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Segment Number 2
Audio File virginia_health/1609vh3b.mp3
Doctors Daniero, James
Featured Speaker James J Daniero, MD
Guest Bio Dr. James Daniero is a otolaryngologist whose specialties include ear, nose and throat problems in people who use their voices extensively, such as singers, coaches and teachers.

Learn more about Dr. James Daniero

Learn more about UVA Otolaryngology
Transcription Melanie Cole (Host): While you may hear about voice problems encountered by singers and people in a variety of fields who use their voices extensively, they can also encounter ear, nose and throat problems and many other people can, as well. My guest today is Dr. James Daniero. He's an otolaryngologist whose specialties include ear, nose, throat problems in people who use their voices extensively, such as singers, coaches, and teachers at UVA Health System. Welcome to the show, Dr. Daniero. So, tell us a little bit about some of the common voice conditions you encounter at the UVA Voice and Swallowing Clinic.

Dr. James Daniero (Guest): Sure, first of all, thank you for having me on the show, Melanie. Some of the voice disorders that we encounter at the University of Virginia, most commonly is just a persistent hoarse voice. That can be broken down into several categories, the most common of which is just a sort of misalignment in the way we produce our voice and then other things that can be associated, such as benign lesions that grow on the vocal cords.

Melanie: So, what are some symptoms? What are some things that people would notice if you're somebody in a profession--you're a singer, or you talk for a living--what might you notice besides hoarseness that would send you to see you?

Dr. Daniero: Sure. Obviously, the number one thing is the change in the voice, which most people characterize as a "hoarse voice", but also neck pain or soreness that develops in the front of the throat, typically throughout the day as the more their voice is used and that's associated with a "vocal fatigue", as I call it. Patients will notice that their voice starts out strong and, in the middle of the day, it starts to fade. By the end of the day, they feel like they're really straining and just having exhaustion from voice use. And then, there's also pain with swallowing or pain with voice use that can be associated symptoms.

Melanie: What do you do to test somebody for issues that you think that they might be experiencing?

Dr. Daniero: In our clinic, we run a multi-disciplinary clinic, and that is a speech-language pathologist as well as myself, the physician and surgeon, is present for the initial interview with the patient. We ask a lot of detailed questions about how they use their voice and what their behaviors are in regards to taking care of their voice. If they have any consideration of how to care for their voice at that point, and then, we also will look at their vocal cords, not only at the structure and looking at them with a very detailed, high-definition camera, but also the way it functions. So, we'll videotape the voice being produced in the various configurations. That videotape can then be slowed down to get a very detailed analysis of how the vocal cords are vibrating to produce the voice which can often identify the problem.

Melanie: Wow. So then, I'm an exercise physiologist, Dr. Daniero, so I know that exercise helps various ailments and things. Are there exercises you'd recommend people to do to protect their voice and possibly prevent some of these problems?

Dr. Daniero: Absolutely. Certainly, for people that are professional voice-users, and that's not limited to just singers, but anybody that uses their voice for their profession. There are a number of different exercises that, when trained by a voice specialized speech-language pathologist, patients can learn to care for their voice and also rehab their voice through these exercises. They usually have to be performed or taught through a speech-language pathologist that has some knowledge of specifically how to do the exercises.

Melanie: So, people can do these exercises and make their voices stronger? Do you advise people that are in these kinds of professions to either use their voice more limited or softer? People yell at their kids and they yell out on the streets. Is that really damaging our voices?

Dr. Daniero: Well, I think everything in moderation is the key there. There are some people that have a tendency to use their voices more forcefully, loudly, and are loud, frequent talkers and they, if they're professional voice users, might need to have some consideration of the amount and volume of voice use that they're using throughout the day, to limit it in certain situations. Then, there's others that are generally voice conservationists. They don't really speak out loudly. They speak softly and they're more introverted personalities and tend not to have issues with voice conservation.

Melanie: So, now what about some of the benign lesions and things that you might find? What do you do about them? Is there surgical intervention necessary? Do they go away on their own?

Dr. Daniero: Well, it depends on the type of growth or lesion that's on the vocal cord. A good portion of them will go away on their own if they have proper intervention such as vocal exercises and what we call "vocal hygiene" and behavioral modifications to prevent or limit the trauma on their vocal cords. A good portion of them will avoid surgery if those measures are instituted. Then there's a much smaller portion that does require surgery eventually. That's the type of micro-surgery that I do in the operating room.

Melanie: So, if you're doing microsurgery on somebody, what is that like? What is the recovery like? Is somebody then prohibited from speaking for quite a while? Tell us just a little bit about that.

Dr. Daniero: Sure. The surgery is generally an outpatient surgery. They go home the same day. Typically, it's around an hour, maybe an 1 1/2 hour of surgery but the key to the recovery is actually what happens after that. So, we typically will have patients that have anywhere between three to seven days of absolute voice rest. That means no noise coming from the vocal cords in coughing, throat-clearing, humming or voice use. During that time period, we're trying to get an area of surgery, the incision, to heal up well without the vibration irritating that area from producing the voice. Then, after that time period, we'll generally have them begin a rehab treatment. Similar to the way, if you had an orthopedic surgery for a shoulder or a knee, you would begin physical therapy after that, we do the same for the voice. We do a physical therapy for the voice that begins with the speech-language pathologist retraining the patient to use their voice in a much more efficient and less traumatic fashion.

Melanie: Dr. Daniero, are there other conditions, co-conditions, that can contribute to vocal problems? Reflux, sinus conditions? Do any of these contribute?

Dr. Daniero: Absolutely. Often, when we initially perform an assessment, those are things that I inquire about in detail; those are symptoms of acid reflux or even risk factors for acid reflux. We know there's a group of patients that may not have any symptoms of acid reflux but might have the findings. Some of that could be throat clearing or frequent belching but not the classic heartburn symptoms that you would associate with acid reflux. Then, allergies and sinus complaints often will produce thick mucus that drains down onto the vocal cords and that could, again, create an issue of chronic inflammation and hoarse voice, as well.

Melanie: In just the last few minutes, first, tell the listeners your best advice for people to protect their voice with voice hygiene, as you called it, and what they can do.

Dr. Daniero: Sure. The simplest thing is to make sure that we're well-hydrated. The classic recommendation is 8-10 glasses of water per day and very few of us actually reach that if we keep track throughout our day how much water we're drinking. The other thing is the amount of caffeine that we consume. Our vocal cords are just a few inches away from our mouths and we all know if we're drinking a lot of caffeine, we'll tend to get a dried-out mouth. So, when we're using our voice with these dried out vocal cords, we're causing a little bit more trauma. So, hydration can just eliminate a lot of the trauma that we're seeing there just by sort of lubricating the system. Other things in hygiene that are involved are managing our mucus, as we discussed, acid reflux and allergy symptoms, but then, also limited the trauma of our voice use in general--not calling across the house to our children that may be in a different room and actually walking over there to speak with them; simple behavioral interventions.

Melanie: Always great advice. And why should people with voice conditions come to UVA Otolaryngology for their care?

Dr. Daniero: We have a multi-disciplinary approach with the speech-language pathologist and the physicians creating a consensus that we can understand the problem from both the behavioral as well as the medical and surgical perspective. Also, we just understand the plight of a patient that has a voice problem. This is what we specialize in and we can help them.

Melanie: Thank you so much for being with us today, Dr. Daniero. You're listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Differences Between Medicare & Medicaid

What are the differences between Medicaid and Medicare?

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Segment Number 4
Audio File health_radio/1609ml3d.mp3
Featured Speaker Marianne Eterno, President of Government Relations for GTL
Guest Bio Marianne Eterno began her insurance career in 1987 at the former Golden Rule Insurance Company in Indianapolis, Indiana, and moved to Chicago in 1992, when she accepted a position with Celtic Insurance Company.

Marianne came to Guarantee Trust Life Insurance Company (GTL) in 1996, as a compliance and government relations consultant, and formally joined the company in 1997. As Assistant Vice President of Government Relations, she represents GTL in both the state and federal arenas, drives coalition development for the company, and serves as the company's media and public relations spokesperson.

