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Additional Info
- Segment Number 3
- Audio File city_hope/1534ch2c.mp3
- Doctors Ziari, Mo
- Featured Speaker Mo Ziari, MD
-
Guest Bio
Mo Ziari, M.D., is a clinical assistant professor in the Department of Hematology & Hematopoietic Cell Transplantation and Department of Medical Oncology & Therapeutics Research at City of Hope Corona. Prior to joining City of Hope, he was at Wilshire Oncology/US oncology for four years.
Dr. Ziari completed his undergraduate degree in Shiraz, Iran, at Shiraz University of Medical Sciences. Following medical school, he completed his residency at Saint Louis University, and later he completed his fellowship in Dallas at the University of Texas Southwestern.
Dr. Ziari is board certified in hematology and oncology, and is an accomplished and experienced clinician and clinical researcher. He has particular interest in breast and lung malignancies. He has written peer-reviewed publications and has presented at national meetings. Dr. Ziari sees the full spectrum of cancers in adults.
Learn more about Mo Ziari, M.D -
Transcription
Melanie Cole (Host): For people who are diagnosed with lymphoma, the Tony Stevenson lymphoma Center at City of Hope is one of the biggest and most successful treatment centers in the nation. Because of the vast experience in treating patients with lymphoma, the specialists there lead the field of hematopoietic cells transplantation with excellent outcomes. My guest today is Dr. Mo Ziari. He is Clinical Assistant Professor in the Department of Hematology and Hematopoietic Cell Transplantation and the Department of Medical Oncology and Therapeutics Research at City of Hope. Welcome to the show, Dr. Ziari. So, tell us a little bit about Hodgkin's lymphoma. We hear about non-Hodgkin’s. What is the difference between those two?
Dr. Mo Ziari (Guest): Good morning. The two main type of lymphoma are Hodgkin's lymphoma and non-Hodgkin's lymphoma, which are classified by certain unique characteristics of the cancer cell. So, for example, in Hodgkin's lymphoma you may see a reed sternberg cell, but in non-Hodgkin’s lymphoma which have a lot of different types, you may see different type of cell.
Melanie: And what would somebody notice? Lymphoma, being a blood disease, what would people notice as symptoms of something that would send them a red flag to go see a doctor?
Dr. Ziari: Well, people may see a swelling of the lymph node and drenching night sweat, weight loss--significant weight loss--and loss of appetite, sometimes itching and significant other symptoms. It depends if swelling lymph node is adjacent to an organ, it can cause organ damage as well.
Melanie: Are there certain risk factors? Is there a genetic component to Hodgkin's lymphoma?
Dr. Ziari: Well, there are some risks actually for this. One of them is a virus. We know Epstein-Barr virus has a significant role. The virus that cause infectious mono, and in lymphoma cells, they notice the presence of them in about 20% to 80%. The other risk factor is familial. So, we have seen this in same sex siblings and the identical twin of a person with Hodgkin's lymphoma are at high risk of developing the disease. Children with parents who have Hodgkin's are also at increased risk. The other thing is environment. So, fewer siblings, early birth order, single family home and fewer playmates are associated with increased risk of developing a Hodgkin's lymphoma, possibly due to lack of exposure to bacterial and viral infections at an early age.
Melanie: Wow! So people hear the word lymphoma--very scary, Dr. Ziari. If they had to choose, which is the preferable cancer? Hodgkin's or non-Hodgkin’s? Which one is more easily treatable?
Dr. Ziari: Well, now we have a lot of progress. Now, we have a lot of treatment for them but Hodgkin's lymphoma has a better prognosis with a very good success rate compared to non-Hodgkin's lymphoma. Again, it depends on the type of what type of non-Hodgkin's lymphoma--if it is aggressive or non-aggressive. But, in general, Hodgkin's lymphoma has a better prognosis.
Melanie: And what are some of the treatment options? What can you do for people that have been diagnosed?
Dr. Ziari: Well, a lot. As I mentioned, we a lot of good treatments available for Hodgkin's lymphoma. If they are at an earlier stage, they may require few chemotherapies plus/minus some radiation therapy. If they are more advanced and high risk, they may have to get more chemotherapy compared to earlier stage plus radiation therapy. There is some favorable risk and some non-favorable risk that we categorize based on this. Some blood work, for example if a patient is anemic, typically males, have a worse prognosis compared to females, aged more than 45, those patients with higher stages, meaning that more lymph nodes involvement and also bone marrow involvement, higher blood count also have a poor risk. And so, we stratify this based on a good risk, fair risk and poor risk. So, definitely poor risk has less response and good risk has a much better response.
Melanie: What are we looking at, at the horizon picture, Dr. Ziari, for lymphomas of all types? Because there are a few types of lymphoma and what are you seeing as going on in the future and the exciting new developments?
Dr. Ziari: Well, definitely there is a very, very good horizon for this such as immunotherapy. It's now in the market and a lot of research on that, in combination with standard chemotherapy which has shown a much better efficacy. The other things are some antibodies against, for example, CD30 in combination with chemotherapy in clinical trials which is very optimistic with much higher and better response rate compared to standard chemotherapy available at this point.
Melanie: When you talk about immunotherapy and people hear words like stem cell transplantation. What's involved in that? Is this controversial or no, not really? This is standard courses of treatment?
Dr. Ziari: Well, this is, first of all, a preliminary result that we see in combination with transplants that have some good results. I don't see that there might be an interaction with the stem cell transplant. What we have data about is about those patients that relapse either after transplant or they had relapse before transplant and they had so good response. We need to have a head to head comparison of clinical trials on those patients that have had those transplants versus non-transplant with immunotherapy to have a better answer.
Melanie: So, in the last few minutes, Dr. Ziari, give your best advice to the listeners on possible prevention or lifestyle behaviors where it relates to lymphoma and Hodgkin's lymphoma, and really something encouraging for them and why they should come to City of Hope for their lymphoma care.
