Inactive (722)

Segment Number 1
Audio File allina_health/1604ah3a.mp3
Doctors Hennessy-Keimig, Kate
Featured Speaker Kate Hennessy-Keimig, PsyD, LP
Guest Bio Kate Hennessy-Keimig is a doctor of psychology at Allina Health Mental Health – United Clinic.

Learn more about Kate Hennessy-Keimig
Transcription Melanie Cole (Host): You may hear some people say that pain is all in your head but healthcare and mental health care providers would agree that this is an obsolete philosophy and just because you can’t see pain doesn’t mean that you can’t treat it. My guest today is Dr. Kate Hennessy-Keimig. She is a psychologist at Allina Mental Health United Outpatient Clinic. Welcome to the show, Dr. Hennessy-Keimig. Tell us a little about chronic pain. How does it differ from acute pain and why do some people having trouble believing people are in pain?

Dr. Kate Hennessy-Keimig (Guest):   The differences between chronic pain and acute pain sometimes can be kind of subtle. The common feeling in the pain community is that chronic pain occurs when something happens in the nervous system that causes those pain pathways that transmit pain sensations to become oversensitized. So, patients might be experiencing a pain response to a stimuli that we might not normally see as painful. It differs from acute pain in that when we hurt ourselves, typically, with acute pain it’s kind of mechanical. We smash our thumb with a hammer and it hurts where we hit it, maybe it goes on and it hurts for a while, but it’s time limited. It gets better. With chronic pain, it’s pain that goes on and on in duration beyond the expected healing period. It might not be localized. While originally, there might have been an injury to a specific place, that might not be the place that keeps hurting. It may not be the kind of thing where like, if you break your leg, you shouldn’t move it for a while but with chronic pain, a lot of times, if the provider has diagnosed chronic pain, they’ll say the best thing that you can do is keep moving so that people don’t have that downward spiral of being inactive and isolated and deconditioned. One of the reasons why it’s really hard for my patients with chronic pain is, a lot of times it is invisible. Other people around them, their family members, their associates, and even sometimes their caregivers can’t really see what’s happening and so that makes it really hard. Sometimes, you can’t discover exactly why it’s happening.

Melanie: That’s my next question. What are some of the causes of chronic pain and as an exercise physiologist, doctor, I have people with back problems and they have chronic pain from various places and we don’t always know what it’s from. How do you even determine where it comes from?

Dr. Hennessy-Keimig: A lot of times that can be really difficult because, while it can be triggered by an injury, or it can be triggered by a medical procedure; it can be because of a degenerative process--like I would imagine lot of people you see; it can be caused by side effects from medication. We have people that have ongoing chemo pain. Or, it can be neuropathic pain like people with diabetes. We really may not know what sets it off in some conditions. I know I have patients that are very frustrated because they keep going to specialist after specialist and nobody can say, “This is really the cause” and yet we know that their pain is real pain and they are truly suffering from it. Sometimes it seems like it moves around and that gets really frustrating for them as well sometimes for their providers.

Melanie: Is there a way to measure someone’s level of pain besides asking them, “Is your pain a 9 or a 10”? Is there actually anything to monitor that pain level?

Dr. Hennessy-Keimig: It gets tricky because pain is perceptive. My 8 might be somebody else’s 4. There is actually a pain scale that the chronic pain providers tend to like. It takes that one to ten scale but it puts some little qualifiers on it. Like, if pain is from 1-3. Well, it’s there but it doesn’t really bother me. If it’s a 4-5, it bothers me but I can handle it. If it is a 6 or 7, it’s really intrusive and it’s interfering with my life. If it’s higher than a 7, I can’t think about anything else. By being able to put some of those qualifiers on it, it makes it a little bit easier for the patient as well as the provider to understand it. What we find is, with a lot of people who come to us for treatment of chronic pain, they’re consistently 6 or above. It’s really intrusive and they can’t think about anything else. Our hope is by treating the chronic pain or by helping people learning to manage it, rather, that we can get them down to below that 6. It can bother them, it’s there, it’s not going away, but they can still handle it.

Melanie: Are there certain factors that make a person more susceptible? As you said, it’s really subjective and if certain people feel more pain than others, some women can have a baby without any kind of an epidural and some women absolutely ask for it at the first little sign of labor. Is there any factor that makes a person more susceptible than another?

Dr. Hennessy-Keimig: I don’t know that there is one particular factor, but, as you said, it is an experience that is both sensory and emotional and we all have different pain tolerances for various reasons. People’s emotional relationship with pain can certainly have an impact on the way they experience pain. Then, there’s also all of the lifestyle things. I talk with my patients a lot about having an energy budget. Just like we have our checking account and if you have chronic pain, it’s like having a daily automatic withdrawal from your energy budget. We all know what happens if we overdraw our accounts, we get in trouble. In addition to that automatic withdrawal, there are things that people can do or they have habits of mind that either take from or add to what we bring to the table to deal with our pain. Things like fatigue and stress and changes in the weather and people’s level of self-care and their coping skills and their support level and their relational stressors. All of those kinds of things can absolutely contribute to how well people are managing pain. That is really a lot of what I deal with as a psychologist with people with pain. Not so much trying to reduce the pain itself because that may not be possible at least by me, but by attending to all of those other factors, we can reduce the suffering that they are experiencing.

Melanie: We have been seeing pain places -- and really this is a burgeoning field in pain management--cropping up all over the country. Tell us about some of the therapy approaches that have been effective in treating chronic pain. What do you do for people that are in chronic pain?

Dr. Hennessy-Keimig:   My approach, obviously, is a psychological approach. Generally, my goal is to help people improve their functioning and be able to manage their pain better. A lot of times, the way we do that is by helping people become more psychologically flexible by helping them learn some coping skills that might help them accept that fact that this is chronic. It’s not going to be fixed. It’s not going to go away. By helping them to learn to pace their life better. By not doing this all or nothing thing that a lot of people – all of us with or without chronic pain tend to do. A lot of times, patients will do the feast or famine thing. If they are having a good day they will just kill themselves with activity and then they will pay for it for days. Trying to help them either learn that skill or if there is something underlying to them having trouble practicing that skill. Like, maybe they haven’t accepted the fact that their pain is chronic or by working on understanding that they have to grieve and deal with some of the emotions that go with it. A lot of my personal experience, my personal approach is based on mindfulness which really helps people develop the ability to take a little bit of a step back from their experience and not be so locked in and just responding and reacting to every stimuli as it rises and falls. Otherwise, they can become very psychologically rigid which makes it even more difficult to deal with pain. Mindfulness helps people direct their attention to chosen sensory or cognitive types of events like the breath or something that they are doing so they can lean into the pain and lean away and refocus their attention away from either the experience itself or their emotions about the experience.

Melanie:   Traditional approaches and alternative, or integrative, as you say mindfulness. This is huge today, people are using mindful medicine for so many different things. How does this help for them if they are more mindful of the pain? Do you want them to take charge of it and feel this pain and acknowledge it or do you want them to try and forget that it’s there?

Dr. Hennessy-Keimig:   Actually, it’s not really either one of those things. What I tell people about mindfulness is it gives you an option in between either pushing something away or falling off the deep end into it in that you can selectively direct your attention towards – say, for example, your breath. You’re following your breath and then you notice that you are distracted and you go back to the breath. Over time, this gives you the ability to take a step towards something. Take a step away from something. With pain, what this helps people to do is to realize that it’s not the central focus of action; that they can disengage from maybe the idea that they are going to be able to fix the pain and learn to kind of live in the presence of it. They can move toward it. They can move away from it. It gives them more of a sense of control.

Melanie:   That’s absolutely fascinating. In just the last minutes, please, doctor, tell us a little bit more about your chronic pain management group.

Dr. Hennessy-Keimig:   The group is a six week group. It focuses exactly on the things that we have been talking about. It is totally mindfulness based. I teach the mindfulness skills to the patient. We do a practice every week. I ask them to practice at home. It also gives them an opportunity to share how things are going in their life. We talk about things like pacing and staying in the present moment and self-care and support and self-management, acceptance, grief and loss – all of those things that people are dealing with; as well as just lifestyle things that might help manage pain better. People who have attended the group have indicated that has been really helpful to them as well as the fact that they have group support. They’re in a room with other people who actually really do get it. A lot of times, being in chronic pain is very isolating for people so having that opportunity to just share with other people who are going through similar experiences is very powerful.

Melanie: It’s such great information. Thank you so much, Dr. Kate Hennessy-Keimig, a psychologist at Allina Mental Health United Outpatient Clinic. 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.
Internal Notes back
Hosts Melanie Cole, MS

Cancer Genetic Counseling: Knowing The Facts To Help Your Family

Additional Info

Segment Number 5
Audio File allina_health/1601ah5e.mp3
Doctors Baldinger, Shari
Featured Speaker Shari Baldinger, CGC -Genetic Counselor
Guest Bio Shari Baldinger, CGC, is the manager of Genetic Counseling Services for Allina Health’s oncology clinical service line. Her clinical focus and passion are hereditary cancers, risk assessment, testing and prevention. With more than 30 years of experience in genetic counseling, Baldinger works to help families identify and manage cancer risks that may run among them. She oversees a team that provides genetic counseling services at multiple sites of the Virginia Piper Cancer Institute and via TeleHealth at a number of regional and affiliate partner locations.

