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Why isn't the Affordable Care Act producing the lower, affordable premiums which were promised?
Additional Info
- Segment Number 2
- Audio File health_radio/1543ml5b.mp3
- Featured Speaker Marianne Eterno, President of Government Relations for GTL
-
Guest Bio
Marianne Eterno began her insurance career in 1987 at the former Golden Rule Insurance Company in Indianapolis, Indiana, and moved to Chicago in 1992, when she accepted a position with Celtic Insurance Company.
Marianne came to Guarantee Trust Life Insurance Company (GTL) in 1996, as a compliance and government relations consultant, and formally joined the company in 1997. As Assistant Vice President of Government Relations, she represents GTL in both the state and federal arenas, drives coalition development for the company, and serves as the company's media and public relations spokesperson.
In addition to sitting on committees for every major insurance trade association, Marianne serves on the Board of Directors of RetireSafe, a 400,000 member grassroots advocacy organization for senior citizens and as the Executive Director for the Council for Affordable Health Insurance. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 3
- Audio File virginia_health/1543vh5c.mp3
- Doctors Lather, Leigh Ann
- Featured Speaker Dr. Leigh Ann Lather
-
Guest Bio
Dr. Leigh Ann Lather is board-certified in pediatrics and specializes in pediatric orthopedics, including bone fractures.
Learn more about Dr. Leigh Ann Lather
Learn more about UVA Orthopedics -
Transcription
Melanie Cole (Host): When children are active, injuries are always almost possible, including bone fractures. What are some of the most common fractures and what steps can parents and kids take to reduce this risk? My guest today is Dr. Leigh Ann Lather. She's board certified in pediatrics and specializes in pediatric orthopedics, including bone fractures. Welcome to the show, Dr. Lather. Tell us a little bit about the most common bone fracture that you see in kids.
Dr. Leigh Ann Lather (Host): Yes. Thank you. If you don't mind, first, if I can clarify that bone fractures are broken bones. It's amazing how many times we tell folks they have a fracture and they ask, "So, is it broken?" Yes, it's broken.
Melanie: Good point.
Dr. Lather: You can have small breaks or pretty bad breaks that might need surgery. They all hurt but the most common ones that we see in kids are usually involving the arms and the legs. So, with arms, we see a lot of elbow fractures, forearms, wrists and fingers, and then, the legs, knee, ankles and the shin bone and some femurs--the thigh bone.
Melanie: So then, tell us a little bit about what causes these injuries. If we’re talking, forearm and thigh area, what will generally predispose a child to having these kinds of injuries?
Dr. Lather: Well, I think there are a lot of things that parents can do to reduce their children’s’ risk of fractures. I like to think of it as a three-pronged attack: good nutrition, plenty of exercise and god safety--avoiding unnecessary risks. So, as far nutrition goes kid s are growing fast and you want them to grow long strong that are more resistant to injury, then you need to make sure they are getting plenty of calcium and vitamin D every single day. Then, with exercise, kids should get at least 30 or 60 minutes of exercise a day Exercise build stronger bones. Our muscles are attached to our bones and as the muscles pull on the bone, the bone reacts by building more, stronger bone. So, exercise is also very important. Then, for the safety piece and avoiding unnecessary risks, kids are going to play and they are going to fall down. They are going to get injured. There are some things that we know are high risk. As far as different age groups go, toddlers tend to fall and one injury we see commonly that people are unaware of is foot entrapment on a slide. So, if you’re riding down a slide with your small child on your lap, please make sure to keep those feet tucked in. Elementary-aged kids turn to get hurt on the play ground. Playgrounds are great but the monkey bars are what cause most our arm injuries, especially about the elbow. So, if you’re at a playground with your kid and you’re on the monkey bars, consider just standing underneath them in case they fall .It's a long fall and they tend to land on the arm. Then, with older kids, we see mostly sports injuries--sports related injuries. So, I think it's important to avoid early specialization in one sport where we turn to see overuse injuries and avoid playing in multiple teams in one season and continue to cross-train around all different kinds of sports and activities. Then, the last high risk thing I should probably mention is trampolines and trampoline parks. Trampolines are great. They are great fun and exercise but we see most of the injuries in situations where there's more than one bouncer at a time on the trampoline. Usually, it's the smaller kids that get hurt.
Melanie: I'm sure that usually is. That's such good advice about risk assessment and where those injuries happen. Now, let's start with some sports injuries because parents tend to think, “Well, these kids are wearing pads. They’ve got helmets on. The coach knows what they are doing. Especially in contact sports, or even in lateral movement sports, where, you know, just one little movement. So, you spoke about sports specific training, overuse injuries, overtraining, but were broken bones are concerned, does that equipment that they are using protect them or is that pretty much a myth for parents?
Dr. Lather: I think there is some equipment that is protective. Certainly, the helmet is important for football and then, for skiing and sports were you’re riding a motorized vehicle, it's very important to wear the protective equipment but it doesn't prevent all bone fractures. If you get hit hard, you’re going to get hurt. So, sometimes it will tend to give kids an inflated sense of protection and they are likely to hit each other harder on the football field because they think they are protected. They tend to have that Superman complex anyway, where they feel like they will never get hurt.
Melanie: Yes, they do. They certainly do. Now, when we are talking abbot bone fractures and broken bones, if a parent has a child with a broken bone, you call 911 right away. We've heard stories of bones sticking out and all of these things with kids. What do you do for them? What's the first line of defense when you know there is a broken bone and then, what are the risks that a child is going to have some sort of aftereffects from it?
Dr. Lather: Right. Well, I think the first thing to do when your child gets hurt is to take a deep breath. Yes, sometimes there are bad broken bones, where it's obviously an emergency but most injuries not that bad, fortunately. So, the best thing to do immediately is to have the child rest that body part. Don't use it; don't walk on it. You can apply ice. You can wrap it for compression to decrease swelling and you can elevate that body part higher than heart. The sooner you do these things, the better off they are going to be. It makes a huge difference in healing if you immediately respond that way.
Melanie: So then, what do you do? You set that bone back. You get it ready because kids’ bones are in ossification and they’re growing. Is this something that can just takes time and it will heal once you've set it?
Dr. Lather: Yes. I think it's really important when your kid gets hurt to look at the injury. If there is any deformity; if there are cuts in the skin; if there's exposed bones; if the hand or foot feel cold distal to the injury, that child needs to go to an emergency department. That's truly an urgent or emergent situation. But, if none of those things are the case, make a child comfortable, use the ice, give them ibuprofen, wrap it, elevate it and you really don't need to pay for urgent or emergent care. If you think they need pre-medication above and beyond Ibuprofen or Tylenol, then you may need to seek care more urgently so that you can get good pain medicine. If that’s not the case, you really can keep your child comfortable and call your regular doctor’s office during office hours, tell them exactly what happened. Tell them you suspect a broken bone, even if it's not badly broken and they may send you directly to an imaging center or you can ask for a referral to an orthopedics office where you are likely to get the most efficient care.
