, is just treated medically, and by that means control all your risk factors, as we just discussed. Quit smoking, take medication, do our drugs that’s specifically designed to improve the blood circulation in the leg, and a vascular surgeon, a vascular specialist, can discuss the use of those drugs with you. A lot of times patients will be also prescribed a blood thinner, that can be just a plain 81 milligrams aspirin, that taking daily, can improve the circulation to your legs.

After that, your vascular surgeon will discuss with the patient with you, how can we actually do exercise? What kind of exercises can be monitored for patients with peripheral vascular disease? And getting to a program, so they will build up this exercises with the peripheral vascular disease, and will develop more blood flow to their legs.

Melanie: Dr. Gorski, what about the risk for non-healing wounds. If someone has poor circulation in their legs, are they then at risk for wounds that do not heal or wounds that they do not recognize are there?

Dr. Gorski: That’s another excellent question. So, we do see a lot of patients that come to our office, yeah, vascular surgeons, they were risk for it because they’re primary care physician diagnosed them with PAT. They say, “Look, you have decreased pulses or you don’t have any pulses. You start to have pain when you’re walking and that’s called claudication.” That’s a lot of times is how the patients present with peripheral vascular disease, and we see them in the office, and we discuss options, treatments, and one of the key issues is you must be very careful with your feet and legs as far as any kind of trauma or exposure to warts.

So, that covers two key questions. Do you have any non-healing wounds? Do you have any ulcers on your feet? And what are you doing to take care of it? So, there are different specialists who will work very closely with those patients. Some of them are diabetic, some of them have also neuropathy. They have poor… other than the peripheral artery disease, they don’t have a lot of sensation in their feet. So, they can actually develop wounds or ulcers because they just don’t feel their foot. They have a poor feet in shoe, and they these ulcers without even feeling for them. So, it’s a very important when we talk to them, that they take care of their feet, that they take care of their wounds, and a lot of times, as I said, we work in conjunction with different specialists, we recommend the patients to see a podiatrist. And that if they do have wounds, we work in close relations with a wound care specialist.

Melanie: So, in just the last few minutes, Dr. Gorski, what would you like people with peripheral vascular disease who, or maybe are at risk for this, to know and give us some good information about preventing it in the first place.

Dr. Gorski: Yes, that’s great. I think what we need to make people aware of is peripheral vascular disease is very prevalent. As you just brought it up in the beginning, I think the number is close to 80 million in the U.S., that they have peripheral artery disease, but a very small percentage of those patients are actually offered treatment, and treatment it starts just preventing and working with the risk factors. As simple as quit smoking, taking an aspirin a day, and taking of your diabetes, high blood pressure, and high cholesterol. Then once you were diagnosed with PAD, you must see a specialist, you must see a vascular surgeon, who can discuss with you, what are your options to treat that diagnosis? And it can be, as I said, starts medically, it can be with drugs, it can be with exercises, but in advanced cases, a vascular surgeon can actually offer treatment before you develop significant tissue loss, before you at risk for repetition. And that treatment can be a balloon in your plastic, can be a stent placement, can sometimes even be surgery, but a lot of these patients with peripheral vascular disease, they are at risk for progression of the peripheral artery disease at forelimb off for amputation.

So, it’s very important that as soon as they are diagnosed, that they see a specialist, that they see a vascular surgeon, who can discuss with them management, and they can monitor them over the years. And if they do develop wounds, they will need to see a wound care specialist early in the stages of this wound, so it will not progress to tissue loss that’s not reversible.

Melanie: And why should they come to Southwest Healthcare System for their care? Tell us about your team.

Dr. Gorski: We have great team at Southwest, and I’m very proud to say that because I’ve been at Southwest for almost 20 years, and we have been pioneers in a lot of procedures in the valley. And one of things that we do that makes us a great resource to our community is the teamwork, we do have a diagnostic department where we can diagnose PAD from it’s very early stages.

We have an excellent laboratory where we perform ultrasonography and measuring of pressures in the legs. We have state of the art CT scan, and MRI, we have an interventional CAT lab, where we perform, again, state of art interventions. We do angiograms, we perform angioplasty with balloons. We use atherectomy devices, that we can actually debug plaque. We can do what a lot of people use in late terms, like rode a router off arteries. We have a variety of skins available in the market, and this can all be done as an outpatient. And Southwest has a great team, we have a great success with both of those procedures. We also have a one-care center, associated to Southwest, where we work very closely.

I do work with Dr. Khateeb for a few years now, and he’s an excellent one-care specialist. Dr. Khateeb is a surgeon, who has been dedicated, his last year’s just for one-care. We have a great one-care center, we offer hyper- Baraty therapy, and in a lot of patients, that’s critical to prevent them from having an amputation and limb loss. So, close relation, close work with the one-care center, one-care specialist, great tools for diagnostic, and for minimally invasive treatment. Right there in… for our communities in their backyard. I’m very fortunate to be able to practice there.

Melanie: Thank you so much, Dr. Gorski, for being with us. It’s really great information. You’re listening to Southwest Health Talk, with Southwest Healthcare System, building relationships that touch the heart. For more information, please visit, SWHealthcareSystem.com, that’s SWHealthcareSystem.com. Physicians are independent practitioners who are not employees or agents of Southwest Healthcare System. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole, thanks so much for listening.
Hosts Melanie Cole, MS

The Latest Advances in Head and Neck Cancers

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Audio File city_hope/ch107.mp3
Doctors Gernon, Thomas J.
Featured Speaker Thomas Gernon, MD
Guest Bio Thomas J. Gernon, M.D., is an associate clinical professor in department of surgery, specializing in head and neck surgery. Dr. Gernon came to City of Hope from the University of Arizona College of Medicine, where he was an assistant professor in the department of surgery, division of otolaryngology.

Learn more about Thomas J. Gernon, MD
Transcription Melanie Cole (Host): Head and neck cancers are particularly unique and complex requiring a personalized treatment plan for optimal clinical, quality of life and cosmetic outcomes. My guest today is Dr. Thomas Gernon. He’s a head and neck surgeon in the division of otolaryngology head and neck surgery in the Department of Surgery at City of Hope. Welcome to the show Dr. Gernon. Let’s just start by sort of a broad overview of head and neck cancers and what encompasses these types of cancers and then we will get into some specifics.

Dr. Thomas Gernon, MD (Guest): So, head and neck cancers are any cancers really of the face and upper aero digestive tract so it can include anything from skin cancers including run of the mill basal cell cancers, squamous cell cancers to melanomas and then you move inside into the upper aero digestive tract and we can have tumors of the sinuses or the oral cavity which is the anterior part of the tongue, the jaw bone and then you can get into the oropharynx which are tumors of the tonsils and the back of the tongue. You can have tumors of your voice box. You can also have tumors of the salivary glands. You have the parotid glands which are major salivary glands and your submandibular glands as well as minor salivary glands. And then also a number of tumors that we treat are tumors of the thyroid gland. So, it is really quite a broad array of tumors and there are also other tumors which are less common that can also pop up which we deal with intermittently.

Melanie: So, Dr. Gernon, people hear oropharyngeal cancers or oral cavity cancers and it really, I mean of all of the cancers you think about, the ones that involve your mouth and head and neck freak people out pretty much. Tell us a little bit about these cancers and who would be at risk.

Dr. Gernon: So, those are two different very different areas but I can speak in depth about both of those because I treat a lot of those. So, tumors of the oral cavity are tumors of the anterior tongue. So, the anterior tongue is pretty much the anterior two thirds of your tongue and then the oropharynx tumors include the posterior one third of your tongue and that also includes the tonsils which we typically have removed as a child. The posterior one third of your tongue also has tonsil tissue on the back of it which we don’t ever get treated as a child. So, patients who get tumors of the anterior part of the tongue, are typically smokers and typically people who consume a significant amount of alcohol and those are the more traditional squamous cell cancers that we have treated throughout the years. Interestingly, in the anterior tongue, the largest population that is growing is young white women who have not smoked so it is really becoming a pretty common thing in women who have not smoked and we don’t know why that is at this point but that specific population is on the rise. It is also in men in young white men who are nonsmokers as well. In contrast to that, tumors of the back of the tongue and tonsil are typically related to the HPV virus which is the same virus that causes cervical cancer in women. And typically, those patients are males greater than females, they typically are nonsmokers and they occur in patients in their fifties to sixties. So, that is really a large group of patients that we are treating now. Specific people that are known in the media specifically are Michael Douglas had a base of tongue tumor and I believe George Karl did as well. So, those are tumors that are related to likely the HPV virus. So, I am not specific in their certain cases but typically we are all subjected to that virus at some point in our adolescence and it lays dormant in our system and then reactivates when we are in our fifties or sixties.

Melanie: So, Dr. Gernon, as we are talking about HPV and we hear about it with cervical cancer and now the vaccine and do you think and this is just your opinion, that with this vaccine, with Gardasil, that you might be seeing less oropharyngeal cancers if they are directly related to HPV infection?
Dr. Gernon: I think we will but that is going to be many years to come because if you think about it, I, myself, I’m forty years of age and even people younger than myself, we were not vaccinated and we still have the period of time to hit our fifties so there is a thirty-year gap like my children will be vaccinated. Most children this day and age are vaccinated. So, there has been a gap though of 20-30 years where people have typically been exposed to the HPV virus and that virus lies dormant in their systems. But it’s absolutely correct that hopefully the Gardasil vaccine is now being offered to boys and girls and that will immunize them against the HPV virus and this type of disease in the future.

Melanie: So, if someone has been tested for HPV, maybe a woman who goes to her gynecologist and gets that test because they want to know if they are supposed to get their PAP smears every year, or a man and as you say we are giving our kids this vaccine so it’s going to be a while before we see if that takes hold. If you tested negative for HPV then does that decrease your risk of this type of cancer?

Dr. Gernon: It does. So, if you are negative for HPV your chance of getting this cancer is significantly decreased. What they are finding is that it’s not, interestingly in women, you commented about cervical cancer. So, what the belief is is that researchers have looked at this and they feel that women who are exposed to the virus in the cervix are actually able to immunize themselves against the virus and that’s why we think that we are seeing fewer incidences in women who present with head and neck HPV related tonsil or tongue base cancer in comparison to men. Because the men are exposed supposedly in the oropharynx and they are exposed to a larger amount of virus and then that virus kind of lays dormant and the thought is that the immune system drops off and then it reactivates in your fifties, middle fifties to sixties as a cancer.