Learn more about Shari Baldinger, CGC
Transcription Melanie Cole (Host): If you or a close relative has had cancer, you may be concerned about not only your own risk for a future cancer but whether your children or other relatives are at risk. You’ve heard about cancer genetic counseling but how do you know if genetic testing is right for you? My guest today is Shari Baldinger. She is the Manager of Genetic Counseling Services for Allina Health’s Oncology Clinical Service Line. Welcome to the show, Shari. Who is a genetic counselor?

Shari Baldinger (Guest):    That’s a good question. A genetics counselor is actually a specially trained healthcare provider. We have national certification to do our job. Our goal is to take a person’s concerns about family history and interpret those complex histories. Try to, based on personal family history, help craft an individualized risk assessment for that patient. Given that personalized risk, propose health strategies – whether it’s screening, prevention, interventions--that are best for them. There is all this talk these days about when women should start mammography screening. It really should be personalized. It should be precision medicine. A genetic counselor can help assess that. Genetic testing can play a huge role in a small number of people to help in that endeavor. We can help them make informed decisions about testing and help interpret those results.

Melanie: When might genetic counseling be right for an individual or a close relative?

Shari: In general, if someone is really concerned about their cancer risk, I always say it’s good to get a good risk assessment because people often overestimate their risk. The red flags when a familial risk may be a unique concern or a person may benefit from considering genetic testing is if there is young onset cancer in the family. For instance, breast cancer before age 45 or 50. Probably any woman who has had a personal history of ovarian cancer or a close family member with ovarian cancer would benefit from that discussion. For colon cancer, young onset would be before 50. If there is a cluster of cancer in the family – three of four people with cancer – one should talk to a counselor. Then, of course, there are some rare tumors that may prompt, under any circumstances, they should be addressed for possible familial risk; like a medullary thyroid cancer something called a “pheochromocytoma” or certain types of brain tumors.

Melanie: Is it safe to say that for people who have no family history of cancer but still get cancer, genetics doesn’t necessarily play a role in that cancer?

Shari: No. Sometimes the family structure can be limited, for instance with ovarian cancer. Of women who have an inherited predisposition to ovarian cancer, probably 30-40% of those women had no prior family history of a relevant cancer. Let’s say I’m a woman who has only brothers and I got a genetic risk from my father who had only one brother. You may be fooled by the absence of other cancers in the family. If you’re young, even without a family history, it may be important. Again, certain types of tumors would prompt investigating the possibility of a familial risk.

Melanie: What would you like people to know about genetic testing itself?

Shari: I think a couple things. One, genetic testing doesn’t equal genetic counseling. There are people who benefit from a discussion with a genetics professional to learn their cancer risks and how they should manage those risks when genetic testing may not be relevant in that circumstance. The other thing is, with respect to genetic testing, the goal of it is, if we can figure out what causes the cancer in the family, we can be more proactive rather than reactive in their risk assessment and management. We often may learn that there is a risk for cancer that’s not obvious based on the family history and sometimes can impact better treatment of those cancers and we can provide a huge benefit to the family. I think that’s something people should realize that the benefits, I think, extend beyond what most people realize.

Melanie: What is involved in a genetic test, Shari?

Shari:   Physically, a genetic test is usually a tube of blood. It’s not a big deal. Physically, it’s not a big step for a person to take but the information is powerful, it’s limited, but it can be empowering. What’s important is, if a person gets a genetic test is that number one, they want to know is it the right test, how valid is the test, what’s it going to tell me if it’s abnormal, what’s it going to tell me if it’s normal. You don’t want to be blind-sided by information. You need to know this up front. Whether a person says “yes” or “no” – they know what they are saying “yes” or “no” to.

Melanie:   What do you tell people about the results and what they can do with what they find out?

Shari:   That is one of the beauties of genetic testing. If we learn that someone is at a uniquely high risk for a particular cancer, we often can start screening much earlier. For instance, it may be appropriate to start breast screening with MRIs in one’s 20’s not at 40 or start colonoscopies in one’s 20’s and do them every one to two years. That would allow us to do one of two things, either find a cancer very early, which, if they wait, it could be life-threatening, or, in many cases, prevent cancer. There are also certain medicines that people can take to lower their risk of cancer depending on what we find. It allows us to get in the way and get better outcomes if we know what’s going on in the family. It’s not like learning that you are at risk for something and have to sit back and can’t do anything about it. We actually can do stuff about this.

Melanie:   Are there concerns about insurance paying for these services and are people concerned with if the results come back positive risk for a certain type of cancer that, then, this is on their record and they may have trouble getting life insurance and such?

Shari:   Gotcha. When I first started in genetic counseling and testing for cancer in the late 90’s, the number one reason people chose not to get a genetic test was fear that their health insurer would cut them off or raise their rates. Two things have happened since then. One, in the State of Minnesota in 2000 the State Legislature passed a law that does not allow an individual or a group insurer to use genetic information for underwriting purposes. Probably more importantly, in 2008, this preceded the Affordable Care Act, Congress passed the Genetic Information Non-Discrimination Act which basically prohibits group and individual health insurers from using the results of a gene test for any underwriting or eligibility. To be fair, most of my patients who have heritable risk want their health insurers to have this information so that they support and pay for the more frequent screening, the risk reducing surgeries, the interventions that are so important to keep them healthy.

Melanie: In just the last few minutes, what is the most important thing that you want people to understand about cancer genetic counseling and how it can help families?

Shari:   I think it comes down to what I alluded to and what has gotten a lot of press very recently is the notion of individualized or precision medicine. Through seeing someone in genetics, we use family history and sometimes genetic testing to tailor risk and management for an individual and empower them to take control of this concern instead of being the victim of the concern. I think that a genetics professional can really help put all of this in perspective for individuals and families and help them manage these risks and prevent cancer. There is an old quote, and I can’t get it directly from someone in the 1600’s that said “a physician is far better to prevent disease because he prevents his patients from having the burden of disease upon him.” That’s what goal of cancer genetics is to prevent disease.

Melanie: Thank you so much, Shari. That is great information and so beautifully put. You’re so well-spoken. Thank you so much. 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

The ‘Why’ and ‘When’ of Getting a CT Angiogram

Additional Info

Segment Number 4
Audio File allina_health/1601ah5d.mp3
Doctors Lesser, John
Featured Speaker John Lesser, MD
Guest Bio John Lesser, MD, FACC, FASCI, FSCCT is the director of cardiovascular CT and MRI at Minneapolis Heart Institute® at Abbott Northwestern Hospital. He was the past president of the Society of Cardiovascular CT. He has 27 years of experience diagnosing and treating patients with cardiovascular diseases. Lesser also values the importance of research and he has been involved in over one hundred studies aimed at improving the quality and level of cardiovascular care offered to patients.

Learn more about John Lesser, MD
Transcription Melanie Cole (Host): A computer tomography angiogram, otherwise known as a CT angiogram, is a mouthful to say but this procedure can be a very useful tool to patients having heart problems. My guest today is Dr. John Lesser. He is a cardiologist and the Director of Cardiovascular CT and MRI from Minneapolis Heart Institute. Welcome to the show, Dr. Lesser. To begin, tell us what a CT angiogram is.

Dr. John Lesser (Guest):    Sure. Thank you. It’s nice to be here. A CT angiogram is a test that is done generally as an outpatient. You will require an IV. You get into a CT scanner and the scanner is a special kind of scanner that is very, very fast so it can stop the motion of the heart. You inject IV dye, or contrast, in the IV and then by timing it properly, you fill up the arteries of the heart. You can see the lining of the wall of the arteries of the heart and the area that carries blood. So, you look for blockages as well as plaque that is in the wall of the artery.

Melanie: Is this considered an invasive procedure and does it hurt?

Dr. Lesser: Good point. It is a non-invasive procedure, which is good. You might feel hot when they give you the contrast. It wouldn’t hurt except you have to put an IV in.

Melanie: Once you’re doing this and, because you’re in a CT scanner, are you then able to follow up with an angioplasty at the same time or is that a whole separate procedure?

Dr. Lesser: Right. That’s a whole separate procedure. What a coronary CT angiogram is designed to do is to make a diagnosis. Is your symptom related to the heart; and then, how bad is it and where is it? Or, are your symptoms really from something else? The idea of being able to fix the problem you have to be in a completely different spot and that would be during an invasive procedure.

Melanie: How is a CT angiogram different than the standard angiogram?

