Inactive (722)

Audio File texoma/tm007.mp3
Doctors Kureshi, Ikram
Featured Speaker Ikram Kureshi, MD
Guest Bio Ikram Kureshi, MD is a General and Weight-Loss Surgeon and a member of the medical staff at Texoma Medical Center.
Transcription Melanie Cole (Host): More than 12 million Americans are severely overweight according to the US Department of Health and Human Services. Many people who are seriously overweight have tried different dies, medications, and professional weight loss services for years without long term success. My guest today is Dr. Ikram Kureshi. He is a general and weight loss surgeon and a member of the medical staff at Texoma Medical Center. Welcome to the show Dr. Kureshi. So what is defined as severely overweight or severe obesity?

Dr. Ikram Kureshi (Guest): Well the definition actually has to do with what we call body mass index, which is basically a ratio of your height and weight. But to make it simple, essentially if you’re at least 50 or more pounds overweight you would be in the category of severely overweight or obese.

Melanie: If people are severely overweight or obese, they have some options, maybe they’ve tried diets or medical weight loss programs. When it comes to bariatric surgery this is a big decision. What goes into making that decision? Is it psychological counseling, is it health history, what goes into making that decision?

Dr. Kureshi: It’s multifactorial. I think there’s all of the things you mentioned plus some other issues. First of all, each person needs to make the decision themselves based on their history of weight loss in the past. For example, if they’ve tried medications or different weight loss programs and have had minimal success or only temporary success then surgery is an option for them. But they also have to keep in mind that surgery is a permanent change to your body and you have to be mentally ready for that and ready for making some changes with your eating habits as well afterwards. But I think if someone does feel that way it is the most successful way to permanently lose significant amount of weight.

Melanie: And then what would be the parameters under which you would tell them yes we can perform this type of procedure?

Dr. Kureshi: Well first of all we make sure their body mass index is meeting the criteria so that at least 50 pounds or more overweight. We also want to make sure that they’ve tried other things for weight loss, for example medications or weight loss programs. And if they haven’t had success then technically they meet the criteria to proceed with surgery as long as they are mentally prepared and ready for it.

Melanie: And mentally prepared, what does that mean?

Dr. Kureshi: Well I did mention earlier that people we’re changing your body during a weight loss procedure and changing your stomach to a certain extent, there are some eating changes that have to be made after surgery. Namely you do have to eat a lot slower, really chew your food well. We want our patients eating a high protein, low carb, low sugar diet. And that’s critical to being successful with weight loss surgery. If you plan on just eating all the wrong things even after surgery you won’t get the results that you want. So we want to make sure that each of our patients is mentally prepared for that and motivated to do that.

Melanie: Before we talk about the type of procedures, Dr. Kureshi, what would you like them to do in advance as far as exercise and eating and should they still try to lose weight and do some strength training or maintain their medications. What would you like them to do in advance?

Dr. Kureshi: Well we always encourage ongoing weight loss even prior to surgery, but most importantly I think it’s making sure that they get accustomed to eating the right things that they’re going to need to continue after surgery. So like I mentioned, lots of protein, low carb, low sugar diet. Maybe even practicing eating slower and chewing well. Starting an exercise regimen that they feel comfortable with and feel like they can maintain after surgery as well. So we try to get our patients to start all of that beforehand so it makes the transition a lot easier afterwards.

Melanie: So let’s discuss the types of bariatric surgery that you perform at Texoma Medical Center. So there’s a few types people have heard of. They’ve heard of the adjustable gastric band or a sleeve gastrectomy or the gastric bypass. So what don’t you start with the bypass. Explain a little bit about what that means, what that is and a little about the procedure.

Dr. Kureshi: Well the gastric bypass is the oldest of all the procedures you’ve mentioned. It’s been around a long time. It is the most invasive of all the procedures. Meaning we are changing the digestion of each individual person the most. So what we do in a gastric bypass is we actually take the stomach, make it smaller, and connect it directly to the intestines. So you have a smaller stomach but also you don’t absorb a lot of the nutrients that you do eat. And so for that reason it is very effective. The weight loss is very fast. However, because it’s very invasive there are a few more complications that can occur with gastric bypass. Some of them being the patient cannot absorb enough vitamins and minerals. So for that reason it is just not as popular as it used to be especially now that the other procedures you also lose the same amount of weight but don’t have as many issues compared to a gastric bypass.

Melanie: What’s life like for someone who’s had the bypass? They’ve got that small pouch now that’s where their food goes. What’s life like and what are they supposed to do afterwards as far as eating?

Dr. Kureshi: Well the good thing is that those folks they get full very quickly so you either eat very small meals, usually half a cup of solid food is enough to fill the pouch and you fill full. But again, you don’t absorb a lot of what you eat so you have to be very careful about making good food choices and taking the appropriate supplements that you have to take permanently afterwards. But if you can do that then the weight loss is extremely effective and it is permanent. But again, it’s important ot make those eating changes to be successful.

Melanie: And what about the gastric sleeve, what is that?

Dr. Kureshi: The gastric sleeve actually is one of the newer procedures and its actually become very popular because it is not as invasive as the gastric bypass. And what I mean by that is in a sleeve gastrectomy we do make the stomach smaller into a smaller pouch but you still absorb all of your food the exact same way as you do before. So we don’t have the issues of malnutrition or malabsorption with the sleeve procedure, but at the same time you still get full very quickly with a very small quantity of food. And the weight loss is just as effective as the gastric bypass but without all the issues that we had mentioned earlier.

Melanie: Does it involve a shorter hospital stay?

Dr. Kureshi: It is. Yes. Because it’s less invasive we’re talking about an overnight hospital stay with the sleeve procedure going home the next day, most people are back to work within a week after surgery. And again you don’t have to take long term supplements as long as you eat a balanced diet you get all the nutrition that you need but at the same time losing the weight that you want to.

Melanie: And tell us about the gastric band, what is that?

Dr. Kureshi: Well the lap band procedure is also not a very invasive procedure. What I mean by that is it basically creates again a very small stomach pouch so eating a small amount of meal fills you up quickly but without having to effect the digestive or absorption of the nutrients that we take in. Now the issue with the lap band is that it is a foreign body and we are placing this device around the stomach. For some people it has led to issues such as the band moving out of position or infection, so that’s something that we have to consider when doing a lap band. But it is very effective. The weight loss is a little bit slower compared to a sleeve procedure or a gastric bypass procedure so that’s a consideration. But is is effective for long term weight loss.

Melanie: One question I’m sure you hear a lot; how much weight can they expect to lose with any of these procedures?

Dr. Kureshi: It of course depends on the weight that each person is starting at. For the most part most people can lose anywhere from 100-200 pounds with any of the procedures that we discussed. And that may take anywhere from 6 months to 2 years post-op to lose that much weight depending on the procedure that you have. But that’s about the rang of weight loss that we’re talking about. And again, most importantly I think this is permanent weight loss. So whatever weight you lose with a weight loss surgery, you’re going to keep it off forever.

Melanie: And you’ve mentioned lifestyle management and proper eating a few times in this segment Dr. Kureshi, what would you like listeners to know about the lifestyle after surgery as far as their activity and the foods that you’d like them to steer clear of and what they can do? What would you like them to know?

Dr. Kureshi: Well I think if you talk to anyone that’s had weight loss surgery they will tell you that it is a lifestyle change. So it’s not just a matter of doing surgery on the stomach, but it’s also your mental outlook on approaching eating. And that’s a very important part of this whole process to be successful. And the main things like I mentioned are making good food choices. So high protein foods, low carb foods, not doing a lot of bread or rice or pasta or potatoes. Not doing a lot of sugar. For example, sodas, that’s another thing we have our patients limit or completely eliminate from their diet. And that’s not easy to do for anybody. But it is very important to be successful. And then of course exercise is another critical component to this. And so we want our patients to be ready and willing to do an exercise program again that fits their lifestyle, fits their health and what works for them. But I think if you can do those things along with surgery you’ll be very successful in significant weight loss for a long period of time.

Melanie: And why should they come to Texoma Medical Center for their care?

Dr. Kureshi: Here at Texoma Medical Center we have a comprehensive program for weight loss surgery. And what I mean by that is not only are you taken care of from your physicians but also our nurses, our operating rooms, our recovery areas. Even we have a support group that meets every month for our patients. We have dieticians and even psychologists that help our patients from before surgery, during, and after to make sure that our patients are successful. We are actually an accredited, certified center for weight loss surgery here at Texoma Medical Center and we’re very proud of that again because it means that we proceed the utmost care and attention to our patients who have weight loss surgery.

Melanie: Thank you so much Dr. Kureshi for being with us today. You’re listening to TMZ Health Talk with Texoma Medical Center. For more information you can go to TexomaMedicalCenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The hospital shall not be liable for actions of treatments provided by physicians. Individual results by very associated with any surgical procedure. Talk with your doctor about these risks to find out if surgery is right for you. This is Melanie Cole thanks so much for listening.
Hosts Melanie Cole, MS

Identifying Diarrhea and Intestinal Parasites in Children

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Audio File doctors_laredo/dl009.mp3
Doctors Soriano, Asuncion
Featured Speaker Asuncion Soriano, MD
Guest Bio Asuncion Soriano, MD is a Pediatric Gastroenterologist and a member of the medical staff at Doctor's Hospital of Laredo.

Learn more about Asuncion Soriano, MD
Transcription Melanie Cole (Host): Viruses, bacteria, and parasites are living organisms that are found all around us. They're in the water, in soil, and on the surfaces of the foods that we eat. They're also on surfaces that we touch, such as countertops in the bathroom or kitchen. Some bacteria live in and on our bodies and don't cause problems. Others are not so innocent. My guest today is Dr. Asuncion Soriano. She's a pediatric gastroenterologist and a member of the medical staff at Doctors Hospital of Laredo. Welcome to the show, Dr. Soriano. What are viruses, bacteria, and parasites? Explain how we get those. Really what are they?