Melanie: One thing I want to make sure to mention, Dr. Lather, is so many of these kids are using skateboards and scooters and things and they fall, and, as you mentioned, forearms and wrists, what can we do in those situations as parents, to say, “Let’s reduce that risk,” because they flip over these things all the time.
Dr. Lather: I know and I think that's just going to happen and a certain number of injuries are just going to happen when you let tour kids be active. It's important to let them be kids. They can wear elbow guards and wrist guards but sometimes they are going to get injured anyway and, you know, we are fortunate here at UVA that we have pediatrics orthopedic specialists and sports specialists. Kids have unique types of injuries. They may involve the growth plates and so, I think it is lucky that we can take our kids to place with knowledgeable, specialized care. Kids often need half the time in a cast than an adult would need and they are much less likely to need surgery. So, if you go to a pediatric orthopedist, I think you are going to get the most appropriate advice as far as treatment needed, whether it’s a splint, brace, cast or even surgery. You’re going to get the best advice about return to play for sports. Sometimes, if you go to a doctor who doesn't see a lot of trauma, you may be held out too long or sent back into you sport too soon before you’re really healed.
Melanie: In just the last minute or so, why should families come to UVA orthopedics to get treatment for children sports injuries?
Dr. Lather: I think for all the reasons that I just mentioned, it's good to go to a place where you’re going to get specialized care. We have people in the office all day, every day. We can fit people in on an urgent basis if they have injuries and we've got a specialized team of staff and nurses that treat kids all the time. So, it's like going to your pediatrician’s office where they know how to deal with children of all ages and talk to kids of all ages. It's just that we happen to do all orthopedics but it is a pediatric office. It's set up to make it easier for kids with televisions to distract them while they are getting their casts and colorful casts and waterproof casts. Then, we have physicians in the office who are there all the time. We also have two surgeons who can respond if an injury needs that kind of care.
Melanie: Thank you so much. It's great information. You’re listening to UVA Health Systems Radio. For more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 2
- Audio File virginia_health/1543vh5b.mp3
- Doctors Vollmer, Dennis
- Featured Speaker Dennis Vollmer, MD
-
Guest Bio
Dr. Dennis Vollmer is a board-certified neurosurgeon who specializes in spinal surgery.
Learn more about Dr. Dennis Vollmer
Learn more about UVA Neurosciences Center -
Transcription
Melanie Cole (Host): Spinal cord injuries often profoundly affect a patient's life. What treatment options are available for these very serious injuries? My guest today is Dr. Dennis Vollmer. He's a board certified neurosurgeon who specializes in spinal surgery. Welcome to the show, Dr. Vollmer. First, tell us, what are some of the most common causes of spinal cord injuries?
Dr. Dennis Vollmer (Guest): Well, in general, the most common cause of spinal cord injury is motor vehicle accidents. But, in certain age groups, particularly the elderly, falls then become a very common cause. Less common things that people need to at least be aware of are injury mechanisms like diving into shallow water and also certain athletic events carry some risk of spinal injury. Things like skiing and some competitive sports, one needs to be coached in the proper techniques to avoid these risks.
Melanie: So, what can people do to avoid those risks? If you're going to go skiing, would a helmet keep you from getting a spinal cord injury? Does a seatbelt help in a car? Tell us about any way that we can, that would give people a little bit of prevention advice.
Dr. Vollmer: Well, you know, some injuries are just not entirely preventable but certainly safe defensive driving practices are a good place to start in the car, wearing your seatbelt, making sure your car is in good operating condition so that the tires have adequate treads. All of these kinds of things can reduce your likelihood in being involved in a serious accident where you can sustain a spinal cord injury. Now, when it comes to falls, that's a very common area where simple adjustments in how one lives their life can reduce their risk. In the elderly, often falls are caused by environmental hazards: loose rugs, slippery surfaces, poor shoes, and also things like impaired vision. So, making sure your vision care is up to date so you can see the hazards. Poor lighting is another issue. So, there are many things that elderly folks can do to reduce their own fall risk and if there are questions or they've fallen before, they should really get with their physician to make an assessment of how this could be prevented.
Melanie: People hear the word spinal cord injury and right away they think “paralysis”. Does it always lead to paralysis? And, please explain those types--paraplegia and quadriplegia--so people have a better understanding.
Dr. Vollmer: So, to answer the first question, spinal cord injury is a continuum. Unfortunately, the margin between a partial injury to the spinal cord and a complete injury is relatively narrow. But that being said, many patients come to medical attention after an injury with residual function and that's a world better situation when it comes to the likelihood of some return of function. The term quadriplegia, quadriplegia literally means paralysis of all four limbs. Paraplegia refers to paralysis of the lower extremities and that has more to do with the level of injury, in other words, a quadriplegia relates to injuries of the cervical spinal cord in the neck versus paraplegia where it's generally something that occurs below the nervous outflow to the arms and affects the legs primarily. Of course, in both instances, bowel and bladder function can also be affected, so these are very devastating injuries.
Melanie: Are there treatment options available? Because nerves take so long to heal, in the case of a spinal cord injury, do they heal or is this something permanent?
Dr. Vollmer: Well, nerves do have some capacity to heal. If somebody has a complete injury with complete loss of function below the injury, generally the prognosis is quite poor. People who have residual function across the injury site do have the potential to recover. In many respects, once the injury has occurred, certain things cannot be recovered. Our focus in the health care system is to optimize the situation and prevent what we call “secondary injury.” That is injury that can occur because of associated problems. For instance, somebody who is involved in a motor vehicle accident may injure their spine and thereby their spinal cord but can also have problems with a lung injury or other types of trauma that an effect their ability to recover from the spinal cord injury. So, a comprehensive approach has to be taken in that patient to address all of these other associated injuries to minimize their effect on the healing spinal cord.
Melanie: So, speak about treatment options and even therapy afterward to resume some sort of normalcy in life.
Dr. Vollmer: The treatment options, initially, when someone presents with a spinal cord injury, unfortunately, there is no silver bullet to reverse many effects of the injury. Our goals in many patients are to repair the associated spinal damage to prevent further injuries: stabilize the spine, realign the spine, and protect the cord in that respect. In some cases, the cord can be decompressed and this can help, but it doesn't necessarily reverse things. There are clinical trials that are ongoing. We're participants in a large multi-center trial here at UVA of some promising investigational drugs to try and reverse some of the effects or prevent secondary injury. But, again, these are really investigations. We are optimistic but the data is still pending as to how effective these things will be. Some of the treatments really are directed at optimizing function in the context of some irreversible or only partially reversible injury. That's where comprehensive rehabilitation efforts come into play. At UVA, we have people who specialize in physical medicine and rehab of the patient with spinal cord injury. These physicians and specialists will work with patients to teach them how to function in the context of some deficit, whether it's some weakness or numbness or an increase in muscle tone that sometimes occurs that we call “spasticity”. All of these things can limit mobility and function and then, we have ways, both physical modalities of treatment as well as drug therapies, that help with that.