Dr. Ziari: So, first of all, healthy lifestyle helps for most of the cancer, and the second, if you notice any abnormality and the symptoms, including swelling lymph node or drenching night sweats, loss of appetite, weight loss, please don't ignore them and see your doctor as soon as possible. City of Hope is the best place for this because we have the knowledge, we have the technology, and we have all the clinical trials and definitely multidisciplinary approach. So, in case you need to get the standard chemotherapy or clinical trial or, eventually, even if you need a stem cell transplant, we are one of the lead in the nation.
Melanie: Thank you so much. It's really great information. You're listening to City of Hope Radio and for more information you can go to cityofhope.org. That's cityofhope.org. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole MS
Additional Info
- Segment Number 2
- Audio File city_hope/1534ch2b.mp3
- Doctors Melstrom, Kurt A
- Featured Speaker Kurt A Melstrom, MD
-
Guest Bio
Kurt A. Melstrom, Jr., M.D., F.A.C.S., is an assistant clinical professor in the department of surgery, specializing in colorectal surgery. Dr. Melstrom graduated Phi Beta Kappa from Cornell University in Ithaca, NY, prior to receiving his medical doctorate from Weill Cornell Medical College. He completed his general surgery residency at Loyola University Medical Center, where he also pursued a fellowship in trauma and burn research. In 2011, Dr. Melstrom completed his second residency in colon and rectal surgery while training at New York-Presbyterian Hospital/Weill Cornell Medical Center and Memorial Sloan-Kettering Cancer Center.
Learn more about Kurt A. Melstrom, Jr., M.D -
Transcription
Melanie Cole (Host): Colorectal cancer is one of the most commonly diagnosed cancers in the United States. However, advances in detection and treatment have dramatically improved outcomes, particularly in the early stages of the disease. My guest today is Dr. Kurt Melstrom. He’s Assistant Clinical Professor in the Department of Surgery, specializing in colorectal surgery. Welcome to the show, Dr. Melstrom. Tell us a little bit about colon cancer and the diet link. Is there a link between colon cancer and the diet that we consume as Americans?
Dr. Kurt Melstrom (Guest): Sure. No, there definitely is a link. There have been many studies to date and there's no really great evidence or magic bullet that says, “We have to eat this,” or otherwise everybody would be doing it but there definitely is a link between a high fat diet and increased rates of colon cancer and increased red meat intake--a lot of red meat intake. One of the reasons we see this is just the western diet that we’re fed and rates, while significant in eastern countries, aren't nearly the rates that we see here.
Melanie: And what about in terms of things that help with colon cancer? Fiber? People hear about probiotics and fiber and things along those lines. Can they help reduce the risk?
Dr. Melstrom: So, the studies aren't nearly as good for fiber. Fiber certainly will help for other things. Definitely are very helpful in avoiding diverticulitis or diverticulosis. However, not nearly as definitive of a link between that and colon cancer. The one dietary intake that does seem to have or play a role in reducing the amount of colon cancer is high calcium intake.
Melanie: That's interesting. So, let's talk about prevention. We have at our means these days one of the best diagnostic tools in the cancer world, it would seem to me. So, speak about screening for colon cancer and how really easy this is.
Dr. Melstrom: Yes, screening is extremely important. Colon cancer had been rising over the last several decades. However, in the last twenty years, we've seen a decrease in the amount of colon cancer and the reason is the early prevention and the colonoscopy. Right now, the major societies in America recommend a colonoscopy starting at age 50--40 if you had a family member. It's a quick and easy way to get it early lesion before it turns into cancer. A lot of patients do have some hesitancy going into it. They hear a lot of bad stories about the preparation. Now, you do drink a medication that helps clean you out. It gives you diarrhea for approximately 12 hours before the procedure. But, in the long run, a little sacrifice goes a long way.
Melanie: Well, I'm certainly someone who has mine every three to five years because I have a family history. What role does genetics play? Colonoscopies are so easy--not nearly as scary as people think. So, what's that role of genetics and should you be having colonoscopies either earlier or more often because of a family history?
Dr. Melstrom: Sure. So, there are several genetic diseases where you will acquire a colon cancer very much earlier in life. Those being what's called HNPCC or familial adenomatous polyposis. However, most patients will present much, much earlier with that and the family history will be so great that you will know that. Otherwise, there certainly is a link between having a first degree family member--that being a father or mother or a brother or a sister. However, the links aren't quite as strong for that. The only recommendation that we say to have an earlier colonoscopy is if a first degree family member had a colon cancer that was under the age of 50 as well. In terms of the intervals between colonoscopies, right now major studies recommend five to ten years and that seems to be still an okay interval for patients who do have a family history.
Melanie: So, tell us about treatment options. With colonoscopies, you remove polyps which can be pre-cancerous or benign. Tell us a little bit about those polyps so that people don't worry about them so much and that you are taking them out when you do that. And then, what if they are cancerous?
Dr. Melstrom: Sure. So, most colonoscopies, about 70%, I would say, will come back clean. However, if you do have a polyp, it's nothing to worry about. Nothing to lose sleep over. We are able to remove those polyps completely and they are considered pre-cancerous lesions but they still are in the benign state, meaning if left in place over the course of about ten years--which is why we use that ten year interval or so--they could lead to cancer. If a polyp does harbor cancer in it, it depends on how deep and how long it's been there, how invasive it's gotten. There are certainly some early cancers that are in polyps that we can remove completely with just the colonoscopy. However, if it has invaded into the colon wall, then the next step is a surgery.
Melanie: What's involved in that? People hear that right away, Dr. Meltsrom, and they think colostomy bags. They get very scared. Tell us about what goes on in treatment?
Dr. Melstrom: Sure. So now, that's my specialty. That's what I do and I'm seeing patients every day who I take to surgery. Again, it's certainly something that patients are very apprehensive about but much easier once you get through the whole process. The only chance of you needing a colostomy or a bag that will come out the side of your abdomen is if the cancer is so large that it's completely unresectable or if it's so low, close to your anal canal that we have to take that out. The majority of patients will not need that. For someone diagnosed with a colon cancer, chances of them needing a colostomy is in the single digits. Most of the time, we are able to take the cancer out completely and attach the colon back together. We use staples to put everything back together.