Dr. Asuncion Soriano (Guest): Well, those are all organisms that cause infection and disease whether it's gastrointestinal or pulmonary or any organ system. In particular, we have to focus ourselves on bacteria and parasitic diseases as these are the infectious agents that need treatment and increased surveillance. Viral diseases by definition have a very self-limiting course, unless of course we talk about the deadly viruses which is not the topic for now, but for intestinal diseases, viruses are quite mild, self-limiting. They don't go to chronicity. It's the bacterial and the parasitic diseases that have long-term sequelae.

Melanie: So, Dr. Soriano, how does a child usually come in contact with a bacteria or a parasite that could cause something like diarrhea?

Dr. Soriano: Well, there are very easy ways or common ways which we don't recognize. We can -- first is contaminated water -- if we are in an area where the child is in the pool; there was a fecal accident of another baby -- soiled or even any other person who by chance had soiling of that pool or water supply. That's a source. Secondly, daycare. That's quite common, and you've heard the stories of moms saying that one child was sick in the daycare so then another one got ill so, it just follows like a chain reaction. The parent can be infected themselves and unless you are really very cognizant of handwashing -- very, very careful and aware that you can pass it on because these are microscopic agents. You don't see them. You just have to be aware of them. Not only parents, caregivers -- anybody that changes diapers or comes from the bathroom and then you did not soap your hands, and you can be an asymptomatic carrier and that alone will pass it on to the next child or person.

Melanie: So, let's talk about some of these intestinal parasites and what are the most common ones that you see as a pediatric gastroenterologist, and what should parents look for as far as red flags -- something that would signal -- whoa, something's going on, and I need to get this child to the doctor?

Dr. Soriano: Well, we're approaching summer, and Giardia is number one on the list. It's a very common parasite that has outbreaks during the summer. As what I said any common source: water, pool, swimming in lakes, anywhere even in the daycare if the person came from a contaminated area, so, Giardia's number one on the list. Cryptosporidium has been noted in big outbreaks like there was this problem in Minnesota way back. That occurs in clusters, but then my area in south Texas, it's Giardia and that’s something that we have to have a heightened awareness.

Melanie: So, there are some other things that we know about like rotavirus and even people here in the media hear Salmonella and bacteria E. coli. So what do you want people to know about these things, and you mentioned handwashing? What are some things that we can do as parents and teach our children to do to avoid some of these things that might be around?

Dr. Soriano: Well, apart from handwashing and I'm talking about strict handwashing, just not with water -- it's a little bit funny to think that some people just think it's just putting water and that's it, but soap and water, at least to rub your hands and then for any -- in and out of the toilet, doorknobs, you know, even telephones and of course, whatever is the source of water in your area. For instance, my area in south Texas is quite known for having a poor water source or reservoir. There is a map that was released by the Centers for Disease Control, and they do send it out every year showing areas where there is an increased surveillance of all of these parasitic diseases, and south Texas is in that area just because of our proximity to the Rio Grande River, to Mexico where there is, you know, water and parasites that are not treated.

Melanie: So, what do we do? If our child starts to come up with diarrhea, and we notice that there is something going on -- we take them to the doctor and find out whether it's a virus or a bacteria. Is there anything that can be done?

Dr. Soriano: Well, certainly, you have to take the child away from the daycare. She is going to be a contaminant. The best way to stop the symptoms from progressing any worse is to get treatment. There are so many diagnostic tests available, but in my practice of 20 some years in Laredo, a lot of these stool studies are non-diagnostic. It is very difficult to isolate these parasites, especially if they are not picked up by an astute diagnostician or a laboratory technician. So, a pediatric gastroenterologist or a pediatrician who's very attuned to these disease can initiate treatment and there is really nothing wrong in initiating empiric treatment for these common parasites.

Melanie: And what would some of that treatment entail?

Dr. Soriano: Well, one would be metronidazole. It's an anti-parasitic agent that's been around for a very long time, but my experience in our community is that a lot of my patients have this resistant strain. They do not respond to the initial treatment, so they come back to me. They may have some relief, but then it recurs. The other agent that I have used with a greater degree of success is nitazoxanide, marketed as Alinia, and it's really been very effective, and it's a very short treatment of three days and somehow it is best to just initiate that treatment, and it affects a lot of the common parasites and bacteria, and it gets the mom back to work, gets the child back to the daycare.

Melanie: You mentioned resistant strains, Dr. Soriano. When we're cleaning those surfaces and spraying Lysol all over the place, are we over sanitizing and then making it so that our bodies are less able to in our immune system and in our gut are we less able to fight off some of these parasites and bacteria and viruses that seem to be all over the place?

Dr. Soriano: Well, it's been written that somehow the more you aggressively sanitize you create more mutant strains. Soap and water is just a general rule. We don't overdo stuff. We don't cause any carcinogenic risk with using a lot of these powerful agents. So, basic handwashing with soap and water is okay. Alcohol is not as effective. It's basically soap and water.

Melanie: So what do you want people to know about trying to avoid these parasites -- bacteria and viruses -- and these places like common water, swimming -- how do you know if there's been a baby in there that has done that, and is it just wishful thinking that it's going to be clean all the time? What do you want to tell listeners about recognizing the red flags, spotting this, and getting their child the help they need and possibly prevention of transmission all together?

Dr. Soriano: Well, first of all, you can't predict if the swimming pool or any of these lakes are going to be contaminated. I would just say heightened awareness. If you feel that the public pool is frequented and it's overcrowded, I would stay away. Parents can ask how often these pools are -- the waters are changed. Bear in mind, chlorine doesn't kill these parasites. It does not.
Secondly, if you are in a pool that you think is clean or you are swimming in the lake, you are a backpacker, do not swallow the water. I know that is difficult, but you just have to impress it on the child they cannot swallow the water. They can swim with their goggles on and keep their mouths closed. Really, it's ingesting it orally, and only ten cysts can you know -- cyst: c-y-s-t, those are the eggs of these parasites -- can cause a GI problem, so truly the only way for it to come in is through the mouth. That's a common portal of entry or in an open wound, and we know that open wounds -- we can't really swim with open wounds, but to ingest it by mouth -- that's a common way for it to come into their intestinal tract -- if you feel that you need to swim, or you think that the pool is clean.

Melanie: And tell us about your team at Doctors Hospital of Laredo.

Dr. Soriano: Well, I'm a pediatric gastroenterologist. I’m a sub-specialist of pediatrics. Pediatrics by definition is from birth to age 21. I take care of diseases from the oropharyngeal area that's not up to the intestinal tract which all the way is to the rectum. For those patients that do not get any relief for treatment from a lot of these diseases to their usual medication given by the pediatrician, then the patient gets referred to me, and like what I said, it's the chronicity of the symptoms that makes the pediatrician refer the patients to me, and when I say chronic symptoms, by definition is symptoms more than 2 weeks, 14 days. However, if the parent feels that it's not getting better after a week, certainly they can ask for your pediatrician to refer their child to me. The symptoms can be anywhere from having difficulty with eating, a lot of nausea, vomiting, abdominal pain, a lot of cramping, a lot of gas, diarrhea. Whether it's once a day or twice a day, but it's persistent, watery -- something out of the ordinary -- those are red flags, and, of course, the ultimate visible sign is the patient is losing weight. So, that alone triggers a referral to a pediatric gastroenterologist.

Melanie: And what would you like parents to do at home with their children while they're getting treated for whatever parasite? What can they be feeding, how should they be giving them liquids, even if the child is having trouble keeping them down to make sure that they stay hydrated?

Dr. Soriano: Certainly any soft foods is important as long as it doesn't require the digestive tract to exert a lot of work in processing that food. Non-acidic foods, non-fried foods. To avoid dehydration, certainly lots of fluids oral or rehydration solutions with a lot of the electrolytes. The Gatorades are good with that, or you can just buy the Pedialyte. There's a lot of fruit-flavored Pedialyte around, popsicles. They make it so enticing that the child can take them without being coerced to drink. Bananas are good. Any of the BRAT diet that we’ve been told and taught way back when those are good. Anything that's not so sugary because sugar can induce more diarrhea. We have to go bland. We have to go soft, and basically just any calories that we can give to the child so they don't get dehydrated any further or lose weight any further, as long as it's not irritating those are good.

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

Recent Zika Virus Updates 2017

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Audio File allina_health/ah139.mp3
Doctors Parker, Meiling
Featured Speaker Meiling Parker, MD
Guest Bio Meiling Parker, MD is a board-certified maternal-fetal medicine specialist with Minnesota Perinatal Physicians, part of Allina Health. Minnesota Perinatal Physicians offers expert and personalized high-risk obstetrical care for all maternal health concerns, pregnancy complications and fetal abnormalities.

Learn more about Meiling Parker, MD
Transcription Melanie Cole (Host): It's been over a year since the World Health Organization declared the Association of Zika Infection with microcephaly and other neurological disorders as a public health emergency of international concern. A lot has happened since then, including several confirmed cases in the United States. My guest today is Dr. Meiling Parker. She's a maternal fetal medicine specialist with Minnesota Perinatal Physicians, a part of Allina Health. So, Dr. Parker, welcome to the show. We’re here to do some updates on the Zika virus and what women and men who are planning for a family need to know. So, what has changed? We're into 2017 now, and what is the Centers for Disease Control and Prevention speaking about now?

Dr. Meiling Parker (Guest): Hi, good morning, Melanie. Thanks for having me back. In the last year, scientists have been able to now detect Zika virus in brains, amniotic fluid and placentas of affected babies, and they have also been able to isolate Zika virus in specific areas of injured brain cells. So, using these studies as well as others, the CDC has now concluded that there is enough evidence to support the Zika virus is a cause of microcephaly and other severe brain anomalies. In addition, using what we know about the current outbreak in Brazil, scientists have estimated that the risk of microcephaly with a first trimester infection is between 1% and 13%. There's not enough data at this point to estimate what the risk is when the parent is infected in the second and third trimester, but scientists think it's probably a little bit less than infection in the first trimester.