Dr. Lesser: In a standard angiogram, you numb the skin in the leg or the arm and you thread a tube up in your artery, not in the vein. The tube then gets up into the arteries that feed the heart. Then, you inject contrast directly and that outlines the arteries and you look around at multiple angles to see where a blockage might or might not be. The ability to see the blockage is very, very good when you do a direct injection. The coronary CT angiogram is a little different. That’s where you inject it in a vein. The contrast floats around the body and then you time it properly and you’re able to see the arteries themselves. The value, in addition, with the CT is you can see the wall of the arteries. With the invasive angiogram, you see the inside of the artery where the blood flows and you can get a better sense, sometimes, of what the long-term risk might be of a future heart attack by getting the CT angiogram as opposed to the invasive angiogram. The invasive angiogram is designed to make a definitive diagnosis – do you have severe blockage--and to be in a position to fix it at the same time.

Melanie: What a wonderful explanation. It’s absolutely fascinating. How do you determine if a patient should receive the CT angiogram? Are there certain parameters by which you go where you can tell somebody, “I’d like to do this first”?

Dr. Lesser:   Yes. If you don’t know for sure that the problem is from the arteries of the heart and that it needs fixing, you’ll do the non-invasive test first because there’s no risk, or minimal risk. By doing the noninvasive test, then you can make your judgments much better educated. Sometimes, all you’ll need is medication and then you don’t need to go on to the next step even if the blockage is the cause of the symptoms.

Melanie:   If a patient doesn’t have any symptoms but they are curious about their risk of heart disease, would they get this type of angiogram? How do you determine whether or not? Could this become a new screening method, Doctor?

Dr. Lesser:   That’s a really good point. When you do a screening test, there are different things about a test that you need. One, when you do a screening test you don’t want to be exposed to anything that might cause a problem because you are really doing this for large segments of the population. When you do a CT angiogram, you have to give angiogram dye and there are some people who react to that. Right now, if you have no symptoms, probably the best way to access the long-term risk you might have would be from a calcium score which is a CT scan without contrast. If you have symptoms, that’s when adding the contrast adds the extra value.

Melanie:   As a researcher how do you see this technology changing? What do you see happening in this coming bunch of years?

Dr. Lesser:   There are things that are going on right now. First, what a CT angiogram does it gives you the anatomy. It shows “does the wall have plaque; does it have blockage”, but it doesn’t say “does the blockage limit flow to your heart”. We just make an assumption about that. Now, there is something called an FFR-CT. What we do is we get the CT information, we send it and analyze it through a super computer and a special technique and that tells us “is the blockage able to limit blood flow to the heart”. Not just “how does it look”, but does it actually limit blood to the heart. It is very, very accurate. It is something done by post-processing information instead of having to do something extra to a patient.

Melanie: Are there some limitations of CT angiography?

Dr. Lesser:   Yes, there are. Sometimes you have so much calcium in your artery, you can’t see through it because calcium is very bright. At a certain point, it is not worth doing and we often would check to see what your calcium level is in the artery by a quick picture before we give the IV dye or contrast. Other times, if you can’t cooperate – if you’re moving around, you can’t hold your breath, or your heart rate is very, very fast – those are other reasons why the scan would not have the right quality.

Melanie:   So then, talk about the results just a little bit, doctor. Who interprets those results? What goes on with follow up? What do you want patients to know about after care?

Dr. Lesser:   Good point. The person who interprets the results is someone who is already skilled and trained to do so. This requires special training. It can be either a radiologist or a cardiologist, but if it is someone who doesn’t have special training in reading the heart arteries, then it’s not a very good way to go. That is a very important part of that. Oftentimes these people will help to design the scan so you get the right information. That’s another important thing. It’s not as simple as going to get a CT scan of the abdomen. The general set up has to be very specific for the heart. After you get that information, then the patient has to understand “what does this all mean” and that requires, really, I think, a conversation with your doctor who gets the information, who will understand what the comments are when they talk about the CT to try to make a judgment.   Do you need to be on medication to prevent a future problem like cholesterol medication? Or, are you perfectly fine and your risk would be extremely low in the next 15 years? There can be a wide range of recommendations based on what we see.

Melanie:   This is great information, doctor. Just in the last few minutes, give patients and listeners your best advice for those who think they might have heart disease; who would like to be checked and who are considering a CT angiogram.

Dr. Lesser: If you have no symptoms and you might have some risk factors, the calcium score – and that doesn’t have the contrast – would be your first best step if you’re going to have a scan to access your risk. If you have symptoms and you want to know “do I have plaque and is the plaque the source of my symptoms”, then the CT angiogram makes sense. I would make sure that you go somewhere that is familiar with doing that and that you have a situation where someone can explain the results to you and put it in context. So, you would know “is this really related to my current problem and what do I do for the long-term”.

Melanie: Thank you so much for being with us. You’re listening to The WELLcast with Allina Health. For more information you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

ACA: Changes & Delays in Your Insurance

Congress recently enacted some changes to the ACA taxes and timelines. What are they?

Additional Info

Segment Number health_radio/1602ml4c.mp3
Audio File 3
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

How to Reduce the Added Sugar in Your Food

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Segment Number 4
Audio File beth_israel/1601bi5d.mp3
Doctors Richards, Marcia
Featured Speaker Marcia Richards, RD
Guest Bio Marcia Richards, RD is a Registered Dietitian/Nutritionist with BID Plymouth.
Transcription Melanie Cole (Host): Added sugar provides calories with no added nutrients and can damage your metabolism in the long run. My guest today is Marsha Richards. She is a Registered Dietician in the Department of Nutrition Services at BID Plymouth. Welcome to the show, Marsha. So, tell us about added sugar. Where might we find that in our foods?

Marsha Richards (Guest): Right now, what we understand is about 47% of added sugar comes from beverages. That is going to be an important item to consider, especially sodas, energy drinks, juice drinks. You can also find a lot of added sugar hidden in a lot of foods that you really wouldn’t expect to see it in; things like whole grain cereal, granola, and instant oatmeal, some frozen foods and pasta sauces also have added sugar. Dried fruits, canned fruits, even condiments like barbeque sauce, ketchup, and salad dressings. So, it’s really important to look at labels for total grams of sugar but more importantly, look at the ingredients. Look for ingredients like sugar, cane sugar, evaporated cane juice, corn syrup, high fructose corn syrup, brown sugar, honey, maple syrup and also brown rice syrup. Ingredients are always listed from most to least. So, if you see these items at the beginning of the ingredients list, that item could have a fair amount of sugar in it.

Melanie: In the new dietary guidelines that were just recently released, they are asking us to consume less than 10% of calories per day from added sugar. So, what are they talking about with these beverages and things that you are discussing right now?

Marsha: The new guidelines recommend less than 10% of our calories from sugar. For kids, it translates to about three to four teaspoons per day; pre-teens and teens about 5-8 teaspoons. If you look at a label, every four grams of sugar equals one teaspoon. So, when you’re looking at a label if you see those sugars that I mentioned before in the ingredients list, then you can take a look at the label and see how many total grams of sugar and divide that number by four and that will tell you how many teaspoons. But, as you mention with your intro, sugar does not provide us with any nutritional value. It provides us with calories. It is causing a lot of trouble with dental health as well as overweight and obesity. It is an important item for us to pay close attention to.

Melanie: Marsha, people hear the word “sugar” and they hear the word “carbohydrates” and staying away from those because people hear that those are types of sugars. Explain the difference and why not all carbohydrates are considered added sugars.

Marsha: Carbohydrate is the broad term. We’ve got six major categories of nutrients: carbohydrates, protein, fat, vitamins, minerals and water. Carbohydrates are a group of nutrients that are really, really important for us. Sugar is one small part of that big group. Fruits, vegetables, whole grains are all considered carbohydrates. What we want to pay attention to is those simpler sugars: the sugars that are added after the fact. We’ve got natural sugar in food, like in fruit and even in milk. That’s okay. But it’s when we’ve added a lot of added sugar to food, we’re adding calories but we’re not adding nutrition.

Melanie: How does that added sugar contribute to metabolic disease? What happens to it when we eat it?

Marsha: If we eat more sugar than we’re able to burn for energy – when we eat foods they convert into glucose. Sugar also converts into glucose. Then, we should use that glucose for energy. But, if we consume more of it then we’re able to burn for energy, we’re going to store it as fat. Quite often, where we store that fat might be in our abdominal area and that begins to affect our metabolism. It may affect cholesterol levels and some of those other lipids like LDL and triglycerides. In some people it can lead to metabolic illnesses like diabetes.

Melanie: Just in general, when we’re speaking about healthy eating, people are always asking about protein to carbohydrate radio. Based on the new guidelines and your expertise, what do you want people to know about when they see these diets that are very high in protein and low in carbohydrates? What do you want them to know about healthy eating?

Marsha:   I want them to know that they need to eat a variety of foods because every type of food provides us with a different variety of nutrients. One of the things that we do know right now is that half of the population is eating too much protein and too much grain but they are not the right types of grain and protein. We should be eating more whole grains and the protein in our diets should be leaner and maybe even more plant-based. Fifty percent of Americans have one or more chronic diseases which can be linked back to poor diet as well as low physical activity. Three quarters of our population eats a diet that is low in fruits and vegetables. Those fruits and vegetables provide us with so many important nutrients, vitamins, minerals, phytochemicals, and flavonoids--things that have been linked with promoting better health. If we’re not getting our good carbohydrates like fruits and vegetables and whole grains, we’re not getting those nutrients that are going to protect our health now and in the future.