Melanie: How interesting. So, then what do you do? How is this diagnosed? What would somebody notice for an oropharyngeal I mean are they going to notice pain in their throat or hoarseness, trouble swallowing, any of these things that you think about when you think about checking for these cancers?

Dr. Gernon: Definitely. So, I would say probably one of the most common ways that patients present is typically a male as I said, in their fifties or sixties and they present to their primary care provider because they have a lump in their neck that has been there for a couple of months and they have tried a couple of courses of antibiotics and it hasn’t gone away. So, a lot of patients don’t have any other symptoms other than a neck mass. And that is typically what happens is that the tumor is fairly small in the back of the tongue or the tonsil and then it – but it has a propensity to spread into the lymph nodes in the neck and typically it is one or two lymph nodes and they kind of grow rapidly and then they hang out there for a while. So, oftentimes we do see that patients are treated with antibiotics when in actuality, they have a tonsillar or a tongue base tumor which is there so that’s something to be aware of. And then the other type of patients that we do see is exactly what you talked about. Patients who are developing increased difficulty with swallowing, they feel that solid foods don’t pass as easily into the esophagus when they eat, typically have a harder time with solids than they would with liquids and other times patients will have pain particularly referred to their ear. You know when you were a kid and you had a sore throat the pain oftentimes you felt like you had an earache but it is because there is referred pain which is from the back of the tongue into the ear. So, that is how patients typically will present. Sometimes they present with changes in their voice, their voice is muffled or they sound like there is something in the back of their throat. But those are the typical presentations that patients have.

Melanie: And one of the things people worry about of course, with these type of cancers is eating, talking, and you know and it’s not vanity, but their looks because you are dealing with the face the neck, the head. So, what do you tell people about treating these types of cancers and their ability to live a somewhat normal life?

Dr. Gernon: So, fortunately, these tumors are fairly well-treated. So, some of the head and neck cancers that we treat, I feel you know you get the diagnosis and it is not a great thing, cancer is never a good thing, but the possibility that they do well when I get a diagnosis for certain types of cancer, in my own heart I feel like oh this a tough diagnosis but fairly typically HPV related tonsil and tongue base and oropharynx cancers you know patients for the most part do very well and so that has really changed our approach to treatment because we are really focusing on knowing that patients are going to live into their later ages, and we want to focus on their quality of life 10 years after their treatment has been performed. So, there are two main types of treatment and there is either a nonsurgical treatment which can be with chemo and radiation therapy and then there is also a treatment with trying to investigate less invasive surgery with either a robotic surgery through the mouth and then with the hopes of giving the patient less radiation or no chemotherapy or potentially no additional treatment at all. So, treatment is really moving towards de-escalation of therapy for these types of tumors meaning that trying to decrease the amount of treatment they are getting overall. So, decreasing the radiation dose because radiation ten years down the road can have significant effects on the jaw function, the jaw viability, also the swallowing function. So, we are really trying to decrease therapy overall for these patients.

Melanie: So wrap it up for us Dr. Gernon with your best advice about these oropharyngeal cancers and kind of summarize everything that we have been discussing, the HPV, and how somebody might find it and who is at risk and why they should come to City of Hope for their care.

Dr. Gernon: It’s hard to really know, you know we oftentimes have patients come into clinic and they are very concerned that you know maybe they had an HPV exposure at some point in life. I would say, the majority of us being normal adults probably have been exposed to it at some point. So, there is nothing really to do or to prevent it at this point. I think it is being proactive if you do notice that there is lump in your neck, something feels odd, you are having difficulty swallowing or whatnot then you present as quickly as you can. Because as I said, routinely these things are pretty well treated. I think as far as our treatment at City of Hope, we really focus on treating the patient, each individual patient based on how they present to us. So, we aren’t super pro surgery, we aren’t super pro chemo and radiation. We really prioritize each patient into how we feel they are going to do the best, based on the disease stage that they have when they present. So, if we feel that the patient can potentially get through treatment with surgery and nothing afterwards, we will offer that and then we try to do that with a surgical approach that is through the mouth, so we aren’t making any incisions – huge incisions in the neck to open the jaw or anything of that nature which decreases their morbidity and then we would remove the lymph nodes through the neck and if a patient has a tumor stage that is too great for that, then we would move towards possibly chemo or radiation or both together to treat the tumor if we felt that the surgical approach was going to be too much and wasn’t going to benefit them. We really are focusing on decreasing overall therapy so that patients can get through the treatment with as little treatment as possible and the fewest side effects as possible, so that patients can move towards a normal life down the road.

Melanie: Thank you so much for being with us today Dr., it’s really great information. You are 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

The Benefits of Breastfeeding: Doctors Hospital Offers Classes and Support

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Audio File doctors_laredo/dl012.mp3
Doctors Avila, Maria Noela
Featured Speaker Maria Noela Avila, RN
Guest Bio Maria Noela Avila, RN is a Lactation Consultant and a member of the medical staff at Doctors Hospital of Laredo.
Transcription Melanie Cole (Host): When you breastfeed you give your baby a healthy start that lasts a lifetime. Breast milk is the perfect food for your baby. My guest today, is Maria Noela Avila. She’s a Registered Nurse and Lactation Consultant at Doctor’s Hospital of Laredo. Welcome to the show, Maria. When should a woman begin making the decision to breastfeed? Should it be when she is pregnant or does she wait until after? When does she make that decision?

Maria Noela Avila (Guest): A mother should be thinking about what she will be feeding her baby way before she has her baby. It’s a way they need to prepare themselves by getting the education that they need just to know how their body is going to be working and how the baby should be responding so that they have a good, informed decision by the time they have their baby.

Melanie: What are some of the health benefits that we know now – and also from the American Academy of Pediatrics, which says that breast milk is the best food for baby – what are some of the health benefits of breastfeeding?

Maria: Well, there’s a lot of benefits in breast milk. One that it is so easy for the baby to digest – it helps them – it’s like a laxative, and they can digest really quickly, as well as nutrition. It’s also got all of the minerals and vitamins and everything that the baby needs for complete nutrition. It will help with his reproduction of all his organs. It’s going to provide a lot of antibodies so that he can have defenses. It will help with his respiratory system, kidneys, with less ear infections. Overall, it’s the best nutrition for a baby.

Melanie: And what about for mothers? It’s good for them as well?

Maria: Oh yeah, for mothers, the fact that when a baby is breastfeeding on a mother’s breast, it’s going to exercise her body so that she can start going back to her pre-pregnancy weight. She loses anywhere from 500 to 600 calories per day whenever she is breastfeeding. She starts losing the weight that she gained during her pregnancy sooner. Because she is exercising her body, she has less risk of getting obese and getting type two diabetes. She also is going to be healthier. It’s got many, many benefits also for mom.

Melanie: Let’s talk about beginning breastfeeding. After the baby is born, what’s the first thing you teach women about latching on and about not getting frustrated because it’s not always the easiest thing, is it?

Maria: Oh, no. There are many challenges in that a baby – after the first hour – the first hour they’re very alert, and they will be able to breastfeed, but after the first hour they go into deep sleep cycles. It becomes a little challenging because the mother wants them to eat and baby is not cooperating. I will usually tell mom, “You know what? We need to let the baby transition. Let him begin to ask for the feedings.” As soon as – I will teach them that they do have milk because that’s one of the – 99% of our moms say, “I don’t’ have anything for my baby,” because they don’t see any milk coming out. With breastfeeding, they need to actually establish the milk to begin to circulate and make more.

The baby’s tummy is super tiny, and that’s one of the things that I have to keep reinforcing to them. You don’t need to have a lot of milk so that the baby can be well-fed because the baby’s tummy is the size of a little marble, they digest it really quickly, and then they’ll be hungry often. That doesn’t mean that you don’t have enough milk. It just means that they want to be practicing in the latching and the suckling and getting it all to become abundant.

Melanie: And how do you advise women to get their partners involved in the breastfeeding process?

Maria: Usually, I like to teach both of them as I am giving them my education no breastfeeding. I tell dad you will have to be part of the feeding because you do need to bring the baby to the mom, remind the mom when it is feeding time, and help out with changing the diapers and to become part of what the baby will be doing.

Melanie: And what about some common breastfeeding challenges? You’ve already spoken about low milk supply and letting women know that it does happen. What about if it’s painful for the woman or she’s having issues with it? What do you tell about just continuing with it or some of those challenges – are there something they can do when it becomes painful?

Maria: Yes, it’s very important to teach the mom how to latch the baby because a lot of the moms have the concept that the baby should be watching just to the nipple and the baby should be opening his mouth wide and latching around the areola. That would be a more comfortable fit the way that the baby will be latching on the breast. And also, being that the breast has the ducts that are filled with liquid towards the back of the breast, the baby has to suckle around there so that they can get enough milk also.

If it becomes painful, I believe that the baby is just on the nipple, so we have to teach the moms the correct latching. Also, to alleviate any soreness or irritation, I usually will tell mom to express a little bit of her milk and baste it on her breast and let it air dry. Being that her milk is so rich in antibodies, it will heal much quicker.

Melanie: And what would you tell a mother about eating healthy while she’s breastfeeding? What are some tips and suggestions you would like her to do and maybe even some things you would like her to avoid?

Maria: Well, things to avoid are usually things that are high in caffeine, things that cause a lot of gases, or things that are too spicy or too hot -- if they eat too much of it. Usually – and I give them also a list of fish that have a lot of mercury. We try to avoid that, and we try to get them to eat a more nutritious meal than just fast food or things like that. I usually will tell the mom that what she eats, the baby is also eating, and of course, you want to make good milk for the baby.

Melanie: And what about pumping? If a woman does have to go back to work after however many weeks, what do you tell her about how much she should be expressing and what to do with it once she has done that? Can it be frozen? What do you tell her about that?