Melanie: So, what does this mean for women who are planning a family or for the men involved in the situation as far as travel? I mean, we've come up to the summer, people want to travel plus in certain parts of the United States it's been identified. What do we need to know about this upcoming summer?

Dr. Parker: Well, it's important to check the CDC website for recent updates regarding areas with local transmission, and it's really important for pregnant women and those who are trying to become pregnant to avoid traveling to those areas with active transmission because it's important to know that there's still no cure for Zika virus or for congenital Zika virus.

Melanie: So, can you give us an update, Dr. Parker, on where the Zika virus is currently found or if it's active in parts of the United States?

Dr. Parker: So, there have been over 5,000 cases total reported in the US, and these are contained within every state except for Alaska. There are now cases of local mosquito-borne transmission in Florida and Texas and those counties and areas are on the CDC website, but the main areas to avoid in Florida would be Miami, Dade County and then Brownsville, Texas.

Melanie: Wow, so a question that I have heard people ask is if this is being spotted in Florida or in Texas, can the mosquitos carrying this virus -- can they travel? Can they fly to other parts or is it being transmitted by somebody in that area coming into this area and brining it that way?

Dr. Parker: Well, the range of the mosquito is pretty short, so it's unlikely for a mosquito in Texas to make its way up to for example, Minnesota, but people who are infected in Texas who then travel to other states, and who are bitten by a mosquito while they still have virus in their blood have the potential for infecting mosquitos in that local area, so that's mostly how the infection was spread across the US.

Melanie: So then speak about how it is spread person to person? What are the modes of transportation?

Dr. Parker: Well, we do know that Zika is sexually transmitted so it can be passed through secretions during intercourse. There are also cases of Zika identified in donor blood as well as, you know, one or two cases of laboratory transmission. There has been a case where two people living in the same household transmitted Zika virus to each other, but it's not known at this point what that specific route of transmission was.

Melanie: Is there any new news about diagnosing Zika if you are a pregnant woman, and you think you might have been exposed to this virus, what do you do?

Dr. Parker: Well, the first thing is to notify your OB/GYN provider so that testing can be done. Even women without symptoms who suspect that they were exposed either by travel or by an infected partner can be tested and so the testing modalities are still the same. It will involve a blood sample and a urine sample as well as ultrasounds during pregnancy.

Melanie: And then is this something that if they detect it, this is reported?

Dr. Parker: Yes.

Melanie: --I mean this is something that gets reported to the CDC and then what's a woman to do about that? How does her OB/GYN and Dr. Parker, you know, you're a maternal fetal medicine specialist so what would you do with the woman if you have discovered that she has Zika? How do you help her through that pregnancy?

Dr. Parker: So, keeping in mind that even with confirmed Zika infection, a minority of women will go onto have congenital Zika infection or babies affected by Zika; however, every woman with confirmed infection needs to be followed closely throughout pregnancy, and that's mostly by following the growth of the baby with ultrasound and using ultrasound to look for Zika specific birth defects as well. These babies after birth will also have blood testing done in order to confirm congenital Zika infection.

Melanie: So, women should stay away from these certain areas -- kind of wrap it up for us with some updates for women and men who are planning a family, and what they should take into account in regards to the Zika virus this year and what it means for pregnant women and those trying to become pregnant.

Dr. Parker: So, there is still no cure for Zika virus so the most important thing is preventing Zika infection, and the easiest way to do that is to avoid traveling to areas with active Zika transmission, and those areas are all outlined on the CDC website so before traveling to other countries, or to the southern United States, women and their partners should check the CDC website for the most up-to- date guidelines. If travel is absolutely necessary, they should make every attempt to avoid being bitten by a mosquito, so that means using mosquito repellent with DEET, using mosquito netting at night, staying away from outdoor areas and staying in lodgings that has air conditioning rather than opening windows.

If a woman has to travel to these areas, they should notify their OB/GYN so that testing can be done when they return and so that their babies can be followed with ultrasound. If their partner has suspected or known infection, they should abstain from intercourse for the remainder of pregnancy or use condoms every time.

Melanie: It's really important information, and thank you so much Dr. Parker for being with us again. You're listening to the Wellcast with Allina Health and for more information, you can go to allinahealth.org. That's allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Hospitalist Medicine: Part of Your Care Team

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Audio File corona/cr014.mp3
Doctors Kamalpour, Fari
Featured Speaker Fari Kamalpour, DO
Guest Bio Fari Kamalpour, DO is the Director of the Hospitalist program and a member of the medical staff at Corona Regional Medical Center.
Transcription Melanie Cole (Host): According to the Society of Hospital Medicine, hospital medicine is a medical specialty dedicated to delivery of comprehensive medical care to hospitalized patients. Internists practicing hospital medicine are frequently called hospitalists. My guest today is Dr. Fari Kamalpour. She's the medical director of the Hospitalist's Program and a member of the medical staff at Corona Regional Medical Center. Welcome to the show, Dr. Kamalpour. So, let's start with what is a hospitalist? What is your training like? What do you do for the patient?

Dr. Fari Kamalpour (Guest): Good morning. My training, like most doctors and hospitalists is in internal medicine. Majority of the hospitalists in the United States are internal medicine trained physician. Obviously, we have some family medicine physicians who actually perform as the hospitalists plus some mid-level practitioners like nurse practitioners or physician’s assistant.

Melanie: So, how did this come about? Tell us a little bit about the history of hospital medicine.

Dr. Kamalpour: Well, the history goes back for at least 20 plus years. With the expansion of chronic diseases and the complexity of the care developed most of the internal medicine physicians, who were monitoring their patients in the community were not able to perform in terms of the time constraints and the new advances in hospital management of the patient in the hospital. So, the specialty was born to coordinate the care for the complicated patients that come into the hospital and their primary care physician is either unable, time-wise, or not available in the community to take care of the patient in the same hospital. The hospitalists came around 1995, the first company with a large group of hospitalists was established, but now we have numerous companies across the country with employed or independent practitioners that work with the hospital to provide the care.

Melanie: Okay, so what an interesting, you know, development because this is really a growing population of internists that are becoming hospitalists. So, Dr. Kamalpour tell us what you do exactly for the patient. How do you work with the nurses and the on-staff people at the hospital and the families and where is their regular physician in this picture?

Dr. Kamalpour: Well, our job, like any other hospitalist across the country, it starts when the patient is being admitted from the emergency department. We're going to be the sole physician responsible as the primary attending physician for the patient. Our job is to coordinate the care during the hospitalization with other specialists that are helping out with the management of the care. Also, coordinate the care with the ancillary service with the tests and everything that needs to be done. We do diagnosis, treatment, and procedures on the scope of our practice plus we coordinate and collaborate with other healthcare providers in the team. Majority -- I mean if the hospitalist is on the case -- the primary care physician would not be seeing the patient. Our job will be to safely transition the care after discharge to the primary care physician.

Melanie: Okay, so in the hospital itself, then once they're out, then it goes back to the primary care physician. What are you able to do? Can you recommend tests, do you speak with the family about outcomes? Can you even help them set up appointments with other doctors if they've been told they have cancer or some chronic lung condition? Can you help them set up those appointments?

Dr. Kamalpour: Absolutely. Absolutely. Our job is very comprehensive. After we make the diagnosis, if it's a new diagnosis, we set up the follow-up treatment as an outpatient. Obviously, any treatment or further testing that needs to be done as on inpatient basis will be performed before the patient leaves, but the follow-ups will be arranged prior to discharge. Also, with the families and the social aspect of the care we're going to be the direct person to contact the family and usually with our patients we have daily meeting if the family's available. We coordinate the care with our case management if the patient needs a transitional care after discharge, going to rehab, or long-term acute or even transfer to tertiary center because in my hospital -- we are a community hospital, and a lot of hospitals in the country have to occasionally send the patient to a higher level of care. For all those, we are going to be responsible -- we are going to be the one who calls it in, makes a decision, and recommends.

Melanie: And what about once they are released and helping them settle into one of those facilities you mentioned or even home? Can you help the families set up home health care or any equipment needed? Can you advise them on what it is that they're going to need if they are taking their loved one home?

Dr. Kamalpour: Absolutely. At the time of discharge, usually there is an evaluation in terms of the physical ability of the patient or any speech therapies that they need physical therapy, occupational therapy that they need, and we are going to recommend -- a home-health agency will be decided before the discharge, but the family gets the choice of different companies available in the community, and they choose their own company, and they usually are met by the agency's representative within 24 hours at home. If the patient goes to a skilled nursing facility, either the primary care physician will take care of them, or the medical director of the facility will take care of them while the patient is still there. If the patient is going to long-term acute rehab, usually, it's the medical director, or based on availability, the primary care physician may choose to monitor the patient during those courses of rehabilitation. We also help our patients with end of life decision making. If they need comfort care arranged for them in terms of hospice, that is going to be arranged in the hospital, and the patient either goes home with hospice, or if they need to go to a setting -- if skilled nursing is available -- it's going to be arranged.

Melanie: What about if they have to have surgery, Dr. Kamalpour, where do you fit into that picture, then? Are you with them before and then after and the surgeon takes over for the procedure, whatever they may need? How does that fit into this timeline?