In addition to sitting on committees for every major insurance trade association, Marianne serves on the Board of Directors of RetireSafe, a 400,000 member grassroots advocacy organization for senior citizens and as the Executive Director for the Council for Affordable Health Insurance.
Hosts Melanie Cole, MS

What to Expect During a Coronary Artery Bypass Graft

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Segment Number 1
Audio File virginia_health/1609vh3a.mp3
Doctors Kern, John
Featured Speaker John A Kern, MD
Guest Bio Dr. John Kern is a board-certified thoracic and cardiac surgeon who specializes in adult heart surgery, including coronary artery bypass grafts.

Learn more about Dr. John Kern

Learn more about UVA Heart & Vascular Center
Transcription Melanie Cole (Host): Coronary artery bypass grafts are among the most common heart surgeries but what should you consider if you're somebody that has coronary artery disease? My guest today is Dr. John Kern. He's a board certified thoracic and cardiac surgeon who specializes in adult heart surgery, including coronary artery bypass grafts at UVA Health System. Welcome to the show, Dr. Kern. Tell us, who might be somebody that would be a candidate? Who might need coronary artery bypass surgery?

Dr. John Kern (Guest): Well, many patients with coronary artery disease might, in fact, need coronary bypass surgery. Coronary artery disease is when the arteries that supply blood flow and oxygen to the heart become blocked and that's the main cause of heart attacks. So, there, fortunately, are many different ways to treat coronary disease. Some patients might just need medications or changes in their lifestyle. Some patients, fortunately, can have their blocked arteries treated with stents but for a significant proportion of patients, depending on the number of blocked arteries and their other medical problems, it turns out that the best treatment, the best long-term treatment, would be coronary artery bypass surgery.

Melanie: How would somebody know if they have coronary artery disease?

Dr. Kern: Well, for a lot of patients, the first symptoms can be quite dramatic, meaning they're fine one day and the next day, they start developing chest pain and may be so unfortunate as to actually have a heart attack. Of course, those patients go to the hospital get evaluated, and treated, and probably get a cardiac catheterization, and then, depending on those findings, we decide, should those patients be treated with stents or should they undergo surgery? A lot of patients, the symptoms can be much more subtle. They aren't so dramatic. So, patients may be fine, but ,over the course of time, they develop some chest pain that they've never had before and if they're good about going to their doctor, they'll have it evaluated further. They may undergo a stress test, and then, ultimately, their coronary artery disease may be diagnosed.

Melanie: So then, you spoke that some people might start with medication. What would those be? What would be the first line of defense if you determine somebody has these blockages and coronary artery disease?

Dr. Kern: Well, a lot of the medications are designed as what we call "risk factor modification." So, certainly, aspirin or some form of anti-platelet therapy, medications to control blood pressure, medications to keep the heart rate under control, and then, other forms of medications to treat any kind of cholesterol or lipid imbalances which may also contribute to the development of blocked arteries.

Melanie: So, if medicational intervention does not work and you've determined that somebody might need bypass surgery, what's involved? What can they expect as a pre-surgical intervention and then, what's it like?

Dr. Kern: The pre-surgical interventions are mostly all diagnostic and are tests that are done to ensure as safe an operation as possible. In this day and age, coronary artery bypass surgery is remarkably safe. Nearly 99% of the patients who undergo coronary artery bypass surgery recover just fine with no complications. The time in the hospital is roughly five days. Most people are able to go home after surgery and all we do is ask them to take it easy for three to four weeks. The incisions we use in this day and age are much smaller than they used to be. A lot of people have friends or family who had coronary artery bypass surgery 10 or 20 years ago and they have very long incisions, either on their chest or they have long incisions on the leg from where we take some of the vein to use for the bypasses. These incisions are much smaller now, and, in fact, the incision on the leg is sometimes only an inch long because we use scopes to take the vein out, and so, the postoperative recovery is a lot quicker now than it used to be.

Melanie: So, speaking of taking that vein, the saphenous vein, whatever vein you choose, how does that work? You take a piece? Can they deal without a piece of their vein? What do you do with that?

Dr. Kern: Absolutely. Fortunately, the body is a remarkable machine and it's made with a lot of backup systems in place. When you talk about veins, even anyone can look at the back of their hand and see all of the blue veins on their hand and you might imagine that you can do without one of those and all the other veins take over its job.

Melanie: That's absolutely fascinating. So, once you do that and you've grafted this piece of vein in there, does the body create a collateral circulation or does it all run through what you've just grafted?

Dr. Kern: Exactly. The whole purpose of coronary artery bypass surgery is to provide a conduit for the blood flow to flow through around the area of blockage in the artery on the heart. So, we don't remove the blockage, we just provide another pathway for the blood to flow. Sometimes we use vein from the leg for that. Most of the time, for the main artery on the front of the heart, we use an artery on the inside of the chest wall called the "internal thoracic artery". That's very important because, that particular artery, when used as a bypass, stays open for the entire lifetime of the patient. In addition, we sometimes use an artery from the arm. The forearm has two arteries and we sometimes use one of the arteries from the arm. So, we have lots of options for alternative blood vessels to use for bypasses.

Melanie: And, what is the outcome? What is their life after surgery like this take place? Back in the day, Dr. Kern, as you say, you asked them to take it easy, but there was no exercise, no nothing. Are you getting them up pretty quickly? Asking them to move around and get some exercise pretty quickly after that or, what is their life like?

Dr. Kern: Oh, absolutely. It starts right after surgery. Some of the things I hear from patients, again, is they had friends or family who had this operation 10 years ago and they remember they were on the breathing machine for three days and long times in the hospital. Now, this operation is like many other operations we do where the breathing tube is taken out and they're off the breathing machine within an hour of surgery. A lot of folks are sitting up that night of surgery and we're getting them out of bed and walking around, really, within 12-24 hours. And then, once the initial recovery is over, we really encourage everyone to engage in some form of cardiac rehab. There's really nothing too fancy about that, but what it is, is it's a dedicated exercise program done a few times a week which is done under some medical guidance. It reassures the patient that their heart is fine and they can gradually work up to pursuing their active life and maybe being even more active than they were before because they're no longer being limited by their chest pain.

Melanie: How long can these grafts last in somebody?

Dr. Kern: So, that's what I was referring to earlier. The artery that we use from the inside of the chest, literally has a 99% patency rate over the course of the lifetime. So, it's very unlikely for that bypass would ever block back up. The veins that we use to do bypasses don't have quite that high of a long-term patency rate, but, in this day and age, with the new medicines that patients are able to take after surgery; the statins to help keep the cholesterol and lipids under control and better blood pressure medications and staying on aspirin. The long-term patency of even these vein grafts can be very, very good.

Melanie: Dr. Kern, as a cardiothoracic surgeon, give your best advice to the listeners so that maybe they don't have to come see you.

Dr. Kern: Well, the best advice is you can never start too early when it comes to living a heart-healthy lifestyle. Many of us, we come, we grow up, we're in our teens, our 20s, our 30s, and we're invincible, but you really have to start all the way back in your teens living a good, healthy lifestyle. So, proper diet, and don't smoke; good exercise; don't get overweight. All those things contribute to the development of coronary artery disease.

Melanie: And, in just the last minute, Dr. Kern, it's such great information and you're so well-spoken, why should patients come to UVA Heart and Vascular Center for their heart surgery and for their heart care?

Dr. Kern: The unique thing about UVA is we have is what we call a true multi-disciplinary, collaborative heart team. When you come to UVA with a heart problem, you will not see just one individual, you will see a group of individuals with their own expertise in the area of heart disease. You will see the cardiologist, the interventional cardiologist, the cardiac surgeon, the specialized nurses, the exercise folks, the rehab folks, the physical therapists--the entire team that an individual would need to regain their heart health.

Melanie: Thank you so much for being with us. Really, really great information. You're listening to UVA Health Systems Radio and for more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Serving Dental Patients with Complex Health Needs

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Segment Number 5
Audio File virginia_health/1608vh3e.mp3
Doctors Leinbach, Thomas E
Featured Speaker Thomas E Leinbach, DDS
Guest Bio Dr. Thomas Leinbach is the chair of the Department of Dentistry at UVA Health System; his specialties include caring for patients with facial pain.

Learn more about Dr. Thomas Leinbach

Learn more about UVA Dentistry
Hosts Melanie Cole, MS

What You Need to Know About Dry Eye and Lasik Surgery

Can lasik surgery help with your dry eyes?