Maria: Yeah, a lot of moms do work, or out of their homes after a few weeks. I don’t recommend pumping right away unless they have a baby in intensive care that they need to begin earlier. I usually will tell a mom if it’s a term baby that is with rooming in with her and everything, to wait at least two weeks so that she can have a supply so that she can actually be able to collect anything. A lot of times they get the idea that they don’t have enough milk because they used the pump and they only have a drop or two coming down on the first day. I tell them that if they are going to pump, they need to be doing it often, at least every two to three hours, and be consistent because that’s how they’re going to build a supply.

As far as storing milk – especially for moms that are working – I usually will tell them to start at least ten days before they go back to work where they can store the breast milk in the freezer. Anything after they breastfeed they can collect, they can put it in the freezer, label it, put the date and time that they breastfeed so that they can always use the older milk first. And actually, milk can last from six to twelve months in the freezer, so they can have a good supply. They can still pump while they’re working or going to school if they have at least two breaks during the day so that they can keep their supply going. They need to continue doing frequent stimulation on the breasts.

Melanie: And tell us about your Basics of Breastfeeding classes at Doctors Hospital of Laredo.

Maria: Okay, we have a childbirth class ever month. Actually, it’s two classes on the first two Tuesdays of the month. They are from 6pm to 8pm. Moms that want to attend the classes should register. They can go onto the Doctors Hospital website, and there’s a place where they can register. It’s good for her and her partner. The first class will cover the labor and delivery procedures, the labor process, pain management, and postpartum period. The second class is on breastfeeding and newborn care.

These are very good classes for them so that they can be able to educate themselves and know what to expect once they have their baby. We also have a breastfeeding class held on the last Thursday of the month. This is a two-hour class, and it’s more in-depth into breastfeeding as far as this goes into positioning and latching. It’s just more information. This one is held here in the postpartum conference room, and it’s from 1:30 to 2:30 in the afternoon.

Melanie: And to learn more about the Basics of Breastfeeding at Doctors Hospital of Laredo, you can attend this free class, which is offered the last Thursday of every month by calling 956-523-2530 to register. And to wrap it up for us, Maria, your best advice about women making that decision to breastfeed?

Maria: My advice would be to get educated, take advantage of anything that you can be able to read. Do not go by what a lot of people will be telling you. A lot of times people will have bad experiences, and they relay them on to their families and everybody else, but they should get evidence-based information. These are the type of classes that would give them that type of information.

Melanie: Thank you, so much, for being with us today. You’re listening to Doctors Hospital Health News with Doctors Hospital of Laredo. For more information, you can go to IChooseDoctorsHospital.com, that’s IChooseDoctorsHospital.com. Physicians are independent practitioners who are not employees or agents of Doctors Hospital of Laredo. The hospital shall not be liable for actions or treatments provided by physicians. Doctors Hospital of Laredo is directly or indirectly owned by a partnership that includes physician owners, including certain members of the hospital medical staff. This is Melanie Cole. Thanks, so much for listening.
Hosts Melanie Cole, MS

Better Sleep For A Better You

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Audio File doctors_laredo/dl011.mp3
Doctors Cardenas, Antonio A.
Featured Speaker Antonio A. Cardenas, RRT
Guest Bio Antonio A. Cardenas, RRT is the Director of Cardiopulmonary and a member of the medical staff at Doctors Hospital of Laredo.
Transcription Melanie Cole (Host): Of the nearly 70 million Americans who have sleep problems, about half have chronic disorders that keeps them from getting the restorative sleep they need according to the Centers for Disease Control, and many are completely unaware that something's wrong. My guest today is Antonio Cardenas. He's a respiratory therapist, the cardiopulmonary director, and he oversees Doctors Hospital of Laredo's Sleep Center. Welcome to the show, Antonio. What are some of the most common sleep disorders and what's going on in the country today -- why are we not getting that quality sleep?

Antonio Cardenas, RRT (Guest): Well, some of the most common sleep disorders that we have going on is the -- most absolute common one is obstructive sleep apnea and what goes around with -- what happens with sleep apnea, obstructive sleep apnea is our airway tends to get closed while we're sleeping. So, therefore, we're not allowing adequate oxygen to go into our system, so, therefore, when we see -- when we hear -- maybe we're sleeping with someone that they're snoring and all that stuff, that's kind of the airway closing down on them and not allowing that, pretty much that air and oxygen going into the system properly. We tend to see that more with our obese patients or anyone with a neck size greater than 17. They are more prone to have this disorder of OSA. So, that's what I see here at the sleep center when our patients come through and they start going through their diagnostic procedures and whatnot.

Melanie: So, what would signal to someone that they have sleep apnea? Is it a loved one that lets them know? Is there snoring? Would they notice any red flags or symptoms?

Antonio: Actually, some of the more common red flags also -- it doesn't have to be like a loved one or somebody that's sleeping in the room next to you that's complaining. It's actually yourself when you wake up, and you're going throughout your day, are you feeling any type of daytime fatigue? Are you kind of at your office and sitting and kind of dozing off? Or while you're watching TV in the evening are you noticing that within 10 minutes, you see yourself dozing off? Those are kind of classic signs that tell you that you're not getting adequate sleep at night. For some reason, you're not being to be functional for a long period of time during the day, and that's kind of like the first trigger that you should, as an individual, take that -- hey, maybe something is going on. What am I doing differently or what's going on differently?

Melanie: If someone notices that, or a loved one says, “Hey, you snore really a lot,” and so you need to get in -- what's involved in finding out what's going on -- whether it's sleep apnea or something else? What's a sleep study?

Antonio: Okay. So, the first thing you want to do is have that great conversation with your general practitioner. You need to go in and just say -- I've noticed for several months, you know, or several years, some people go on, you know, long time without even discussing it because they think, “Oh, I'm just tired; no, I didn't get good sleep." They tend to blame it on something else that's going on, probably like a late night and so on. But having that great conversation with your general practitioner saying, "Hey, I’m having these issues. I'm noticing that while I'm at work, I tend to fall asleep or if I’m not doing any activity, and I’m sitting there, I tend to doze off." From there, your general practitioner should recommend if anything to kind of rule out is the first night diagnostic sleep study. With a first night's diagnostic sleep study, what goes on is we bring you into our sleep center. We set you up on pretty much on equipment that's from like head to toe. We’re literally monitoring all the waves from your sleep activity in your brain all the way down to how much you breathe per minute, your O2 saturations and so on and so forth.
And from that sleep diagnostic, whenever we receive the results, we start going off of some of the key points like the AHI Index which is an apnea hypopnea index. Kind of lets us know that if there was moments that we stop breathing and then at the same time how long did we stop breathing for? Once we accumulate all that information, there's a certain number that we go off of for that index, and if that index reads really high, then there's a very strong possibility that you're suffering from OSA in which you would come in for a second night, what we call a treatment night, and in that second night, we pretty much bring you in, do the same set up as the first time but this time we start treating you with a -- what we call a CPAP device, or continuous positive airway pressure system -- in which we put on that mask or a nasal mask, and we kind of start seeing if we can give you that adequate pressure to open up your airway and allow for better sleep, better oxygenation, reduces the amount of snoring and then from there we re-evaluate your sleep and how you did with the machine. If we see positive that everything -- all your numbers -- went down, you breathe more adequately, and so on and so forth, then it's a positive thing. It means that you're going to get those good responses from using the device at home.

Melanie: Antonio, do people really get a good night's sleep at a sleep study? What do you want them to know about that? I mean if they're hooked up and maybe a little bit nervous -- is there, I mean, can you get good readings when somebody is there if they are nervous about being watched?

Antonio: Just like any exam that you undergo with a doctor or lab work -- it's anxiety -- we all experience it. We're going in, "Oh why do they need this? Why do they need that?” We see it, too, when some of the patients come in. Like, it's overwhelming, the amount of equipment that can be put on, and for them it doesn't seem normal, but for the most part, once we start coaching and talking to the patient and letting them know that this is for the benefit of you, and really, that we're not poking them or anything like that, they tend to calm down a lot better and pretty much we say, "Hey, you're going to get a great night's sleep here -- we're going to figure out what's going on with your sleep, if anything's going on."

Melanie: What about adherence to protocols like the CPAP that you've discussed? Do you see that people don't want to use them or do they have issues using them? What about CPAP?

Antonio: Ok. We see a mix; we see like a good mix of response. Most of it is positive. Most of them after they undergo their second night treatment that we've placed them on the CPAP machine and we've kind of titrated the levels that they need to be. Some will wake up really refreshed and comment right away that, "Wow, I feel really, really awake right now," and most of the time it's because we're meeting that adequate need for the patient. Then, there is the flip: the small percentile that sometimes, no matter what we do or how we do about it, they just cannot get used to it. They feel like it's too much. You know, most of them that experience any type of claustrophobia, of course, we're putting on a mask on their face, and they don't like that feeling. So, we do see some patients that unfortunately, they do not tolerate.

Melanie: What about your best advice for sleep hygiene -- good sleep hygiene -- so that people can get that good quality sleep whether it's electronics or the light in the room because we have – I mean, we're all on our electronics until late at night and keeping them right next to your bed. What do you tell people every day, Antonio, about getting that good, quality night's sleep and the importance of it?

Antonio: I always tell patients, or people in general that I have conversations with, is just that yourself to put your phone and your TV and turn it all off at a certain time. I'm a believer where I don't keep my TV in my personal bedroom; I leave it outside, so therefore, when I leave the living room and go into my room, it's kind of like a lights out, kind of time out zone for me to turn everything off. It's very difficult because we are in a world of technology that everything's at our fingertips, and I've noticed that people tend to, you know, they're going to go to bed, and they'll take their phone or their handheld device and they'll start scrolling saying, "I'll fall asleep right now; I’ll fall asleep right now," but as you know, I mean we get caught up in something or some clip or something that's on there. We just have to be really, really good and let ourselves know that we have to at a certain amount of time, start winding down, start relaxing our brain and start telling it, “Ok, it's time to go to bed” and then go on and so on and so forth, and I always use the weekends personally, to catch up, like if during the week I stayed up a little bit extra because of whatever reason. I always use the weekend to kind of catch up and let myself sleep in and let my body kind of catch up because we tend to -- we tend to overdo it sometimes.

Melanie: We certainly do now. Tell us a little bit about the Sleep Center at Doctors Hospital of Laredo. What other types of conditions do you treat?