Dr. Kamalpour: Actually, in our hospital, our surgical cases that come through the emergency department are admitted to internal medicine and that fits a lot of hospitals across the country. If the patient is admitted to us, we're going to be, obviously, from the very beginning, to the end. The hospitalist will be responsible for admitting, arranging for the surgery, obtaining medical clearance for patient if they are at some level of risk for a surgery, and also coordinating the surgical procedure with the surgeon. Post-op care also is going to be on hospitalists until the patient gets cleared by the surgeon. That's when, if the patient is medically stable, can be discharged home -- so, from very beginning until the end. There are other aspects of involvement of a hospitalist in the surgical cases is that the patient comes in as an outpatient scheduled surgical procedure which occurs all across the country, and the majority of these cases we are being in the team as a form of a consult for the surgery. Basically, the surgeon would be the primary, and we act as the consult in terms of medical management of the patient. We clear the patient medically at the time that the patient is appropriate to go home, and the surgeon is actually the one who discharges the patient.

Melanie: Wow, so you really have a very comprehensive, multi-disciplinary job for the patients that are in the hospital. So, wrap it up for us, Dr. Kamalpour and give your best advice or your best information, what you like people to know about what you do for a living, and why they should come to Corona Regional Medical Center for their care.

Dr. Kamalpour: Well, what I do for a living is to be with my patient at the worst time of their life, being in a hospital -- in a nutshell -- but in general, what I do is I will fill in the transitional gap in their care until they get back to their primary care physician, and even if they don't have a primary care physician -- let's say the patients were new to the area and their first encounter with a medical profession in the community is the hospital. We help them to find a primary care physician at discharge. While they are here, they're going to be directly under my care. Obviously, there is a huge collaboration between me and my colleagues, the different specialties, and also other services in the hospital to make sure that their stay in the hospital is safe, efficient, and hopefully with the best outcome. The other aspect of my job would be involved in the hospital system improvement. As a hospitalist, I participate in many programs that are aimed at quality improvement, patient safety, medication safety and all those things that is not going to be mentioned at the patient bedside, but definitely impacts the patient's care on a daily basis.

Melanie: And tell us about your team at Corona Regional Medical Center.

Dr. Kamalpour: Well, my team, like any other team in the country we have providers that are here, usually from 7am to 7pm, and I am blessed with having four very good colleagues that work with me as a full-time basis. I also have some providers that work with us as part-time basis. They are all physicians. Some of them have been in this hospital for a longer time than others. I, myself, have been here for about five years. I've had the pleasure of taking care of the people in the Corona community. I have been involved in improvement projects in the hospital. They are looking forward to serve the community for many years to come.

Melanie: Thank you so much for being with us today. You're listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to coronaregional.com. That's coronaregional.com. Physicians are independent practitioners who are not employees or agents of Corona Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Sepsis: What You Need to Know About this Emergent Condition

Additional Info

Audio File florida/fl020.mp3
Doctors Hahn, Sheri
Featured Speaker Sheri Hahn, ARNP
Guest Bio Sheri Hahn, ARNP is a nurse practitioner with Florida Hospital Memorial Medical Center.
Transcription Melanie Cole (Host): According to the CDC, sepsis is the body’s overwhelming and life-threatening response to infection, which can lead to tissue damage, organ failure, and even death. My guest today, is Sheri Hahn. She’s a Certified Family Nurse Practitioner at Florida Hospital. Welcome to the show, Sheri. What is sepsis?

Sheri Hahn (Guest): Like you said, Melanie, it’s a complication that’s caused when the body has an overwhelming and potentially life-threatening response to infection. Most people can fight off an infection, but some people can’t. In a worst-case scenario, it can lead to tissue damage, organ failure, and sometimes, even death.

Melanie: Are there certain people with an infection that are more likely to get sepsis – people with immunocompromised systems, or elderly? Who’s most likely to get it?

Sheri: Oh, absolutely. Everyone is at risk, but individuals who are at greatest risk for developing sepsis are neonates and infants – those children under the age of one – elderly patients, of course, over the age of 65. Frequently, we see elderly patients that suffer from simple urinary tract infections that turn into sepsis – that quickly advances to sepsis. Immunocompromised patients, or more specifically, patients with diabetes, and that’s because these patients tend to have poor wound healing or neuropathies, which means they have decreased sensations in their extremities. They’re often unaware that they have suffered an injury that can lead to an infection. Patients with renal failure, particularly those patients that are on dialysis or patients that have indwelling urinary catheters -- again, any time you introduce a foreign object into your body such as a catheter, it becomes a portal or an opportunity for that infection. Our patients that are in nursing homes or long-term care facilities, recent or prolonged exposure to antibiotics, recent surgery or hospitalizations, IV drug abusers, smokers, alcoholics, obese patients, and people who are malnourished all are at increased risk. So, you can see that covers just about anybody.

Melanie: Because it’s such a quick moving situation, what are some of the signs and symptoms that somebody should be aware of that would concern them enough to call 9-1-1 and say it’s possibly sepsis?

Sheri: Well, symptoms are very wide-spread and can vary significantly from patient-to-patient, but some of those symptoms are subtle, such as confusion and agitation. They can be painful urination or a decrease in your urinary output, diarrhea, increased heart rate, increased respiratory rate, any alteration in your body temperature, such as a fever that is classified as anything over 101.5, or hypothermia when your temperature is below 95, when you have cool or clammy skin – your extremities feel cool or clammy to the touch -- when your blood pressure is altered – when it’s either extremely high or extremely low -- when you notice a warm or hot, reddened area on your skin or a red streak coming from an area particularly in an area of a wound. Those are all good reasons to seek out your primary care provider or the Emergency Room.

Melanie: Let’s talk about that for a second. If somebody thinks that they’ve got an infection that is possibly becoming sepsis, do they call 9-1-1? Do they drive themselves? And if they call 9-1-1, is it that important that they say this could be sepsis so that EMS knows what to look for?

Sheri: Anytime a person is concerned enough that they’re questioning in their mind should they call 9-1-1, I always suggest that they do. If that’s something that they’ve even questioning, then it’s better to be safe than sorry. Often times it’s something that we see in the primary care office that we can evaluate an order the proper labs or imaging tests and get our patients going down the right path before it requires hospitalization, but that’s a big part of what we do. We have to make sure that patients are maintaining that chronic disease management, seeing their primary care provider, making sure that they are being cared for properly. It doesn’t always require going to the Emergency Room or being hospitalized, but prevention is the key and hoping that we don’t get to that point.

Melanie: And how do you assess or diagnose that it is sepsis, and then what are the resulting treatments? Is there a way to stop this from progressing?

Sheri: Yep. First, it’s going to be a big fact-seeking mission. We’re going to do a history. We’re going to look at clinical findings. We’re going to order pertinent labs and imaging based on where we think that infection may be – is it respiratory? Do we need to do chest X-rays? Is it urinary? Do we need to order a urinalysis and urine culture? Just where do we think the source of the infection is? Urinary – urosepsis is a big one that we see, and often times in the elderly population, the first sign of that is very subtle. It’s just confusion. They may not act themselves. They may be having frequent falls. We check their urine, and lo and behold they’ve got some signs of infection in their urine dip, and we send it off for culture. We start them on an antibiotic, and the culture comes back and tells us exactly what the organism is, and make sure that the antibiotic that we have selected is appropriate for treating that organism. If it’s caught early on and we get them started on the appropriate antibiotic and get them treated, then yes, we can keep them out of the hospital. That is, obviously, our ultimate goal.

Melanie: Are there different antibiotics, Sheri, that would work for sepsis once you’ve identified what type of organism that this is?

Sheri: Absolutely, there’s all different kinds of antibiotics depending on the organism -- there’s gram positive, gram negative, there’s broad spectrum. That’s all part of identifying exactly what the organism is. Another big thing – we’re always encouraging our patients that if an antibiotic is prescribed by your primary care provider, it’s imperative that you take that antibiotic until the course of treatment is complete, even if you feel better a few days into treatment – encouraging those super-bugs that’s all over the media and that you’re hearing about these days.

Melanie: So, sepsis can be stopped, if caught early?

Sheri: Yes, it can. And the goal is to prevent an infection from becoming septic – or becoming sepsis. You want to take – somebody can have an ordinary infection, a wound infection, that can progress to sepsis or an ordinary urinary tract infection that can progress to urosepsis or pneumonia that can progress to an overwhelming sepsis. The goal is to, obviously, see those patients, treat them, and give them the proper modalities to prevent them from becoming septic, and keeping them out of the hospital.

Melanie: Is there a way to prevent sepsis?

Sheri: Well, yeah, prevention is always key. You want to follow good hygiene. Simple things like good handwashing, and cover your mouth when you sneeze and cough, getting recommended vaccines – that’s a big one. That’s something that you need to make sure you’re having those conversations with your primary care provider, and again, good chronic disease management -- making sure you’re following up with your primary care provider, making sure that your hypertension, your diabetes, your renal disease, are all well-controlled. Or, make sure you don’t progress to having any of those chronic diseases. Smoking cessation, that’s a big one. People who smoke are at a huge risk for developing sepsis before someone who doesn’t smoke. People who drink excessively are at a greater risk. All of these things are things that your primary care provider wants to educate you on, and help you with, and give you the modalities to work on prevention and not do.

Melanie: Thank you, so much, Sheri, for being with us today. It’s such important information for listeners to hear. You’re listening to Health Chats by Florida Hospital. For more information, you can go to HCPPhysicians.org, that’s HCPPhysicians.org. This is Melanie Cole. Thanks, so much for listening.
Hosts Melanie Cole, MS

The Benefits of Mammography

Additional Info

Audio File allina_health/ah136.mp3
Doctors Schneider, Lisa
Featured Speaker Lisa Schneider, MD, VPCI (Piper Breast Center)
Guest Bio Dr. Lisa Schneider is a board-certified radiologist at Piper Breast Center in Minneapolis and Consulting Radiologists in Plymouth, Minneapolis and Edina as well as Twin Cities Medical Imaging in Edina. She specializes in breast imaging such as MRI and mammography.