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Segment Number 4
Audio File virginia_health/1608vh3d.mp3
Doctors Golen, Jeffrey R.
Featured Speaker Jeffrey R. Golen, MD
Guest Bio Dr. Jeffrey Golen is a fellowship-trained ophthalmologist whose specialties include cataracts and cataract removal.

Learn more about Dr. Jeffrey Golen

Learn more about UVA Ophthalmology
Transcription Melanie Cole (Host): Your eyes are so precious but when your vision is compromised or you suffer from dry eye, you realize how important it is to get the best care. My guest today is Dr. Jeffrey Golen. He is a fellowship trained Ophthalmologist at UVA Health System. Welcome to the show, Dr. Golen. Tell us a little bit about dry eye. People have heard this term and they don’t even really know what it means.

Dr. Jeffrey Golen (Guest): Hi. Thank you for having me. There are actually two different types of dry eye. There’s a dry eye where you don’t produce enough tears. Then, there is another type of dry eye where we do produce enough tears but our tears are really not adequate to keep our eyes lubricated. They don’t have the right components and there are some inflammatory problems with the tears.

Melanie: What are some of the complications? We all need to keep moist eyes and be able to make tears. What can happen if you can’t?

Dr. Golen: I think a lot of people get confused about dry eye. They try to compare it to dry skin, I think. For a lot of men who might have dry skin, they don’t really get too worked up about it. But, the problem with dry eye is that it will not only lead to discomfort but will actually cause issues with vision. It can cause blurred vision or issues with glare. It actually does affect our vision.

Melanie: What do you do? How do you even know, first of all, that you have it? Will your eyes be itchy? Will they feel that dryness? Like you say, like dry skin, but will it feel itchy and like you just need something in there? What does it feel like? What are some symptoms?

Dr. Golen: It really does depend on the patient but oftentimes the patient will complain of eyes that feel dry or irritated or, sometimes in severe cases, it will actually feel like something is in the eye.

Melanie: If they’ve got any of these, they get to an ophthalmologist pretty quickly because you don’t want to mess around with your eyes. What do you do for them? How do you find out this is what is going on?

Dr. Golen: First we check their vision and examine the patient. There are a number of different tests we can do to check to see how dry one’s eyes are or if they are having issues with dry eye. After we do these tests and properly make the diagnosis, then we move forward to the treatment. There are a number of different modalities we use to treat this. We typically start with artificial tears, actually. It’s usually the most simple way to start. It’s not always adequate for every patient but artificial tears are available over the counter. I think one of the most common problems that patients make is that, instead of buying artificial tears, they will actually buy eye drops that are designed to get the red out. In fact these drops, while they do a good job of getting the red out, are not designed for long term use. What will happen is, the patients will be on these drops and their eyes will be perfectly white but they will not be adequately lubricated.

Melanie: If they are using those products, which are not the right product for this situation, do you put them on a product that they then have to be on long term, Dr. Golen? Is this something that maybe comes and goes?

Dr. Golen: It can come and go depending on the environment. It’s typically worse in the winter because there is less humidity in the air. I talk to patients about modifying their environment so that it’s the best possible environment for their dry eye. For example, recommending staying away from fans at night time, using a humidifier if possible in their house--things such as this. For the artificial tears, we typically start as an as needed basis. If the patients are doing fairly well with environmental modification, just as needed. But, if the patients are still having issues with dry eye, then we are going to go up on the artificial tears and use them more frequently.

Melanie: People have also heard about LASIK surgery, Dr. Golen. They hear it on commercials and late night television. There are people all over the country that talk about this now. What is the connection between LASIK surgery and dry eye?

Dr. Golen: That’s a great question. There, actually, are quite a few connections. First off, people who have dry eye oftentimes do worse in contact lenses. Our patients who have issues with contact lenses are usually the first patients who want to get LASIK. Unfortunately, they are not always the best candidates because it is a fact that LASIK, or its cousin procedure PRK, will make the eye, actually, more dry. This is definitely something to keep in mind for someone who does have dry eye.

Melanie: It sounds like a vicious circle, if you have dry eye and you want to use contacts but you can’t because you have dry eye. You’re the person who wants to have LASIK but it can make the situation worse. What do you tell people--that they are just going to have to stick with glasses and use the artificial tears and go from there? What can they do?

Dr. Golen: They can be evaluated by an ophthalmologist to determine how bad their dry eye is. If it’s mild dry eye, typically, we can proceed with a procedure such as LASIK. As long as the patient is educated that afterward they will need to lubricate their eyes more aggressively, then it’s fine. If they have more severe dry eye, then we might think twice about doing the procedure. It really depends on the scale of the dry eye – the actual problem.

Melanie: Are there certain people who are more at risk for dry eye?

Dr. Golen: Yes, the elderly are more likely to have dry eye. In addition, women tend to have dry eye worse than men.

Melanie: Wow. Why is that? Do we know?

Dr. Golen: We don’t know exactly. We think it’s related to hormones, though.

Melanie: Doesn’t everything just seem to be related to hormones? What else can you tell the listener about LASIK surgery and how to find somebody if you are somebody who maybe doesn’t suffer from dry eye and you’re somebody who really wants to consider LASIK surgery, how do you find somebody who is really good at it and that you can trust?

Dr. Golen: You want to find a doctor who is willing to have the discussion about whether or not you are an ideal candidate for the procedure. Ideally, you should be a patient who has had a very stable refraction, meaning your glasses prescription hasn’t changed recently. You can’t be pregnant and you can’t have any history of eye trauma to the eye, ideally. We don’t want anyone with corneal scarring. There are a few different things that make a patient a non-candidate for LASIK. There are other tests that we do in addition to rule out a patient for the LASIK procedure. Things that we are looking for are thin corneas, or corneas that have an abnormal shape. You wouldn’t really know this unless you saw an ophthalmologist and had the appropriate tests taken but we do this for safety. Patients who get LASIK, typically, have otherwise healthy eyes and they see quite well with glasses. They are perfectly healthy. They just need the glasses. As a result, we don’t want to operate on eyes that are anything less than perfectly healthy.

Melanie: What do you tell people when they ask you, “Is this a permanent condition now? Am I going to be able to get LASIK surgery and be able to see perfectly and not have to do this again or never have to wear glasses – I can throw them away?” What do you tell people as a realistic outlook from this?

Dr. Golen: That’s a great question. It really depends on the patient’s current situation but I never promise that it’s permanent because it’s almost never permanent. The reason why is what we do is, we reshape the cornea so that the patient, at any given time of surgery, can see very well ideally at distance. If the patient is over the age of 45, they will probably need some form of reading glasses to see up close, especially, if we set them for distance. In addition, if we’re dealing with patients who are a little bit older they, perhaps, might develop cataracts in the future which would be another issue. With your typical LASIK patient who might be in their 20’s or 30’s, they’ll, typically, have at least 10 years of good vision without glasses in the best case scenario but it is almost never a permanent situation like that.

Melanie: Dr. Golen, in just the last few minutes, give listeners your very best advice about LASIK, about dry eye, and why they should come to UVA Ophthalmology for their care.

Dr. Golen: If you do have dry eye and you are considering LASIK, you should get evaluated for dry eye first, in my opinion, because the LASIK procedure can actually worsen the dry eye. One of the first things that any ophthalmologist will tell you is start with an eye drop such as artificial tears. I, typically, prefer preservative free artificial tears because preservatives can sometimes irritate the surface of the eye. After we lubricate the eyes adequately, we can go from there but there might be other procedures that are needed. For example, if people have severely dry eyes we can actually put little plugs in their eye lids and that can help hold in more natural tears.

Melanie: Why should they come to UVA Ophthalmology? Tell us about your team a little bit.

Dr. Golen: We’ve got a very strong team here. We cover every discipline of ophthalmology and we have an optometrist who specializes in difficult to fit contact lenses. We really have everyone across the board in one department. We have excellent specialists, no matter whether you need an ocular plastic surgeon, a retina specialist or a cornea specialist. We’ve got everything covered. We communicate very well with each other.

Melanie: Thank you so much, Dr. Golen. What great information. So beautifully put. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Boost Your Brain By Eating Better

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Segment Number 4
Audio File allina_health/1604ah3d.mp3
Doctors Carlson, Jamie
Featured Speaker Jamie Carlson, RD, LDN -Licensed Dietitian/Nutritionist
Guest Bio Jamie Carlson is a Registered and Licensed Dietitian/Nutritionist who specializes in integrative nutrition therapy for the prevention and treatment of a variety of health conditions and for weight management. She knows how challenging and confusing it can be to eat well in this day-in-age, and she meets patients wherever they are on their journey to eating better.