Melanie: Well, that's certainly encouraging, Dr. Melstrom. It really is. What's on the horizon for treatment of colon cancer? It's a scary diagnosis but you're this amazing surgeon and really giving hope to people that this isn't necessarily life-threatening all the time.
Dr. Melstrom: If we can catch a colon cancer in its earlier stages, the chance of survival is very, very high--80% to 90%. One of the things that is on the horizon and has already come into play, is better chemotherapy options. In the 1990’s and early 2000’s, two new chemotherapy drugs came out that really helped eradicate any extra cancer cells that are around. From the surgery standpoint, major breakthroughs have been accomplished in the techniques of how we do surgery. I've been trained in doing minimally invasive cancer surgeries now where we’re not making a large open incision down the middle of the abdomen. Instead, we are using a small camera blowing the belly up with air, doing all the work on the inside and that leaves the patient with a small incision.
Melanie: That's great news to hear. In the last few minutes, please give listeners your best advice and hope about colon cancer and why they should come to City of Hope for their care.
Dr. Melstrom: Sure. If you are ever diagnosed with colon cancer, understand that while a serious disease, the majority of them are still curable. If it becomes to an incurable stage, we still have a large amount of options to keep the cancer at bay or keep it dormant. Even if it stays in the body, you can live a significant amount of time with it in place. City of Hope is a special place in that we are a cancer-only hospital. We are a small hospital but our entire focus is just cancer. We have excellent surgeons, colorectal surgeons, like myself, as well as liver surgeons where if the colon cancer spreads--it usually goes to the liver--and a wide array of medical oncologists that are all giving new and different chemotherapy options. The City of Hope has been known for discovering and inventing new, novel chemotherapy drugs.
Melanie: Thank you so much for such great information, Dr. Melstrom. You're listening to City of Hope Radio and for more information you can go to cityofhope.org. That's cityofhope.org. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole MS
Additional Info
- Segment Number 2
- Audio File virginia_health/1538vh5b.mp3
- Doctors Berg, Kristina L.
- Featured Speaker Kristina L. Berg
-
Guest Bio
Kristina L. Berg is a child life specialist in pediatric hematology/oncology at UVA Children’s Hospital.
Learn more about UVA Children’s Hospital -
Transcription
Melanie Cole (Host): Surgery or any other medical procedure can be so scary for both children and their parents. What can you do to ease your child's concerns? My guest today is Christina Berg. She's a child life specialist in pediatric hematology/oncology at UVA Children's Hospital. Welcome to the show, Christina. So, as a child life specialist what do you do to help children at UVA get ready for surgery or procedures?
Christina Berg (Guest): That's a great question. After assessing, the situation I always ask the child first to tell me in their own words what they know about their upcoming surgery. I then ask if they would like to learn more about it. If they do, I explain what the surgery is for and how it's going to help them. I discuss the sequence of events and sensory experiences including things they might see, smell, taste and feel. Throughout preparation, I use visual teaching aids including pictures of what they'll see and actual medical equipment such as an anesthesia mask. I utilize medical play during preparation which allows additional insight into a child's understanding and fears of the procedure. This is a really great opportunity to address fears and their misconceptions. Finally, as a child life specialist, I plan and rehearse coping strategies with the child in order to give them a sense of mastery and control over their situation. These things include things like deep breathing, guided imagery, muscle relaxation or choice of their distraction.
Melanie: So, when a child asks you these questions and you say you give them sensory input on what they can expect to see and hear and smell. Do they express their concerns to you? Are you able to, Christina, help them with those fears as far as, “What if my parents aren't right there next to me?” How do you allay those fears?
Christina: That's a really great question. As a child life specialist, we always advocate for a parental present, and we get permission from the anesthesiologist. If not, we are actually able to go back into the OR with children and to provide that continued support and utilize those coping strategies that we planned. A really big question children ask is, “How is anesthesia going to make me feel? How do I fall asleep?” So, this is a great opportunity to utilize medical play with the anesthesia mask. We practice breathing through the anesthesia mask. We let them decorate their mask. We really kind of try to make it fun and relaxing for them during this kind of stressful time.
Melanie: That's so important and I would think one of the biggest questions children have is, "Will it hurt?" What do you say when they say that?
Christina: Well, as a child life specialist it's our job to be as honest as possible with them. So, if something is going to hurt we do say in a simple, friendly way, “It might feel uncomfortable. It might burn your skin, it might feel like your skin is tingly, you might feel sleepy.” We do let them know if something is going to be slightly painful, we do let them know. We never say, “No, it won't be painful if it could be.”
Melanie: So, that speaks to the trust issue with children where they're looking at you as a child life specialist and trusting you that the information you're giving them is really what's going to happen and their parents as well. Is there any feeling of mistrust where the kids really think that you guys are just telling them things to get them where they need to be?
Christina: With their goal for them not to feel that way and we always do relay the message to parents as well to try to keep them as honest as possible with their children. We explain the importance of this so that they do continue to build trust with their children and so, if they do have future procedures, the child knows that they can ask questions to their parents and they'll know that their parents are going to tell them the truth and they'll know what to expect.
Melanie: Now, for the parents: what tips do you--when you're working with the parents on this too--what do you tell them about getting their children ready to even go to the hospital that day or the night before?
Christina: I always encourage parents to be as honest as possible with their children about what they are going to experience and use age appropriate language in their explanations and preparation. I encourage them to encourage their children to ask questions and make sure to keep the lines of communication open. Let them know that it's okay to ask questions. I remind them to try to remain calm. This is important because children really feed off of their parents' reactions and they can sense when their parent is anxious or stressed. It really does help when parents remain calm. I continue to encourage them to stay positive and provide reassurance that whatever feeling their child has, that those feelings are okay and give them opportunity to express those feelings.
Melanie: That's a huge point, Christina that children feed off their parents. And how can a parent not be nervous when they know that their child is going in for surgery? You work in pediatric hematology and oncology so you must see children with cancer and things. How do the parents maintain that sense of calm on the outside when inside they are really terrified?