Melanie: Dr. Vollmer, what do you want the loved ones of those who have suffered a spinal cord injury to know? What do you tell them, generally?
Dr. Vollmer: Well, I try and tell them that a spinal cord injury, that while it may initially appear devastating, may not preclude that person from living a very satisfying, rewarding life. I've worked with patients who've had severe, complete cervical cord injuries that have gone on to get married, raise a family, hold a full time job and even drive a vehicle. So, these injuries, while they're quite devastating, and, especially to the families who love these individuals, they're not the end of hope. Many times, there is improvement as well. So, if the patient is cared for, optimally, there can be recovery, particularly with incomplete injury. When the injury is incomplete, we certainly have a high degree of optimism that we're going to see improvements.
Melanie: In just the last minute, why should patients come to the UVA Neuroscience Center for their care for their spinal cord injuries?
Dr. Vollmer: Well, of course, many times these things happen suddenly and patients don't have a lot of time to weigh their options. Many times, there aren't options. You need to get them into care as soon as possible. The thing about UVA is that it has a broad range of surgical and medical specialists who are available to provide really comprehensive care for patients who have suffered these unfortunate injuries. Much of the optimization of care really goes beyond what we do in the spinal surgery realm and includes people like respiratory therapists, pulmonologists, cardiologists, intensive care physicians and a whole range of others. Those kinds of teams of expertise are not available just anywhere and that's why I think UVA stands out, certainly in our region, as a leader in this kind of care.
Melanie: Thank you so much, Dr. Vollmer. That's great information and I applaud all the great work that you do. You're listening to UVA Health Systems Radio. For more information you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 1
- Audio File virginia_health/1543vh5a.mp3
- Doctors Ragosta, Michael
- Featured Speaker Michael Ragosta, MD
-
Guest Bio
Dr. Michael Ragosta is board-certified in cardiovascular disease and interventional cardiology; his specialties include coronary artery disease and chronic total occlusion.
Learn more about Dr. Michael Ragosta
Learn more about UVA Heart & Vascular Center -
Transcription
Melanie Cole (Host): Chronic total occlusion is a potentially serious heart condition that sometimes has no symptoms. My guest today is Dr. Michael Rogosta. He's board certified in cardiovascular disease and interventional cardiology. His specialties include coronary artery disease and chronic total occlusion. Welcome to the show, Dr. Rogosta. Let's start by telling the listeners a little bit about coronary artery disease and some of the things that go along with it.
Dr. Michael Rogosta (Guest): Thank you. Yes, as you know, coronary artery disease is a very common condition and, essentially, there's plaque in one or more of the coronary arteries. That plaque may obstruct or limit the blood flow in the coronary artery and that can cause symptoms such as chest pains, shortness of breath, fatigue and, of course, it can lead to heart attack and other more serious problems down the line.
Melanie: Are there certain risk factors for coronary artery disease as a whole? And then, we'll speak about chronic total occlusion.
Dr. Rogosta: Yes. So, you should first consider chronic total occlusion as a subset of coronary disease. That's the nature of it. It's a total occlusion of the artery instead of a narrowing to some percentage and it's been there for a long time. That's what is meant by chronic total occlusion. As a subset of coronary artery disease, it has the same risk factors as patients with other less severe forms of coronary artery disease. That includes high cholesterol, smoking history, diabetes, hypertension, and, of course, family history. So those are the important risk factors that lead to coronary artery disease.
Melanie: So, speak about chronic total occlusion as a subset of coronary artery disease. You mentioned symptoms – some of the symptoms you might experience – but often sometimes you don't experience these. How would you even know if you have coronary artery disease?
Dr. Rogosta: That's a great question and in a lot of people it is asymptomatic. For a lot of those folks it is asymptomatic because it's not causing a particular problem with the blood flow. So, it's a very prevalent condition but in a lot of folks who don't have symptoms and don't have any serious sequelae from the blockages, we just treat that medically with the goal to be to treat the risk factors that might lead to progression. So, it's really only when the disease becomes more severe and is obstructing blood flow and leading to some of the symptoms that we would then recommend more aggressive treatment which are the revascularization procedures such as stenting or coronary bypass surgery.
Melanie: And how is it diagnosed, Dr. Rogosta? Is this something you have to go in and have an angiogram to figure it out or can you tell by what they're experiencing?
Dr. Rogosta: Well, the symptoms would then lead you to probe more deeply. Usually, the first line of diagnosis is a stress test which shows you essentially the effect these blockages may have on the circulation of the heart in terms of how the heart is functioning or how the pattern of blood flow appears in an image that is done non-invasively. If that test comes back normal, then usually we treat that medically and, again, treat the risk factors of coronary disease. However, if the stress test does show evidence of lack of blood flow to the heart, then we would go to a more invasive approach like a coronary angiogram which is a type of cardiac catheterization procedure. That is considered the gold standard for diagnosing blockages in the coronaries because we can see the artery in fine detail and know exactly how blocked it is and that leads to how we would usually treat from the angiogram.
Melanie: So, speak about treatment then. What would be the first line of defense? If you've performed these exams and determined there's a total blockage, then what?
Dr. Rogosta: So, it depends on how severe the patient's symptoms are and how much it's affecting the blood flow to the heart. In some patients that have a chronically occluded artery, it leads to minimal or no symptoms and there's adequate blood flow to the heart because the heart actually creates what's called “collateral channels” which are essentially a rerouting of the circulation around the blockage. So your heart does that by itself. If that's adequate--in other words, if there's adequate blood flow to the heart through these collaterals, then we just treat the risk factors and treat medically those patients. However, if the symptoms are not controlled with medicines or there's really a large area of the heart muscle not getting blood flow during stress, then we would warrant more aggressive treatments. Chronic occlusions historically have been very difficult to treat with the catheter-based techniques like angioplasty and stenting. However, recently, in the last maybe 5-10 years, there have been great advances in the percutaneous treatment of chronic total occlusions that have led to greater successes. So, our success rate now is in the 80-90% range for a chronically occluded artery, to be able to open that using a catheter-based technique; whereas, historically, it was only in the 40-50% range.
Melanie: Isn't that amazing that the heart can actually make that collateral circulation? It always fascinates me. Now, what about after the procedure. What kind of lifestyle does that patient have afterward and what can they expect as far as their ability to exercise and conduct normal life?
Dr. Rogosta: Yes. If they were pretty symptomatic before the procedure and we're successful in restoring the blood flow, then usually we see a great improvement in their ability to exercise, in their exercise tolerance and in their symptom control. Many patients that we've been successful have had resolution of their angina, which is the chest pain syndrome that you typically get with a chronic total occlusion or their shortness of breath syndrome which also may be a manifestation of the chronic occlusion. So, usually, if they're very symptomatic they get a lot of symptom relief with this and are able to exercise more and then are able to do the more healthy things they need to do to maintain their health over a long time.