Melanie:   We even hear about addiction to sugar and there are groups around to help you with the sugar addiction. Is that a myth or can you really be addicted to this type of added sugar?

Marsha:   There is research that is indicating that some people seem to show addictive tendencies towards certain foods as far as realizing that they should avoid them but they can’t. They’ve also done some brain scans and shown different parts of the brain light up when certain sugars are consumed. It is an area of research that is very fascinating. If a person is having difficulty, there are several groups that can help. Overeaters Anonymous is one group.

Melanie:   So, along with getting rid of soft drinks and, obviously, candies and sweets and even baked goods, how else can we minimize sugars in the diet? People like orange juice and grapefruit juice and even fruit that is in cans sometimes can have that added sugar. So, what should we do about that?

Marsha:   I think we all need to limit and maybe even eliminate the soft drinks. As far as canned fruits, you can get them canned in their own juice or sometimes canned in water or canned in pear juice. There are several little changes that lead to big results as well. So, even with something like a fruit-filled bar, like a breakfast bar or a cereal bar, maybe having a piece of fruit instead. Instead of having a chocolate bar, maybe have a handful of unsalted almonds or walnuts. If you do like those sugared beverage sodas and juices, maybe try water or even an infused water with your own fresh fruit. They have bottles that they make now that you can put fruit in a tube that’s inside the water bottle, so you can get a nice flavored water and some extra vitamins through that fresh fruit at the same time.

Melanie: Based on these dietary guidelines, and in just the last few minutes, Marsha, give your best advice for sorting this out; where those added sugars are and what you want people to know about healthy eating and sugars.

Marsha:   To keep in mind that a little bit of sugar is going to be okay but it should be a treat. The foods that are highest in sugar: sugared beverages, candies, cakes and cookies and pastries, they should be the exception versus the rule. They should be the treat that happens once in a while. When we think about a healthy diet, we need to make sure that we get all of the nutrients that our body needs to be healthy throughout our entire life. The way we do that is by eating a variety of foods; having fruits, having vegetables, having whole grains, having calcium rich foods whether it’s from a dairy or from a plant-based; and also having our lean protein. If we choose fresher, less processed foods, we will be able to decrease our sugar. Most of this added sugar is added to foods that have been highly processed. So, just getting back to basics as much as you can. Make your own peanut butter and crackers. Get plain yogurt and sweeten it with your own fresh fruit or frozen fruit without added sugar. If you like cereal, get a cereal that does not have added sugar and sweeten that with your own fruit or a small amount of sugar. These are some strategies that you can have a little bit of sweetness but you can take complete control over how much sugar is in your diet. We are what we eat. That adage is just so very, very true. Most chronic diseases that people in the U.S. are suffering from can be linked back to the quality of our diet and the quality of our activity level. It’s just so important that we encourage everybody to eat a healthy diet and focusing on reducing sugar from those foods that it has been added in after the fact.

Melanie: Thank you so much, Marsha. It’s great information. You’re listening to BID Plymouth Wellness Radio and for more information you can go to BIDPlymouth.org. That’s BIDPlymouth.org. This is Melanie Cole. Thanks for listening.
Hosts Melanie Cole, MS

Keeping a Healthy Sinus

Additional Info

Segment Number 3
Audio File beth_israel/1601bi5c.mp3
Doctors Wilson, Lisa
Featured Speaker Lisa Wilson, MD
Guest Bio Dr. Wilson grew up in Pennsylvania and attended college at the University of Pennsylvania where she graduated with a Bachelor of Arts in Biological Basis of Behavior and a Minor in Chemistry. She received her medical degree from New York Medical College in Valhalla, New York. Dr. Wilson then completed her surgical internship at Beth Israel Hospital in New York, New York and her residency in Otolaryngology from the New York Eye and Ear Infirmary. She went on to then study under the guidance of Dr. David Ellis at the University of Toronto in Ontario, Canada, a highly competitive one year fellowship position, one of 43 in North America offered by the American Academy of Facial Plastic and Reconstructive Surgery. Dr. Wilson is double board certified through the American Board of Otolaryngology and American Board of Facial Plastic and Reconstructive surgery. She is on staff at Beth Israel - Plymouth, UMass Memorial Medical Center, Saint Vincent Hospital, and Massachusetts Eye and Ear Infirmary.

Learn more about Dr. Wilson
Transcription Melanie Cole (Host): You’re sneezing, you have a stuffy nose or sinus pressure. Sinus problems can often be prevented with some simple steps for sinus health. My guest today is Dr. Lisa Wilson. She is an ENT and facial plastic and reconstructive surgeon with BID Plymouth. Welcome to the show, Dr. Wilson. Tell us about the sinuses a little. What are they intended to do and how come they get clogged up so easily?

Dr. Lisa Wilson (Guest): Thanks for having me, Melanie. I want to just start off by letting people know about their sinuses and that we actually have multiple sinuses within our head region. Most people point to the ones that are directly in their cheeks and under their eye, but we actually have ones in our forehead which are called the “frontal sinuses.” The ones in our cheeks are the maxillary sinuses. We have the ethmoid sinuses within our nose and then even ones that further back called the “sphenoid sinuses”. Why we need our sinuses is that the lining of them, as well as the lining inside of our nose help with a number of different functions. First and foremost, people probably already know that our nose and our nasal cavities help with our sense of smell. Two, the other very important function is that it helps with respiration. It humidifies the air that we breathe and it traps particles in that way as well as it makes for easier gas exchange when the air finally reaches down into our lungs.

Melanie: At this time of the year, people have colds; there are still people with allergies or asthma, any of these things. What do you tell people, Dr. Wilson, when they come to you and say their sinuses feel so much pressure or their sinuses hurt? What is your first best piece of advice that you tell people all the time?

Dr. Wilson: I think the most important thing is to try to keep the nose clean and clear. As I just mentioned, our nose does a lot of filtering and so is the first line of defense for us in the air that we breathe. There could be bacteria in there; there could be viruses in there; there can be allergens or dust that are aggravating on the tissues inside our nose. What it will cause then, is swelling. That swelling inside the nose will block off the nasal cavities and it makes it difficult for us to breathe and smell and it relates to this pressure that people feel. Oftentimes, something as simple as nasal saline will help to open up the passageways and there are also other medicated nasal sprays that we can talk about as well.

Melanie: Let’s talk about some of these because people hear in the media that they shouldn’t be using certain over the counter medications and nasal sprays because you can become addicted or they could be making your sinuses more congested after using them. Is this a myth?

Dr. Wilson: No, it isn’t. That is absolutely correct. The safest thing to use, like I mentioned, is nasal saline which is just a wash for the nose. There is a spray bottle that people can use or there can be an irrigation which is a low pressure but high volume wash for people that do have chronic sinus issues. People often mistake just using just a nasal spray such as saline and end up inadvertently picking up a nasal decongestant. Of the nasal decongestants, the most common one on the market the name is “oxymetazoline”. Other people know it by its brand name such as Afrin. What this medication does – it’s very powerful – the warning signs are on the box to not use it more than three days because it can cause what we call “rebound congestion”. Even somebody that is just walking around and has no sinus complaints, if they use a nasal decongestant such as Afrin inside the nose, they will feel that they can breathe even better but that is not necessarily physiologically normal. It sets off a cycle where people tend to get addicted to use of the nasal spray because they feel that they can’t breathe without it. I advise my patients when they are going to use a nasal decongestant to do so for a very short period. Say, when they are in the worst days of their cold. They can just get a little bit of air through and they can get on with their day and with their activities.

Melanie: What about antihistamine medications? These are more systemic. You take them orally, for the most part. What are those doing for us? Is that something that you recommend often or not so much?

Dr. Wilson: To be honest, not so much. I believe that antihistamines should be used for patients that actually have allergies. Some people know what they are allergic to based on exposure but others sometimes aren’t 100% sure. There are allergy tests that can be done. The antihistamines themselves could work against some people with chronic sinus problems. If you have an acute sinus infection and you’re using an antihistamine, sometimes it can dry out your nasal secretions too much if that’s the only thing that you are using to treat your infection. It is a good way, in terms of keeping the inflammation down inside your nose to help prevent, if you have documented allergies.

Melanie: When we look at some of the more complimentary type treatments, you mentioned keeping your nose clean. What do you think of nasal lavage or neti pots and those kinds of things? They are not that comfortable but they do a good job.