Learn more about Dr. Lisa Schneider
Transcription Melanie Cole (Host): According to www.breastcancer.org, about 1 in 8 women will develop invasive breast cancer over the course of her lifetime, and many experts are saying that starting at age 40, most women should have a mammogram every year that can help catch breast cancer early on when it's most treatable. My guest today is Dr. Lisa Schneider. She's a radiologist and the Medical Director of Imaging at Piper Breast Center, part of Allina Health. Welcome to the show, Dr. Schneider. So, women hear that word “mammogram” and they recoil. What do you want to tell them about a mammogram and not to be afraid of it and then let's talk about when they should start getting it?

Dr. Lisa Schneider (Guest): Oh, all great things to talk about, Melanie. Good morning. It's so good to be here again with you. First of all, I want women not to be afraid of mammograms. I understand the fear; I understand the anxiety and I often say that part of what I do in my job is treat anxiety as well as read the mammograms. I know it's an understandably concerning and can be a very scary time. But, what I want to share with women is that it's been a success story. Since women have started getting screening mammograms in the United States, starting in the 1980s, we've seen the death rate from breast cancer go down about 30%. So, we have proven the test over time that it does decrease our death rate because we are able to detect breast cancers on screening mammography before they have a chance to spread and potentially kill and be the cause of your death. So, it's been just a real win. It can be uncomfortable. I always recommend that women go to a place that they're near--that's near to them—and that they're comfortable with. The other message I like to tell women is any mammography center in the United States that has its doors open has already had to kind of cross a high bar in terms of having their doors open. In 1992, Congress passed an act that said any place in the country doing mammography has to meet certain Federal guidelines and regulations and they are inspected once a year to make sure those things are met--everything from the training of the technologists to the physicians who read them to the equipment. So, they should be assured that number one, there's a very high quality of mammography that's done in the United States and that screening mammography works because of early detection.

Melanie: So, Dr. Schneider, there has been some controversy. People hear ACOG saying one thing and people are going back and forth about when we should start our screening mammography and how often after that we should get it. What do you say?

Dr. Schneider: Right. So, I am a member of the Society of Breast Imaging, full disclosure, I am also a member of the American College of Radiology and I'm a radiologist who works in a breast center who deals with women with breast cancer every day and I'm very active clinically and I see the benefits of screening mammography. That being said, there is controversy. The American College of Radiology and ACOG recommend age 40. The American Cancer Society recently changed their guidelines to starting at 45, and then the United States Preventative Task Force Services recommend 50. So, there's all of this confusion of these different organizations and women don't know who they should believe and I always tell women, “Know the facts. Talk it over with your doctor and kind of go from there.” So, one of the facts that women will sometimes say is "Well, there's nothing like that in my family history and therefore, I probably don't need to start screening until I'm 50." I will tell women that the majority of breast cancer occurs in women who don't have a family history. So, I just simply arm women with the facts about it, and that there's no scientific or biological reason to delay screening until the age of 50--because no decade of life, the 40s, the 50s, the 60s, or the 70s, account for more than 25% of the cancers diagnosed each year.

Melanie: So, okay. So, women hear this, they hear all these different sort of recommendations and if they start, and then there's difference between diagnostic and screening. They wait for that letter or that word from you and it's a very scary time, Dr. Schneider. Women sit there and you talked about anxiety before, and so we sit there and we wait to hear. What do you want women to know about that waiting to hear whether you have to come back for the diagnostic?

Dr. Schneider: Right. So, I want women to know that the majority of women don't need to come back for a diagnostic mammogram. You know, nationwide, it's about 10% of women that we call back and out of those 10%, the majority of those, it will just simply be a couple of extra pictures that will resolve the problem and they don't have cancer, and then we say "You've passed your screening test now, we'll throw you back in the pool and you can come back and have a screening in a year.” A very small percentage of those will have something abnormal in their mammogram, and we will need to do a biopsy, perhaps, and it's a needle biopsy, okay? It's not an open biopsy. The majority of biopsies done today in the United States in the breast are done with a needle. It's a percutaneous procedure, a little bit of local anesthetic. Women should also know that by law, they have to receive the letter within a certain amount of time, okay? Stating whether or not their mammogram was normal or abnormal, and then, there is a guideline, particularly within Allina, that once we tell a woman that her mammogram is abnormal, we adhere to a standard of getting that woman in as quickly as we possibly can for that diagnostic workup and so at that time, she can consult with the radiologist an she can kind of know a little bit more information. So, two things we try. Number one, it's not a lot of women that get called back. Some women that get called back are getting called rightfully so, because there is a cancer that needs to be detected and treated, and potentially cured. And then, the rest of the women that have that anxiety about they don't know or they do know, or the don't know, we just try to get in and work them through the system as quickly as possible and communicate with them, all along the way.

Melanie: Can you tell, as a radiologist, whether something looks benign, like a papilloma or something, or whether you suspect that it is cancer? Can you see that on the picture?

Dr. Schneider: Sometimes, yes. Of course. So, sometimes I can look at a screening mammogram and I can say from the doorway that's cancer until proven otherwise. I need to put a needle in that and prove to her doctor and to her that it's cancer and it needs to be treated. The challenge of my job--and that's the challenge of any radiologist--is trying to sort out those in-between cases. You know, is this concerning enough? Is there something sneaking around or hiding in there that could be a cancer and it concerning enough that I should call her back? Or, is it something that's you know, benign and I don't need to call her back? Where it's really helpful for a radiologist is having a track record on this woman. By “track record”, I mean her old exams. If she has got her old exams and she's been faithfully getting mammograms for a long time, that really helps us out a lot. An old teacher of mine once said "Old films make you smart," meaning old images make us smart so that we have the previous exams to say, “Everything has been there before. This clearly isn't a cancer; it's benign,” and we can dismiss it.

Melanie: Should women with breast implants still have screening mammograms? Or, if they've after a mastectomy, if they've had reconstruction, do they then still get mammograms?

Dr. Schneider: Good question. Women with implants, if they're over the age of 40, should absolutely be screened for breast cancer. Again, there's a special mammographic view that we do where the technologist will gently push the implants back and pull the breast tissue forward so that we can get an optimal view of that. I will say they do get a little bit more radiation when they have a mammogram versus women who don't have implants, because we need to take extra pictures to screen them to make sure we're doing an adequate job of seeing all of their breast tissue. That extra radiation that they're getting, I think over a lifetime of just getting one screening mammogram a year is negligible and not likely to cause them any harm. Your other question was about once you've had a mastectomy. So, once you've had a mastectomy, it depends on the kind of reconstruction that you get. If you have a mastectomy and you get reconstruction with an implant, that breast no longer needs to be screened, but we would screen your other breast if you still have your native, other breast. If you get a reconstruction with what we call a “tram flap”, which is a mound of tissue that the surgeon places over the breast, it can sometimes be difficult to detect a recurrence in that breast and a lot of plastic surgeons like us to go ahead and just gently do a mammogram on that lump of tissue that has been used to reconstruct the breast.

Melanie: Are there different types of mammogram? We hear now that there's 3D digital mammography, tomosynthesis, we've heard about a whole breast ultrasound, and MRI. Speak about those other types of mammograms that people may want to ask their doctor or radiologist about and then what's on the horizon for mammography?

Dr. Schneider: Right. So, screening mammography, number one, has been the only examination that has been shown to have an impact on the mortality rate of breast cancer. That's the screening test that we recommend women get every year. For women who are at higher risk, and we have documented that they are higher risk, be it family history, previous biopsy, personal history of breast cancer, if you meet sort of a 20% threshold, then we recommend that there is another screening test that be thrown into the mix, either whole breast ultrasound to look for cancer, or breast MRI to look for cancer. Mammography itself is evolving. You touched on 3D, or digital tomo breast synthesis, which is the same thing. What that is is a new mammogram that not only gets kind of the two-dimension look at the breast, but it takes tiny little slices, like a CT scan, through the breast. It allows me, as a radiologist, to uncouple the tissue and cancers that are hiding within that tissue, a lot of times become more conspicuous. And then also, that tissue overlap is sometimes the reason we call women back because we're not certain if there's something hiding in there. This new modality has saved us calling women back. So, it's increased specificity and increased sensitivity for a screening test that's already been shown to decrease mortality rate. I think with this added tool of the 3D technology, we're going to see the mortality rate hopefully drop a little bit more and our anxiety rate drop even more since we will have to call women back less frequently.

Melanie: And, what about women with dense breast tissue? What do you tell them? Again, this is something we're getting letters about now, and there's requirements in certain states that you be notified about dense breasts. So, what do you want to say about that?

Dr. Schneider: Right. So, dense breasts, the reason people get concerned about dense breasts is that it can hide a breast cancer in your mammogram. It can make detecting a breast cancer more difficult in a woman that has dense breasts versus a woman that has more fatty breasts. The law came into being in different states after a woman who had breast cancer didn't have any idea about the density of her breasts and she said, "If I would have known I had these dense breasts, and that was hiding my breast cancer, I would have done something else in addition to getting a mammogram. There ought to be a law." So, indeed now, many states have passed a breast density law stating that in addition to informing women of the results of their mammogram, we need to inform them whether or not they have dense breast tissue. So now, that's what we do and Minnesota now has this law, and it states something to the effect of the letter, “You have dense breast tissue. This can make cancer more difficult to detect. It also places you at a little bit higher risk of developing breast cancer. Talk it over with your doctor if you want another screening exam.” And that screening exam, there's no consensus on which other screening exam would be the best fit. You can do breast ultrasound or you could do breast MRI. There is, however, a test coming out, it is out right now, and it's being utilized across the country, it's called an “abbreviated breast MRI” and instead of a full diagnostic breast MRI, which take up to half an hour or 40 minutes, this abbreviated test for women with dense breast takes about seven minutes. It takes the radiologist a lot less time to read and it will probably be a lot less money once it's implemented than the full diagnostic MRI.