Melanie: What about it coming back? Does that happen in that area that you've cleared out? I mean, if there's a stent in there does that mean that it's not going to close up again?
Dr. Rogosta: No, unfortunately. Just like a stent placed for a less severe stenosis, the blockage can reoccur in the stent. Now, it is a different process. It tends to be scar tissue related rather than the atherosclerosis buildup that started the process in the first place. However, those can often be treated successfully with an additional procedure and, at the end of the day, if the stent procedures fail and they do occur, there's always the option of coronary bypass surgery which is also a treatment option for these patients if we aren't successful and are able to open their artery.
Melanie: In just the last few minutes, Dr. Rogosta, why should patients with chronic total occlusion come to UVA Heart and Vascular Center for their care?
Dr. Rogosta: Well, a couple of reasons. I think first, we have a really great team approach to patients with complex coronary disease and this would be a form of complex coronary disease. What I mean by that is, a lot of these patients are evaluated by the interventional cardiology group, which is the catheter-based techniques, but also by heart surgeons. We, together, decide what may be the best options for that patient. So, the team approach is very, very valuable at giving the patient the best care. In addition, we have a lot of interest in managing these types of complex diseases and have spent a lot of effort and time learning the special techniques that are needed to be successful and we really focus on this so our success rate is very high. So, for those reasons, that's a big advantage of coming to the University of Virginia.
Melanie Cole: Sounds like a great multidisciplinary approach to helping those with vascular disease. Thank you so much, Dr. Rogosta. You're listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole, thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 3
- Audio File allina_health/1541ah3c.mp3
- Doctors Anderson, Nancy
- Featured Speaker Nancy Anderson, MA, LMFT - Grief Counselor
- Guest Bio Nancy Anderson, MA, LMFT, is a grief counselor with Allina Health Hospice.
-
Transcription
Melanie Cole (Host): The holiday season, or any special days throughout the year, can be so difficult for people who have experienced the death of someone near to them. It's often a time when the experiences and feelings of loss can really be heightened. My guest today is Nancy Anderson. She's a grief counsellor at Allina Health Hospice. Welcome to the show, Nancy. Tell us a little bit about the holidays or special days. If someone has lost someone they love, why are those days, in particular, more difficult?
Nancy Anderson (Guest): Well, the first thing that I want to speak to is a definition of grief and that is that grief is an experience of loss or change in one's life and it includes a whole range of emotions that could be, as you said, heightened or increased during the holidays. Some of the normal feelings that I talk to people about when they come to me, probably the most important one is people feel dread. They just think, “I don't really want to do that this year. It's really hard to face this and if I could just go through this month without having to hear or think about holidays I'd be happy.” But, of course, it's happening and so to feel some dread about it is pretty darn normal. When other people are feeling joyful and looking forward to anticipating an exciting time, people who are grieving, often their pain is increasing; their sadness is increasing. So, their memory of the loved one becomes an even more painful experience during holidays for some people. It can sometimes feel like they're even more alone, sort of alone in the crowd almost. Families can feel that way as well where they feel like everybody else is enjoying this time and we're just sort of limping along as best as we can.
Melanie: I'd like to start by also asking you before we get to “how can you deal with your own grief during the holidays”, I'd like to ask you how we help someone we love because I have that in my life now and I'd like to be able to help the people that I love as these holidays approach. What is your best advice, Nancy, for people having the holiday party, if they've got someone coming who's lost a dear one?
Nancy: One of the most important things you can do is to acknowledge their loss. I have people who I sit with who say, I was with a gathering of people who care about me and nobody acknowledged what I was going through and I felt so alone. So, don't be afraid to acknowledge the loss this person is experiencing. Another is definitely don't offer advice or assume you know how they feel, even people who've experienced the loss of their own. We don't know exactly how this other person is feeling; to know that they're going through something unique and acknowledge that it's their own very special, unique experience. Be a good listener. Let them set the pace for what they want to share, what they don't want to share. Another thing that people tell me all the time is that they love to hear stories of their loved one. Sometimes they get to hear stories that they've never heard before that you carry--that the person you are sitting with carries--that they've never heard before. Even stories that they have heard before, they love to hear again. So, don't be afraid to share the stories. Don't be afraid to acknowledge that this loss has happened in their lives and include them. It's very painful when people say, “Oh, yeah. I'll have you over for this or that,” and then it doesn't happen. So, even if they don't feel like they can get up for it, to be offered an invitation means a lot. So, a gathering, a meal, a religious service, those are the things that I would encourage and offer help. Don't wait to be asked. Just say, “I'm available” and with their permission “I'll be over and help you prepare food,” or “I'll take care of your kids,” or “I'll wrap gifts for you,” if it's a gift-giving time. So, those are the things I would suggest.
Melanie: So, now some ideas for dealing with that grief if you're the person who lost a loved one. How do you go to those parties and attend those functions when you're feeling like you've lost a part of yourself?
Nancy: I think that you have to give yourself lots of flexibility about that just to say, “I would love to join you all and if I can, I will and on that day may not be a good day and I may not be able to do this”. Prepare people. Hopefully, they'll completely understand but many times, people will put something on their calendar and they want to join the group but sometimes on that day, it's not a good day and it's okay to bow out. It's okay to go and leave after an hour. Drive your own car so you can do that. Those are a couple of suggestions for events that you might be invited to.
Melanie: Should you change what you used to do? If you always were the one hosting Thanksgiving or you had certain trends or traditions that you did, should you change that if you're grieving around the holiday time?
Nancy: I think it's useful to. If you're the only person that's involved, there are a few more options. You could continue your traditions as usual. You could even change it and go someplace. If you're part of a family, then it is very important to include other people's needs as well, especially if you have children. Make sure that children get some semblance of the holiday. It would probably be a good idea to simplify it and to make it a more flexible plan. Having a plan is always something we suggest. It helps reduce some of the dread. The ideas about having to do it a certain way need to just be kind of let go of. There are options but the thing is that, it's never going to be the same whether you do it exactly the way you used to do it or you bring in some new traditions and change it up, or even go away. It's never going to be like it used to be, and that's the pain. The pain will be a part of this experience .The loss will be in the middle of it no matter what you do and so, having realistic expectations about that is important.
Melanie: So, in just the last few minutes, Nancy, what would you like to tell the listeners about going into the special days and holidays when they've lost a loved one and when they should possibly seek counselling and get some extra help?