Dr. Wilson: Absolutely. There is a little bit of a learning curve in terms of using them. My preference is to use a nasal lavage for patients with chronic sinus pressure to try to keep passage ways open and to wash any mucus that is within the sinuses causing that fullness. My preference for bottles is to use one that is a high volume. So, a lot of liquid – probably about 240 milliliters or cc’s--and it’s going to be low pressure, meaning that you control it yourself. Oftentimes, it is a squeeze bottle that patients can use and even if you don’t have a specifically formulated bottle people can do this with just having just a large syringe. Often times the lavage that people use is recommended to be hypertonic, ,meaning that it is a little bit saltier of a solution so that it can draw out the mucus from your sinuses. Tricks that I give my patients in terms of using it is to bend over; to hold the nozzle in one nostril and irrigate it just enough so that you can have the irrigation fluid come out your other nostril. That leaning forward just helps prevent any of that irrigation fluid from going down the back of your throat and swallowing.

Melanie: What about things like humidifiers and air purifiers? Do they help to keep our sinuses from having to filter so much stuff?

Dr. Wilson: Yes, I believe that they do help a number of patients, especially in these winter months, too, as well. The air purifiers help to remove any dust or allergens that are in the room. Oftentimes, dust particles like to stay on things like drapes and bedding and sheets. Often, it is helpful for patients to have that in their bedroom. At the same time, the coolness humidifier in the bedroom at night will help to keep the air nice and moisturized so that our nose and our nasal passages don’t have to work as hard in filtering the air that we breathe in.

Melanie: Dr. Wilson – more myth busting here. People hear that mucus can be created by dairy products that can cause it to thicken up. Do beverages or hydration have anything to do with our sinuses?

Dr. Wilson: Yes, I often recommend to our patients to keep well-hydrated. To drink six to eight glasses of water a day as it helps with a number of other physiologic functions in our body. We want to keep our mucus thin so that it can come out of our nose if we need to blow. Oftentimes, when people have a sinus problem or an infection it isn’t uncommon for patients to find that Mucinex is helpful to thin out those secretions. In terms of dairy, I think that we’re still going to find people in both camps. There are some patients that are very sensitive to dairy and that it causes them to produce increased mucus. Dairy in kids has even been linked with infections, whether it is of the sinuses or the ears. But, it is not something that applies to everybody. I think it is very specific in terms of allergens that one person can be affected more than another. I do not routinely recommend that people cut out dairy completely.

Melanie: Dr. Wilson, if everybody has tried the usual techniques for dealing with their sinus issues when does it come to using steroids or intranasal steroids?

Dr. Wilson: Intranasal steroids is something that we have been using for many, many years now. Recently, it has been available over the counter. Intranasal steroids are wonderful because they do treat inflammation inside the nose. When people have cleared their nose and they are still inflamed, the nasal steroids will help decrease that to help with breathing. A few concerns that we have about steroids is that even though it is something that is safe to use on a long-term basis, there are some application techniques that are important like placing it towards the outside corner of the eye and not pointing the medication at a certain spot. Pointing at a certain area towards the septum, which is the middle partition of the nose, people can cause a lot of problems with bleeding and crusting from over application at that site. It can even progress to something more severe such as a perforation or a hole in the septum. I often recommend to my patients that if they find nasal steroids helpful and useful, it is certainly safe to use them but they should get their nose checked probably once a year by somebody who is really going to evaluate the nose to make sure that we don’t find any of the beginnings of these problems.

Melanie: In just the last few minutes, Dr. Wilson, please give your best advice for keeping healthy sinuses this time of the year and all year round and what you like to tell people every day doing what you do.

Dr. Wilson: I think my best piece of advice would be that if you experience any stuffiness inside your nose or beginnings of pressure is to start on washing your nose out and getting all the allergens out as quickly as possible. What I find is that if people let something fester and brew, it can actually progress to an acute bacterial infection that you may then need antibiotics for. Staying on top of your sinuses, being in tune with your body, knowing that you’re feeling a little bit different, I think, will go a long way.

Melanie: Thank you so much. It’s great information. You’re listening to BID Plymouth Wellness Radio. For more information you can go to BIDPlymouth.org. That’s BIDPlymouth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Top Medical Advancements of 2015

Additional Info

Segment Number c
Audio File allina_health/1601ah5c.mp3
Doctors Bache-Wiig, Ben
Featured Speaker Dr. Ben Bache-Wiig, -President, Abbott Northwestern Hospital
Guest Bio Dr. Ben Bache-Wiig, President of Abbott Northwestern Hospital.

Learn more about Dr. Ben Bache-Wiig
Transcription Melanie Cole (Host): The science of medicine is always improving and evolving and Abbott Northwestern Hospital is often leading the way. My guest today is Dr. Ben Bache-Wiig. He is President of Abbott Northwestern in Minneapolis and he’s here to talk with us about some of the medical advancements that we saw in 2015. Welcome to the show, Dr. Bache-Wiig. Tell us first about immunotherapy cancer treatments and where has this gone? It’s such an exciting field.

Dr. Ben Bache-Wiig (Guest): It is Melanie. What immunotherapy is for cancer is a treatment that activates the patient’s immune system to fight off the cancer. It’s used primarily now in patients who have failed standard treatments and still have evidence of cancer. The drugs are given and they activate the patient’s immune system and we’ve seen some tremendous responses in patients with lung cancer, kidney cancer and melanoma that would have been very difficult to treat in the past.

Melanie: How does it compare to traditional cancer chemotherapy or radiation treatments?

Dr. Bache-Wiig: One of the things is that it doesn’t have some of the side effects that are traditionally involved in those treatments. There can be other side effects but, in general, it’s well tolerated by patients. It can be used in patients who haven’t responded as well to those more standard treatments. We’ve seen some quite lasting responses in cancers that are often very challenging to treat.

Melanie: Will this be more of a first line treatment in the way of maybe cancer vaccines and other immunotherapy treatments?

Dr. Bache-Wiig: In general, with the way cancer research works, we tend to start with new treatments to be sure they are safe in patients who have failed other treatments because we have good treatments and we don’t want to use the experimental ones before we know that they work as well as they should. As therapies prove their benefit though, they tend to move up the line. I think with some of these immunotherapy treatments, we’re already seeing them move into more of a first line role in some clinical situations.

Melanie: Now, we’re going to move on to lung cancer screening. We’ve heard a lot about this in the media, Dr. Bache-Wiig. Tell us a little bit about lung cancer screening, the guidelines and what patients are referred for in the screening.

Dr. Bache-Wiig: This is primarily done for patients who are at higher risk for lung cancer. That primarily is patients with a smoking history or an exposure to chemicals that may increase the risk of lung cancer. In the past, we’ve used chest x-rays as the main screening tool. The challenge with chest x-ray is that often the tumors are of such a size when we find them that they are beyond the place where surgery can be curative. Using a CT scan specially modified to minimize the radiation dose, we can find cancers at a much earlier stage where they are much more amenable to treatment.

Melanie: What’s involved in this screening? If it’s got a lower dose of radiation and it’s pretty easy to do, why isn’t everyone who has ever smoked allowed to get the screening?

Dr. Bache-Wiig: I think one of the challenges has been to prove that we actually make an impact on outcomes in patients with screening tests. Abbott was one of the study sites that really demonstrated the value of this technique and that led Medicare to go ahead and approve its use in patients who are at higher risk for lung cancer. So, smokers now can get this screening and have it be covered. What’s involved is a CT scan that is done on a periodic basis and if there’s anything found, then those findings are followed up with additional testing.

Melanie: Which smokers are allowed to get this screening – or recommended to get it?

Dr. Bache-Wiig: In general, there is a dose relationship between smoking and the risk of cancer. This would generally be patients who had smoked somewhere on average of 10 cigarettes a day or had a more than what we would call a ten-pack a year smoking exposure over their lifetime.

Melanie: Tell us about the new treatment of mechanical thrombectomy for stroke patients. What is this and how does it work?

Dr. Bache-Wiig: With strokes, in the past we really had very limited treatments other than rehabilitation and monitoring. Over the last few years, it has really exploded with the number of new treatments. First, clot dissolving drugs that are given early on in the course of a stroke can open an artery that has been blocked. Now, we’ve added additional treatments for patients who may not respond to the clot busting drugs or have a more major artery plugged where we can go in with a catheter and, using suction, remove a clot and restore circulation to that brain tissue before it suffers permanent damage.

Melanie: That’s fascinating. Is this available at Allina Health?

Dr. Bache-Wiig: It is. At Abbott Northwestern, we have been doing it. One of the absolute keys to being eligible for this kind of treatment is that if someone has stroke symptoms that they get medical attention as quickly as possible. There is a window of time, usually somewhere in the range of three to six hours in which if we apply these treatments, we can see improved recovery. If we are out beyond that, they just don’t have the same benefits. We really encourage people to call 9-1-1 at the first onset of any stroke related symptoms so that they have the maximum opportunity for being treated.

Melanie: It’s true that time is brain when it comes to stoke. That’s a fascinating type of procedure. Now, onto heart flow analysis, what are some of the new techniques for identifying blood flow in the arteries of the heart? People worry about this, Dr. Bache-Wiig as far as their risk of heart attack or impending heart disease. Tell us about heart flow analysis.