Antonio: So, here at Doctors Hospital of Laredo, we have a two bedroom sleep center in which we see pretty much two patients a night and from there we see not only just obstructive sleep apnea, we also see sometimes disorders that are neurological that more are concerned with central sleep apnea whereas it's kind of another issue going on and then as well as we see sometimes every now and then those who suffer -- or think that they're suffering from some type of narcolepsy. We do run MSLT studies on them, too.

Melanie: So now your best advice, Antonio, for recognizing sleep apnea and other sleep disorders and the importance of getting that good quality night's sleep, and why they should come to Doctors Hospital of Laredo for their care?

Antonio: So, best advice is always kind of stepping back and recognizing, “Hey, I've noticed this -- what's going on" or "This is what’s changed in the last few months." Always take that moment to kind of consider it is something different or it is something that's a continuous problem. Once you acknowledge it, it's very important to, like I said, to have that good conversation with your general practitioner to see if a sleep study is the best route to see if you are really truly suffering from something going on.
Now, here at Doctors Hospital, of course, we're going to give you that awesome care here, and we're going to set you up and bring you in some of our greatest rooms. You will have, you know, just, we mimic your own personal bedroom where you walk in and it's not hospital furniture, it's actual furniture and, you know, your own restroom and so on and so forth. And we make you feel like you're at home because we all know sometimes sleeping somewhere else also increases the anxiety of anything.

Melanie: Thank you so much, Antonio for being with us today. You're listening to Doctors Hospital Health News with Doctors Hospital of Laredo. For more information, you can go to ichoosedoctorshospital.com. That's ichoosedoctorshospital.com. Physicians are independent practitioners who are not employees or agents of Doctors Hospital of Laredo. The hospital shall not be liable for actions or treatments provided by physicians. Doctors Hospital of Laredo is directly or indirectly owned by a partnership that includes physician owners including certain members of the hospital medical staff. This is Melanie Cole, thanks so much for listening.
Hosts Melanie Cole, MS

Signs of Stroke: FAST (Face, Arm, Speech, Time to call 911)

Additional Info

Audio File virginia_health/vh179.mp3
Doctors Chiota-McCollum, Nicole
Featured Speaker Nicole Chiota-McCollum, MD
Guest Bio Nicole Chiota-McCollum, MD was born and raised in Ocala, FL. In 2004, she graduated from Furman University located in Greenville, SC. There she double majored in biology and Spanish language and literature. In 2008, she graduated from Georgetown University School of Medicine.

Learn more about Nicole Chiota-McCollum, MD
Transcription Melanie Cole (Host): Stroke can happen at any age. In fact, one-third of strokes happen to people under the age of 65. Many of the risk factors for stroke can be changed – smoking, obesity, heavy drinking, high blood pressure all can play a role as conditions such as heart disease. It’s important for you to know the signs of a possible stroke, learn your risk factors, and identify what you need to do if you suspect if you or a loved one is having a stroke. My guest today, is Dr. Nicole Chiota. She’s a neurologist at the UVA Health System. Welcome to the show, Dr. Chiota. Tell us about stroke. What exactly is a stroke?

Dr. Nicole Chiota (Guest): Thanks, Melanie, I’m happy to be here. Stroke is an interruption of the normal blood flow to the brain. That can actually come in two different forms. There's a type of stroke called a bleeding or hemorrhagic stroke, which is really the minority of stroke that we see – it only accounts for 10 to 15% of strokes. The much more common type of stroke that we see is what we call an ischemic stroke where there is a blood clot that interrupts the blood flow to the brain, depriving the brain tissue of the oxygen and sugar that it needs for normal function.

Melanie: What puts somebody at higher risk for having one of these strokes?

Dr. Chiota: You mentioned a bunch of the risk factors that we typically think of. The same risk factors that put people at risk of developing heart disease also apply to developing stroke. High blood pressure, smoking, diabetes, obesity, an irregular heart rhythm called atrial fibrillation -- which can also be associated with heart disease in general, is another major risk factor. When someone comes to us with stroke-like symptoms, the first thing that we want to do is identify if in fact there has been a stroke – either a bleeding or an ischemic stroke. Then the next course – or the next phase of care is really identifying what any particular individual’s risk factors are, and then trying to mitigate those risks – implementing prevention strategies to reduce their risk of having another event.

Melanie: Well, let’s talk about something pretty important because there is a moniker that people should know if they think that they or a loved one are having a stroke. Tell us what that is and why time is brain, and that is so important when a stroke might be occurring.

Dr. Chiota: You’re absolutely right. We have effective interventions for stroke, but they are only available to people within the first several hours of when symptoms start. Recognizing the signs of stroke, calling 9-1-1 and seeking attention as fast as possible is really the cornerstone of effective stroke care. Recognizing the signs of stroke means being aware, and there’s an acronym, FAST, F-A-S-T, that you can remember to help keep the signs and symptoms of a stroke on top of the mind if you will.

The F stands for facial droop. The A is for arm weakness. S is for speech difficulty. If you have any of those symptoms, the T stands for time to call 9-1-1. Face, arm, speech, time to call 9-1-1. There’s been a recent analysis of how sensitive those symptoms are to detect stroke, and what they actually found was that it’s very good. About 85% of stroke patients have one of those three symptoms. If you’re already familiar with the acronym FAST and you want to go to the next level of knowledge, you can add BEFAST to your awareness -- B meaning balance and E being eyesight symptoms. If you include those two symptoms, it actually increases your sensitivity to detect stroke up to 95%. Balance, eyesight, face, arm, and speech are symptoms you want to keep in mind, and if you have – if you or any of your loved ones have any problems in those arenas, you want to call 9-1-1 because we would want to evaluate urgently for stroke.

Melanie: Dr. Chiota, what is the importance of calling 9-1-1 as opposed to driving a loved one to the hospital? Are there certain things the EMS can do on the way to the hospital that make it that much more important?

Dr. Chiota: That is a great question, and the answer is yes. EMS, in our current system of care, pre-alerts the hospital that they are arriving – triaging the patient too -- so that a team is in place when that patient arrives for an expedited evaluation. Here at UVA, that means that the neurology stroke team is actually awaiting patients in the Emergency Department. We have the CT table cleared so that as soon the patient is deemed stable and safe to go to radiology; we can get that scan done as urgently as possible. We have pharmacy support ready in the event that we need to mix the clot-busting medicine called tPA and administer it as fast as possible.

In the future, we anticipate that there may be other opportunities for advanced evaluation of patients while they’re still in the field, either using telemedicine or even by phone with the EMS providers to make sure that the patient is being triaged to centers that can provide the right level of care for the presenting symptoms.

Melanie: Speak about what you do when you’re waiting there for this suspected stroke patient. You mentioned tPA and the clot-busting medication, so let listeners know what they can expect. What does that do?

Dr. Chiota: tPA, the clot-busting medication, is the only FDA-approved medication that we have to treat acute ischemic stroke – the type of stroke where there is a blood clot. We actually all make tPA. It’s an endogenous substance, so it circulates in our bloodstream, but when we have a patient that we suspect that there is an acute blood clot, we can give a super dose of tPA to help the body break down the clot. What that does is restore blood flow to the area of the brain that has been robbed, if you will, of adequate oxygen and sugar stores. The idea is to restore blood flow to the area at risk around that brain tissue that hasn’t been receiving enough blood flow.

In cases where we actually see the blood clot on vessel imaging, we can combine tPA with a procedure called thrombectomy. What happens with a thrombectomy is our interventional neuroradiologist or vascular neurosurgeons can actually place a catheter through the groin and snake that catheter up into the blood vessels of the brain and pull the clot out. There have been several studies in the past several years that the combination of tPA with that type of procedure actually dramatically increases the likelihood that someone will have a functional, independent neurologic recovery after a stroke compared with folks who receive only tPA alone or no intervention at all.

Melanie: What is life like for stroke recovery and rehabilitation, and does this put someone at risk for having a recurrent stroke?

Dr. Chiota: People who have had one stroke are at high risk for having a second. Even if you have stroke symptoms that resolve, which we would call a TIA or transient ischemic attack, that indicates to us that you are at high risk for having another event that could put you at risk for disability or even death. We take these events very seriously in trying to identify what any individual’s risk is, and therefore, direct our preventative strategies to that individual’s risk. For some, that means screening for that irregular heart rhythm called atrial fibrillation. We put patients who have atrial fibrillation on different medicines than those who do not to try to prevent stroke. Treating blood pressure, screening and treating for diabetes, smoking cessation, are things that we encourage in all of our patients who have had strokes of either the hemorrhagic or the ischemic type.

In terms of life after a stroke, the fortunate thing is that strokes do get better. It takes time, and it takes rehabilitation. Working with our colleagues in physical therapy, occupational, and speech therapy, and the physicians who oversee all those therapy programs – in physical medicine and rehab – is a key part of stroke care. Our goal in evaluating people acutely is to offer interventions that will decrease the likelihood that patients will experience disability. But as I said before, really knowing the signs of stroke, seeking emergent attention if you were to ever experience them, and then, engaging in healthy lifestyles and having your risk factors treated is really the key to preventing disability from stroke.

Melanie: Dr. Chiota, tell us about the Stroke Center at UVA Health Systems achieving the target Stroke Elite Plus Honor Roll, which is the higher honor role for stroke centers.

Dr. Chiota: Yes, thank you, Melanie. We are very proud of this distinction that we’ve recently received. What it basically means is that we provide the highest level of care for patients presenting with complex vascular neurology problems -- whether that be TIA, hemorrhage, subarachnoid hemorrhage, ischemic stroke. We offer a 24 hour, 7 days a week program with coverage from the moment the symptoms are identified in the field, and we’re pre-alerted, and our team is ready to greet people in the Emergency Department, through potentially intensive care and the interventions that we offer, and then all the way out into the outpatient setting where we have our outpatient clinic coordinators to ensure that the stroke care that we offer from stroke onset all the way through the rehabilitative process is as comprehensive as it can be.

Melanie: Wrap it up for us, with your best advice about stroke awareness, knowing your risk factors, and also knowing what to do if you suspect that you or a loved one is having a stroke.