Christina: You now, it is a very interesting topic because on one side, you want the parents to remain calm during stressful times, during procedures, but at the same time you're encouraging your child--you're trying to let your child know that, “If you feel scared, if you feel worried, that's okay, too.” So, there are times when parents say, "Well, I don't want to breakdown in front of my child. I don't want to cry around them." And sometimes you have to say, "Well you know, it's okay. That will let them know that it is okay to cry and it is okay to be upset if you're scared." But during really stressful times and procedures, I try to prepare parents as well. I let them know what their role is during that time for their child so they can be there to support them as best as they can.
Melanie: And in just the last few minutes, what's your best advice for parents who are considering having surgery or procedure for their child and why should families come to UVA Children's Hospital for their care?
Christina: I think my best advice would be to provide preparation for your child in advance and let them know what to expect and talk about some of those things, use those tips that I provided. I think families should come to UVA for their care for the great comfort and care that they receive throughout their stay. Staff members as a whole really goes extra mile here to make sure children and their families are as comfortable as possible.
Melanie: Thank you so much and I certainly applaud all the great work you do at UVA Children's. 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/1538vh5a.mp3
- Doctors Walton, Diamond
- Featured Speaker Diamond Walton
-
Guest Bio
Diamond Walton is an injury prevention coordinator in the trauma program at UVA Health System.
Learn more about UVA Trauma Program -
Transcription
Melanie Cole (Host): How long does your child need a child safety seat and how can you be sure your child's car seat is safely installed? My guest today is Diamond Walton. She's an injury prevention coordinator in the Trauma Program at UVA Health System. Welcome to the show, Diamond. So, tell us a little bit about car seats safety. Who needs a car seat? And let's go from infancy up a little bit. Give your basic recommendations.
Diamond Walton (Guest): Yes, absolutely. All children ranging from newborns all the way up to around 7-8 years old should be in some type of a car safety seat. So, of course, as the child grows you want to graduate to different types of car safety seats but they all serve the same purpose--to ensure that the child remains secure in their seat and protected from injuring in case of a crash. So, once the child is tall enough to sit against the vehicle's back seat with their knees bent and comfortably over the edge of the seat, then they probably should be wearing the regular seat belts but until then they should be in a car safety seat.
Melanie: So, when we start with little infants, the day you leave the hospital, those little car seats that face backwards--the rear facing seats—
Diamond: Right.
Melanie: How long should babies be in them? And what if somebody is leaving a hospital and they can't afford a car safety seat?
Diamond: Yes, those are great questions. According to the National Highway Traffic Safety Administration, children should be in rear-facing car safety seats up until around the age of three. And then, they'll graduate to forward facing car safety seats until the age seven and then they can move on to booster seats up until they’re around the age of around 12. But all of this is very much dependent on the weight and the height of the child. So, it's important to look at the bottom of the car safety seat when you purchase it, to look at the appropriate weight and size of the infant that's supposed to be using that seat and then purchase your seat accordingly. But, if you aren't able to afford a car safety seat, there are a number of programs in communities, especially through Departments of Health who distribute free car safety seats for individuals who are eligible. You can also reach out to local organizations like churches or nonprofits who distribute them as well.
Melanie: So, once your child is done with the rear facing and then you've turned them back around, should you be adding any of those little cushions on the seat belts to make it look more comfortable? Because parents look in their rear-view mirror and they say, “Oh, well, that looks like it's cutting into them,” and they add these little things. Tell us about that.
Diamond: Right. Unfortunately, that happens a lot and there are a lot of advertisements trying to push a lot of really cute toys for the children while they're in their car safety seat but it's really important to use a car safety seat as the manufacturer has intended because that's how the seat was tested during crash testing to ensure that it actually works. So, it's really important for parents and caregivers to use the seat without any kind of extra padding or extra things in the seat because the seat is safe as it is.
Melanie: And when do they get to move from the car seat to more of an adult car seat to the booster seat?
Diamond: Around seven years old. So, forward-facing, usually children, if the child is a little bit larger, around three years old, they can be in the forward0facing car seat until around seven years old. And then, they'll be in a booster seat. But they'll be able to wear just a normal seatbelt once they are around eight years old because that's usually around the age where the bones start rounding out around the hips and so the seatbelt will actually fit and stay on the hips and stay on the shoulder bones the way that it would on an adult.
Melanie: Now, you've mentioned eight years old. Does height has much to do with it? Height and/or weight? What if they are a tiny eight-year-old?
Diamond: Oh yes! If they are a tiny eight-year-old, then they should stay in a booster seat but if their feet can touch the ground and if their back can sit up against the back of the seat in the car, then they are at the appropriate height to wear just the regular seatbelt.
Melanie: And what about the front seat, Diamond? Because some parents like to put their kids in the front seat way too soon and the airbags are not really set for children, are they?
Diamond: No, not at all. It's very much recommended that if a child is in any type of car safety seat, whether that's rear facing or a booster seat, that they should be in the back seat. And it's also recommended that even once the child graduates to a regular seat belt, they should remain in the back seat until around 13 years old. Mostly because that's just the safest place for a child to be in the car.
Melanie: What advice do you give parents when they say, “My child is arguing with me? They say I'm too big to be in a booster seat,” but knowing that's much safer and that the lap belt--the seat belt—is not hitting them properly, what do you tell parents to tell their kids?
Diamond: I would definitely just remind them that they are doing this for their safety and that you are kind of setting an example also for their friends and for other parents as well. I think a lot of times whether parents make their child stay in their car safety seat while they are in their own car, they may not be as strict when their child is travelling with their grandparents or with a neighbor. And so, it's really important to keep that messaging consistent whether that's in your car, whether your child is riding with their grandparents or with a neighbor that a child should remain in a car safety seat until they are of the appropriate weight and height.
Melanie: And what about installing them correctly? Because they have a lot of latches these days especially for the infant car seats. Diamond, how do you that you are installing it properly and you're putting the belt through all the little latches it's supposed to go through?