Learn more about Jamie Carlson
Transcription Melanie Cole (Host): Well, it's not just your waistline that suffers if you're not eating well. Your brain is one of the first organs in your body to feel the effects of poor food choices. My guest today is Jamie Carlson. She's a registered dietitian/nutritionist at Allina Health Woodbury Clinic. Welcome to the show, Jamie. People don't think about brain food but we've heard about brain food for years. How does what we eat affect our brain function?

Jamie Carlson (Guest): Yes, that's a great question. Thanks for having me today. When we think about food and our brain, you're right, we don't always make that connection. What we have to understand is something that really impacts our brain is our blood sugar. Sometimes we think of blood sugar as only what we talk about with diabetics, right? But every single cell in your body uses blood sugar. So, imagine if you're blood sugar spikes, and this will happen if you’ve eaten something really sugary, maybe obviously sugary things like a soda or a donut, but also there are a lot of other things that spike our blood sugar that don't sound sugary, like a bagel, pasta, breads. These will all spike our blood sugar and, actually, they overload our cells with sugar. What that means to your brain is that, over time, when we do this day after day, if we're eating a bagel for breakfast, sandwiches for lunch; we're having cereal late at night for a snack, this constant influx of sugar creates inflammation in the body. The brain cells are part of those cells that get inflamed. This creates an issue because we've all heard of those “feel good hormones”. Sometimes we call them neurotransmitters. When our blood sugar spikes, we can't use those quite as well and so that creates us to not have those kind of calm, well-being moods that we once had. So, that spike and inflammation inflames our brain, also--not just our body. Not only a spike in sugar can do that but if we have a low blood sugar. So, say, you run out of the house, you haven't eaten all day, you get to lunch, you just grab a candy bar because that's all that you have time for. When we get those high blood sugars, they're going to fall really fast and those low blood sugars also hurt our brain. So, like I said, if you've gone too long without eating, a lot of people have now describe this as feeling as "hangry", right? You may be so irritable and anxious and those low blood sugars is that your brain is essentially mad; it's irritated because we had a high blood sugar at one point for your brain and now we don't have any sugar for your brain.

Melanie: So, people hear about inflammation these days and its relationship to heart disease and stress and cortisol and gut health and immune function and all of these things, Jamie.

Jamie: Yes.

Melanie: So, tell us how that affects brain function, as well.

Jamie: Yes, a lot of times we don't think of that inflammation as always something that's impacting your brain and certainly, we don't always find that impact, or that connection, between our gut health. What's going on in our intestines affects not only your brain's daily functions, but also can determine your risk of neurological conditions that might come on later in the future. So, when we're thinking about this, something we have to think about is gut bacteria. That's something that's becoming more popular. It's also called your good bacteria, your microbiome, and this is the bacteria in our gut. It plays such a critical role in so many systems in the body. It supports your immune function; it supports decreasing inflammation; it helps actually make neurotransmitters, that bacteria. I think that's a cool one--it makes neurotransmitters. It helps us make vitamins and absorb nutrients. So, this gut bacteria is really critical in how it impacts the brain. So, a few things I always tell people are that we really need to think about supporting our gut health when we think about supporting our brain in preventing things, like dementia and ADHD, maybe, in children. My three tips for that is one, to eat probiotics or foods with probiotics in it. Probiotics are live bacteria we need. Like I said, these are what live in that digestive tract. Although we tend to take supplements of them, you can find them in a lot of foods. Anything that says "live cultures" is a place where we'd find it. So, we might see that in yogurt; we might see that in something called kefir. Kombucha is a fermented tea that contains this. Then, we have some other more unique ones like kimchi and sauerkraut. That's where we can find some bacteria, too. These probiotics help support the gut lining and it helps keep inflammation low in the gut and we want to have low inflammation in our gut because if we've got high inflammation there, we're going to have that in our brain, as well. So, one is to eat probiotic rich foods. The second is to—and I already touched on this--reducing those carbohydrates. Those high blood sugars, like I already said, not only inflame the brain, they also create an imbalance to our gut bacteria. They feed all our bad bacteria and they don't support enough of our good bacteria. So, we'll want to reduce those carbohydrates. The third thing we want to do is to drink filtered water and that's not always something we talk about, either. A lot of the water we consume now is treated with chemicals like chlorine. Chlorine is something that will actually come into the body and it can kill off that good bacteria that's going to keep our inflammation low and help us make neurotransmitters in the gut. So, those three things are really important. To support your gut actually helps support your brain.

Melanie: I would just like you to clear something up, Jamie, when you talk about carbohydrates, because we need those for brain and spinal cord function.

Jamie: Yes.

Melanie: People, we hear, are on these high protein diets and they think carbohydrates are the enemy, but you're not talking about a carrot or a tomato, are you?

Jamie: No.

Melanie: Or, a piece of fruit? So, clarify that for the listeners.

Jamie: Carbohydrates, like you said, could be a fruit; it could be a vegetable. Where we tend to overindulge in is our processed carbs like our breads, our cereals, our granola bars, bagels; a lot of these things we find in processed forms, right? So, these are where we see really, really high amounts of refined sugar and all of this turns into blood sugar and spikes that inflammation in the body.

Melanie: So, now what about the good fats? Avocado and Omega-3's and our oily fishes? How do they help our brain?

Jamie: Yes, fats. This is my favorite nutrient for two reasons for the brain. The first reason is that fat stabilizes your blood sugar. So, when you eat about 2-3 tablespoons of a fat, that keeps the blood sugar stable for about 4 hours. We've already established that that's really good for a healthy brain. But ,our brain is actually made up of 60% fat and it's made up of the fats we eat--mostly those Omega-3 fatty acids; like you said, the ones we find in fatty fish like salmon but also nuts and oils. So, these fats are required to support that brain tissue. The phrase "you are what you eat" is so true because these fats actually make up and become the cells in your brain. If we're not giving our body these great Omega-3 fatty acids that are really anti-inflammatory, we're going to have more inflammation in the brain, then.

Melanie: So, in just the last few minutes, incorporate some foods that are really good for our brain, into our daily life. Give people tips and how we can just get those foods in every day.

Jamie: For sure. Right. It does no good if we just know this information and can't actually do it. So, we have to be able to practice this on a daily basis. So, in the morning, this might look like you wake up and you take some healthy fat. So, you could do some butter or some coconut oil; these are great fats to cook with high heat. So, I might stir fry some veggies in there like kale and peppers, maybe a little bit of hash browns and then I'll fry up 2 or 3 eggs. Then, on the side, I might do some full fats like plain yogurt. This would be one that contains those live cultures. So, I'm getting my fats, I'm getting protein, I'm stabilizing my blood sugar but I'm also putting that good bacteria into my gut, also. For lunch or dinner, I might make a big salad with lots of veggies. Salmon is sometimes hard to find fresh, so I might do some wild-caught canned salmon and do a dressing that has an olive oil base or maybe an avocado on it. And, we can even do this when we go to eat. If we go out and we want to get burgers with friends, we have a burger, but then we skip out on the bun. That's where we get a lot of those processed carbohydrates. Instead, we ask for a fried egg on top of our burger and maybe top it with and avocado; if you're adventurous, maybe a bit of sauerkraut. That's a good way to get some good bacteria in.

Melanie: Oh! You're rockin' my world, here. What about snacks? People really don't know what to snack on to help our brains.

Jamie: Yes. So, snacking is another thing, right? If we snack on carbohydrates, those processed ones, that's going throw off our blood sugar, too. So, our snacks need to be something that are also focused on blood sugar stabilization. I keep coming back to the idea that I said that fats keep your blood sugar stable for four hours, so snacking on fats is a great way. So, like some raw or dry-roasted nuts like almonds. I like to just cut up a half avocado, add a little salt to it, and eat that for a snack. So, really trying to skip out on doing a lot of the kind of sugary, processed snacks, like some granola and protein bars that we grab. Those can have almost 25 grams of sugar in just one bar. So, making sure to grab for those fats instead of grabbing for some of those other convenient processed foods.

Melanie: Just give us your best advice in the last minute, here, for eating well for our brain health.