Dr. Chiota: Awareness is key. Remember FAST – Face, Arm, Speech, Time to call 9-1-1. If you can remember BEFAST where Balance and Eyesight problems are also signs of stroke. Calling 9-1-1 to seek emergent care as soon as any of those symptoms are recognized in either yourself or a loved one is of paramount importance. And beyond that, knowing your risk factors, working with your primary care physician to make sure that your blood pressure, and your sugar, and your cholesterol are under control, engaging in a healthy lifestyle – all of those things are the way to prevent stroke and ensure a long, healthy, and functional neurologic existence [LAUGHTER].

Melanie: Thank you, so much, for being with us today, Dr. Chiota. It’s really important information for listeners to hear. If you’d like to assess your risk of stroke, you can go to uvahealth.com/services/stroke-center, that’s uvahealth.com/services/stroke-center. This is UVA Health Systems Radio, and I’m Melanie Cole. Thanks, so much, for listening.
Hosts Melanie Cole, MS

Bariatric Weight Loss Surgery for Severe Obesity

Additional Info

Audio File southwest/sw003.mp3
Doctors Suh, David
Featured Speaker David Suh, MD
Guest Bio David Suh, MD, is the Medical Director of Bariatric Surgery at Southwest Healthcare System.
Transcription Melanie Cole (Host): Being seriously overweight can lead to life-threatening medical conditions such as diabetes, high blood pressure, sleep apnea, and more. When combined with a comprehensive treatment plan, bariatric surgery may often act as an effective tool to provide you with long-term weight loss and help you improve your quality of life. My guest today is Dr. David Suh. He’s the medical director of bariatric weight loss at Southwest Healthcare System. Welcome to the show Dr. Suh. Who should consider bariatric surgery and are there certain parameters to consider bariatrics, who can qualify?

Dr. David Suh, MD (Guest): Yes, thank you for having me on. Basically there are certain criteria that are set aside by national entities such as American College of Surgeons that determine patients who have BMI or body mass index which is calculated by your weight over your height (kg over meters square), if it’s over BMI of 40 then individuals are considered to be morbidly obese and those individuals who then can undergo different evaluations to see if they qualify for surgery or patients who have diabetes, high blood pressure, severe sleep apnea or severe reflux disease can have BMI over 35 and be a candidate for surgery.

Melanie: So if somebody is determined to have that BMI and they’re a candidate for surgery, what then are the steps that they would consider taking before they can actually have the surgery? Is there psychological counseling involved, what would you like them to know about what they should do?

Dr. Suh: Yes, I think it’s important that individuals consult their primary doctors first to determine whether they would be a good candidate for this type of surgical procedure. Before considering surgery, they should certainly try other methods of weight loss, certainly diet, exercise, and even some medications can be effective. If these fail, then consulting with their primary doctors then they would ask for referral or find a qualified bariatric program and inquire about possible surgical options. Now once patients are introduced to the program, we have the patients go through a variety of evaluations including psychological evaluation, there are many steps in terms of nutritional counseling and nutritional classes that patients must also attend. Patients may need to demonstrate some weight loss prior to being a candidate for surgery. Certainly they may undergo medical evaluation to make sure that their hearts and their lungs and there are no other medical issues that would preclude them from having surgery.

Melanie: Does insurance typically cover bariatric surgery? Or are there certain requirements?

Dr. Suh: All insurance including PPO and HMOs and Medicare do cover bariatric surgery, however different insurances have different requirements before patients can be a candidate. Certain insurances require nutritional counseling for a certain period of time, sometimes it can be 3 months, sometimes it can be 6 months. They also require psychological evaluations; they also require different insurances have different criteria that may vary from the national standards.

Melanie: So then let’s speak about the types of bariatric surgery that you perform at Southwest HealthCare System. And start with the bypass, the gastric bypass, please explain a little bit about what this procedure is and give the listeners just a little walk through about what they can expect.

Dr. Suh: Gastric bypass is a procedure that has been around for quite a bit long time. It’s been around since the 60s, late 50s and the procedure involves separating the upper 20% from the rest of the 80% of the stomach. Then rearranging the small intestine so that the upper part of the separated stomach empties directly into the small intestine, thus bypassing the majority of the stomach itself. So this certainly limits the amount of food that patients can intake. It also helps them control their appetite because of the separation of the majority of the stomach reducing the appetite hormone ghrelin. This surgery is effective in achieving weight loss by a small part of malabsorption of calories that helps them lose weight. The surgery again has been around for a long time and has a good track record when performed in competent hands. The surgery is very safe. It has been shown to be very effective in treating diseases such as diabetes aside from achieving weight loss. So in patients who are severely diabetic who are on multiple medications can actually achieve great benefit sometimes achieving what we call permanent remission from diabetes. So there are some concerns in the long term which involve ulcers that can form and so the patients who undergo gastric bypass have a precaution not to ever smoke or take any aspirin, Motrin type of medications.

Melanie: And what about the gastric sleeve, what’s the difference, you mentioned malabsorption so gastric bypass creates the pouch and the gastric sleeve is a little bit different, explain about that.

Dr. Suh: So gastric sleeve is a simpler procedure. It involves resecting approximately 75% of the stomach, the outer part of it, so that rather than having a bag-like stomach you end up with a very narrow, slim, elongated stomach that is in the shape of a banana or a sleeve. So it’s called gastric sleeve or it’s called vertical gastrectomy. Now when you do that you result with a smaller stomach so your intakes are reduced as well as also separating or removing the outer part of the stomach loses a significant amount of ghrelin or appetite hormone so your appetites decreased as well. Weight loss primarily is because of the reduction in portion size and your portion size reduction can be achieved because your appetite is so reduced so the weight loss is achieved. It is more of a recent procedure; it’s been around for about maybe 10 years. We do have some tenure outcome data out now but this procedure so that is does achieve very good outcomes in terms of weight loss, in terms of achieving resolution of some of the comorbid conditions such as diabetes though might not be as effective as gastric bypass but achieving weight loss can be as effective. Now the precautions about the gastric sleeve are that the patients with severe reflux may actually experience continued reflux or maybe even slight worsening of it in the long run in a small percentage of patients so that’s a precaution.

Melanie: And what is life like after bariatric surgery for these patients? As far as going to restaurants and group support and supplementation, do they have to take supplements? Speak a little bit about life after surgery.

Dr. Suh: So whether its gastric bypass or gastric sleeve, patients who undergo surgery they require to adapt the same lifestyle changes in terms of modifying their diet, they have to certainty along with a reduction in their portion sizes they have to actually exclude certain type of food from their diet, patients who are morbidly obese they have difficulty controlling some sugar intake, certain food can trigger their hunger and cravings long after the surgeries done so that their same behaviors that existed can return. Therefore, certain snacks, soda, and sweets need to be avoided after surgery, however aside from that their food intake as far as the variety of food that they can have is not much changed in terms of fruits, vegetables, dairy products, meat, these are slowly reintroduced to their diet so eventually patients are able to have all these variety of foods. However, certainly portion sizes will be reduced for the rest of their lives therefore they have to adhere by paying attention to how much they intake. When they go to restaurants they can certainly order food off the menu, however their portion sizes will be smaller so usually they end up sharing a meal with their family or their partners. We do give small cards that they can present at the restaurants, sometimes they do honor these cards so they can order even off the kids menu. Both gastric bypass and gastric sleeve patients have to take supplements; multivitamin, vitamin B12, calcium, and sometimes in addition B1 or B complex and keratein, vitamin D. These supplements must be taken by both patients because it’s really do to the reduction in portion sizes rather than actually the malabsorption part that they require vitamins. Certainly gastric sleeve patients because we’re removing part of the stomach, the B12 supplement is actually very essential.

Melanie: And how much weight can someone expect to lose?

Dr. Suh: Well it varies depending on how much weight they need to lose. Some patients are 100 pounds over their ideal body weight, some patients are 200 pounds over. Both procedures we can expect to lose a significant amount of weight, however in my experience, gastric sleeve you can achieve up to about 100-120 pounds weight loss effectively. So if patients need to lose about 120 pounds they can expect to lose somewhere close to that amount or 85-90% of it with the gastric sleeve. However, when you go over 120 pounds then the effectiveness of gastric sleeve may be challenged in losing beyond 150 pounds of weight loss may be difficult. In gastric bypass patients the upper limit of weight loss can be extended up to 250 pounds of weight loss so patients that are over 150-200 pounds of weight loss in terms of their weight they may benefit from gastric bypass versus gastric sleeve.

Melanie: In just the last minutes doctor, what should people who are severely overweight think about when considering bariatric surgery?

Dr. Suh: Well I think it’s important that you have to think that you’re doing this for your health and that your health is what’s important. Sometimes patients think about bariatric surgery because they’ve been diagnosed with hypertension or diabetes recently or patients have been required joint replacement such as knee or hip and their surgeon requires them to have weight loss. So again because of the criteria that exists we certainly make sure that the patients who qualify for surgery are patients who actually can certainly greatly benefit from the reduction of weight loss but it’s really more for the benefit of achieving a healthier lifestyle. Now aside from that they need to remember that surgery in itself may result in weight loss initially but after beyond a year to a year and a half not everyone keeps the weight off. So it does require commitment to make lifestyle changes and that is essential in achieving long term weight loss otherwise even gastric bypass or gastric sleeve may result in only temporary weight loss that may give you weight loss for a brief beyond time of just 2-5 years.

Melanie: And why should they come to Southwest Healthcare System for their care?

Dr. Suh: Well Southwest Healthcare System has been a center of excellence for bariatric surgery for the last over 11 years. That means that they have a track record in terms of overall quality of care that we’ve provided that’s been overseen by national entities. We’ve done over 7500 procedures at Southwest Healthcare System and patients ask me which or what are the safe bariatric procedures whether it’s gastric bypass or sleeve or any other procedure. My answer is safe bariatric procedure is bariatric procedure performed by an experienced bariatric surgeon and an experienced comprehensive center. We make sure that we provide safe and effective care. So I think Southwest Healthcare System has demonstrated to be such a center.

Melanie: Thank you so much for being with us today. You’re listening to Southwest Health Talk with Southwest Healthcare System. For more information, go to SWHealthcaresystem.com. This is Melanie Cole, thanks so much for listening.
Hosts Melanie Cole, MS

What is Oral Allergy Syndrome?