Diamond: Yes, I mean, it's hard. A lot of times there are a lot of latches but it's important to read one, the manual for the car safety seat. They have a lot of great instructions, very specific to the car safety seat that you purchased, as well as your car manual, because cars are different makes and models and so the anchors for the car safety seats are in different places. So, make sure to read the safety seat manual as well as your car manual and to determine how to properly install it. But I would also recommend that parents and caregivers visit their local fire department, police department or health department because one of those local organizations will likely have a registered individual who knows how to properly install car seats and they don't necessarily need to install it for you but they can at least check to see if it's been installed correctly.
Melanie: That's exactly what I did. I went to the local fire department and they were happy to help me figure out how to put my car seat in when I had a new baby. It was so easy. How do you find out more about car safety seats?
Diamond: Well, the National Highway Traffic Safety Administration has a great website so, parents can visit www.safercar.org and you can click on “Parents Central” and it has just a myriad of resources for parents and caregivers.
Melanie: In just the last minute, Diamond, why should patients come to UVA for their trauma care?
Diamond: UVA Trauma Center has been designated as a Level One trauma center since the ‘80s and recently we have been verified by the American College of Surgeons as a Level One trauma center. So, this puts UVA as one of two other ACS verified Level One trauma centers in the state of Virginia. This is a big deal and what this means to the public is that UVA is committed to not only treating injured patients but preventing injury, providing the best care if the injury does occur and then ensuring that there is a quality rehabilitation so that patients can resume their lives.
Melanie: Thank you so much for such great and so important information. You're listening to UVA Health Systems Radio. And for more information you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 5
- Audio File allina_health/1534ah1e.mp3
- Doctors Celkis, Maried
- Featured Speaker Maried Celkis, MD,- Family Medicine
-
Guest Bio
Maried Celkis, MD, is a busy mom to two young children as well as and a family medicine doctor practicing at the Allina Health Oakdale Clinic. Her professional interests are in pediatrics, preventive care and women's health.
Learn more about Maried Celkis, MD -
Transcription
Melanie Cole (Host): For a lot of moms, especially first time moms, returning to work after maternity leave is often hard and it can be a struggle to manage work and family responsibilities. My guest today is Dr. Maried Celkis. She's a busy mom with two young children as well as a family medicine doctor practicing at Allina Health Oakdale Clinic. Welcome to the show, Dr. Celkis. You're a busy woman.
Dr. Maried Celkis (Guest): I am.
Melanie: Being a physician, a family medicine physician, and being a mom of two young children, how do you get back to work after just having your baby, how soon do you recommend women do it, and what's your best advice about getting back into it?
Dr. Celkis: Yes. Hi. That's a good question. So how, let me unpack it. So, when do I advise for moms to go back? You know, the legal standpoint is at least six weeks that they have to be given maternity leave and that's really per the person's job. A lot of times, you can do all the way until 12 weeks, but it just depends on how much you’ll get paid as far as a paid leave of absence. So, it's really the mom has to figure that out with the boss and do what's best. I don't recommend anything that's less than six weeks, for sure. While you're getting ready to go back to work from maternity leave, there are a lot of things that the mom can do to get kind of mentally ready and get her body even physically ready to go back to work. So, during maternity leave it is important for her to stay active as best she can, knowing that if she had a C-Section or even if she had a normal delivery, it takes time for the body to heal; and making sure that she gets plenty of rest, drinks plenty of water, and then gets on a good pumping schedule if the mom is nursing.
Melanie: That's good information, good advice. Are there some steps--I'm going to back up a little bit--that you should take before going on maternity leave that you want women who work to do and to know?
Dr. Celkis: Yes, kind of like I said before, getting on a pumping schedule. It is important for you to be able to know how to use a breast pump, and it's important for you to get on a schedule because your body's just going to react to that and you're going to pump at the same time every day. It makes your maternity leave easier; it makes work easier, if you're just kind of on a scheduled pump time and also it's important to give the baby a bottle before you go to work because you're not going to be there anymore to nurse the baby and it takes a couple days for the baby to get used to that bottle--to the new bottle--as opposed to mommy. So, it's a very good idea to get all that stuff done before you head back to work.
Melanie: And how do you manage going back to work when you're exhausted from six weeks with a new baby? How do you concentrate at work? What advice do you have for moms?
Dr. Celkis: That's a very hard question and what I would say is, again, touching base on the pumping. If you are able to pump at a scheduled time and you know that your child is getting nutrition while you are at work, that takes the stress off and you are able to concentrate better at work because you know your child is at least being taken care of and is being well fed. So, I feel like if you feel comfortable where your child is at, you're going to be able to perform your duties at work. Another advice is getting partner involved. Once you go back to work, it is important to get as much sleep as you can and help with a newborn they get up a lot in the middle of the night. So, since, hopefully, you're pumping at this time, give daddy the bottle, he can take care of the baby so you can at least get more sleep that way and you're going to have to take turns.
Melanie: What about those feelings that you get, of guilt? I am a working mother myself and if all the feeding situation has worked itself out, what do you tell women about the guilt that we feel going back to work and looking at women in the fifties that stayed home with their babies?
Dr. Celkis: Yes. That's a good question and that's a hard question to answer. I guess what I would say is one, everyone feels those feelings. Every mom has felt them, I have felt them. It is hard to leave your child and, as a woman, to leave your own children behind, I don't think any mom doesn't have those feelings. So, it's just to know that you're not alone and it's okay to feel those feelings. It's fine. I would say if you know that your child is well taken care of, you at least have a little less guilt if they're at a good daycare or you have a good nanny, or grandma and grandpa are taking care of them. That helps a lot with the guilt. Lastly, you are doing it to provide for your children. So, be proud. Be proud that you are a working mom. They will see that and they will see the work ethic from you when they get older and they will be proud of you. So, you be proud of them and set an example of what it is to be a good, working, adult citizen.