Jamie: My favorite recommendation is to think about your blood sugar. Balancing out your blood sugar is not only going to support the brain health, it's going to reduce your risk of diabetes, managing our weight, keeping inflammation low in the body and the trick to help out our brains is keeping inflammation low. So, we do that by making sure we reduce a lot of those processed carbohydrates. Try to eat the real ones; more vegetables in the diet, adding in lots of healthy fats, not being scared to do that. Great things like avocados and coconut oil and lots of different good fats out there now. And, making sure we get protein in, too. We didn't talk about that much this session but protein is really great for stabilizing your blood sugar, also. And all of that is going to keep the inflammation low in the body so that we're not creating inflammation in our brain.

Melanie: Thank you. What great information. You are excellent and so well-spoken. You're listening to The WELLCast with Allina Health. And for more information, you can go to Allinahealth.org. That's Allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Recovering from a Ruptured Achilles Tendon

Additional Info

Segment Number 3
Audio File virginia_health/1608vh3c.mp3
Doctors Cooper, Minton Truitt
Featured Speaker Minton Truitt Cooper, MD
Guest Bio Dr. Truitt Cooper is a board-certified orthopedic surgeon whose specialties include caring for patients with foot, ankle and leg injuries.

Learn more about Dr. Truitt Cooper

Learn more about UVA Orthopedics
Transcription Melanie Cole (Host): The Achilles tendon is the largest tendon in the body. It connects your calf muscle to your heel bone and is used when you walk, run, and jump. While it can withstand great stresses from running and jumping, it is vulnerable to injury. My guest today is Dr. Truitt Cooper. He's a board certified orthopedic surgeon whose specialties include caring for patients with foot, ankle and leg injuries at UVA Health System. Welcome to show, Dr. Cooper. Tell the listeners first of all, what is the Achilles tendon? What does it do?

Dr. Truitt Cooper (Guest): Basically, the Achilles tendon is the bundle of collagen, just like all of our tendons, that connects, like you said, the calf muscle, the gastrocnemius and the soleus muscles, to the heel bone--the calcaneus. It helps us during weight-bearing by letting us push off with the forefoot. Basically, that's its role.

Melanie: So then, how is it injured? Women wear high shoes, we step off of curbs; we do all sorts of things. What are some of the most common injuries to the Achilles?

Dr. Cooper: Actually, if you're wearing a shoe with a higher heel, you're probably less likely to injure your Achilles because it's at rest when the foot's flexed like that. The most common injuries are with sort of high-impact cutting sports and jumping sports, when the foot has sort of a sudden and unexpected dorsiflexion, or the foot's forced up when you're landing or trying to decelerate.

Melanie: Okay. Let's get to this first. Is there a way to prevent these types of injuries, as you say, in sports injuries or kids playing sports, quick movements, deceleration, jumping. Is there something we can do to sort of calm this injury?

Dr. Cooper: Potentially. The most common group of people that rupture their Achilles tendon would be males between 37 and, say, 42. A lot of these people are sort of what we would call the "Weekend Warrior" where they're sedentary all week and then they go out on the weekend and participate aggressively in sports, and that, I think, is a set up for injury. With the sedentary week, you're developing tightness and potentially weakness in some of those muscles as well as in the tendon itself. So, I think a good overall fitness program that includes strengthening and stretching can help prevent some of those injuries as well as warming before activity.

Melanie: What would the symptoms be to know? Are they going to hear a pop? Are they going to feel something roll up? What are they going to feel if they've really torn their Achilles?

Dr. Cooper: With an acute, sudden injury where the Achilles is completely or nearly completely ruptured, it's a pretty dramatic event, usually. It's variable in how much pain one has. Usually, they'll feel a pop. A lot of times people will, if they're playing, say, squash, they'll say they thought that their partner or their opponent hit them in the back of the heel with a racquet. Some people will say they felt like they were kicked in the back of the heel and then they look around and no one's there on the soccer field, or something like that. So, it's a pretty sudden, usually a pretty dramatic pop-type injury. The amount of pain is variable. It’s usually very painful, initially, but often it's not terribly painful within a few hours.

Melanie: Now, these "Weekend Warriors" that you're discussing, if they don't rupture it but they do strain it, or something happens where it's really just very sore at the bottom of the calf muscle and they know they moved wrong, what do you recommend people do for home treatment?

Dr. Cooper: Yes, I think with a strain, often the strains occur, like you said, at the bottom of the calf muscle or even up higher in the calf muscle. Those usually respond really well to a period of rest, ice, and then gradual return to activity. If they're more severe, sometimes people will go into a walking boot or not be able to put much weight on it for a few days with those types of injuries. The other issue we run into are the tendonitis-type issues where the Achilles tendon becomes either inflamed or a little bit unhealthy in the tendon itself. Those, often, will respond, again, to rest, ice, good stretching, eccentric-type exercises, which is a particular type of strengthening and stretching exercise which is often done with a physical therapist. Those types of things.

Melanie: So, people, Dr. Cooper, do calf raises and they think these are just great and they do them off of a stair. Then, they go really, really low and then you hear people at the gym say, "Oh, I ruptured my Achilles," or "I tore my Achilles doing those calf raises too low." Do you tell people not to go below neutral; not to go low-floor height? Or, to do that gently and stretch them long?

Dr. Cooper: Well, I think it depends a little bit on where the problem is with the Achilles. If you have, say, a tendonitis, or an irritation, where the Achilles actually attaches to the bone, down really low on the back of the heel, I think going down below the stair is definitely harmful and can cause more inflammation with that. If you have like a tendonitis or something that you're trying to treat with some stretching and strengthening activities and it's higher up, in the middle part of the Achilles, then going down a little bit below neutral is okay. But, the people that tend to have a rupture during an exercise like that, or something, usually have a longstanding problem with the tendon where it's actually unhealthy tendon tissue.

Melanie: What do you do? If someone comes to you and it's swollen and they had that acute event and it was dramatic, then what? Is this a surgical thing? It requires that intervention?

Dr. Cooper: Yes. There are really two options: you can treat them either with surgery or without surgery. Probably 20 years ago or 25 years ago, there was a feeling that anyone with an acute Achilles tendon rupture required surgery to fix it or that there were some papers that showed that they had a really high rate of re-tearing the Achilles if they didn't have surgery. They were just treated in a cast. Then, in the last, say, 10 years or so, in America, at least, there have been some good studies that have shown that actually you can treat these without surgery. So, I think that, in certain situations, you can either treat it with surgery and get a good result or you can treat it without surgery and get a good result. They key thing for the people, especially if you're going to treat them without surgery, is not immobilizing them for too long. You can't just put them in a cast and give them crutches for three months because the tendon will heal but it won't heal with the appropriate strength. They do have a higher risk of re-rupturing. So, a lot of patients choose to have surgery for this because there's a feeling that you can get back more of your strength and get back to activities quicker. I think that gap between the two treatments is closing, certainly in America. In some other countries, they're treating almost all of these without surgery.

Melanie: Yes. It certainly used to be RICE and now it's MRICE, and now there's movement, or RISEM. Now, they add movement in there. When you were talking about that eccentric strengthening protocol, tell the listeners what you mean by that because if they're going to try and really do this and work their Achilles so that they don't injure it, explain what that is.

Dr. Cooper: First of all I think that in a lot of cases, it's really helpful for people to see a physical therapist maybe one or two times to help develop this program but what eccentric strengthening is, is basically you get on a stair, or something like that, and you go up on your toes fairly quickly. That's not the part of the exercise that matters. So, you do an easy toe raise, and then, the part that matters is coming down very slowly so that the muscle is sort of contracting as it lengthens. That has been shown, in these more chronic situations, to help the tendon heal and improve the structure of the tendon and help it get back more to normal.

Melanie: Where are shoes and orthotics in this picture? People use them for plantar fasciitis and arch problems but are they involved in the Achilles issues, as well?