Dr. Bache-Wiig: What heart flow analysis does is take the information from another CT scan procedure – CT coronary angiogram which basically saves the patient from the risk of having to have a catheter placed in the heart and, instead, can measure using data from the CT scan how the blood is flowing through the coronary arteries and decide whether a patient needs more invasive testing or can be safely treated with medication to prevent progression of the blockage.

Melanie: Is this hoping to find various heart diseases earlier? Is it available at Allina Health?

Dr. Bache-Wiig: It is. Actually, one of our physicians at the Minneapolis Heart Institute, Dr. John Lesser, was instrumental in developing this technology and we were one of the first places in the world where this technique was available. It does help us to both find heart disease early but also help us make decisions and get patients back functioning without putting them through unnecessarily risky procedures.

Melanie: Sometimes, heart valves go bad in the heart. Mitral heart valve replacement. Tell us a little about what is involved in a valve replacement.

Dr. Bache-Wiig: As you say, as the heart ages or is affected by other processes, there can be problems with the heart valve. They can either become narrowed or they can start to leak and when that happens, it can cause significant problems with shortness of breath, heart failure and other serious medical issues. We’ve had heart valve replacement – Minnesota has always been a leader in heart valve treatment. In this last year, we were the first in the world to use a minimally invasive technique to replacement the mitral valve which is the valve between the top and bottom chamber on the left side of the heart. Instead of having a major open sternotomy and open heart surgery in the traditional way, this is done through a small incision in the chest and then, a catheter that puts the valve in place. It’s a big advance and what it does, I think, is make this treatment available to patients who might have been too ill to undergo open surgery and they end up with a much faster recovery and get back to functioning more quickly.

Melanie: Dr. Bache-Wiig, tell us about the exoskeleton for spinal cord injuries and the Courage Kenny Rehab providing this new treatment. It is an absolutely amazing treatment. Tell us about it.

Dr. Bache-Wiig: It really is. This is a treatment that really borrows from the world of robotics and has created these devices which a patient puts on supporting their lower back and legs and then, using the controls coupled with their own nervous system are able to get back to ambulating or being able to walk. It’s been really life changing for our patients with spinal cord injuries who are often confined to wheel chairs to be able to actually get up and move again and get the benefits from ambulation and being upright.

Melanie: Now tell us, in just the last few minutes, what are some of the new medical studies and advancements that you see coming to us in 2016?

Dr. Bache-Wiig: We’re really fortunate here at Abbott Northwestern to have a culture of innovation that’s an ongoing thing that has been supported by our Abbott Northwestern Foundation. I see a lot of progress being made in the areas of heart disease and cancer and in neurology as well as rehabilitation. I see those things coming together. Some of them are new devices and drugs. Some of them are approaches to making care more coordinated and helping patients flow better through the system. It’s all targeted to getting people back on a path to better health.

Melanie: Thank you so much for being with us. What great information, Dr. Ben Bache-Wiig, President of Abbott Northwestern in Minneapolis. 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.

[END OF RECORDING]
Hosts Melanie Cole, MS

What Do The New Dietary Guidelines Mean To Me?

Additional Info

Segment Number 2
Audio File allina_health/1601ah5b.mp3
Doctors Brommerich, Lauren
Featured Speaker Lauren Brommerich, RD, LD -Clinical Dietitian
Guest Bio Lauren Brommerich is a clinical dietitian at United Hospital in St. Paul has been a registered dietitian for about a year and half. She enjoys working as a clinical dietitian in a hospital because it allows her to reach people who may not have access to the nutrition education and counseling they need. Every day, she educates and counsels patients and their families on how to live a healthier lifestyle by making simple changes in their diet. She loves being able to work as part of a team with dietitians, nurses, doctors, pharmacists and other staff on a daily basis.
Transcription Melanie Cole (Host): The USDA and Department of Health and Human Services recently updated the dietary guidelines – the rules we should follow in our approach to food. My guest today is Lauren Brommerich. She is a registered dietician with United Hospital. Welcome to the show, Lauren. Everybody has been hearing about this in the media. Tell us, what are some of the major changes in the new dietary guidelines?

Lauren Brommerich (Guest): The new dietary guidelines have a few changes particularly focusing on added sugars, sodium and cholesterol. They changed a few of the percent recommendations. For instance, sugar should be less than 10% of your daily caloric intake. Sodium intake should be less than 2300 milligrams and less than 10% of your calories should be coming from saturated fats. Also, they’re now showing that dietary cholesterol is no longer considered a nutrient of concern.

Melanie: Well that’s a huge change right there and we’ll get into that one just a little bit more but how often does the USDA update these guidelines? So, as a result, people are taking these rules and now applying them.

Lauren: Sure. They change them every five years. So, technically these are late. These new ones are the 2015-2020 dietary guidelines.

Melanie: Do you think that these guidelines are important for us to follow or do you think that they are common sense kinds of rules that we should have been following all along anyway?

Lauren: I think it is important to take into account these guidelines just because they are focused on science-based, evidence-based research. I think that listening to research is important, but some of it might be common sense as well.

Melanie: I’d like to talk about what you mentioned that the dietary cholesterol is no longer a big nutrient of concern as we look at inflammatory processes and that cholesterol may not be the contributor that we always thought that it was. Tell us what this means for people and what they should be looking for when they are looking at labels.

Lauren: You’re right. Cholesterol isn’t a nutrient of concern anymore. They are actually finding that saturated fats are what causes increased levels of cholesterol in the blood. When looking at labels, try to focus on foods that are lower in saturated fats and not necessarily focus on the cholesterol levels. For example, now eggs are considered okay so you can incorporate eggs into a healthy, balanced diet. But you might want to limit meats with saturated fats like sausages or bacon.

Melanie: So, even those more processed foods and that’s sort of what it comes down to Lauren, doesn’t it? Tell us a little bit more about the sodium and added sugar. Some of these just scream processed foods as compared to whole foods.

Lauren: Exactly. In general, if you are eating less processed foods, you are likely eating less sodium, less added sugar and probably less saturated fat as well.

Melanie: What do you look for on the label for added sugars and sodium? You mentioned 2300 milligrams a day total for sodium. That’s pretty easily read on a label – how many milligrams a particular product has. What about added sugars? What do you want the listeners to know?

Lauren: For added sugar, one of the main things to avoid would be soda or pop. That is one of the biggest things that has added sugar. You can also avoid things like candy bars that have added sugar. If you’re looking at a label, you can look for sugar in the ingredients list. Pretty much anything that is a dessert or anything processed will likely have added sugar as well.

Melanie: What about refined sugars and refined things like flours and pasta and things that are not whole? Does it mention any of those?

Lauren: Just briefly looking at the dietary guidelines, they did recommend incorporating at least half of your grain by making them whole grains. To find a whole grain, you can look at the label on, let’s say, a piece of bread. If you look at the label and it says “whole wheat flour,” that would be a whole grain. On the opposite scale of that, if it says refined white flour, that would be a refined grain. Try to incorporate at least half of your grains, make them whole grain. That could be whole wheat bread, whole wheat pasta, oatmeal, barley. Those are just some examples of whole grains.

Melanie: It’s true that people don’t always know what that exactly means when you hear whole grains and where we are finding those kinds of things. Then, they hear about products like quinoa and bulgur – these things that they don’t know what to do with. What do you tell them, Lauren, when they say, “What do I even do with this stuff?”

Lauren: Well, I try to figure out what kind of grains they tend to lean towards. If they haven’t had quinoa before, I would tell them how to use it in a dish. But, usually, I say, “If a dish has rice in it you can incorporate quinoa or barley in place of that rice.” That’s how I usually explain how to incorporate these new whole grains that people may not have used before.

Melanie: What would you tell people about taking these new guidelines and making some of those changes? Some of them are hard to make.

Lauren: They are. The first thing I tell people is to try to focus on one small goal to begin with. For example, if you drink two Cokes a day--or some sort of soda every day – try to dwindle that down to maybe half. Maybe just try to do one pop a day. Then, if you reach that goal you can try to eliminate it completely. Start small, focus on one goal and then when you are finished with that goal, you can focus on a new one.

Melanie: The website ChooseMyPlate.gov, do you recommend this to some of your listeners? It does help put this out a little bit and explain some of it.

Lauren: Yes, I do recommend that website a lot. It has really great resources. They have information on how to incorporate whole grains. It shows you a plate which shows you how much of each food you should be getting. It is a general way to figure out how big of portions you should be getting for each food group.

Melanie: Lauren, calories aren’t spoken about much in the dietary guidelines. Why is that?

Lauren: They’re not. I think they avoided the calories and specific portion sizes for people because they wanted to give a general guideline for everybody and then allow different families and different individuals to figure out what portion size works for them because one portion size or one calorie level may work for one person but it might now work for somebody else.

Melanie: Now onto proteins. With so many diets out there being protein strong and limiting certain types of carbohydrates, what do you tell people when they come to you and they say, “I’d like to try a really heavy protein diet”? What do the new guidelines speak about protein?