Melanie: I agree with you completely, Dr. Celkis. I think that it does set a good example and you're doing it for your children and for yourself because some women, such as you and me, we probably love what we do and it gives us a sense of self. So, getting past that guilt and what about, as you say, the exercise and getting ourselves back into shape as we're doing that. How much do you recommend?
Dr. Celkis: You know, it's still recommended at least 30 minutes a day, if at all possible. Now, with small children, I know this is hard. It's something I, myself, even struggle with when you have a baby that gets up every other hour, it's hard to be like, “Okay, let's go exercise!” But, you know, this could be small things like even putting the baby in the stroller and going for a walk. It is so important for your physical health and your mental health to get out and exercise.
Melanie: Where should you turn if you need more help? Who would you go see if you were feeling those feelings of guilt; you were feeling the stress, the exhaustion? All of these feelings we've been talking about.
Dr. Celkis: Yes. So, you can for sure see your family doctor. But, if you don't feel like you need to go see your doctor for that, turn to any mother that is around you. They know exactly what you're going through. These feelings are not new, everyone experiences them. Turn to your sister, your girlfriends, your mother. They will understand and will be there for you.
Melanie: That's absolutely great advice. In the last few minutes, give us your best advice as women for preparing for that maternity leave: finishing up your work, knowing that you're going to have a baby any week now and then going on maternity leave and then going back to work afterwards.
Dr. Celkis: Sure. So, the weeks before you leave for maternity leave, it's busy, and it's exciting because you're about to have a baby. So, I would say, sleep is still crucial. Still get plenty of sleep, even before the baby comes because you're going to be sleep deprived once the baby comes. But, as far as work, make sure that you leave everything done. Every day before you go home, make sure there are no messages that you need to get back to, no emails that you need to reply to; your desk is clean. Just make sure that everything is done, so if you don't come back--because we don't know when that baby is coming--if you don't come back the next day because you had a baby, you don't have to worry about it. You can just enjoy the experience of giving birth and having a brand new baby and not even think about work while you are on leave because that's the time to be focusing on that brand new baby.
Melanie: That certainly is great advice and I applaud you and returning to work as a family physician. It's not easy for mothers out there. Thank you so much, Dr. Celkis. 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 3
- Audio File allina_health/1534ah1c.mp3
- Doctors Risse, Gail
- Featured Speaker Gail Risse, PhD,- Clinical Neuropsychologist and Director of Psychological Services at Minnesota Epilepsy Group.
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Guest Bio
Gail Risse, Ph.D. is a Clinical Neuropsychologist and Director of Psychological Services at Minnesota Epilepsy Group. She has many years of experience in the neuropsychological assessment of adult patients with epilepsy, dementia and a broad range of other neurological disorders.
Learn more about Gail Risse, Ph.D -
Transcription
Melanie Cole (Host): You may have noticed your parent is forgetting things or repeating the same story. How can you tell if these changes you're seeing are a part of the normal aging process or if it's a symptom of something more serious? My guest today is Dr. Gale Risse. She's a Clinical Neuropsychologist and Director of the Psychological Services at Minnesota Epilepsy Group. Welcome to the show, Dr. Risse. Tell us a little bit about your specialty of neuropsychology? What does that mean for the listeners?
Dr. Gale Risse (Guest): Sure. And thank you for having me, Melanie. A neuropsychologist is actually a doctoral level psychologist who has a specialty training in the neurosciences and in the evaluation of cognitive brain functions; things such as memory, problem solving, attention and overall intelligence. These functions can be affected to varying degrees by neurological disorders that directly affect the brain. Some examples of that would be things like epilepsy, dementia, stroke, head injury, brain tumors and many other conditions. The neuropsychological evaluation consists of a series of cognitive tests and they are administered on a 1:1 basis by a trained examiner. Mostly, we use a question and answer format and sometimes, visual motor performance tasks. For example, a patient may be asked to memorize a list of words by practicing the list a number of times or identify a pattern in a visual puzzle. A comprehensive exam can take several hours to complete with breaks depending on the question that's being asked and depending on the stamina of the patient. The test results are then interpreted by a neuropsychologist who can provide information about general efficiency of mental functions overall and also identify any specific cognitive deficit, such as poor memory for faces or a loss of spatial judgement and many other specific functions. We know that some of these functions are located in specific regions of the brain. If we can discover a particular deficit, it may actually help us to pinpoint the problem area.
Melanie: So, what does your specialty have to do with this aging population that we are seeing today? It's such a growing population. So, how is neuropsychology involved in the aging population?
Dr. Risse: Well, a number of these cognitive functions change quite a bit during the normal aging process. Some of these changes include things like slower motor responses, changes in mental speed and efficiency and mild memory decline. These problems can also be made worse by problems with vision or hearing. These age-related changes typically occur very slowly over a number of years. I often see patients who come in in their mid-fifties who are beginning to notice changes and may have concerns. The tests that the neuropsychologists use take these changes into account so that a normal performance for a woman in her 80s, for example, may be quite different from a normal score for a 25-year-old. The tests that we use have been tried out on large numbers of people in every age range so we have a pretty good idea what is normal for a particular age and education level. In a typical evaluation we are always looking for scores that fall outside the normal limits, especially if they can form a pattern.
Melanie: So, if someone is noticing changes in a loved one and maybe they are normal for their age or they are symptoms of something more serious, what are some of the red flags you would like to let listeners know to watch out for that would send them to see somebody with their loved one to get these things checked out as to whether they are a normal part of aging? Please give us some red flags that people can look for.
Dr. Risse: Sure. I think this kind of judgement can be very difficult for family members because there is so much in the media that people hear about dementia or about Alzheimer’s disease and it's possible that sometimes a family member may overreact and they may see a behavior that's really normal for age, like misplacing your keys or trouble locating your car at the mall, and be concerned that this may represent a disease process. But, in fact, the early stages of Alzheimer’s disease or other forms of dementia typically involve more extreme changes in behavior. So, some examples of this would be frequent forgetfulness to the point that it's actually causing practical problems in daily life, or extreme repetitiveness in conversations--not just occasionally retelling a story that was told at a previous family gathering, for example. Getting lost or confused when driving. It can be a change in personality or some kind of a decline in the patient's routine and personal grooming habits. So, any of those things that really look different from the way that person would normally function.