Nancy: Well, I think as I began talking about grief as the normal experience of loss and change, that grief is not a pathology. There's not something wrong with us when we feel the intense pain of loss. That’s a normal feeling. I think when someone you know begins to have more extreme symptoms like intense hopelessness or noticeable changes in weight, decline in hygiene or suicidal feelings with a plan, those are things that are more symptomatic of depression, although grief and depression can look a lot alike. Depression is something where someone can't really rise to the occasion. People who are grieving tend to be able to rise to the occasion, even if they're still feeling pain. A depressed person probably can't. In that situation where someone is in those more extreme responses, going to your physician, even a hotline, but do something. You can even go to an emergency room if there are those kinds of extreme symptoms that are accompanying the loss and change. Sometimes people have a history of depression and it could be exaggerated by grief and then holidays or special days can exaggerate that. So, reaching out for help no matter what--whether you're just going through normal grief and getting support is very important--finding support from friends, family and support groups. Then, if the symptoms are far more extreme, the physician, emergency room and hotlines can be in the mix. For more resources or information, you are welcome to call the Allina Grief Resources line and that number is 651-628-1752.
Melanie: Thank you so much, Nancy. I applaud all your great work and it's really great information. You're listening to The WELLCast with Allina health. For more information, you can go to AllinaHealth.org. That's AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Could your employer choose to pay a penalty rather than provide insurance?
Additional Info
- Segment Number 3
- Audio File health_radio/1541ml3c.mp3
- Featured Speaker Marianne Eterno, President of Government Relations for GTL
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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
Additional Info
- Segment Number 2
- Audio File allina_health/1541ah3b.mp3
- Doctors Meyer, Jeff
- Featured Speaker Jeff Meyer, MD, MPH,- Occupational Medicine/Internal Medicine
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Guest Bio
Dr. Jeff Meyer is a board-certified occupational medicine and internal medicine physician at Allina Health Coon Rapids Clinic. His professional interests include pilot exams, low back pain and spine consults; Dr. Meyer is also an air medical examiner for the Federal Aviation Administration.
Learn more about Dr. Jeff Meyer -
Transcription
Melanie Cole (Host): Back pain is one of the most common and difficult occupational health problems and is a very common reason for absence from work. My guest today is Dr. Jeff Meyer. He's a board certified occupational medicine and internal medicine physician at Allina Health Coon Rapids Clinic. Welcome to the show, Dr. Meyer. How much of a problem is back pain? What is it doing to this country in terms of absenteeism from work and keeping people from living the quality of life they'd like to live?
Dr. Jeff Meyer (Guest): Low back pain is a significant problem. It's a very common medical complaint. Surveys of the U.S. population show that at least 80-90% of the United States population has had at least once significant episode of low back pain. Among medical providers, it is the fifth most common reason for office visits in the United States. But, what is important to realize is that most episodes of low back pain resolved with time if the person stays active; if they stay up and moving and walking. It's very important to be up and walking and moving in order for your low back pain to heal.
Melanie: Are there certain risk factors to having low back pain? I know what you're saying when you say how many people will have had back pain in their lives and you can't appreciate the pain unless it's actually happened to you before. Are there certain things that would predispose somebody to having back problems?
Dr. Meyer: In my experience and when we are testing back strength of patients, weakness of back muscles is one of the most common causes of prolonged back pain. Weakness of the muscles around the core of your trunk, around your back and your abdomen, is a very important risk factor. Now, when they do surveys, smokers have a lot more back pain than non-smokers but that has not been proven to be a cause and effect. You can't say that smoking causes back pain but smokers do have more back.
Melanie: What's the link between obesity and back pain?
Dr. Meyer: You will read often that obesity is a risk factor for low back pain but when you really look at the research, many scientific studies have looked at obesity and low back pain and have not shown that obesity causes low back pain. There was one big study where severely obese patients weighing many hundreds of pounds had bariatric surgery. These are obese patients with low back pain. They lost hundreds of pounds but their low back pain did not improve. So, I want my patients who are obese to lose weight to lower the risk for diabetes, for heart disease, high blood pressure, cancer stroke but there isn't a guarantee that it will lessen their back pain.
Melanie: When you see certain people at jobs and they're wearing back braces, are there certain jobs that are more likely to cause back problems? What causes those sorts of things?
Dr. Meyer: Well, actually, people often think that if they have a job with heavy lifting they will have more low back pain than if they have a sitting job but that isn't necessarily true. There was one study of Swedish farmers--owners of their own farms--who did very heavy lifting and pulling at their work. They also spent hours sitting on a vibrating tractor. These Swedish researchers followed these farmers for many, many years, and they compared them to a group of comparison subjects who did seated jobs, and they found, actually, that the farmers had less neck and low back pain than the comparison subjects who spent all day sitting at an office. So, it's important for the health of your back that you stay active and moving.
Melanie: So, when we're talking about back pain as a general term, how do you determine what is the cause whether it's a bulging disc or stenosis or just osteoarthritis setting in? How do you evaluate back pain and determine what the cause is?
Dr. Meyer: Well, you often get the most information from talking with your patient and doing a physical exam. One of the most frustrating things about low back pain is that 90% of the time, you can't be sure what exact issue or what exact structure in the back is causing a person's low back pain. It is very frustrating. The tissues in the low back that have pain fibers include the muscles, the ligaments on the back of the spine called the “ligamentum flavum”, the facet joints and the outermost part of the disk, which is a tough ligament like structure called the “annulus fibrosis”. The inner part of the disc which is like gelatin has no pain fibres.
Melanie: Wow! So, people don't even always realize in the movements and the things that they do. Do you send people for an MRI or do xrays show what you need to find out? What do people have to do to figure out what the cause of their back problems are?
Dr. Meyer: In certain situations, MRI scans can be very helpful and they are indicating if a patient has sciatica, which is nerve pain traveling down the back of a leg to the foot or if this patient has had back pain with sciatica that has not gotten better with time, with staying active, and with walking or with physical therapy or with chiropractic manipulation. But, if there's no pain traveling down the back of the leg to the foot; if there's no sciatica, then lumbar MRI scans actually don't tell me much because it is really common to find abnormalities on lumbar MRI scans of people who have no low back pain. There was one study of volunteers--they were pretty young. Their average age was 35 years--and they had no back pain. Among these 35-year-old average volunteers, 40% had disc protrusions and 18% had disc extrusions, yet they had no low back pain. Now, patients will often say, “My back pain is from a disc bulge” but disc bulges are a normal finding on MRI of the spine. Everyone has disc bulge on MRI scans. The disc is a gel pack shock absorber and it's meant to bulge. So, this is really frustrating but you can have a patient with excruciating low back pain from a muscle strain and they can have a disc protrusion or a disc extrusion on their MRI that is not causing their low back pain. If you would take a patient like that and you do a lumbar fusion, where you remove their disc and replace it with bone and metal hardware, their low back pain will not get better because that disc herniation, or that disc protrusion, or disc extrusion was not causing their back pain. It was what we call an asymptomatic finding. So again, MRI scans can be extremely helpful if a patient has sciatica, pain radiating down the back of leg to the foot and they have numbness in their foot in the distribution of the lumbar spinal nerve. If they then have an MRI scan that shows a disc protrusion or a disc extrusion pushing on the nerve that correlates with numbness in that part of the foot, then you know that that is the cause of their sciatica.