Dr. Cooper: Yes. I think in people with Achilles tendon problems, especially if they have a significant, well, I guess what we would call a “deformity” of the foot, the orthotics can help. It can help take the load off the Achilles and help calm things down a little bit. They probably don't have a huge role in preventing ruptures of the Achilles tendon but some of this chronic situations, I think orthotics can help rest it. As far as shoe wear goes, there's been a lot of shift back and forth both ways as far as running shoes go in the last five to ten years where they went from a shoe with a thick heel to five years ago there was a big push towards the minimal barefoot-type shoe. At that time, I was seeing a lot of people with Achilles tendonitis overuse problems because they switched too quickly. If you have a shoe with a thick heel, it sort of lets your Achilles tendon rest a little bit; it doesn't put as much strain on it. Then, if you switch to the minimal shoe, you Achilles and your calf are doing a lot more work. Now, there's sort of a push back going the other way toward more cushiony shoes. So, I think that the big thing is, you pick the shoe that's comfortable but if you're going to change, you have to change gradually, over time. I think that's where people get into a lot of problems, both with their shoe wear as well as their training. You know, increasing their mileage too quickly or their intensity too quickly.

Melanie: In just the last few minutes here, why should patients choose UVA orthopedics for Achilles tendon surgery and for their sports medicine care?

Dr. Cooper: I think here at UVA, we've got a unique situation where we have for foot and ankle, anyway, we have three full-time orthopedic fellowship-trained foot and ankle surgeons. We kind of specialize in the whole pathology of foot and ankle and I think we're very conscientious of each individual patient and their needs, so not everybody that comes in here is going to be pushed towards surgery if it's not right for them. We'll work out a treatment plan that includes physical therapy and other things like that, if that's appropriate.

Melanie: Thank you so much for being with us. It's great information, Dr. Cooper. You're listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

The Latest Research for Stomach and Esophageal Cancer

Additional Info

Segment Number 1
Audio File city_hope/1608ch3a.mp3
Doctors Chao, Joseph
Featured Speaker Joseph Chao, MD
Guest Bio A Board-certified medical oncologist and hematologist, Joseph Chao, M.D. Joined City of Hope in 2007 as a Fellow and advanced rapidly to Staff Physician and Assistant Clinical Professor.

Dr. Chao earned his medical degree at the University of Illinois at Chicago, then continued his training at Harbor-UCLA Medical Center.

Named one of the “Top Doctors” for oncology by Pasadena magazine in 2011, Dr. Chao is among the first medical professionals to be certified by City of Hope's STAR (Survivorship, Training, and Rehabilitation) program which ensures our patients receive the most up-to-date, evidence based rehabilitation services available.

Learn more about Joseph Chao, M.D
Transcription Melanie Cole (Host): More than 18,000 Americans are diagnosed with esophageal cancer each year and timely diagnosis and intervention can make a dramatic difference in improving survival odds and quality of life. My guest today is Dr. Joseph Chao. He's an assistant clinical professor in the Department of Medical Oncology and Therapeutics Research at City of Hope. Welcome to the show, Dr. Chao. Tell us about esophageal and stomach cancer. Who is at risk for these?

Dr. Joseph Chao (Guest): There are so many know epidemiologic risk factors such as, obesity, chronic gastroesophageal reflux, smoking and alcohol are certainly also well-known risk factors for esophageal cancer development. Then, related to stomach cancer, there's h pylori, which is actually a bacterial infection can be related to dietary exposure and factors, but at least the latter in terms of h pylori it has reduced due to better refrigeration and food preservation. These are well-known risk factors for both esophageal and stomach cancer involvements.

Melanie: What are the symptoms? These kinds of cancers affect the quality of life so much. People are worried about disfigurement, if they have to have surgery; and eating something, of course; and talking. So, tell us about symptoms that people might notice that would send them to see you in the first place.

Dr. Chao: So, if I think, what we would call dysphagia, difficulty with swallowing, having food go down, that certainly would be symptoms in which you should seek a medical professional for evaluation. Involuntary weight loss, in spite of trying to eat normally and regularly. Unfortunately, at least in the United States, there are no effective screening programs for detection of early stage esophageal and stomach cancer. As long as you are very mindful as far as symptoms of ongoing gastroesophageal reflux in spite of taking antacids or proton pump inhibitors, such as Prilosec or Prevacid--ongoing symptoms. Then, certainly if you're a male above the age of 50, those will all be things in which you should be prompted to undergo an endoscopy by an gastroenterologist to have work ups to ensure that there isn't esophageal or stomach cancer responsible for ongoing symptoms.

Melanie: Now, you mentioned screening and endoscopy and, just as colonoscopy is preventive screening for colon cancer, do you envision a day when endoscopy is going to be considered part of a well screening to look for these?

Dr. Chao: So, not necessarily endoscopy in its current form. The issue with that is due to still, thankfully in many ways, esophageal and stomach cancers being lower in incidence in the United States versus other countries outside of the United States, such as in Asia, in which there's actually a much higher incidence of stomach and esophageal cancer in which public health screening programs are very cost-effective. There actually are a lot of novel endoscopic approaches being looked at to try and, essentially, increase the cost effectiveness for screening. So, hopefully, as these approaches are better developed, also better detection of, potentially even DNA changes at an early stage in your normal esophagus and stomach, hopefully, measures can lead to more effective screening strategies. So, yes, it will be then implemented regularly to allow for us to find earlier stage diseases as opposed to a lot of times, currently, cancers being presented at late stages.

Melanie: What happens if someone is diagnosed with one of these types of cancers? What is the outlook, or prognosis? Do they, then, have to be worried about being able to eat or talk or all of these kinds of quality of life issues?

Dr. Chao: So, it definitely depends in terms of the stage of the cancer that's found. If it's an early stage cancer, prognosis actually can still be very good with a combination of chemotherapy and sometimes radiation therapy, but most importantly, surgery for early stage esophageal and stomach cancers. So, speaking really isn't something that should be affected, but, yes, eating definitely. In terms of having part of your esophagus removed or your stomach removed, there can be adjustments made in terms of eating more frequent, smaller meals. Also, in terms of insuring that you’re staying hydrated. There certainly are measures that can be taken to adjust for the surgical outcomes in terms of having your stomach and esophagus removed. With time, after surgery to remove your stomach, things do re-expand in terms of if there's a remnant stomach left over and long-term quality of life actually still can be maintained. Actually, there's also a lot of research trying to look at long-term quality of life outcomes.

Melanie: If someone is subject to Barrett's Esophagus, is this a pre-cursor for this type of cancer?

Dr. Chao: So, Barrett's, yes. It is certainly known to be a pre-cursor for esophageal cancer, though not every case of esophageal adenocarcinoma is necessarily due to Barrett's, and, actually, still a very small proportion of Barrett's does develop into esophageal cancer. So, certainly there are approaches to ablate a Barrett's to try and prevent early stage disease or prevent progression into cancer. So, actually that is part of the screening efforts for esophageal cancer.

Melanie: Dr. Chao, tell us about Precision Medicine Initiative and how does this have to do with cancer and the treatments you provide at City of Hope.

Dr. Chao: Because of, unfortunately, a lot of cases of esophageal and stomach cancer being at late stages, Stage IV, usually that eliminates surgery as being an effective treatment option. So, we are mainly looking at chemotherapy. We are also finding out with cancers in general, not every single cancer is exactly the same. You know, we have the tools now to really look at every cancer in terms of their respective genetic code, their DNA mutations. We know that cancer is a disease, in terms of gene mutation, that leads to abnormal growth of cancer cells. So, in terms of being able to look at the genetic code, there actually are many different target therapies that can essentially go after a certain genetic alteration in the cancer. Actually, there is precision medicine being practiced at the moment for esophageal and stomach cancer with targeting of this gene called HER2. So, the latter is actually a gene that was initially discovered to be very important in breast cancer treatments, so a lot of the drugs used in breast cancer, targeted drugs such as Herceptin, actually have been found to be very effective in stomach and esophageal cancer. So, this is still only one targeted drug at the moment for stomach and esophageal cancer. We definitely want to continue to expand further on that and so actually in terms of the clinical trials that we have ongoing at City of Hope, we're looking at the genetic code of each person's individual cancer to then see, can we find a clinical trial that matches up to that genetic code of the cancer? And, essentially being more precise with our treatment.

Melanie: Is there a genetic component to these types of cancers?

Dr. Chao: So, in terms of known genetic, inherited mutations, it's still only a very small proportion, probably 1% of stomach cancers, in which we can point to a gene mutation. There is ongoing research to try and see if we can find more gene mutations that can be inherited and predispose someone to developing stomach and esophageal cancer. But, this is still, again, a very small proportion, but in terms of the genetic code of the cancer, I mean, there can be what we call "somatic mutations" in which, it's independent of the genes that you inherited. The big question is why do these changes happen in the first place? Those are also very important questions that we hope to address in future research studies.