Melanie: So, if somebody notices these kinds of things--and I've had so many older relatives, Dr. Risse, that I see these things that you're describing so often. When you notice these things who do you go see first? Do you go to an internist? Do you go to a neuropsychologist? What is involved? How do you get an evaluation?
Dr. Risse: I would suggest that the first thing to do is to bring it up with the primary care provider. So, a concerned adult child, for example, could go with their parents to their primary care appointment and bring it up at that time. Some doctors may choose to do an evaluation on their own and others may feel the need to refer to a specialist. That specialist could be a neurologist who might perform lab studies and other tests to examine whether this might be the beginning of a dementia and it could be a neuropsychologist. Very often, the neurologist will then, as a next step, refer to a neuropsychologist. It's also possible to make a diagnosis of dementia or to determine the genetic risk of dementia with some very exotic laboratory tests and certain kinds of brain imaging. But, it's important to remember that these procedures are still quite expensive, they may not be covered by insurance and they are really not yet widely available. So, to understand what's going on, the degree of loss, and whether the behavioral changes seem to be in line with the diagnosis of dementia, I think the neuropsychological testing is really still the most accurate method. Another thing to remember is that this testing does require that the patient be completely cooperative and willing to participate in all aspects of the exam. It's very helpful for a close family member to accompany the patient to this exam in order to provide additional details about the specific symptoms of concern, the history and when the changes were first noticed.
Melanie: So, how do you approach your elderly relative if this is something that some people take offense at? They say--and I know people this has happened with—“I'm not having issues. I'm not forgetting things. No, that's not me, I'm not going through those things.” How do you approach the person and get them to go with you to see somebody to discuss this?
Dr. Risse: This can be very tricky and I think all of us with older parents have had this type of experience. I think it's very important to remember that these concerns should be discussed in the most caring way possible. Sometimes it can be very annoying to deal with repetitiveness and forgetfulness. If your parent is in denial of difficulty, it's usually not helpful to try to convince him with examples or logical reasoning and, of course, it's never a good idea to argue. I think it's important to let your parent know that your main concern is his or her safety and comfort and that you're there to help and support them in any way needed. Undergoing a neuropsychological exam can also be presented as a way to seek reassurance and you can tell your mother or your father, “Let's just go get the testing and then we won't have to worry about it anymore.” So, even though denial can be a common obstacle to getting your loved one in for the exam, most patients can usually be convinced to go along with it. Sometimes they agree just as a way to prove that they are right.
Melanie: In just the last few minutes, Dr. Risse, please give us your best advice for those loved ones, people that we love that are getting older, starting to exhibit some of the normal signs of aging, what we should be watching out for? What you really want them to know?
Dr. Risse: I think the most important thing to remember with aging is to live a healthy lifestyle. None of us know what's coming down the road in two years or five years and we can't predict and latch on to every possible symptom and be worried about it at all times. I think everyone, whether they feel they have symptoms or not, everyone that is aging should be concerned with getting plenty of rest, exercising, eating right, maintaining good social relationships and they shouldn't be afraid to seek assistance from their children and other caregivers when it comes to making important medical decisions or financial decisions. For the children of the elderly, I think sometimes they can help most by trying to anticipate issues before a serious problem arises. This might mean sitting down with your siblings and discussing safety concerns; for example, if the ability to drive or to live independently is in doubt. When a parent insists there is no problem, sometimes it's tempting to let it go for a while because you don't want to get into a conflict. But, again, this is when that independent neuropsychological evaluation might provide the push that is needed to make these necessary changes.
Melanie: 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
What if you lose your job/insurance in the middle of the year and it's still some months before open enrollment starts?
Additional Info
- Segment Number 3
- Audio File health_radio/1537ml4c.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
Do you still have unanswered questions on how the ACA works?
Additional Info
- Segment Number 3
- Audio File health_radio/1536ml3c.mp3
- Featured Speaker Marianne Eterno, AVP 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/1534ah1b.mp3
- Doctors Johnson, David
- Featured Speaker David Johnson, MD,- Family Medicine
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Guest Bio
David Johnson, MD is a family medicine doctor at Allina Health Plymouth Clinic. He has professional interests in caring for children from infancy to adolescence. Johnson is father of three who enjoys staying active outdoors camping and tandem biking on his “bicycle built for two.”
Learn more about David Johnson, MD -
Transcription
Melanie Cole (Host): Due to academic demands, schools have shortened gym and recess time leaving students to sit for longer periods of time. Are children getting enough movement in their day and how can we all, as a community, be involved and get our children up and moving? My guest today is Dr. David Johnson. He’s a Family Medicine Physician at Allina Health Plymouth Clinic. Welcome to the show, Dr. Johnson. Let’s start with what are the recommended activity levels for children, adolescent and teens, and what does activity mean for this group?
Dr. David Johnson (Guest): Hey, Melanie. Nice to be on the show. The current recommendations for kids between the ages of 6-17 is to get at least an hour of aerobic activity every single day. That’s what we’re looking for. As far as what constitutes activity it really is pretty broad ranging. We know that, of course, most kids don’t get the activity that they need and so really anything that we could increase is going to be a positive for many of our kids. However, what we want is for the kids to be doing some sort of moderate intensity activity, so running around, playing basketball, swimming, things like that, at least three days of the week with lower forms of activity, the other times of the week would be acceptable. If we can get them to do moderate activity or even higher, that would, of course, be great.
Melanie: So, speak about the correlation, Dr. Johnson, between activity – physical activity--and academics and what they’re doing at school; why it’s so important that they get that blood flow going for their brains to work.
Dr. Johnson: You bet. This is a very important point. A lot of parents don’t know and a lot of the students don’t know that if kids are physically active, they seem to have better concentration. They’re more attentive to the task. It’s not, of course, the perfect treatment for things like ADD, but we know that it does help as far as being able to really pay attention and to actually score better. We know that the kids that are physically active do tend to have higher grades and part of this may be due to the fact that they also have better self-esteem when they’re working out and that may improve the school performance as well.