Lauren: For protein, what they are recommending is to focus on lean protein. From what I read, they are not giving you a certain amount, but they are focusing on the type. A lean protein would be a chicken breast or a turkey breast or a lean percent ground beef. What I tell people is to try to focus on the type of proteins they are consuming and try to choose the leanest protein that they can.

Melanie: In just the last few minutes, give your best advice for hearing about these new guidelines and what they mean for people and what you really want people to know about them.

Lauren: I think my best advice is to consume everything in moderation. When you’re looking at these guidelines, you notice that they are not saying don’t consume any sodium, don’t consume any sugar. They are telling you less than a certain number but if you eat everything in moderation and you’re cutting out a lot of processed food, it’s very easy to meet these recommendations. If you need to make changes, do it slowly. Incorporate one of the recommendations at a time and just try to eat a well-balanced diet that incorporates each of the food groups.

Melanie: That’s great advice. Thank you so much for clearing all that up for us today, Lauren. 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

Managing Your Diabetes

Additional Info

Segment Number 2
Audio File beth_israel/1601bi5b.mp3
Doctors Clark, Nathaniel
Featured Speaker Nathaniel Clark, MD
Guest Bio Nathaniel Clark, MD, MS, RD specialty is Endocrinology at Beth Israel Deaconess Specialty Group.

Learn more about Nathaniel Clark, MD.
Transcription Dr. Melanie Cole (Host): Are you at risk or have you been diagnosed with diabetes? Patients with diabetes at BID Plymouth are cared for used a patient-centered, team-based approach based on national standards. My guest today is Dr. Nathaniel Clark. He’s an endocrinologist with Beth Israel Deaconess Hospital Plymouth. Welcome to the show, Dr. Clark. Tell us what’s going on in the world of diabetes today. We seem to be hearing more and more about it with the obesity epidemic that we’re seeing in this country. What are you seeing as a diabetes specialist?

Dr. Nathaniel Clark (Guest): I think what I’m seeing mostly is just what you said: that there is clearly an increase over time in terms of the number of patients being diagnosed. We don’t know that that’s really a combination of the number of people that are getting it but also increased recognition of those that already have it. I’m also seeing that it’s very important for patients to be referred appropriately if under the care of their primary care provider, they are not achieving the goals they need to achieve to reduce the risk of complications of diabetes.

Melanie: So then, let’s start with the risks of complications from diabetes, the risk factors for diabetes because I think that’s something that people need to hear as many times as we need to tell them because there are certain things we can control .There are certain things we can’t, but certain things that we can. So let’s talk about those controllable risk factors for type-2 diabetes.

Dr. Clark: I think the most important risk factor that we can control for type-2 diabetes has to do with weight. It’s clear that in those that are overweight and certainly those that are obese, that there is a dramatic increase in the risk of type-2 diabetes. That is really been the only major factor which is controllable. Those that we can’t control that are important to recognize is that as we get older, our risk increases and certainly in those that have a family history of type-2 diabetes or in women who had gestational diabetes during a pregnancy, or those that are in specified risk categories that are shown to have higher risk of type-2 diabetes. All of those together sort of constitute what the risk is.

Melanie: We hear more and more about checking your blood sugar levels. You even see on commercials different products that are advertising being able to keep track of your blood sugar. What do you want people to know about managing your diabetes and keeping track of these things, Dr. Clark?

Dr. Clark: I think for those that have been diagnosed, clearly the greatest advance has been the ability for patients to check their own blood glucose or blood sugar levels and to know what the goals are and to make sure that whatever treatment their on, whether that’s diet and exercise alone or that plus a medication that their goals are being achieved. So, we ask patients to check their blood sugars. It varies the number of times per day depending on what medication they are on or where they are in regards to their diabetes. That, really, is critical for the patient to know whether they’re doing well and then, in turn, for their provider to know whether they are doing well.

Melanie: How often do you want people to have the A1C test?

Dr. Clark: The A1C test should be done according to the guidelines of the American Diabetes Association, and that is every six months in those that are at goal and nothing has changed in regard to their treatment. Generally, every three months in those where they are not at goal and they are trying to get to goal or there may be a change. Functionally, I find with my patients that I want them to be checked every three months because even those that one might not suspect that anything had changed, I do find that patients that are doing quite well. If I didn’t check any more frequently than every six months, I may find that something has changed and I wish that three months before that, I had known that and could have made an intervention.

Melanie: Dr. Clark, how important is blood pressure in the management of diabetes as these things together contribute to the risk of heart disease? How important is it to manage your blood pressure?

Dr. Clark: I think you’ve asked several different questions. I don’t know that there’s any importance to checking blood pressure in regard to managing the diabetes but it is critical to manage the blood pressure in terms of reducing one of the major risk factors of diabetes being heart disease. Studies have shown that the management of blood pressure is perhaps even more important than the measurement of blood sugar in regard to the macrovascular or large vessel complications of diabetes being heart disease and stroke. So, although managing your cholesterol and managing your blood pressure are not technically important in terms of managing the diabetes, they are critical important in terms of the complete treatment of the patient with diabetes.

Melanie: Now, speaking of treatments and learning to live with it, trying to help control those blood sugars, what do you tell people about diet and exercise and the most important information that you give them about their everyday activities that can help them manage it and give them a higher quality of life?

Dr. Clark: I think that your question has given most of the answer to the question. I think diet and exercise is critical in all patients. Unfortunately, I think the medical community jumps too quickly over lifestyle modification and moves into the medications but all of the medications work much better in a patient who is doing their best to maintain their weight and to be as physically active as possible. In terms of what I tell patients, what you’ve said is really the critical factor and that is physical activity is very, very important and that does not only mean going to the gym or engaging in regular exercise. It can also mean walking, so parking further away from a building, walking upstairs instead of taking the elevator or the escalator and being active in your life can be extremely important in terms of weight maintenance.

Melanie: Are there some foods that you like them to stay away from when they are trying to manage diabetes?

Dr. Clark: No. I would say the issue with diabetes management is you want the patient to do as well as they can with managing their blood sugars but, at the same time, to learn to live their life and to have a good life while managing their diabetes well. So, I tell patients there really is no food that if they really want to eat that food, that they need to give that food up. However, the portion of that food or how often that food is what may need to change. I find that if you take an approach of saying to a patient, “You, unfortunately can never have this again because you have diabetes,” then that really detracts from the long-term management in that patient. They begin to think of diabetes as a punishment, a prison sentence, and they resent it. But, if you tell them, “Look, you’re going to celebrate birthdays. You’re going to celebrate holidays. You’re going to go out for a special dinner and as long as those are occasional events, there are all those foods that you enjoy eating now that you can continue to eat but you need to be much more careful of portion size and how often you have them.”

Melanie: What do you tell your patients about the importance of getting a complete foot exam or an eye exam, dental exams and how often they should be doing these every year?

Dr. Clark: All of those are extremely important in terms of the complete care of the patient with diabetes. Foot exams fall in two categories. One, I examine the feet at least twice a year in people who have low risk feet in terms of problems and at every visit in somebody who has a high risk foot. Also important to know is that I would say 90% of the foot exam can be done by the patient by simply looking at the bottoms of their feet and looking for any changes, any sores, any redness, etc. If someone can’t see the bottoms of their feet, they can use a hand mirror or they can find a friend or family member to look at the bottoms of their feet periodically. We could dramatically decrease the risk of foot problems with diabetes if patients would simply look at the bottoms of their feet regularly. Dental exams, generally, are recommended by dentists to be done every six months and I think that’s a very good piece of advice. Eye exams, according to current guidelines, should be done once a year and should be done by an eye care professional who dilates the eye in order to see into the back of the eye to look for any changes in the blood vessels. So, whether that’s an optometrist or whether it’s an ophthalmologist is not as important than it is that it is being done by an eye care professional. It’s important to note that this is looking inside the eye to look for changes. It is not a vision exam. When someone says, “Oh, my primary care checks my eyes and my vision is fine,” that’s a separate category in terms of eye issues.

Melanie: In just the last minute, please, Dr. Clark, and its great information and so important, please give your best advice for those living with diabetes in managing it and why they should come to BID Plymouth for their care.

Dr. Clark: Well, I think that the most important thing, which I’ve already said, is to find a way for the patient to live the life that they want to live, to enjoy their life but, at the same time to incorporate good diabetes care into their life; to not have it be a burden, to not have it be a limitation, a disability, but to learn how to manage their diabetes and yet still enjoy those things they enjoy. The reason to come, in my mind is, that’s the approach that I use. I run a very upbeat, positive practice. In general, I think most patients enjoy coming in. I’m not judgmental. I don’t yell at patients because I feel that it’s their diabetes. I’m just there to help them and to support them. More important than the medical care of diabetes that I offer is really the support, the coaching, the encouragement and we do that by showing patients how much better they can do with the medication or with lifestyle change and to constantly keep them on track and to support them in doing the best they can.