Melanie: So, Dr. Meyer, people are back and forth about bracing your back, about ice and about heat. What sort of a man are you? Are you an ice man? A heat man? What do you do when people first experience this back pain? We don't have a lot of time but I'd love to get to treatments and things people can do, and those exercises to keep your core strong.
Dr. Meyer: Sure. Heat or ice can be helpful for the back. When you sprain a joint, you always ice it but when it's a muscle strain, you can do either heat or ice. Ice does not feel good for me when I have a back strain. As far as back braces, they have not been shown to be helpful or to prevent a back strain. One of the most important treatments for low back pain is to stay active in moving and avoid prolonged bed rest. Prolonged bed rest has been shown in studies to be harmful. Over the counter medications like Ibuprofen, Naproxen or Tylenol could be helpful. Walking is very helpful. Physical therapy and chiropractic manipulation can be beneficial. I have found that programs to increase the strength of the back muscles are very effective treatment for low back pain. Now, for someone who has had recurrent episodes of back pain or really prolonged episodes of low back pain where standard physical therapy hasn't helped, there is a computerized strengthening program called The MedX that has been invented and it's very effective for treating prolonged low back pain. They have The MedX at many different location. They have it at the Courage Kenny Spine Rehabilitation Institute; at PNBC; at the Institute of Athletic Medicine; at Twin City Orthopaedics; at PDR and the Hudson Physicians in Huston, Wisconsin, have it. There are several other locations. It's very helpful.
Melanie: Dr. Meyer, when is surgery what has to be done? People go for back surgery all the time. Is it really necessary? Give us your advice about back surgery.
Dr. Meyer: Sometimes lumbar surgery is necessary. If a patient has a disc herniation pressing on a nerve and that patient develops weakness in their leg or if their low back pain and sciatica do not go away with other treatment, but it's important to remember that disc herniations do get absorbed by the body over time and disc herniations often heal without surgery. There was a study in Norway on patients with a disc herniation pressing on a spinal nerve causing sciatica where you knew that the disc was the cause of their pain and in these patients, The MedX intensive strengthening program was as effective as the lumber fusion.
Melanie: So, in just the last minute or two, Dr. Meyer, give your best advice for something that is so painful and so common, that so many people have for their back pain. Give your best advice for possibly preventing it in the first place.
Dr. Meyer: The most important way to prevent back pain is to keep your back muscles strong, to stay active. I think, in summary, the most important parts to remember about back pain is that most episodes of low back pain do resolve if a person stays active and out of bed. Over the counter medications can help. Physical therapy and chiropractic manipulation can help. MRI scans are usually not indicated early on when somebody has back pain and they often don't tell me what is actually causing a person back pain. And, The MedX intensive strengthening program can be very effective.
Melanie: Thank you so much, Dr. Meyer. It is great information. You're listening to The WELLCast with Allina Health. For more information, you can go to AllinaHealth.org. That's AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 1
- Audio File allina_health/1541ah3a.mp3
- Doctors Stiehm, Andrew
- Featured Speaker Andrew Stiehm, MD -Pulmonologist
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Guest Bio
Dr. Andrew Stiehm is a board-certified pulmonologist, specializing in sleep medicine, critical care and internal medicine. I have professional interests in insomnia, lungs and lung nodules, sleep apnea, obstructive sleep apnea, narcolepsy and COPD (chronic obstructive pulmonary disease).
Learn more about Dr. Andrew Stiehm -
Transcription
Melanie Cole (Host): Maybe your partner has told you that your snore is deafening or you've woken up on more than your fair share of mornings feeling less than refreshed. In these instances, it may be a case that something is disrupting your normal night’s sleep. My guest today is Dr. Andrew Stiehm. He's board certified pulmonologist specializing in sleep medicine, critical care and internal medicine. Welcome to the show, Dr. Stiehm. Tell us, what is sleep apnea and how do you even know you've got it?
Dr. Andrew Stiehm (Guest): Sleep apnea means paused breathing when you sleep and that is most typically a disease that we call “obstructive sleep apnea.” Obstructive sleep apnea is fundamentally a disease of narrowing of the throat. Throats can be narrow for a variety of reasons. Some people are born with narrow throats and we do see obstructive sleep apnea, for instance, in babies with large tonsils. As we get older, there is also a tendency for our throats to get a little bit, for lack of a better word, mushier, and our throat can narrow because of that mushiness. For those of us who have a couple extra pounds, in addition to getting bigger on the outside, we actually getting narrower on the inside. Our tongues get bigger and our throat can enlarge from some extra fatty tissue and our throat can narrow because of that weight gain. What that narrowing adds up to, particularly when we sleep and our muscles are the most relaxed, is difficulty breathing and that is obstructive sleep apnea. It is most commonly diagnosed by a sleep study which is where we scientifically watch you breathe and sleep at the same time. More colloquially, it's diagnosed by the person you're laying next to who notes the snoring, the choking and the pause in your breathing.
Melanie: Dr. Stiehm, if you do have to go for a sleep study, does anybody actually get a night's sleep at those things? Do you actually fall asleep so that you all can record what's happening?
Dr. Stiehm: That's very typical. The warning I give patients is that it will take them about 10 minutes longer to fall asleep in a sleep lab than it will at home. But they should expect beyond that, a pretty typical night's sleep. Most of our patients will spend more than 80% of their time in bed asleep the night of a sleep study. So, I know that's a very common concern but it just doesn't materialize. For those that are very worried, we will frequently offer them a sleeping pill that they can bring with them on a “just in case” basis.
Melanie: If this disorder goes untreated are there complications?
Dr. Stiehm: It depends on the severity. Across all severities of obstructive sleep apnea, we worry about things like productivity at work and automobile accidents because you're just so sleepy that you're not as sharp as you should be. So, maybe you enter your thumb on a blade at work or you fall asleep on your commute in the morning. The more severe of the sleep apnea, it can then start contributing to cardiovascular diseases like high blood pressure, stroke and heart attack. People with severe sleep apnea do live shorter lives because of some of those cardiovascular consequences when they leave their disease untreated.
Melanie: We're learning more and more about the relationship between insomnia, sleep issues, sleep disorders, and all kinds of diseases. What treatments are out there for obstructive sleep apnea and do the ones like a CPAP, actually, are they being adhered to? Are they difficult to follow?