Additional Info

Audio File allina_health/ah142.mp3
Doctors Johns, Kenneth
Featured Speaker Kenneth Johns
Guest Bio Dr. Kenneth Johns specializes in allergy and immunology and practices at Allina Health clinics in Cambridge, Coon Rapids and Maple Grove. His professional interests include child and adult asthma, seasonal allergies, hives and skin rashes.

Learn more about Kenneth Johns, MD
Transcription Melanie Cole (Host): Have you ever noticed an itchy or tingly sensation in your mouth after biting into certain fruits or vegetables? People who are allergic to pollen are accustomed to runny eyes and sniffles this time of year, but seasonal allergy sufferers may have it worse. They can actually develop allergic reactions to common fruits and vegetables. My guest today is Dr. Kenneth Johns. He specializes in allergy and immunology at Allina Health Clinics in Cambridge, Coon Rapids, and Maple Grove. Welcome to the show, Dr. Johns. So, what is oral allergy syndrome? What does that mean when people get that itchy sensation in their mouth after biting into certain fruits and vegetables?

Dr. Kenneth Johns (Guest): Well, it's the extremely common food intolerance; it’s not really a food allergy. So, by definition, it's itching, tingling, very unpleasant sensation in the mouth and lips and oral cavity immediately after you eat this increasingly growing list of fruits and vegetables, and sometimes even tree nuts. So, it isn't a true allergy. By definition, the symptoms are localized to where the food touches your body -- mostly in the mouth -- and does not progress to things like anaphylaxis, where you lose your blood pressure or your airway or have a severe reaction.

Melanie: So, is it considered more of a nuisance or is this something that you want to do something about?

Dr. Johns: Well, you know, I tell patients that it's more disruptive than it is dangerous. It -- I would say half of my patients choose to keep eating those fruits and vegetables and half of them choose to avoid them, and I’m ok with that either way. There's certainly strategies to keep eating the fruits and vegetables but not have the symptoms. So, for example, we tell people if you cook that apple or blanch that apple or freeze that apple, you're a lot less likely to have those symptoms. So, the protein that we think is responsible for the symptoms is apparently very sensitive to heat. So, you can eat those fruits and vegetables and avoid symptoms by cooking them or even freezing them.

Melanie: So, Dr. Johns, when little kids eat things like tomatoes, and we've always just thought that this was the citrus or the acid when their lips get red around the edges after eating cherry tomatoes or something like -- is that the same thing? Or is that just a reaction of their sensitive skin to that acid in the tomato?

Dr. Johns: Well, that's exactly right. It's really not an allergic reaction. It's really not oral allergy syndrome. It's just very acidic food contacting that very delicate skin. As kids get older and they learn to not smear the food all over their face, they tend to have less of those symptoms, but toddlers, especially can have a lot of that red, itchy mouth. We really don't have a good name for that one, but it is frequently seen with cherry tomatoes and citrus and other acidic foods.

Melanie: Well, I wanted to bring it up because I wanted to make sure that people don't confuse this and say, "Oh my gosh is this now oral allergy syndrome?" So, they are definitely two different things then --

Dr. Johns: -- yeah --

Melanie: -- if people do cook or freeze some of these things, is it something that they just never have to really deal with again? Or should they come to see an allergist about it?

Dr. Johns: Well, I think the concern for a lot of people is whether those symptoms actually represent a mild true allergic reaction, so for example, when someone gets an intensely itchy mouth, when they eat kiwi fruit, there's a concern that -- boy, maybe that's the first sign of an allergic reaction. So, it can be sometimes hard to tell them apart, and I think that's where it’s a good idea to discuss it with your physician. Tree nuts -- we see true allergic reactions to tree nuts, and we also see oral allergy syndrome with tree nuts, and it can be hard to tell them apart. A lot of that is again, having a discussion, and trying to tell those apart, again, can be a challenge. We really don't have the good tests for food allergy. They are very inaccurate and have a very high false positive rate, and we certainly don't have tests for food intolerances.

Melanie: So, in the event that this happens to somebody, and they notice it, how long does it take to wear off and does rinsing their mouth water or warm water or brushing their teeth, or any of these things -- is there anything they can do to get that sensation to go away? Should they try antihistamines?

Dr. Johns: When people get those full-blown oral allergy symptoms, and again, I am not minimizing them. They can be very uncomfortable. I haven't thought a whole lot that helps. We’ve tried pre-medicating with antihistamines and other types of things, which really don't block it, which I guess is another way of saying is it really an allergic reaction? I can't block it with allergy medicine. After the fact, once that mouth is itchy and tingling and burning, I've found full-fat warm liquids to be the most effective thing to help with the symptoms. So, if you have a latte after you eat the fresh apples, a lot of times that’ll help minimize the symptoms.

Melanie: Well, and in certain cultures – if food is very spicy and burning the inside of their mouth, they drink milk and --

Dr. Johns: -- I think --

Melanie: -- and is that sort of the same kind of, you know?

Dr. Johns: I think it's probably the same mechanism.

Melanie: Wow.

Dr. Johns: I think that’s probably pretty similar.

Melanie: Does it go away? Is it something that kind of sticks with you for life?

Dr. Johns: Like a lot of food intolerances, it does sort of come and go. It isn’t unusual for the food-related symptoms to occur later, and sometimes you see patients where the first thing that they notice is the oral allergy symptoms and other things develop later. So, there's always been an association of oral allergy syndrome with pollen allergy, and unlike the pollen allergy, the food-related symptoms can sort of come and go. There's a tendency for sometimes to add food intolerances so they’ll tell you, “I've always had problems with apples, and now I’m having problems with fresh cherries,” but again, sometimes they just go away.

Melanie: So, do you see that people with oral allergy syndrome may find their symptoms worsen during pollen season, and would it help to be washing your foods more? Is there anything to that?

Dr. Johns: No, it isn't something on the surface of the fruit. If you were to blanch that fruit, you know, where you dunk it in boiling water and then in ice water, that might break down that protein that we think is responsible, but it isn't something that's on the surface that could be washed off.

Melanie: So, people that are seasonal allergy sufferers that maybe also have oral allergy syndrome are kind of getting hit from both ends, and what to you tell them about identifying the triggers of both the seasonal allergies and oral allergy syndrome and kind of, you know, being able to modify some of the results of these allergies at certain times of the year?

Dr. Johns: Well, again, you can’t do tests for pollen allergies that can predict whether you might react or not. We don't have tests for the oral allergy syndrome. We certainly don't have anything that's been shown to be an accurate test for oral allergy syndrome. It's really trial and error. There is some sort of groupings. For example, people with tree pollen allergies, so they have spring seasonal allergies, they tend to have problems with the stone fruits and the apples. People that have a ragweed sensitivity, so they have fall hay fever, ragweed allergy, they tend to have problems with watermelon and related fruits. So, there's some associations with pollen allergy. So, sometimes you can predict what an oral allergy syndrome might be, but otherwise, we don't really have a way to test for them.

Melanie: So, your best advice about dealing with them, Dr. Johns.

Dr. Johns: So, if you choose to keep eating those fruits, I think that's a good idea -- or vegetables. If you want to avoid them, I tell people keep trying different fruits and vegetables. You'll find fruits and vegetables that don't bother you -- that don't induce the symptoms. I tell them if you would like to keep eating those fruits, cook them or freeze them or smoothie them. That's not really a verb, but when you run them through a blender with some yogurt and what have you -- that seems to reduce symptoms as well. So, if you do choose to keep eating them, there’re certainly ways to reduce your symptoms.

Melanie: Thank you so much, Dr. Johns, for being with us today. You're listening to the Well Cast 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

Exercise and the Brain

Additional Info

Audio File allina_health/ah141.mp3
Doctors Ericson, Gail
Featured Speaker Gail Ericson, PT, MS
Guest Bio Gail Ericson, PT, MS is a physical therapist with the Penny George Institute's LiveWell® Fitness Center. She enjoys working with a clients seeking services for a variety of reasons. They may be recovering from cancer, transitioning from clinical therapy to community-based exercise, or seeking a more active lifestyle. Ericson is a past marathoner who now enjoys yoga, strength training, and a multitude of summer and winter activities.

Learn more about Gail Ericson, PT, MS
Transcription Melanie Cole (Host): Just like the rest of your body, your brain needs the right exercises to perform well. Studies show a strong link between regular exercise and a boost in verbal, memory, and learning. My guest today is Gail Ericson. She’s a physical therapist with the Penny George Institute’s Live Well Fitness Center. Welcome to the show, Gail. Exercise and the brain – people think of the brain as not something that benefits from exercise, so speak about how that works.

Gail Ericson (Guest): There’s quite a few benefits to the brain, both directly and indirectly, from exercise. They used to think that the brain – the neurons – we didn’t ever gain any more neurons. Our brains inevitably would shrink as we age, and there was no way to change that course. Now, they’re finding that that’s not true.

Directly, exercise obviously brings more oxygen and blood flow to the brain. At the cellular level, they are finding that there is a protein that helps to increase your neuron growth and activates more neuron growth, especially in the area of the brain called the hippocampus, which is our main piece of our brain that helps us with memory and new learning. Yeah, there’s really great evidence out there, and lots of ways that it can help your brain.

Melanie: When we think of exercise – people have heard about brain games, and then they think of regular, formalized exercise. Let’s start with the regular, formalized exercise. Are we talking about all kinds of cardiovascular specifically, or weight training and yoga – because some people say yoga and meditation, that can help? Tell us what kinds of exercise you’re talking about?

Gail: What they’re finding currently in the research is that it is mostly – you’re mostly going to get the effects of new brain cell development with sustained aerobic activity, so anything that gets your heart pumping – from walking to riding your bike – for as little as 20 minutes a day. Even better, 30 minutes a day, seven days a week is great. Strength training hasn’t been really found to have those effects on the brain because typically, you’re not going to have a sustained heart rate during that time. Anything that gets your moving is going to affect your brain.

Melanie: If the American College of Sports Medicine and other organizations are recommending 150 minutes a week of cardiovascular sustained exercise, which can be broken up, Gail – they say into ten-minute increments and such. Are those then just as good for the brain if we break them up, or is this a little caveat to that 150 minutes a week where it should be a sustained 45 minutes kind of thing?