Melanie: What great news for women to hear, Dr. Schneider. Wrap it up. Best advice about all the controversy surrounding mammograms, what you want women to know about them getting that baseline mammogram so that you have those old films, as it were, and you can look at it and give us a better diagnostic tool to catch breast cancer early.

Dr. Schneider: You know, just talk it over with your physician when you turn 40 about having a mammogram. Really consider strongly about having a mammogram in your 40's. I think that's a time when women are very productive, very active and if they were to develop breast cancer, give yourself every opportunity for that cancer to be caught early when it is very treatable and curable.

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

Understanding Type 2 Diabetes

Additional Info

Audio File doctors_laredo/dl008.mp3
Doctors Zamarron, Eloy
Featured Speaker Eloy Zamarron, MD
Guest Bio Eloy Zamarron, MD is a doctor of internal medicine and a member of the medical staff at Doctors Hospital of Laredo.

Learn more about Eloy Zamarron, MD
Transcription Melanie Cole (Host): Diabetes is a growing problem in the United States. In fact, according to the American Diabetes Association, almost 25 million children and adults have Type II Diabetes. If you're told you have pre-diabetes or full-blown diabetes, there are some very important steps you can take to manage your condition and take control of your health. My guest today is Dr. Eloy Zamarron. He's a family medicine physician and a member of the medical staff at Doctors Hospital of Laredo. Welcome to the show, Dr. Zamarron. So, I'd like to first ask you what is Type II diabetes? It used to be called “adult-onset” but now you're seeing it even in children? What exactly is it and who is most at risk?

Dr. Eloy Zamarron (Guest): Thank you, Melanie. Type II diabetes is the lack of control of the sugar levels by our bodies and the Type II diabetes is called in this way because like the difference from Type I, Type II diabetes patients has their pancreas releasing insulin but this insulin is not enough to control the diabetes and there are contributing factors to that. But, in general, this is the main difference between both of them.

Melanie: Who is at risk for this type of diabetes?

Dr. Zamarron: The main cause of Type II diabetes is overweight. That's one of the first causes and that can start happening at a very early age in life. So, overweight is the first factor. There are some people, not a lot, 20%, who are not overweight, but nevertheless, they are already eating more than what they really need. But, in the bottom line is overweight.

Melanie: Would somebody know? Are there some symptoms that they might experience if they are pre-diabetic or have diabetes? How would they know?

Dr. Zamarron: And, that's a very interesting question because that starts happening at a very early age and this is classic to see in young children when they are already chubby and they are very hungry and they are eating all the time. So, if you have a child who is eating all the time and hungry all the time, even though he or she already had a good meal and is already asking for more, that's a wake up call. That kid needs to be checked because it's very likely that the diabetes or pre-diabetes is starting already. Now to tell in adults, which is the same situation, people start being hungrier than normal and hungry all the time and eating frequently. So, that is one of the first symptoms that patients can have. Other symptoms when the diabetes is already ongoing, people start having problems to urinate a lot, they urinate frequently, they are very thirsty because the high levels of sugar create a dehydration. The body needs more water to control the building of the very concentrated sugar in the bloodstreams. People start having, as I said before, overweight. So all are, in general, the very first signs.

Melanie: Would this be something, Dr. Zamarron, that people would know when they get their annual physical and they have a blood test? Is there anything in the blood test that would signal to a doctor, "Hey, this is prediabetes or diabetes and we need to start looking at this condition,"?

Dr. Zamarron: Definitely. One of the tests that shows very early chances of the body already having problems to control the sugar is the creatinine level. A low serum creatinine is the way the body starts responding trying to fight the high levels of sugar and this is even before the patient has already his or her sugar higher than normal. Of course, there are other tests once the diabetes is already set, the high sugar levels, and then insulin levels can be checked also and those can be checked before the sugar is high. In cases with pre-diabetes, insulin and another test called “P-peptide” is also a test that can help us to determine the pre-diabetes condition as well.

Melanie: If someone is diagnosed as prediabetic or you tell them that they have diabetes, what is the first line of defense, Dr. Zamarron? What do you tell them that they have to do right away to start controlling and managing some of those symptoms?

Dr. Zamarron: Definitely. If a person is a young person, meaning less than 40 years of age, diet. That's a plus, that's a base that everyone should do. And, of course, when a person starts dieting, they may start having symptoms and the person needs to be aware of the symptoms so they won't scared. The other thing is exercise which is also a very, very important part in a young patient. After 40 years of age, then a person can need medications and that's another step that is very important, depending on how bad the diabetes is already by the time it's detected, is the type of medication will be needed along with diet and exercise, as well.

Melanie: Before we get into some of those medications, what are some complications to poorly controlled diabetes or if someone does not find it, what are some things that they might look to? Eye health or foot health? Are there some things you like them to watch out for?

Dr. Zamarron: Yes. Definitely one of the things that the patient can notice themselves, before they are checked with the doctors, sadly the symptoms are already late in the disease but if the patient or the person has a blood test, they already have one of these symptoms, it is urgent to check with a doctor. It's very sad to see a patient in the office when I am checking their feet and then, all of a sudden, I find a nail or a tack and the patient never felt it. Why? Because it's already advanced in the disease where the sensation in their skin is gone so they don't feel injuries; they don't feel infections; they don't feel warmth in their feet. But, besides those complications, it's very sad that the complications that can be detected in a patient, the first thing when diabetes is discovered, is heart attacks. Sadly, very, very late in the disease. Another one is strokes, same thing. And, another one is kidney problems, where their kidneys starts failing and because of the toxins that the kidneys should get rid of, accumulates in the body and they start causing effects that prompts the patient to seek medical attention and, again, it's already late because of the kidneys are already failing.

Melanie: People hear the word “insulin” and they think of those pictures of people giving themselves insulin shots. Tell us about Type II diabetes and what oral medications might be available before they would have to resort to insulin shots.

Dr. Zamarron: Definitely besides diet and exercise, medications nowadays are very helpful. Those medications do not cause many side effects. There are some medications that the doctor can consider necessary that may lower the sugar level a lot but there are others that do not do that too much in a more gradual way so that the patient will not have too many hypoglycemic symptoms and be able to control it. Remember, diabetes is a chronic disease and it's not possible to treat it in one or two visits, you're going to need several visits until the diabetes is controlled and then, after that, regular visits--either one every month or every three months or every six months according to the patient's needs.

Melanie: In just the last few minutes, Dr. Zamarron, what should people who've been diagnosed with prediabetes, or full-blown diabetes, think about to manage their symptoms? What is the most important thing you want them to know about this condition?

Dr. Zamarron: I work a lot with my patients with diet and exercise. The young ones are the ones that I encourage this more. For people already beyond 40 or 50 years of age, then exercise might be more difficult for them, so medication is the next thing to do, going into insulin depending on every case and proceeding with the further treatments, according to their needs and if there's any other complications. But definitely the most important thing is to be compliant with the treatment. Compliance that is very difficult because it's a chronic disease. It's not like an appendicitis, where you remove the sick or ill appendix and the problem is gone. No. This needs persistence; this needs discipline. that is something that the patient and the doctor needs to work very hard on.

Melanie: Why should they come to Doctors Hospital of Laredo for their care?

Dr. Zamarron: The blood test that are needed, the studies that are needed, and the rest of the follow up is an excellent source for me and for my patients because the therapists is excellent and the communication, which is very important, is ideal, so that the care of the patient will continue.

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

Can You Get Allergies Later In Life?

Additional Info

Audio File allina_health/ah135.mp3
Doctors Johns, Kenneth
Featured Speaker Kenneth Johns, MD, allergy and immunology
Guest Bio Dr. Kenneth Johns specializes in allergy and immunology and practices at Allina Health clinics in Cambridge, Coon Rapids and Maple Grove. His professional interests include child and adult asthma, seasonal allergies, hives and skin rashes.

Learn more about Kenneth Johns, MD
Transcription Melanie Cole (Host): As you’re enjoying the change of seasons and all of a sudden, your skin starts to become itchy, and your nose is running, and your eyes are burning, just because you’ve been allergy-free your whole life, doesn’t mean you can’t grow into one. For millions of Americans, this is an unfortunate truth. My guest today is Dr. Kenneth Johns. He specializes in allergy and immunology at Allina Health Clinics in Cambridge, Coon Rapids, and Maple Grove. Welcome to the show, Dr. Johns. Why do some people develop allergies that haven’t had them before?

Dr. Kenneth Johns (Guest): Well, let’s start by saying there’s confusion here because allergy means different things to different people. To be clear, when we talk about allergic rhinitis, we’re talking about the nose, and eye, and maybe chest symptoms due to a hypersensitivity to something that blows around in the air like pollen, or mold spore, or dust mite, or what have you. That condition – allergic rhinitis, usually has developed most of the time by late teens or early twenties -- although everybody’s seen those children that seem to have them the day they were born -- but most of the time they’re acquired by the late teens and early twenties and plateau through the thirties, and then gradually fade away. There’s a very specific, natural history there.

When folks seem to develop allergic rhinitis late as an adult, sometimes it’s because they had them all along and they were just unmasked. For example, people that quit smoking can notice their allergy symptoms – maybe they were masked by the constant assault on the respiratory system from tobacco smoke. Other folks maybe become aware of their allergies because they’re all of a sudden exposed, so that’s a person that has always been allergic to cats but couldn’t really tell until they moved into an apartment with cats, and then they start to notice symptoms. Most of the time those allergies are acquired early, and adult-onset or late-onset allergies are maybe an unmasking.