Melanie: In the last few minutes, what's going on that's very exciting and gives hope to patients that have been diagnosed with esophageal or stomach cancer at City of Hope?

Dr. Chao: So, we are finding that immunotherapy, essentially trying to get your own immune system to attack the cancer. These are treatments that have already shown a lot of progress and improvement in the treatment and quality of life for patients with melanoma and lung cancer. There actually have been early studies in stomach and esophageal cancers in which these treatments seem to work as well for patients with Stage IV disease. The issue, though, is that still only a small proportion, maybe 10% or so, of patients in which it looks like these types of immunotherapies that are letting go of the brakes, so to speak, on the immune system to attack the cancer--it's still a very small proportion. So, if anything, ongoing research efforts are trying to see if we can harbor this treatment with the immune system in more than just 10% of our patients with Stage IV esophageal and stomach cancers. So, we are doing studies to try and see if we can find blood markers that may help predict for a response to these types of therapies. We're also in the process of planning a clinical trial to try and see if we can combine radiation treatment and immunotherapies to essentially bring out the immune system more against the cancer, and then, hopefully, get better quality of life and better survival for all our patients.

Melanie: That's absolutely fascinating, Dr. Chao, and I applaud all the great work that you're doing at City of Hope. Thank you so much 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

Eye Health and The Importance of Annual Eye Exams

Additional Info

Segment Number 5
Audio File virginia_health/1607vh4e.mp3
Doctors Kaufman, Evan
Featured Speaker Evan Kaufman, OD
Guest Bio Dr. Kaufman is a clinical optometrist at the Medical College of Virginia. He was appointed to the faculty in 2008. Dr. Kaufman moved to Charlottesville, VA in 2014 to join the faculty at the University of Virginia. He is involved in training residents, fitting specialty contacts and running a primary care clinic.

Dr. Kaufman grew up in Charlotte, North Carolina and got his undergraduate degree from Southern Illinois University. He then went on to earn his doctorate at the Indiana School of Optometry. After graduation, he continued his education and completed a residency in ocular disease at the University of Kentucky. He is an adjunct clinical instructor at the New England College of Optometry. He also is a fan of UVA football and loves to tailgate at the games.

Learn more about Dr. Kaufman

Learn more about UVA Ophthalmology
Transcription Melanie Cole (Host): Your eyes are so precious. Periodic eye and vision examinations are such an important part of preventive healthcare. My guest today is Dr. Evan Kaufman. He is a board certified optometrist at UVA Health. Welcome to the show, Dr. Kaufman. How often should people have an eye exam? Are there some red flags that would signal that it’s time to get in and have your eyes checked?

Dr. Evan Kaufman (Guest):   Thank you very much, Melanie, for having me on the show. When we talk about eye health and how quickly you should get in, it’s usually a good idea to have a complete or routine eye exam once a year. What I tell most of my patients is that sometimes we are not even consciously aware of our vision and if it’s getting worse. That’s why we suggest eye exams once a year. I compare it to watching a child grow. If you see the child every day, you don’t see them grow an inch or two inches or three inches but if you see them at six months or every year they grow like weeds. Just like our vision on a day to day basis, we don’t really see the small visual changes that occur in our eye but if you get your eyes examined every year, an optometrist, ophthalmologist or an eye care provider can track those changes. I also compare it to high definition TV. I did not want to get high definition TV myself but just like the rest of America, we did get a high definition TV. When I look back at the analog I think my eyes are blurry. People’s perception of vision is what they see every day. Sometimes, when we can make micro changes in a person’s prescription or identify a pathology, we can heighten the person’s vision by changing their prescription.

Melanie: Dr. Kaufman, how important is patient history when you’re giving somebody an exam?

Dr. Kaufman: As a primary care provider the history is one of the things that I spend the most time on. It’s kind of one of those things where I want to know what your daily routine is, what your visual needs are. Somebody sits in front of a computer doing a data analization has a different visual need than somebody that might be outside and doing some manual labor versus someone that might be a surgeon and has to look at something that’s at an arm’s length away has different visual needs. The first thing I ask is, “Tell me about what you do in daily life. Are you reading 10 hours a day? Are you on the computer 10 hours a day?” What are the visual needs? The second thing is, is I want to know that the old prescription is or if they’ve ever worn glasses before because that kind of gives me where we’re starting from. If a patient says, “I’ve never worn glasses. I’m coming in because my primary care doctor says I need to have an eye exam” and their acuity, let’s say, is in the 20/40 range, which is just about where the DMV wants you. Anything less than about 20/40, the Department of Motor Vehicles doesn’t like that too much and can restrict your driver’s license. If the patient says, “But I don’t have any problems” maybe they are not consciously aware that they could see better. Or, maybe they are not consciously aware that they could have some type of ocular pathology. Understanding A, what a person’s visual needs are and, too, what their previous history with glasses, contacts, any systemic history is very important, especially a history of diabetes. Diabetes is one of the leading causes of blindness in the United States today in adults over the age of 40. Diabetic screenings once a year is crucially important because diabetic retinopathy or damage to the eye due to high blood sugar can start before a patient is actually aware that they are losing vision. They come in and they say, “I’m seeing fine.” But, we look in the back of the eye and say, “Oops, there is some leakage of blood vessels or there are some early ventricular changes which is what we call early cataracts. These are all things that we want to know about and then we can communicate back to a patient’s primary care provider to maybe either get better blood sugar control or maybe change the medication.

Melanie: Dr. Kaufman, is there a genetic component to what goes on with our eyes?

Dr. Kaufman: It depends on who you talk to. In my opinion, yes. A lot of people say, “My parents wore glasses so I will probably have to wear glasses.” That’s not necessarily true. The latest research is that if you are going to be far-sighted or near-sighted it is “programmed into your DNA” but it’s multi-factorial which means that some of the signal comes from one gene and another one comes from another gene. It has to be a combination of multiple genes in order for them to illicit the trait. Basically, the environment that you put yourself into can illicit whether you are going to be near-sighted or far-sighted. There are some really interesting studies that are going on right now – I was just at a meeting – where they were dealing with how much light is in a classroom. If there is more light, maybe people will not be so near-sighted when they are in class and working on assignments in their class. This is out of Southeast Asia. The study hasn’t been conclusive yet, so I don’t want to say that it all has to do with one particular component but there is a trend to think that there is a genetic component to being either far-sighted or near-sighted but we haven’t mapped it down. We can’t test your DNA and tell you if you are going to be near-sighted or far-sighted because it comes from such a complex, multi-factorial component.

Melanie: Dr. Kaufman, there is so much information. We could speak for an hour about this. Now, tell us about the tests. People hear that you are going to dilate their eyes and they get nervous that they can’t drive afterward. What tests do you do? Are you taking pictures of our eyes or blowing air into our eyes? What are these tests that you’re doing to see what’s going on with our eyes?

Dr. Kaufman: In a standard routine exam, the first thing that we do is something called a refraction. A refraction is where we use a multitude of optical lenses in order to focus an image on the back of an eye at the retina. That can tell us if a patient has normal vision or not. People say, “Do I have normal vision?” 20/20 is really what we call standard vision but just because you don’t have 20/20 vision doesn’t mean that it’s not normal. It’s just kind of where we put the standard. A refraction will tell what the best possible vision a patient can get. If a patient does not have 20/20 vision and it’s worse, then we look for components of disease such as cataracts, glaucoma, macular degeneration, a variety of conditions. The best way that we do that is by dilating the eye. When we dilate the eye, we give medications in the eye that is just temporary that numb the iris, or the color part of the eye, in order to make it very large. It does not constrict. The reason that we want to make it large is that we want to look in the back of the eye through a window not a keyhole. If a patient’s not dilated, looking through a keyhole is very difficult. We can only see what directly passes in front of that keyhole versus that if we do a dilated exam, the pupil dilates and then we have a much bigger window to look up and down and left and right in all parts of the eye. No type of pathology escapes the provider.

Melanie: In just the last few minutes--what great advice – there’s so much that we could cover, Dr. Kaufman. Give your best advice for people to maintain their eye health.