Melanie: With our children, they’re learning and as adults at work we get up from our desks, we walk around but kids aren’t really allowed to do that if they’re sitting in a class. How important is it that they get up and move a little bit every hour?
Dr. Johnson: Yes, of course. Running between classes doesn’t give us a whole lot of activity but there’s a little bit and, of course, with gym classes being cut, of course, that’s another concern as well. Things can be limited during the school day. Certainly getting out for recess, doing something active outside seems to be very critical. So, for schools where this is a recess, playing around on the play sets, running around with friends is one way to do it. Of course, it’s a little bit tougher, of course, as we get into the older ages. Then, often times gym class can, of course, be fantastic but encouraging activities outside of school is also very important as well.
Melanie: How do you think that those grades correlate to inactivity or an increased amount of activity and as parents what do you want us to do to get our children active on the other times when they are outside school?
Dr. Johnson: This is critical. In fact, I believe I’m correct in saying that one of the closest correlations between children’s weight is the activity level of their parents. It’s not so much of what the diet is like in the home but how active the parents are. So, I’m always encouraging parents to lead the way and show that activity is a fun things to do and something that should be regularly rolled into our daily activities. Also, of course, making sure that the kids have plenty of things to play with. Do they have bikes and helmets that are in working order? Do they have balls that they can go outside and play with? Are activities encouraged around getting kids in the neighborhood to maybe have a pickup game of basketball? So, really making it easy for kids to do it is critical. The other thing is really trying to make activity a fun thing to do. So, instead of saying, “Okay. Let’s do our 30 minutes of calisthenics as a family before we can do anything else,” and “This is a requirement,” of course, obviously, is a great way to turn off kids. If they can see that the parents are really liking to do this – going for mountain bike rides and things like that--of course, obviously that will encourage them to do more.
Melanie: Back in the day, children had recess, they would run around, they’d play kick ball and they’d swing and they’d do all these things. Now, Dr. Johnson, if you go by some school playgrounds you see a lot of kids sitting in groups on their phones during recess when they should be running around. Can we get involved in our schools and make sure that they do run around just like in the olden days and get that activity?
Dr. Johnson: Yes, of course. It’s tough. What are you going to do as a parent? Are you going to run over to the school and say, “Get off your butt”? It’s kind of hard to do that.
Melanie: Yes.
Dr. Johnson: I think that we are very fortunate here in Minnesota that we have a strong interest in making our education system the best it can possibly be and so, at least the schools that I’ve been involved with, the administration, the teachers are very interested in hearing input. If we see that sort of thing happening, I think that raising it up with the administration can be a very useful thing to do. Now, it’s kind of interesting. Everybody’s going to apps these days and sitting on their butt and playing with them, although there are a couple of good apps that parents might find helpful to show their kids and that actually may help them get moving a little bit. One that I like a lot is called Iron Kids that was developed by the American Academy of Pediatrics and, specifically, it’s trying to address this whole thing. It talks about primarily an exercise thing, not so much on the diet but it does encourage different like lower body, upper body work. There’s another app that’s for kids of roughly the 6-8 year old range called Fitness Kids that I like quite a bit too. Finally, Smash Your Food is an interesting diet app that is, of course, designed for kids and that also can be very helpful, too. If they’re just sitting and watching these things, it’s not going to help too much, if you know what I mean.
Melanie: And you are lucky in Minnesota. You did rank #2 on the American College of Sports Medicine/American Fitness Index, which says a lot about that state and what your state is willing to put forward for physical activity. What do you want parents to do to get involved with the school because in favor of academics even gym classes are being cut? So, Dr. Johnson what would you like the schools to know and parents to know from a physician’s point of view?
Dr. Johnson: I think that schools are attentive and responsive to what the parents are interested in. Now, of course, there are national requirements but I firmly believe that if parents go to their principal and say, “I really have a concern that we’re not getting enough physical activity for our kids or that it’s being pushed down the priority list in favor of other things” I think that they’ll be responsive to that. Of course, there’s an awful lot of pressures and a lot of things that they have to juggle but I think they will give higher priority to a topic like this if the parents will push the point.
Melanie: And while we do have to keep up with the academics of other countries it is so important that we give the children a chance to run around and get that blood flow. Now, again, as a parent, you mentioned being a role model. What would you like families to do together in the fall and in the winter to be active as a family because that’s really the best way to get everybody together?
Dr. Johnson: You bet it is. Of course, in the fall when the weather is nice and cool and we’re not sweating too much to be outside, one thing that we like to do is mountain biking or road biking. That’s a way to get the family involved. They can go maybe to dinner and make a little bit of an incentive for the kids to bike out to dinner and back. We have now quite a few sets of snowshoes in our family and that’s a wonderful activity in the winter. I always tell patients that move to Minnesota from other states that if they don’t get outside in the winter, they’re really going to start to dislike the state. Snowshoes, cross country skiing, going for walks in the woods, making snowmen and all that, is really critical just to survive the winter, much less being physically active. Those are all wonderful family activities.
Melanie: I love the winter myself. In just the last minute, what’s your best advice about getting children active during the school day and all year round?
Dr. Johnson: I would say that for the school day, again, they have their requirements of what they need to be doing during the actual school time period. Getting outside is really the critical thing. So, for recess getting outside but, of course, the school day, the Monday through Friday week, also includes time after school, too. Getting outside really is the key. Studies have shown if kids are just outside they will be much more likely to get these requirements than if they’re inside watching TV or even trying to active things inside the house. So, get outside.
Melanie: That is great advice. Thank you so much, Dr. Johnson. 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 3
- Audio File virginia_health/1534vh5c.mp3
- Doctors Topchyan, Katarina
- Featured Speaker Katarina Topchyan, MD
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Guest Bio
Dr. Katarina Topchyan is board-certified in internal medicine and specializes in endocrinology, including thyroid conditions.
- Hosts Melanie Cole, MS