Secondly, there are conditions that sound like allergic rhinitis, but really aren’t, and there’s quite a few of these conditions that are mistaken for allergic rhinitis. They follow a different natural history and have different treatment options and the symptoms are just subtly different. Sometimes it’s hard to tell them apart. An example there would be a person that has developed vasomotor rhinitis as an adult. Vasomotor rhinitis is a nose that runs and plugs up because of irritants as opposed to allergens. And again, different natural history, different treatment options.

Melanie: As we’re talking about allergic rhinitis, what about food allergies? Because I’ve heard before about some people who were not allergic to seafood or shellfish, and all of a sudden, in their 50s and 60s, they find that they are. Is this a common thing?

Dr. Johns: Again, to be clear, food allergy is almost always present at birth. It’s not really clear how or why. Later on in life, it’s possible – it’s very rare – it would be reportable that someone has a true food allergy that just suddenly developed as an adult. Most of those adult-onset or later-onset reactors are more of a food intolerance. Food-intolerance would be like a lactose-intolerance, which mostly develops as an adult. A lot of times when you hear this adult-onset food allergy, it’s really more of an intolerance. Again, treatment options are different, and symptoms are slightly different – and don’t get me wrong, some of those intolerances can be very serious, but they aren’t true food allergy, meaning they do not result in anaphylaxis.

Melanie: So what might someone notice if they’ve all of a sudden developed – or maybe not all of a sudden, but a little bit over time – an intolerance to something specific?

Dr. Johns: In terms of foods, again, it’s all about the story. People will tell you -- shrimp, for example, is a very common intolerance that we’re seeing these days. People will tell you that sometimes they can eat shrimp, and sometimes they can’t, or “I used to eat shrimp all the time and never had problems, and now I have reactions to shrimp –,” or some shrimp, or shrimp that is maybe prepared in a certain way. Intolerances can show up, and the symptoms are frequently more delayed than they are with allergy. It can sound like an allergic reaction. There can be a lot of itching and discomfort and swelling of the lips and face, but again, does not ultimately lead to anaphylaxis. A lot of it is the story that people tell that sounds more of an intolerance than an allergy. To be clear, a food allergy is very reproducible. It happens every time you eat the food, no matter how it’s prepared, in any amount, and the first time you eat the food and every time you eat the food. Those are usually very clear-cut. Intolerance is when people aren’t sure, that’s a good hint that it may be intolerance as opposed to allergy.

Melanie: Can anything be done whether it’s allergic rhinitis, whether you’re developing seasonal allergies that maybe you had all the time, but just didn’t realize, or these food intolerances, or even some kind of an intolerance to pet dander? Dr. Johns, is there anything to do about these? Are there some over-the-counter recommendations you’d like to make, or should they come and see an allergist?

Dr. Johns: All of those are possible. I think the first step is to figure out if you have an allergy or not, and that’s where the testing is very helpful. If you’re having nasal symptoms because of allergy to something, or if you’re having nasal symptoms because of irritants – more of an intolerance – our treatment options vary. We have good over-the-counter nasal steroid sprays that are very effective for allergic rhinitis. We have other treatments – also usually topical – that specifically work for the nonallergic nasal symptoms, those vasomotor rhinitis symptoms. Our medications are going to vary, but we do have good treatments for both. A lot of that stems from figuring out whether you have an allergy or not.

Melanie: And what about things like nasal lavage, or Neti Pots, or looking around your house for triggers? How does someone identify their triggers, Dr. Johns, and what would you – is there some prevention possible?

Dr. Johns: Much of that depends on what the specific sensitivity is. If you’re allergic to cats and you have cats in the house, that’s a tough one. There’s a lot of mythology about things that you can do to the cats, or do to the house, or do to the patient, but that’s a tough allergy to treat. Although, again, sometimes that is the culprit and that’s really our best option is to not have cats in the house. I’m not picking on cats in particular, but any indoor pets that are mammals have the potential to be allergens. I think a lot of that stems from knowing exactly what the sensitivity is.

Melanie: And do you sometimes recommend things like the nasal lavage to keep some of those things clear -- or air filters, or any of these things?

Dr. Johns: Air filters don’t have a lot of good data to support their use. Nasal lavage can be very helpful. Some folks with allergies find it helpful where you rinse out your nose with a good squirt of saline that’s hopefully clean and sterile, either with a Neti Pot or just a good squeeze bottle. Folks that are having infectious problems like sinusitis, or chronic sinusitis, they find lavage to be most helpful. My straight-forward allergy patients aren’t as impressed as the people that have other conditions that are more infectious, and they find the lavage to be extremely helpful. Sometimes they’re doing it as needed; sometimes they’re doing it regularly, twice a day. It’s one of those old treatments that’s been around for literally thousands of years, but can be extremely helpful.

Melanie: So then, in summary, wrap it up for us, Dr. Johns, with your best advice for people that may be suffering from seasonal allergies or late-onset intolerance, whether it’s to food or allergic rhinitis, or even to pets, what do you tell them every day about finding those triggers, identifying them, steering clear of them if possible, and when to see an allergist.

Dr. Johns: I think that’s exactly the case, try to sort out which condition you have because treatment options do vary depending on what condition you actually have. Sometimes there’s avoidance measures that we can do. For example, for dust mites sometimes there’s good medication that can be used such as that vasomotor rhinitis and sometimes there’s immunotherapy or allergy shots. Again, it really varies, and it really depends on exactly what the culprit is.

Melanie: Thank you, so much, Dr. Johns, for being with us today. You’re listening to The Well Cast with Allina Health, and for more information, you can go to AllinaHealth.org, that’s AllinaHealth.org. This is Melanie Cole. Thanks, so much for listening.
Hosts Melanie Cole, MS

Urinary Tract Infections

Additional Info

Audio File corona/cr013.mp3
Doctors Louie, Michael
Featured Speaker Michael Louie, MD
Guest Bio Dr. Michael Louis is a specialist in urology and a member of the Medical Staff at Corona Regional Medical Center.

Learn more about Dr. Michael Louis
Transcription Melanie Cole (Host): According to the National Institutes of Health, urinary tract infections are one of the most common types of infection and account for around 8 million visits to the doctor each year. They can affect the kidneys, bladder, and the tubes that run between them. My guest today is Dr. Michael Louie. He’s a specialist in urology and a member of the medical staff at Corona Regional Medical Center. Welcome to the show, Dr. Louie. What exactly is a urinary tract infection and who is most at risk for these?

Dr. Michael Louie (Guest): A urinary tract infection is when you get frequency, burning, and urgency with urination. Sometimes you can have some pain or pressure in your pelvis, or abdomen, or back, and a low-grade fever, or even some blood in the urine and that’s how you know you might have some bacteria in the urine.

Melanie: And who would be at risk? Are there certain things that might predispose somebody to having these kinds of infections?

Dr. Louie: Usually women are affected more than men, and that’s because their urethra is a little bit shorter. When you get a urinary tract infection, most women between the ages of 18 and 70 are at most risk, so it includes most women.

Melanie: As many women that I know that have gotten UTIs at some point in their life, that burning feeling, you don’t always know that’s what it is because it could be chaffing, or dryness, or anything else. What would send you to the doctor? Would it be that you see blood, or wouldn’t you always see that?

Dr. Louie: You don’t always see blood, but basically, once you get the frequency and urgency feeling and that bladder pain, you should probably go see your urologist or your primary care physician to evaluate you with a urine culture to see and diagnose whether you really have a urinary tract infection or whether you just have some chaffing as you explained.

Melanie: And how does a urologist treat a bladder or urinary tract infection?

Dr. Louie: As I mentioned before, first, we’d like to get a urinalysis and a urine culture. It helps determine if you do have blood if you have any inflammatory cells in your urine, and then also determines the type of bacteria that you have growing in the bladder. That affects how we prescribe antibiotics for you, so it’s very important to get the culture. After we get the culture, then we will usually prescribe a three-day course of antibiotics and for most women that are sufficient.

Melanie: Do antibiotics always solve the problem? Can these bacteria hide, or can it move around? Can it move into other organs or surrounding tissue?

Dr. Louie: You’re absolutely right, it can move mainly from the urethra – where you get the burning and urgency first – and then the pelvic pain. That means it might be in your bladder and in severe cases it can move into your kidneys and cause something called pyelonephritis, which is an infection in your kidney. That causes high-grade fevers and chills and requires probably IV antibiotics for treatment.

Melanie: People hear about some of these home remedies to prevent or control them? Do any of these carry any weight – cranberry juice or any of these other things they might try at home?

Dr. Louie: Some of the homeopathic remedies do have some credence, and I do recommend them often with my patients because anything to prevent a urinary tract infection is better than taking antibiotics. I usually do recommend taking four ounces of cranberry juice when you can remember to. Cranberry pills are also used for prevention. Some people may also not know about D-Mannose powder or pills. They’re used in the same way cranberry juice or pills are used, probably once a day. The way D-Mannose works is that it does not allow the E. Coli bacteria to stick to your bladder wall and increases the chance that you’ll just pee out the bacteria.

Other things that you can use are Activia yogurt or your culturing. Those are just two types of things I recommend. What those do is that they give you good bacteria called lactobacillus, which crowd out the bad bacteria so that they don’t have a chance to grow in you.

Melanie: Some women try some of these products like Summers Eve or vaginal washes, can any of these contribute to UTIs?

Dr. Louie: In fact, they can, because these astringents or hard washes really wash away that good bacteria that I was talking about and they might even cause micro tears in your skin down there that also propagate the bacteria. I do not recommend using anything but standard soap and watch to wash your genitalia.

Melanie: What is somebody is someone who has recurrent UTIs, and they just keep getting them, what do you tell them about these?

Dr. Louie: If someone has recurrent urinary tract infections, it usually means they’re having two or more infections every six months. For these women, I usually recommend first, five things to prevent these recurrent infections because that’s the best thing to do besides just giving antibiotics for this. The number one thing is to stay hydrated. Always keep your urine clear when it’s coming out of your body. The second thing I recommend is to not hold your urine. Always listen to your bladder and empty it right away when you feel the need to empty it.