Dr. Stiehm: For obstructive sleep apnea, CPAP or Continuous Positive Airway Pressure, CPAP, is the most frequent therapy and what that is, is an air pressure splint. So, you use air pressure to hold your throat open while you sleep. It is the most effective therapy across all severities of obstructive sleep apnea but you hit the nail right on the head. The problem with CPAP therapy is that even in some of the most rigorous studies 20-30% of the people just can't tolerate CPAP therapy. It then becomes a very expensive bedside piece of equipment. For those people or people with milder forms of obstructive sleep apnea, the most typical plan B is an oral applied or what we call a “mandibular advancement device.” What this is, is a special mouth guard that either typically pulls your jaw forward but will occasionally pulling your tongue forward and it opens up your throat by actually moving the tissues mechanically. There are always lifestyle recommendations that we make. As an example, for every 1% change in your weight, we would expect to see about a 3% change in your sleep apnea. So, if you have enough weight to lose, you can cure your sleep apnea with weight loss. Things that will make your muscles flabbier like alcohol or sedative medication, we also tell people to avoid those because those can also result at worsening of your obstructive sleep apnea. Some people are treated with body positioning. When you sleep on your side or on your stomach, gravity will actually pull your jaw forward and we can use gravity to open up your throat. Then, of course, there is surgical therapy that we offer for obstructive sleep apnea. In children or infants, a tonsillectomy is very effective. Remove those big tonsils and big adenoids and the throat becomes a whole lot more open. There is also jaw surgery. The FDA just last year, approved a nerve stimulator that actually moves the tongue out of the way when you sleep by stimulating a nerve. So, there are surgical options for some people as well.
Melanie: Is there anything that you can do at night? You spoke about lifestyle changes, losing some weight and alcohol consumption. Are there any things that you can do at night to help prepare you for a better night's sleep that might reduce your risk of having those kinds of episodes in the night?
Dr. Stiehm: We've already eluded some of them. Body position is one of them. For some people, obstructive sleep apnea has much worse on their back than it is on their side. People have learned that. This is the wife smacking you in the ribs to get you to roll over so that you stop snoring. Some people will choose to sleep in a recliner and try to not sleep on their back in that way. Avoiding alcohol, particularly two hours before you go to bed, can be helpful. Avoiding nicotine and, in particular, smoking it in the hour or two before you go to bed. That smoke also swells the airways and helps keep your throat open. Any pain medications or medicines that might have the tendency to relax you, if you're able to, are things you should also avoid right before you go to bed, specifically for obstructive sleep apnea. Then, there's a list of other recommendations we make for the people that have difficulty falling asleep as well. I wasn't sure if you might want to explore some of those.
Melanie: Sure. Why not? Let's do it.
Dr. Stiehm: So, in general, the rule there is, if it's not broken, don't fix it. So, if you are able to fall asleep pretty quickly, then none of these rules apply to you. But it's about 1/3 of us that, at some point in our lives, are experiencing some degree of insomnia. For those people, there are a couple of simple rules that we recommend. The first is, only sleep and sex in bed. Those are really the only behaviors you should do in bed. You shouldn't read a book in bed; you should not watch TV in bed; you shouldn't engage in long conversation in bed. Again, this is if you have insomnia. If you have no trouble falling asleep, you don't need to abide by those rules. The other rule is, don't spend more than 20 minutes in bed without success. So, if you haven't fallen asleep in 20 minutes, get out of bed, somewhere else to relax. The bed is where you should come to succeed in sleeping not to struggle to sleep. The struggle should be somewhere else. So, those are some of the standard rules that we recommend for good, what we call “sleep hygiene.”
Melanie: That's great advice, Dr. Stiehm, really, for anybody. Sometimes if you suffer from sleep apnea or insomnia, it can cause issues in your relationships and prevent both people from getting a good night's sleep and thereby making everybody more moody the next day. What are some tips you give your patients?
Dr. Stiehm: Sleep apnea is often a disease of two people and you hit the nail on the head there once again. It's not only the person snoring but the person who is lying next to them, who has just as much sleep disruption if not more, from that snoring. You probably wouldn’t be surprised to know that a lot of my patients see me not because they're having concerns but because their loved one and their bed partner is the one with the concern. So, that would always be the first piece of advice I give you, is trust the person who is lying next to you. They actually have a more objective opinion of your sleep and sleep quality than perhaps you do. If they tell you you're a train with your snoring, if they tell you that you're choking and you're pausing breathing, you should trust that opinion. I know a lot of patients come to me and say they sleep just fine and that's actually the typical mentality of some people with sleep apnea. They fall asleep within two minutes. They feel like they sleep all night. They think that their sleep is great and that's actually not always a good thing. You should not fall asleep that quickly. That's a sign of you being too sleepy. So, you should trust the person next to you, that if they’re seeing a problem, you should perhaps consider seeing your doctor and getting evaluated.
Melanie: In just the last minute, Dr. Stiehm, and it really is just great information. Give your best advice on those who they love that might be suffering from sleep apnea and what they can do about it.
Dr. Stiehm: There are two pieces of advice I think that are the best. The first is what we just alluded to: trust the person who’s lying next to you. If they think you have a problem, there's never any harm in getting it checked out. The second piece of advice I would give you is that sleep medicine has come along way from where it was even just a decade ago and there are simpler therapies and there are simpler tests. A lot of people don't want to get their sleep apnea evaluated because they don't want to spend a night away from home. Well, we're doing about half of our sleep studies in your house and so, we can do the sleep study in your bed. That makes it a lot more comfortable and a lot easier for you. A lot of people also don't want to be evaluated because their fear of “the mask.” The CPAP therapy is something that they've already said they don't want to do in their minds and so they don't even want to commit to testing for fear of therapy. For them, I would say the therapy is not as bad as what you think it is but even if it's not for you--and that's common. Twenty to thirty percent of my patients can’t do CPAP. There is plan B, plan C and plan D and so there are things besides CPAP we can do for you. So, I wouldn't be afraid to just come in and have a conversation. I think it's informative as a quick 10 minutes. This can be one-on-one with the patient. I can be more informative.
Melanie: I'm sure you can. You're just very well spoken—an excellent doctor. Thank you so much. 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
Additional Info
- Segment Number 1
- Audio File city_hope/1541ch2a.mp3
- Doctors Erhunmwunsee, Loretta
- Featured Speaker Loretta Erhunmwunsee, MD
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Guest Bio
Loretta Erhunmwunsee, M.D. is an assistant professor in the division of thoracic surgery. Dr. Erhunmwunsee graduated Phi Beta Kappa from Emory University in Atlanta, GA, then went on to receive her medical doctorate from Harvard Medical School in Boston, graduating magna cum laude. She continued her post-graduate training at Duke University Medical Center in Durham, NC, completing a general surgery internship, followed by a residency in general surgery, after which she served as chief resident from 2011 – 2012. This was followed by a residency in cardiothoracic surgery, also at Duke.