Gail: I don’t know if they know for sure at this point. For most people, I would just say you just need to move. If it’s for ten minutes -- if it’s for twenty minutes, if you can do it for thirty minutes -- and if you can do it every day, the more, the better especially as you age. They have found that in the elderly population – maybe 60 and over – if you keep moving, you’re going to prevent some of that brain shrinkage that comes with normal aging. You’re also going to help with mood, with depression, with decreasing stress, improving your sleep. At this point, I would just say, “You just need to move, and the more you move, the better.”

Melanie: We’ve talked about how much exercise is needed, what type of exercise, how it really benefits the brain. People hear about these brain games – there’s even ones you can do online. There’s ones that you can do all over the place. Are these proven to help the brain cells as well, and even, possibly, help to pre – not prevent, but maybe even delay some kinds of brain disorders – Alzheimer’s, dementia, things like that?

Gail: I think there’s a little bit of research out there that it can help more in the short term. They’re having trouble linking that to any real long-term changes, and they’re not finding that there’s actual physical changes in the brain whereas exercise they can do MRIs and do different things and they can see that, yes, there are actual increases in that hippocampus in the brain. They’re not necessarily seeing that with brain games. It’s hard to tell sometimes if those types of games are helping people in real life with their functioning or do they – if you work on, say, math games, does that transfer into anything else? It also might contribute – if you’re doing a lot of brain games, and my thought, is that it’s going to lead to probably more isolation – because you’re probably doing these things alone – and probably contributing to more sitting --

Melanie: Interesting point. That’s an interesting point. But when people want to know what type of games?

Gail: There are so many out there I wouldn’t be able to give you an idea of what the best kinds of games there are. If they are games that have activity involved with them -- even something like the Wii --because you might be learning some new movement pattern and you have to think about it. That’s what they say about exercise, as well. You’re going to get better brain effects if it’s something that you have to move and you have to think. Dancing is a great option. If you take dance lessons or something like that, you’re learning something new, and you’re moving.

Melanie: What’s so important is that people hear all of this, and they want to do what’s right for their brains. Wrap it up, Gail. You’re a physical therapist, so you work with all parts of the body, and the brain being a muscle, which people don’t really think about – and the heart, as well. Tell people what you want them to know about brain health and even feeding their brain nutritionally, eating foods that are full of antioxidants, and that are getting enough hydration. All of these things go together to help us think a little bit clearer, so wrap it up for us.

Gail: Yeah, you put it all out there. It’s all the things that people know they should do as far as eating better, trying to cut out as much sugar as you can out of your diet, and moving – making those excuses to move as most often as you can. It’s going to help affect your – both your muscles, your muscle strength, your endurance, your learning capability, your memory capability, help you sleep better. There are so many reasons to move, and probably fewer reasons not to, but we have to get around those [LAUGHTER].

Melanie: And you know what they say – the American College of Sports Medicine does say, “Exercise is medicine.”

Gail: Absolutely.

Melanie: And in this case, it’s actually brain medicine. Thank you, so much, Gail, for being with us today. That’s really great information. You’re listening to The Well Cast 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

Erectile Dysfunction After Prostate Cancer Treatment

Additional Info

Audio File city_hope/ch105.mp3
Doctors Warner, Jonathan “Nick”
Featured Speaker Jonathan “Nick” Warner, MD
Guest Bio Jonathan N. Warner, MD is an assistant Professor in Division of Urology and Urologic Oncology, Department of Surgery.

Learn more about Jonathan N. Warner, MD
Transcription Melanie Cole (Host): Patients with prostate cancer that hasn't spread beyond the gland itself have a broad range of treatment options including surgery, radiation therapy, and active surveillance. However, with those treatment options comes certain side effects such as incontinence, bowel function, and erectile dysfunction. Many men will have erectile dysfunctional occasionally. However, if it becomes a consistent problem, it might be time to look to the experts at City of Hope for help.

My guest today is Dr. Jonathan Warner. He's an assistant professor of the Division of Urology and Urologic Oncology in the Department of Surgery at City of Hope. Welcome to the show, Dr. Warner. First of all, men have prostate cancer, they have surgery or certain treatments, what are some of the risks of erectile dysfunction becoming a side effects of some of those treatments?

Dr. Jonathan Warner (Guest): There’s several factors that really play into that. Preexisting erectile dysfunction is probably one of the biggest risk factors for after treatment erectile dysfunction, so a good understanding of how strong the erections are before the operation or before radiation therapy can really be the best predictor of how they’re going to be after therapy. The other factor that comes in with surgery is if the disease is not that advanced, then often times we can perform a nerve-sparing procedure to spare the nerves that run next to the prostate that really controls that erection. Those two factors combined are really the most important factors when it comes to postoperative erectile function.

Melanie: Before they start prostate cancer treatment, do you -- is this a question that is asked, “Have you had erectile dysfunction previously?” you know what kind of baseline you’re starting with?

Dr. Warner: Absolutely, yeah. Most of the surveys we have patients fill out -- or the questionnaires we have patients fill out before the operation at any of the visits -- address that issue. I think for patients it’s also important to bring that up to the physician when you’re deciding on treatment therapy.

Melanie: Do you feel, Dr. Warner, that this helps a patient or makes a patient decide on certain types of treatments for their prostate cancer? Do you think this is a big part of their decision whether or not this is going to be a side effect because this is a big deal for men?

Dr. Warner: It is, and I do think, probably inappropriately, a lot of men will base their treatment decision on their erections, honestly. And why I think it’s inappropriate because if we’re comparing surgery to radiation, the long-term effects of the radiation -- it might take a long time for those to develop --but if we compare surgery to radiation, the erectile dysfunction rates are equal. The nerves, though you’re not having an operation, the nerves are still going to be affected by the radiation negatively. A lot of men think that “Oh, I’m not going to get surgery, I’m going to have erections no problem,” but in truth, their erectile dysfunction rates are, by four to five years, going to be the same as somebody who has had surgery.

Melanie: So you would really like men to make this decision on their treatments, not based on this particular side effect, and to really put that aside when they consider their different treatment options?

Dr. Warner: Absolutely, and I think that the side effects from surgery are very predictable and very manageable. Radiation -- and the majority of men do fine -- but it does result in many, many unpredictable side effects, and the treatment options of those side effects can often be very challenging. I think the best analogy I’ve ever heard is that getting radiation is like throwing superglue at your body, and you just imagine all of these structures stuck together that are supposed to be free and mobile that any treatment that we offer you after the radiation therapy are not going to be as successful just because of the effects of radiation long-term.

Melanie: So then, what do you do for men after they’ve gone through -- whether it’s radiation therapy -- and they do start to report a recurring incidence of erectile dysfunction, what’s the first line of defense? What do you do for them?

Dr. Warner: Right, I think the first line is prevention. We are becoming more and more aggressive about our -- what we call penile rehabilitation after the operation, or after radiation therapy. This may include early oral medications such as sildenafil to help increase the blood flow to the penis during the recovery period. And we’re not expecting people to go out and have sex right away, but we think of it as any other body part. We need to have physical therapy. The penis needs to stay healthy during the recovery period, and for us, we use vacuum erection devices during the recovery period. And for us, we use oral medications in the recovery period to maintain the health of the penis while they’re going through recovery.

Melanie: And then what about the medications? They’re all over the commercials. They’re all over the media. You’ve got Viagra, and Cialis, and all of these things. Where do they come into play?

Dr. Warner: Yeah, so that is a good first-line option for a lot of men. I think the important thing to understand is that these medications rely on those nerves that run next to the prostate to function. For example, if somebody has had a non-nerve-sparing prostatectomy because of advanced disease, then, the oral medication should be skipped entirely, but for somebody who is going through radiation therapy, or somebody who had a nerve-sparing, this is a great option. It will allow the nerves to function more effectively.

Melanie: How long can they be using those medications?

Dr. Warner: As long as they work.

Melanie: That’s a good answer. Then, what if the medications don’t work, then what?

Dr. Warner: Yeah, so then we go on to our second-line therapy. Our second-line therapy includes a vacuum erection device, which essentially is a cylinder that goes over the penis. It creates a seal at the base of the penis, and with a vacuum effect, it will pull blood, giving an erection.

There’s also an ejection that we can put right into the penis. What that does is that bypasses those nerves, so if those nerves are completely damaged or gone, as long as there’s still good blood flow to the penis the injections are usually effective. A lot of men prefer that option over the vacuum, just because it’s a little more discrete, a little bit more on-demand, a little bit more spontaneous than the vacuum erection device.

Melanie: The vacuum erection device is a little bit cumbersome?

Dr. Warner: Exactly.

Melanie: And it’s something that they have to do at the time that they’re going to have intercourse --

Dr. Warner: Correct.

Melanie: And then they have this band placed, so it’s a whole thing that they have to do. Men really do choose penile injection therapy?

Dr. Warner: Yeah, believe it or not. I think -- what I tell most of my patients is that people are very surprised at how little it hurts and how well it works. I think a lot of these guys have already been trying the oral medications, and there’s a long delay time between when you take the pill and when you get the erection -- or when you get the effect. Men have to anticipate. With the injection, it’s more on-demand. A quick injection, within five minutes you have an erection.

Melanie: They give themselves this injection?

Dr. Warner: Yeah, yes.

Melanie: Wow, so you teach the men how to do this, and they’re willing to do this?

Dr. Warner: Absolutely, yeah. We have quite a number of patients who are on this therapy.

Melanie: And how often can they use this type of therapy?

Dr. Warner: Up to every 24 hours it’s safe.

Melanie: Wow, okay, so you’ve got vacuum erection device, you’ve got the medications, you’ve got the penile injection therapy, and then -- is there ever a time when surgical intervention is required?

Dr. Warner: Yes, absolutely. When those therapies quit working, or when someone who doesn’t tolerate the needle injections -- or doesn’t like the vacuum erection device -- there is a surgical option available. To be honest, everybody gets the idea that having an operation that is somehow wrong, or somehow bad. We use the analogy that it’s like a knee replacement for the penis. When the knee goes bad, you get a knee replacement. What happened to the penis is the blood flow is no longer sufficient to provide adequate erections, so we are going to replace that aspect of the erection.