Number three is that cranberry use, cranberry pills, or D-Mannose powder, something to help the bladder out so that it can block the bacteria. Number four, I recommend that lactobacillus, either yogurt or drinks to repopulate the good bacteria in your bladder. And number five, make sure you don’t have any constipation. That actually is a reservoir for the bacteria, and that’s where they come from. Having constipation can also lead to confusing symptoms of frequency and urgency as well.

Melanie: When people wipe themselves, as it were, Dr. Louie, can that also – because we hear about infections that way if you’re wiping the wrong way. And what about urinating after sex? Can that also help to clear you out?

Dr. Louie: Absolutely, so the basics for bathroom hygiene for women is to wipe front to back and that just keeps the front genitalia clean. And then your comment about urinating after sex, that has also been studied, and the evidence does show that that does prevent infection. That leads me to stating that for women who always have infections after sex, they are best treated using a single dose of antibiotics right after sex. That almost prevents all of their more severe urinary tract infections.

Melanie: And what about other things like perfumed products in the genital area -- or even diaphragms or tampons – are any of these things that women should look to as a cause or at least something that can contribute to UTIs or recurrent ones?

Dr. Louie: There has been data showing that spermicides, diaphragms, and sexual intercourse can cause increased urinary tract infections, so you just have to be careful with that. Unfortunately, you really have to, through trial and error, figure out which one works for you. In terms of tampon use versus menstrual pads, there have been some studies that show tampon use is possibly better because it doesn’t keep the whole vaginal area moist during the menstrual cycle, but that’s the data for these specific types of events.

Melanie: That’s really good information. In the last few minutes, Dr. Louie, what should people with recurrent urinary tract infections -- or someone who’s got one for the first time -- what would you like them to know about them? What do you tell people every day about these?

Dr. Louie: Go back to basics, the things that you read about and hear about every day and that is, drink enough water to keep your urine clear. Don’t hold your urine. Make sure that you practice good bathroom behavior, wiping front to back, urinate all of the time after sex, and make sure you don’t have constipation. Those are some really easy things – you don’t have to spend any money, bring in any other outside things into your life -- these will help prevent urinary tract infections.

Melanie: And why should they come to Corona Regional Medical Center for their care?

Dr. Louie: We have great doctors there and are a really good multidisciplinary approach to diagnosing your condition as well as managing it.

Melanie: Thank you, so much for being with us today, Dr. Louie. That’s great information. You’re listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to CoronaRegional.com, that’s CoronaRegional.com. Physicians are independent practitioners who are not employees or agents of Corona Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks, so much for listening.
Hosts Melanie Cole, MS

Do You Suffer From Urinary Incontinence?

Additional Info

Audio File florida/fl019.mp3
Doctors Schneider, Julie
Featured Speaker Julie Schneider, MD
Guest Bio Julie Schneider, MD, is a board-certified gynecologist and urogynecologist with HealthCare Partners at Florida Hospital Memorial Medical Center. She received her Bachelor of Arts degree in biology at Washington University in St. Louis, Missouri, and her medical degree from Loyola University Chicago Stritch School of Medicine in Maywood, Illinois.

Learn more about Julie Schneider, MD
Transcription Melanie Cole (Host): Many Americans suffer from urinary incontinence. Some may be hesitant to seek treatment as they may be embarrassed about this condition or they may think nothing can be done. However, seeking treatment may offer a better quality of life for those that suffer with this highly treatable condition. My guest today is Dr. Julie Schneider. She's double-board certified in female pelvic medicine and reconstructive surgery with Florida Hospital. Welcome to the show, Dr. Schneider. So, what are some of the different types of incontinence and what do we know about the causes?

Dr. Julie Schneider (Guest): Well, most importantly, I would bring up to start with is the incontinence of urine is the sudden release of urine when you're not expecting it and it is never normal. Many people feel that when you get older it's just a natural part of aging but that is actually incorrect. The type is varied. It can be that you have a mixture, which is what we commonly see of anywhere of one to five different varieties. For instance, there is stress urinary incontinence, which commonly people will equate with coughing, laughing, sneezing, jogging--anything that exerts pressure on the lower pelvis. The second most common kind is urgency incontinence where you can't control getting to the bathroom, even though you're not moving or doing anything, in particular. You could be sitting in a chair and your bladder will just simply start releasing before you get any warning or if you get warning, it's certainly not enough to get you to the bathroom. Then, there's some that are more functional when a person is just not able nor capable to walk to the bathroom and that's something that you have to change their walker, for instance, or where the commode is next to the bed, that sort of thing. There's a mixed picture, then there's overflow which is where you have retention. Men seem to suffer with that a little bit more because of the prostate, but women can also experience it for different reasons, particularly with a condition similar to multiple sclerosis, let's say. That sort of thing.

Melanie: Are women more at risk for certain types because of being pregnant? Does that contribute to this for us?

Dr. Schneider: Yes, actually, it does. Commonly, if you've done some kind of childbearing, even the pregnancy itself can exert pressure on the pelvic floor musculature and the labor process and the pressure in that area can do some denervation, which means the nerves themselves can be damaged and that, later in life, similar to what we experience when we layout and we sunburn as children, you usually don't have your problem until later--similar situation with this condition. It will happen oftentimes after menopause but it really can happen at any time. And even one baby, even a small baby, can cause a difficulty with this issue at any time.

Melanie: So, if somebody does notice that they have this, and maybe they don't feel that it's bad enough yet to see a physician about it, what do you recommend that they do at home? Are there some exercises they can try? Do you want them to practice voiding and stopping because there's some controversy on that? What do you like us to do at home to work on this, right at the outset?

Dr. Schneider: Right at the outset, the very first thing I tell everybody is, if you have a few extra pounds on, lose weight. The number one cure, or at least moderation that you can do to correct this problem, to hopefully never need surgery or take medication, all types of incontinence as a general rule, with the exception of some very rare ones, are made better, maybe not 100%, by weight loss. So, that would be the first thing I tell all my patients. The second most important thing is dietary habits that we all sometimes participate in, caffeine being number one. It can be spicy foods, alcohol, different foods, many people are irritated by cranberry juice, which is, of course, what many people feel that they should be doing to help their problem, and in fact, they are making it worse. There are many diets that can be found that will show you things that are bladder irritants, and if you try to avoid those sorts of things, that will help. Those two are the number one and number two things that I recommend. Then, the Kegel exercises, which are pelvic floor exercises, can help. You have to do quite a number of them. They say somewhere around 12 per rep, and five reps per day, so that's approximately 60 or more every day to see some strengthening in the pelvic floor musculature.

Melanie: Can you explain a little bit about the Kegel exercise for people? Because they don't always know how this is done or what it's supposed to feel like.

Dr. Schneider: Well, it's actually best if you have your gynecologist show you when you're doing them how it's best done. Most times people think you go and you go to the bathroom and you stop and start your urine flow. That may be it, but oftentimes, what they are doing is squeezing their abdominal muscles more than their pelvic muscles, and that's where, if you just speak with your physician to get a good sense that you're doing them correctly, it doesn't take long to figure it out, but most of the time, I have found that people come in using more of their abdominal muscles than their actual pelvic floor muscles. Sometimes, it's hard to differentiate the two.

Melanie: So, then what? If they've tried some of these things--lost weight, they've worked on their intake of fluids, maybe they've done their Kegels, and it's still not working. What's the first line of defense that you would use with them? Are there some medications they can try? What do you tell them?

Dr. Schneider: Well, first you have to separate, or tease apart, which of the problems they have. So, for instance, if they have a retention problem secondary to a neurogenic situation, the last thing you would do would be start medication. But, if you have an overactivity of your bladder, which would be muscle spasms, or I like to call them like twitches of your pelvis, then a medication to help with an antispasmodic property may help correct that problem. If that's the case, you may get great relief from a very mild medication. So, that would be for those two instances. If you're talking about stress incontinence, then sometimes a simple surgery, a minor surgery will help, or you can even do collagen injections that can help. There are a lot of options, but most importantly, it's not a one-size-fits-all. You simply have to be evaluated to be certain that what we're treating is the correct diagnosis.

Melanie: You mentioned collagen injections. People hear about Botox, but they don't realize that this could be a treatment for this. Speak about that a little bit?

Dr. Schneider: Botox is used for the treatment of detrusor instability, or overactive bladder. It is not considered a first or second line--it's a third line therapy. It works extremely well but you first have to try some other things prior to the Botox injections. Those injections can be given--it's similar to Botox given anywhere else. It does wear off and it does have some side effects and not everyone is a candidate for Botox but it's the newest in the things that we have that are now approved for the use and insurances are paying for. So, it's new to the arsenal of treatments and we use it if it's appropriate for the patient.

Melanie: So, then, wrap it up for us Dr. Schneider, with your best advice for people suffering from urinary incontinence, what you want them to know about not being embarrassed about this condition, and coming in and seeking help when they need it.

Dr. Schneider: Most importantly, it needs to be explained and understood that 33 million women, at least--that's just the number we know--have this condition. There's nothing to be embarrassed about and it's absolutely so common that there's some great therapies. Even if you've been looked at and evaluated in the past, things have changed and you should never accept that this just is a thing you're going to have to live with and that it's normal because you’re growing older. It's never normal, at any age, and if you haven't sought the care of a professional who deals in urinary incontinence, you should because this is something that will get you back into a normal, functioning life, and will keep you from not participating in things with your friends and family. Move on and get some help and get yourself back into who you want to be and live the life you want.

Melanie: Thank you so much, Dr. Schneider, for being with us today. It's really such important information. You're listening to Health Chat by Florida Hospital and for more information, you can go to www.floridawomenshealthcenter.com. That's www.floridawomenshealthcenter.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

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