Board-certified in surgery, Dr. Erhunmwunsee has been the recipient of numerous honors and awards including the World Congress on Lung Cancer Young Investigator’s Award in 2009. She was chosen as an NIH/NMA Academic Career in Medicine Fellow in 2015, and was chosen as a Feagin Leadership Scholar from Duke University in 2014. Dr. Erhunmwunsee is also the recipient of the Peter C. Pairolero Scholarship Award which she received in 2015 from the General Thoracic Surgical Club. She sees patients with lung, esophageal and mediastinal tumors. Her research focuses on eliminating health inequity in thoracic oncology patients.
Learn more about Loretta Erhunmwunsee, M.D. -
Transcription
Melanie Cole (Host): Lung cancer is one of the most common cancers in America with over 220,000 new cases each year. At City of Hope, we treat the whole person, body and soul, and have a compassionate, unmatched reputation for coordinated comprehensive care. The lung cancer team has pioneered state of the art regimens with procedures that eradicate cancer while minimizing side effects with a broad array of lung cancer expertise from multiple disciplines, all under one roof. My guest today is Dr. Loretta Erhunmwunsee. She's an Assistant Professor in the Division of Thoracic Surgery at City of Hope. Welcome to the show, Dr. Erhunmwunsee. Why is lung cancer in women and non-smokers even, on the rise do you think?
Dr. Loretta Erhunmwunsee (Guest): First of all, thank you so much for having me this morning. That's a very excellent question and it's one that there's a lot of studies going into trying to figure this out. I think primarily its multi-factorial. Specifically for women, it's important to note that lung cancer is, in fact, the number one killer of both men and women. Women in particular continue to have other sort of risk factors that might impact their ability to have lung cancer. Unfortunately, smoking continues to be a significant sort of risk factor that women are exposed to, either primarily smoking themselves to second-hand smoke. I think that's one of the reasons why we're seeing lung cancer in women at such high rates. It's important to understand that there aren't necessarily increased deaths from lung cancer in women. The truth is that the number of deaths from lung cancer in women has actually plateaued and it's actually coming down a bit but it's still a significant problem because it is the number one killer of women. So, long cancer continues to be a problem. Then, with non-smokers, we're starting to realize that actually those numbers are rising and we think that might be secondary to increased rates of second-hand smoking and also through genetic mutations that we're starting to see on the rise.
Melanie: So, is there a genetic component to lung cancer, Dr. Erhunmwunsee?
Dr. Erhunmwunsee: Absolutely. There is a genetic component but we think that the genetic aspect of it is typically sporadic, meaning that it's not the same sort of thing when you consider genetic issues that come from parents. Your parents come together and they, hopefully, will give you normal genes. In most lung cancer patients, they have normal genes but because of the carcinogens or a pollutant, those genes may become injured and then lead to the lung cancer. So, there certainly is a genetic component. There have been lots of studies that show that. We have a better understanding of which gene mutations lead to certain cancers and so, we know that with most tumors, there is a genetic mutation that leads to it. We believe that this is typically secondary to smoking.
Melanie: With estrogen being known to grow things, does that play a role in the development progression of lung cancer? Is there any difference that you see in women that are in perimenopause or post-menopause versus pre-menopausal women and estrogen levels?
Dr. Erhunmwunsee: That's a good question. So, there is a connection between estrogen and lung cancer but it's not as clear as to what that connection is. Certainly, we know that women who take estrogen and progestin sort of when they're menopausal have a higher rate of lung cancer. There are studies that have shown that. We also know that women who have lung cancer who continue to estrogen and progestin have a worse survival with lung cancer. So, there have been studies that have shown that, but it's not as clear because we've also had small studies that have not shown that. So, right now, the thought is that there is a role that estrogen plays with lung cancer and many times if a woman who is on estrogen and progestin develops lung cancer, those drugs will be stopped. We can't say for sure what the exact correlation is because we don't have enough data to support that.
Melanie: Is it more difficult to diagnose lung cancer in non-smokers? If someone is getting a lung cancer screening because they've been a 30 pack a year smoker, and there are a non-smoker but they're exhibiting maybe symptoms or coughing or something and they come to see you, is this the first thing you might think about or is a little more difficult to diagnose?
Dr. Erhunmwunsee: I think you're right. It is, in some ways, very much more difficult to diagnose simply because we are trained to hear smoking history and automatically think of cancer or at least try to rule it out. But, honestly with the increase in rate of lung cancer in non-smokers, this is something that we are starting to look into even in non-smokers. So, if a patient presents with a cough or weight loss or certainly if their coughing up blood, they're going to get imaging of their chest and, hopefully, then we will be able to move forward and find the cancer or whatever, element that they have.
Melanie: Tell us about some of the advances in lung cancer treatment, things that can give people hope if they have been diagnosed with this very scary disease.
Dr. Erhunmwunsee: Yes, it's important to understand that there have been some advances and we're very proud of them. There are many clinical trials on the way that are working to determine which sorts of therapies are best suited for a particular genetic mutation in lung cancer. We, especially here, have focused on minimally invasive surgery in an attempt to improve the way we remove lung cancer from patients who have localized disease. We also are doing more and more studies to understand the role of radiation which may be a way to treat people with lung cancer and hope for a cure if they aren't able to undergo surgery. Then, there are other sorts of therapies that are on the horizon for patients with more advanced disease. So, the truth is there are a lot of therapies that have now been proven to be quite effective and that we're studying and hoping will be effective.
Melanie: Please, in the last few minutes, Dr. Erhunmwunsee, give your best advice for possibly preventing lung cancer in women and non-smokers as well. Lifestyle modifications, things they can do that might reduce that risk, and why they should come to City of Hope for their care.
Dr. Erhunmwunsee: Absolutely. Thank you for asking that. So, the number one risk factor for everyone still is exposure to smoke—to cigarette smoke. So, the number one thing that we can do to prevent lung cancer is to stop smoking. So, if a person is smoking, stopping smoking, abstaining from smoking, never smoking, is the number one thing that can be done to decrease your risk. For those who are not smoking, exposure to second-hand smoke still needs to be stopped. So, if you have loved ones and those around you who smoke, keeping your distance, not allow them to smoke in your car, your home, and reducing that exposure is absolutely key. We also would suggest, be very mindful of your body. So, if you are starting to have symptoms of any sort, if there's a cough that is prolonged, certainly if you’re coughing up blood, see your physician. Honestly, especially those who are smoking, we would recommend talking to your physician about lung cancer screening because that won't prevent lung cancer but it certainly will allow for easier and earlier detection. There are other risk factors including air pollutant and radiation, for patients who have had radiation for lymphoma or those sorts of things, maybe for breast cancer, in the past. There's not much you can do after the fact, but, certainly, again, if there are any sort of symptoms, please make sure to see your physician and discuss further care.
Melanie: Thank you so much. It's great information. You're listening to City of Hope Radio. For more information, you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole MS
Many young people can't afford insurance or don't think they need it. What happens if they choose to remain uninsured?
Additional Info
- Segment Number 3
- Audio File health_radio/1539ml4c.mp3
- Featured Speaker Marianne Eterno, President of Government Relations for GTL
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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