It’s called a penile prosthesis -- an inflatable penile prosthesis. It’s very physiologic in the sense that it’s flaccid when you’re not in use, and then it becomes erect when you want to use it. If we compare patient satisfaction rates comparing oral medications, injections, vacuums, and the penile implant, far and away patients are happier with the penile implant than any of the other options. The reason is because everything is contained within the body. There’s no injections, there’s no pills, there’s no devices you’ve got to put on, and people are quite satisfied with it once they make that decision.

Melanie: Does it stay in for the rest of their life?

Dr. Warner: Yeah, the device -- it is a mechanical device. It’s got some working parts, so the expected lifespan of one of these devices nowadays is about 15 years with regular use.

Melanie: Then wrap it up for is, Dr. Warner, because this is really great information for men to hear, to put all these out there so that they know what their treatment options are, and the ones that they love, their partners can also understand. Wrap it up for us in what you tell patients every single day about the side effects of prostate cancer, treatments, and those options that they have if erectile dysfunction is one of those side effects.

Dr. Warner: Yeah, I think what I like to tell my patients is that don’t let the erections be the decision for treatment. Really look at the side effects beyond erectile dysfunction, and beyond urinary incontinence, because those problems can be treated. If you have good erections, we can guarantee you are going to have good erections after the operation. One way or another, we can get your erections back. It all depends on how important that aspect of your life is, but if it’s important, then we have really, really good options for you to make sure that you are able to preserve that aspect of your life.

Melanie: That’s certainly great information, and it’s really about the quality of life for the men that are going through these treatments. Thank you, so much, Dr. Warner, for being with us today. 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

Your Brain 101: Think With Your Stomach – The Gut Microbiome

Additional Info

Audio File allina_health/ah140.mp3
Doctors Corry, Jesse
Featured Speaker Jesse Corry, MD
Guest Bio Jesse Corry, MD, is board certified in critical care and neurology, and serves as a neurologist at Allina Health’s United Hospital in St. Paul. His clinical interest is in the stroke continuum of care.

Learn more about Jesse Corry, MD
Transcription Melanie Cole (Host): Scientists have known for quite some time that bacteria that occur in our gut affect a person’s health from digestion to allergies. More recently, studies are finding that the microbes that colonize the gut also have an effect on the brain and can play a role in conditions such as autism, depression, and anxiety. Here to explain more is my guest, Dr. Jesse Corry. He’s a Neurologist at Allina Health’s United Hospital. Welcome to the show, Dr. Corry. First, let’s explain a little bit about the gut microbiomes and what are those? What do they typically do?

Dr. Jesse Corry (Guest): The gut microbiome is this fascinating thing that we’ve been learning more and more about over the last decade or so. When I was in school, there was – you were told that the gut bacteria help make Vitamin D, and maybe some digestion – that was really about it. As we learn more and more about this fascinating force in our body -- we now know there’s about a hundred trillion bacteria in our gut. That’s more than our body, and there’s about a hundred different species. These bacteria actually have a larger genome, as much as 150 times as large as our own personal genome, so we’re learning more and more that there’s this symbiotic relationship between the bacteria in our gut and or body. The gut bacteria, depending upon if your body is stressed, or depending upon what our diet is, can affect how we’re thinking, how healthy we are, how well we’re absorbing vitamins, things of that nature.

Melanie: How are these bacteria – and people think of their gut and their colon are way down there, and their brain is way up here – but these bacteria also have their own brains. They think a little bit for themselves and do what they’re supposed to do, so how are these things all connected?

Dr. Corry: Okay, so, you first have to -- I think of it as a top-down and a bottom-up approach. Starting in the gut you have a number of different types of bacteria, and depending upon the type of bacteria you’re having, it can affect how you digest certain foods. We know that a lot of bacteria will help make the precursors for various types of neurotransmitters, so if you’ve got one particular pattern of bacteria, let’s say, you’ll be better at making the parts you need to make that serotonin – that feel-good chemical we all have. Or, if you have a certain pattern of bacteria, you’re going to have a better ability to make what’s called brain-derived neurotrophic factor. This is basically a compound that helps your brains’ neurons form impulsive synapses, or how they connect to other neurons.

This is the bottom-up approach where they’re going to be very good at making the precursors to various compounds. That is also going to be really good at helping us – how we sense that we’re full. If you have a certain bacterial pattern, it’s going to tell your brain, “Hey, I’m full. Don’t eat anymore.” So then, obviously, if you’re not eating as much you’re not going to have to worry about things like diabetes or hyperlipidemia, and that sort of stuff.

There’s also this bottom-down [sic] approach, so if the body is stressed, it will go ahead and send its signals to the gut and say, “Hey, I’m nervous,” and this will affect the bacteria in the gut. Certain bacteria work better or are more likely to make other bacteria if the body is healthy and low-stress. If the body is too stressed, then bad bacteria tend to overpopulate. On top of that, then, the gut also has this – it’s like the first line of defense for inflammation. If the gut bacteria is healthy, it’s going to identify various viruses and bacteria that may injure us through all sorts of inflammatory processes -- infections, that sort of stuff. It’s this back-and-forth between the brain making sure the gut is in a happy state and the gut making the things to keep the brain in a happy state.

Melanie: Are there specific diets – as we’re hearing about his connection – what can people do that can promote that healthy gut bacteria or that microbiome.

Dr. Corry: Great question. There’s been more and more work with certain types of diets, the biggest one being the Mediterranean Diet. We all hear about this – people making sure that they have plenty of fruits and vegetables, the good kind of fats – the polyunsaturated fats we see in things like olive oil. There’s also increasing information on what’s called the Nordic diet or the diet of folks in Scandinavia, which is essentially, again, another diet that’s based heavily on more canola oil, also lots of ryes, and good fibers, vegetables, and whatnot.

What these diets seem to have in common is two-fold. First, they have just the right amount of dairy and fermented-type foods. These, then, provide the nutrition the gut microbiome needs – things like leeks and garlic -- the gut microbiome loves this type of fiber, but it also provides the gut microbiome with the right bacteria -- things like yogurt, or kefir – kind of like a natural smoothie. These provide the gut with the proper bacteria we need to help us improve digestion, improve the compounds our gut makes. That’s what seems to be common in these two diets. There are also high amounts of what we call the polyunsaturated fats or the fats we find from fish, from certain nuts, that help lower our overall inflammation in our body, and also help improve our cholesterol profile.

Melanie: Wow, there’s so many things that are going on, and people don’t even realize it. Now, stress plays another important role because we hear about cortisol, and we hear about these gut healthy bacteria that can help our immune system, and thereby, keeping our stressors from breaking down our immune system. The brain, then, also takes in those stressors, and sometimes we focus on these things. Speak about stress and what that could do to the whole system that should be working efficiently, but sometimes, that can put the brakes on a little.

Dr. Corry: Yeah, absolutely. As our body become stressed, those things like cortisol – these bad hormones – take over. Think of it as a two-fold thing. First of all, what do we do when we’re stressed? We eat bad food, right? We’re hitting the piece of pizza. We’re hitting the chips, and the burgers, and stuff, and so you’re not getting the proper nutrients into the gut. You’re not eating the good quality fats, the fats that put you at risk for atherosclerosis, that sort of stuff. You’re eating foods that aren’t necessarily full of the most natural things. You’re eating lots of things that you can’t pronounce on those labels, and so, the body doesn’t know how to digest these things. What you end up doing is you end up promoting the gut to have the bad types of bacteria -- the bacteria that doesn’t necessarily make good vitamin, that don’t necessarily tell your brain, “Hey, I’m full,” that don’t necessarily break down the food into the precursors to things like serotonin and whatnot.

That’s the first part. The next part is when the body is stressed, and our insulin isn’t quite ready – isn’t quite produced as well. The overall milieu – the environment in the gut isn’t really good, so you’re not necessarily going to have a happy environment for those bacteria to reproduce as well as they should. They’re not going to send the signals to the brain as they should. When they make the precursors for things like serotonin, they’re producing less of those types of compounds, so it’s a two-way street.

Melanie: Okay, so we want to try and keep that good, healthy bacteria. We want to make sure to eat these diets that you’ve been discussing, get those good probiotics – prebiotics, the Nordic Diet, the Mediterranean Diet, our DHAs and our Omega-3s, and all of these things that are so healthy. Do you see, Dr. Corry, that there’s a time when bacteria can be used to treat some psychiatric disorders in the same way that doctors have used Prozac and Valium, and because new gut understandings, as this is coming on, equal new treatment opportunities, I would suspect?

Dr. Corry: Absolutely, and this is what I think is one of the most fascinating fields of this emerging data with gut microbiome. There have been a couple of studies now that have looked at the effects of pre- and probiotics on depression, and the thought is less inflammation and less stress maybe makes more serotonin. In some very early, small trials – in a couple dozen patients – they’re finding that, in fact, after about three to eight weeks, of a diet that’s more along the lines of that Nordic and Mediterranean diet where there’s more good quality dairy, good quality fermented foods, that people actually report improved moods and less anxiety.

Similar things have been found with things like bipolar disorder where they do certain dietary interventions, and again, in three to eight weeks, we see there’s a shift in the pattern of the gut flora more along the lines of what we see with healthy people. We see people are reporting to have less symptoms. A similar thing is ADHD, some types of schizophrenia; we’re seeing that if you improve the quality of the gut microbiome, people report that they’re doing better.

Now, this needs to be reproduced in large, multicenter trials, where it’s more real-world environment and not so micromanaged, but I do believe that as time goes on, we’re going to start seeing that you’re not only-- when you go to your psychiatrist, you’re not only going to have a discussion of what medication you need to be on, but also what diet you should be on at the same time.

Melanie: That’s absolutely really fascinating information, and as these treatment opportunities arise, we will talk about them, Dr. Corry, because it’s really so interesting how the brain – and you’re a neurologist – is now affecting the gut, and vice-versa. It’s something that really people can take, and take this information that you have given us today, and use it tonight by taking those probiotics, by getting that healthy flora in a good, strong way. Thank you, so much, for being with us, today.

Dr. Corry: It’s great to be here. Thank you, so much.

Melanie: You’re listening to The Well Cast 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

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