Melanie: Thank you so much for being with us today. You’re listening to BID Plymouth Wellness Radio. For more information you can go to BIDplymouth.org. That’s BIDplymouth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Breast Health and The Latest Information for Women

Additional Info

Segment Number 1
Audio File beth_israel/1601bi5a.mp3
Doctors Tito, Elizabeth P.
Featured Speaker Elizabeth P. Tito, MD
Guest Bio Elizabeth P. Tito, MD specialty is surgery and breast cancer.

Learn more about Elizabeth P. Tito, MD
Transcription Dr. Melanie Cole (Host): Every year over 200,000 women in the U.S. are diagnosed with breast cancer. When breast cancer is detected early, before it has spread, it’s much easier to treat and women have a much better chance of surviving it. My guest today is Dr. Lisa Tito. She’s the medical director for the Breast Cancer Program at BID Plymouth. Welcome to the show, Dr. Tito. So, tell us a little bit about breast health in women and what do you tell women every single day as your most important bits of information?

Dr. List Tito (Guest): Well, one of the first things I tell people is about their risk of developing breast because there is a lot of misinformation out in the community and I want everyone to know that there are three major risk factors for getting breast cancer. They are: Are you a woman? Do you have breasts? And, are you getting older? With those three risk factors, it gives you a 1 in 8 chance of having breast cancer over your lifetime. So, it essentially means all of us. What do we do? The most important thing a woman can do is to get her mammograms. Now, I know there’s a lot of confusion about who should get mammograms and how often because there’s so many different recommendations coming out. I do know it is quite confusing.

Melanie: So, what do you tell women about getting mammograms? When should they get their first one, their baseline? And then, how often after that?

Dr. Tito: Well, there’s a lot of different recommendations. The most recent one to come out is from the American Cancer Society. I think they are very reasonable recommendations. Their recommendations are that women from the ages of 40-44 have the choice to start annual mammograms starting at the age of 40. However, you also have the choice to wait. I think that’s somewhat reasonable although I have to say that I err on the side of recommending mammograms as opposed to waiting but people do have a choice. I’m in full agreement that women age 45-54 definitely need to get their mammograms every year. The reason for this is breast cancers grow differently in women who are younger than women who are older. Younger women tend to have breast cancers that grow quicker and when they grow quicker they tend to get bad quicker. So, if we find them a year or two earlier, we can change the course of the disease. Treatment options are different; surgical options are different and we decrease death from breast cancer from finding it earlier. So, it’s critical for those years to get them every year. We also know that as women age, their breast cancers change as well. When women are older, breast cancers do to tend to grow a little bit slower and they don’t get as aggressive when they get bigger. So, in women who are older, it might be safe to do it every two years because if we wait two years and miss it for a year, it’s still at essentially the same size and treatment options and you’re unlikely to die because of the delay in finding that breast cancer. All of those recommendations are for the “average risk woman”. The, next question is, how do you tell if you’re average risk or not or average risk?

Melanie: So, tell us a little bit about the risk factors and if you have dense breasts, are there different recommendations or is it the same? Do you recommend women with dense breasts get ultrasound? What do we need to know?

Dr. Tito: First of all, the risks, I think that you’re at average risk if you don’t have a very strong family history, you haven’t had biopsies which show abnormal cells in your breasts – things called atypia--and if you’re not having very dense breast tissue. Dense breast tissue essentially means that your breasts are young and healthy. Young and healthy breasts are very white on mammograms. The problem with very white mammograms is, breast cancers show up as white. So, we are trying to find a white breast cancer on a white background which makes it much more difficult. That said, the majority of women from 40-50 are going to have dense breast mammograms because that’s normal. You’re supposed to have a healthy amount of breast tissue on your breasts before going through menopause. After menopause, that dense, healthy breast tissue slowly gets replaced by fat and fat is black on mammograms. So, now it’s much easier to find a white cancer on a black background. The majority of breast cancers do occur after menopause. About 70% of breast cancers happen after you go through menopause. So, as your risk for breast cancer goes up, the ability to find the breast cancer on your mammogram is much easier. That’s a good thing. The question is, what do we do for women with dense breasts in their 40’s? The answer that I’m most comfortable with is that we continue screening with mammograms for the majority of those women if you are at average risk. However, there is a small group of women who have a higher chance of developing breast cancer over their lifetime and those women should be offered additional screening either with MRI or with ultrasound. The way we find those women is at our institution, we have a risk assessment profile that we run on everyone who comes to get a screening mammogram. When you fill out this questionnaire, it generates a percentage or a number that tells you what is your lifetime risk of developing breast cancer. If that lifetime risk is greater than 20%, we then pull you in and then talk about additional screening. This is in women who have dense breasts or even in women who don’t have dense breasts. We talk about the pros and cons about adding different screening modalities.

Melanie: Women go through so many changes and when we are giving ourselves self-exams, we feel different lumps and bumps. What do you tell women, Dr. Tito, about self-exams, being their own best advocate and not to fear everything they feel?

Dr. Tito: It’s very hard to do a self-breast exam because breasts are very lumpy, bumpy and they are supposed to be. It’s hard even for your primary care physician and its hard even for me and I do breast exams every single day of my practice and it’s still hard. We do not expect you to be the expert of finding the breast cancer in your breast. Sometimes it can be overwhelming because there’s so many lumps and bumps. My recommendations to my patients are two things. First of all, if it’s confusing and you really can’t get it and you’re really terrified of doing your breast exams and it’s making your life worse, don’t do them. Go and get your breast exam once a year by your physician. However, if you do want to do breast exams I approach it a little bit differently. What I tell my patients to do is, “Listen, your breasts are lumpy, bumpy and that’s normal. I just did your breast exam and these lumps and bumps that we are feeling right now are part of your normal breast tissue. So, what I want you to do is go home and learn your normal breast exam. These lumps are yours and claim them as yours.” That way, you help your primary care physician when they do a breast exam and say “What’s that lump in this upper, outer quadrant of your breast?” And you can say, “You know what, that’s my lumps. It’s been like that for three years. Nothing has changes. Those are mine. Leave me alone.” Or, she might feel a lump and you say, “You know what, I haven’t noticed that as one of my normal lumps.” That can be very powerful and helpful when evaluating a very difficult breast exam.

Melanie: Now, women are hearing, Dr. Tito, about the new digital 3-D mammography called tomosynthesis. What do you want them to know about that? Are they requesting this from you?

Dr. Tito: Yes. I’m hearing a lot of questions from patients about tomosynthesis, or 3-D mammograms. It is one of those unique new technologies that I do think is somewhat better. For one reason, especially. One of the down things of having mammograms, especially starting in your 40’s, is we see so many normal things in your breast that need to be worked up. If we see something on a mammogram, we’re not 100% sure that it’s not a cancer so we have to go through additional views and sometimes biopsies and sometimes even operations. We don’t like to do that if we don’t have to. One of the advantages of this new technique is it has a better ability to look at something in your breast and say, “It’s fine.” We can leave it alone. It’s a modality that finds more cancers than regular mammograms and has the ability to say, “We can do less biopsies because that looks normal.” So, that combination of increased sensitivity and what we call “increased specificity,” meaning it can tell you its normal without a biopsy, is a wonderful combination. Now, does everyone have to go out and find a place with 3-D tomosynthesis? I don’t think that’s really necessary quite yet but if you have access to it, it is a nice addition. The group of people that probably benefits the most are those that have difficult to read mammograms because it’s a slightly better way to see through that difficult tissue.

Melanie: In just the last few minutes, Dr. Tito, give women your best advice about this confusing world of breast health and breast cancer and why they shouldn’t be afraid and why they should come to Beth Israel Deaconess at Plymouth for their care.

Dr. Tito: Well, breast cancer is scary for women because it is the number one cancer that we all get and everyone knows someone who’s had breast cancer and it does affect people who are younger, so it is a scary disease to think about. What I want people to know is that we are winning. It is amazing the progress that we’ve made with the treatment of breast cancer. Surgical technique has improved phenomenally. The way I do surgery now is completely different than the way I was trained to do surgery in residency. I use these newer oncoplastic techniques and I’ve been doing this for many, many years with these newer techniques and they are better. So, I can take breast cancer out of women’s breasts and make their breasts look even better than when they went in for the surgery. We’ve also got a lot more medications and drugs that are targeted towards specific breast cancer characteristics. We’ve also gotten much smarter at determining which cancers need chemotherapy and which cancers don’t need chemotherapy and we’re doing a much better at individualizing cancer treatment. At Beth Israel Deaconess at Plymouth, we have a very comprehensive, multi-disciplinary team that works very well together to treat each individual’s cancer as each individual patient’s cancer needs to be treated. We’re a very tightknit team. If you come to our place, you’ll get cutting edge technology. We’re up on all the data and you’ll get a very cohesive, family-oriented, wonderful experience.

Melanie: Thank you so much. It is great information. So, beautifully put, Dr. Tito. Thank you for being with us today. You’re listening to BID Plymouth Wellness Radio. For more information, you can go to BIDplymouth.org. That’s BIDplymouth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

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