Dr. Kaufman: First of all and foremost, yearly eye exams is probably the most important and that is because nothing sneaks up on you such as diabetic retinopathy or any type of refractive error. The second thing is a healthy a diet is important with eye health. I tell my patients that Omega 3 fatty acids, which is found in fish, is very good for the retina and it is also good for dry eyes that a lot of people suffer from. Those are the two things that I would do is have yearly eye exams and eat healthy.

Melanie: Why should someone come to UVA ophthalmology for their eye care?

Dr. Kaufman: UVA ophthalmology is unique because we are a multi-diverse department. We have everything from neuro-ophthalmology that deals with people who have neurological problems with the eye to corneal problems which is people who have infections and ulcers of the eye, to glaucoma and retinal specialists for diabetic retinopathy. In addition to having that, we also run a clinic for specialty contact lenses which deals with people that can’t wear glasses; that have to wear contact lenses. We also have a very large primary eye care clinic where people can just come and get their routine care. It is a very complete package of a department. If you had a condition that needed multiple specialists, we can manage that within the department without having to outsource any care.

Melanie: Thank you so much for being with us today, Dr. Kaufman. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

What is a Herniated Disc?

Additional Info

Segment Number 1
Audio File virginia_health/1608vh3a.mp3
Doctors Hassanzadeh, Hamid
Featured Speaker Hamid Hassanzadeh, MD
Guest Bio Dr. Hamid Hassanzadeh is a fellowship-trained spine surgeon whose specialties include minimally invasive spine surgery, complex spinal deformities and herniated discs.

Learn more about Dr. Hamid Hassanzadeh

Learn more about UVA Orthopedics and UVA Spine Center
Transcription Melanie Cole (Host): Between 60 and 80 percent of people will experience low back pain at some point in their lives. Sometimes called a “slipped” or “ruptured” disc, a herniated disc most often occurs in your lower back and it's one of the most common causes of low back pain. My guest today is Dr. Hamid Hassanzaddeh. He's a fellowship-trained spine surgeon whose specialties include minimally invasive spine surgery, complex spinal deformities and herniated discs at UVA Health System. Welcome to the show, Dr. Hassanzaddeh. Tell us, what is a herniated disc? People hear this term and they're not even sure what that means.

Dr. Hamid Hassanzaddeh (Guest): Good morning. Thanks for having me. So, our discs are built up out of two portions: an outer portion and inner portion. When we get older, that outer portion ages a little bit faster and what happens is, you get small tears into the outer portion and part of the inner porter can come into the canal and pinch our nerve and create back pain and leg pain and so on.

Melanie: So, the spine and the discs--how are they designed and are they supposed to be moving around like that?

Dr. Hassanzaddeh: Absolutely. So, there are cushions for our cord and the mobility of our spine. We're able to move our back and neck because of part of it is because of the joints and part of it is because of the discs. Discs take the pressure when we jump and when we sit and that's where you're more prone to injuries and more prone to herniation or rupture. And, that's one of the first things that would cause a back problem when we get older.

Melanie: Let's talk about what causes it first and then we'll get into some symptoms. What are some causes? How does somebody herniate a disc?

Dr. Hassanzaddeh: One of the biggest causes is genetic. Like, everything else, our genes basically predispose us to better quality or lesser quality of discs. People that have a family history of disc herniation or disc problems tend to have more problems when they become older than those patients that do not have the family trait. Other activities like bending forward--you feel the pressure. People try to lift something. It's a very common scenario that's the most of us try to lift that heavy box or that sofa, and a sharp pain in the back is a very common scenario. What happens when we bend over is, there's the highest pressure on the disc and we add some weight onto that. It increases the pressure in the disc and creates tears and creates the herniation. So, activity and genetics and some of it could be overuse that could cause this disc disease.

Melanie: Is a herniated disc the same as a bulging disc?

Dr. Hassanzaddeh: Not quite. A herniated disc means where a portion of the disc came into the canal and pinched some part of the nerve. Basically, herniation means part of the disc literally tears out of the disc into the canal. A bulging disc could be absolutely normal. When we get older, we lose some of the fluid and some of the height of our discs and the disc doesn't look quite juicy. It's a little like a flat tire and that appearance of a flat tire called a “bulging disc” could be absolutely asymptomatic and all people have it without knowing it.

Melanie: So, what are some symptoms that people experience? People have low back pain from a myriad of reasons such their mattress, or as you say, they just reach something wrong or lift something improperly. What are some symptoms that this is actually an issue?

Dr. Hassanzaddeh: Back pain, per se, is a multi-factorial problem. It could be a structural, or some bony structure, it could be disc or muscle, or all combined to cause back pain. A disc herniation, is very typical, especially in the lumbar spine. Disc herniation could also get in the neck and thoracic spine but the lumbar disc herniation is the most common problem and that is the most common area that it occurs. The lumbar disc herniation--the typical story is that they did something and felt a sharp pain initially and then that pain migrates or radiates down to the lower extremities. That's a very common description of disc herniation symptoms.

Melanie: So, if someone has that pain going down their leg and they say, "Oh, I've got sciatica," then what do you do for them? Give us some of your first lines of defense, Dr. Hassanzaddeh, with some non-surgical treatments; things that you can try at the beginning and then we'll see if it needs to have surgery.

Dr. Hassanzaddeh: Absolutely. The majority of people who have a disc herniation will not need surgery. So, what happens with discs is our body has some healing potential. We absorb the herniated disc and that makes it better. Time usually plays the rule into that. Secondly, we could help with treatment which could include injections. A steroid injection will decrease the inflammation around the nerves and alleviate the pain significantly. We tend to go, after the injection and once the pain is better controlled, we tend to send the patient to physical therapy to increase their core muscles. That’s a very important component of the entire stability of the spine and will prevent further damage and further degeneration of the disc. So, usually, if someone comes to me with acute disc herniation, then my task is, then, before we get even advanced imaging, if they have don’t have a neurological deficit, we send them for an epidural steroid injection followed by physical therapy and wait to see how they do. If the patient is resistant to non-operative management, which includes at least a minimum of six weeks of non-operative management and sometimes as much as three months, then a surgical indication were given. But, like I said, a majority of patients will do well without surgery.

Melanie: How often are you willing to give an epidural steroid injection? Some people want to come in for them every couple of months or every six months. How often can somebody get one of those before it's enough?

Dr. Hassanzaddeh: So, in my practice I do not like to have more than three injections, for those, a third injection, per year. So, if three injections fail to improve the symptoms, then we have to change our management plan, our management strategy.

Melanie: Now, let's talk about prevention. Is there a way to prevent herniated discs and general back problems? What do you tell people, Dr. Hassanzaddeh?

Dr. Hassanzaddeh: So, a strong core muscle could prevent a lot of back issues, if the muscles are very strong. The core muscles include the abdominal muscles, the back muscles, the thigh muscles, the chest muscles--they're all part of the core muscles. A very strong core muscle can prevent disc herniation, disc degeneration, and all other types of cause of back pain. So, my biggest recommendation to prevent back pain and disc disease is to keep your core muscles strong and stay active.

Melanie: So, doing regular bits of exercise and in just the last few minutes here, you mentioned at the beginning some movements that people do. So, learning proper lifting techniques, because in my practice, Dr. Hassanzaddeh, I’ve seen people lift a weight and then they turn to set it down somewhere and right then and there you can see the pain. What do you tell people about these proper lifting techniques so that they don't do that sort of thing?

Dr. Hassanzaddeh: Absolutely. So, this exact scenario you discussed is very common. Lifting and turning around creates increased pressure in the shear force which is a bad combination that could cause a tear in the outer portion. So, usually, I try to tell my patients to not lift from a bending position. Try to go kneel and lift this heavy object. Twisting, usually with the bending position, is not a great exercise for the back and could create inflammation; it could create tears, and so on. I think, overall, if they work on their core muscles, stay active, and do some activity modification, which also includes prolonged sitting, by the way. When we sit down, this is the time when the pressure is the highest on the disc. So, avoiding prolonged sitting, changing positions, standing for a minutes and doing some general modifications will really prevent a lot of trouble for our back.

Melanie: Why should patients come to UVA Spine Center for their care?

Dr. Hassanzaddeh: So, we have a phenomenal team of a multi-disciplinary approach. We have a great team management system and great interventional system where we the patient could receive their injections. We have a broad spectrum of experts including the spine surgeon and neurologists and interventionists that could help the patient to get everything in one place and world-class.

Melanie: Thank you so much for being with us today. You're listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

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