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Segment Number 5
Audio File guthrie/1526gc1e.mp3
Doctors Dr. Daniel Sporn
Featured Speaker Daniel Sporn, MD
Guest Bio Dr. Daniel Sporn is the Chief of Cardiology at Guthrie.

Learn more about Dr. Daniel Sporn
Transcription Bill Klaproth (Host): You may live your whole life and not think about the importance of healthy heart valves but what happens when one of your heart valves isn’t working properly? Here to talk with us is Dr. Daniel Sporn, Chief of Cardiology at Guthrie. Just a quick side note, Guthrie Robert Packer Hospital was named a Truven Health Top 50 Hospital for cardiovascular care in 2014, the 9^th time the heart care team received that award. Dr. Sporn, that’s quite an accomplishment. Congratulations and thank you so much for being on with us today. So, I just want to jump right in. Can you tell us what is heart valve disease?

Dr. Daniel Sporn (Guest): Yes. People have four different valves in their heart and the valves are very important in moving blood from one chamber to another. Heart valve disease can develop for a number of reasons. Sometimes someone may have a heart attack and develop an abnormal heart valve. They can get an infection of a valve called endocarditis that can lead to valve leakage or what we call medically “regurgitation”. Sometimes just wear and tear over the years causes a heart valve to become narrowed and treatment needs to be performed to correct that.

Bill: And it can be congenital right? You can be born with this, too?

Dr. Sporn: Yes. Yes. There are some cases of congenital valve disease. Much, much less common but also something that requires attention many times even as a small child.

Bill: Are there lifestyle things that contribute to heart valve disease?

Dr. Sporn: Many of the same things that cause coronary disease, which is very prevalent, can cause heart valve problems. Diseases such as high blood pressure, hypertension can lead to this sort of thing, even smoking and elevated cholesterol. So, the bottom line is prevention as far as those things are concerned. Walking and living a healthy lifestyle can help to prevent heart valve problems.

Bill: You’ve mentioned that there are two basic forms of heart valve disease. There’s the leaky valve and then the narrowed valve. Is there one that’s more common than the other?

Dr. Sporn: Both are fairly common. The two most common valve problems we see are a narrowed aortic valve called aortic stenosis and this is a problem that typically people have as they get into their later years, their 70s, their 80s, their 90s, which is mostly from wear and tear over the years. Then, there’s the leaky or regurgitant valve. This typically involves mostly the mitral valve. That, again, can be related to wear and tear. It can be related to a heart attack. The other common cause would be congestive heart failure which people can have from many different causes that leads to an enlarged heart and subsequently a leaky mitral valve.

Bill: Is there one that’s more problematic than the other? Is there one that’s worse?

Dr. Sporn: Neither one is a great thing to have. The aortic narrowing, I would say, is probably the worst of the 2. All the blood that leaves the heart goes through the aortic valve and if you get a narrowed valve, unfortunately without fixing it, it just continues to get tighter and the blood can’t get out to the head and the rest of the body and alternately one will succumb to this if every care is not done.

Bill: So, this happens slowly over time. Are there symptoms that start to pop up and if so what are those?

Dr. Sporn: Yes. The most common symptoms with both of these illnesses would be shortness of breath, in some cases chest pain, especially with the aortic stenosis, the aortic valve narrowing. Another common symptom would be fatigue that would be prevalent with both of these problems or any type of valve problem. Those would be the main things. Some of the signs sometimes people may develop swelling in their feet, sometimes that swelling could occur in another part of the body, the hands, the abdomen. They may just notice weight gain for an unexplained reason.

Bill: How do you diagnose this?

Dr. Sporn: Well, there are several ways. The history taking that physicians take is still the most important thing that we do. That gives us 90% of diagnosis. Or, I should say it gives you the diagnosis 90% of the time. The physical examination adds to that and then the common cardiac tests we do. The most common to help secure the diagnosis is called an echo cardiogram. That’s an ultrasound test of the heart. It does not involve needles. We put a probe over the chest and we can see the four chambers of the heart. We can see the four valves. We can even measure pressures inside the heart and see how things are functioning.

Bill: What are the treatment options then? Is it the same for the leaky valve or the narrowed valve or is it different for each?

Dr. Sporn: Well, it is different with that narrowed valve there isn’t a whole lot one can do in terms of medication. Initially, the problems someone will have is they’ll accumulate fluid and one can give a diuretic, so-called water pill, that takes some of the fluid out of the body but, ultimately, that valve gets so tight that that will not continue to take care of the problem. So, that valve has to be replaced and there are a couple of ways of doing that these days. With the leaky valve, one has some increased medical, or medication options. Ultimately, if that leak is severe, one needs to consider surgery for that and, again, there are different types of surgeries that are performed for the mitral valve regurgitation.

Bill: So, tell me about heart valve replacement then. What does that consist of?

Dr. Sporn: With the aortic stenosis, the traditional operation has been an open aortic valve replacement by a cardiothoracic surgeon, a procedure where someone comes in and is in the hospital for about a week and then goes home, recoups from that and basically lives a normal life. The latest and greatest procedure, which is appropriate for some patients that need aortic valve replacement, is called TAVR, which is a transcatheter aortic valve replacement, where we can actually replace that valve without opening the chest, typically doing it in a similar way to how we do a heart catheterization, going up from the femoral artery and putting a new valve inside of the old valve and it works very, very nicely.

Bill: What’s the percentage of TAVR vs. traditional, now?

Dr. Sporn: It continues to increase. It’s a newer procedure and so, right now it’s indicated for the highest risk patents. The ones that typically are just so high risk that they cannot undergo an open procedure or those that are so high risk that we deem them a better candidate for the TAVR rather than the surgical aortic valve replacement which we call SAVR. I would say it’s very much continuing to increase the number of TAVR’s we’re doing. It’s probably right now in the range of 5-10% of the total that are done in this newer TAVR way.

Bill: Now, what’s the recovery time of traditional vs. TAVR?

Dr. Sporn: The traditional surgery, generally you’re in the hospital about 5-7 days after the operation and you go home and over the next few weeks, you continue to recuperate. So, most people by a month out from the surgical operation, and certainly two months out, you’re back to driving, you’re back to work. You’re doing everything that you want to do, really without restriction. With the less invasive approach, most of the time, the goal is to get people out within several days of the procedure. Places are now even starting sometimes to get a patient out the very next day. Those patients, typically, are back to full activity a week later.

Bill: When someone thinks heart surgery, you think, “Oh, my god. Scary.” Is this becoming more of a routine thing? Do people not have to worry as much about this type of heart surgery?

Dr. Sporn: Yes. I mean, it really is the people involved in doing that at Guthrie, you know, are very experienced at this. We’ve developed processes and teams that allow for efficient and effective care and the outcomes are excellent. So, I think as much as it sounds daunting to people, if you need this done, you know, the success rates are very, very good and, again, you should be able to go on and live a normal life once you’ve recuperated.

Bill: Great information, Dr. Sporn. Thank you so much for your time today. We really appreciate it. For more information visit Guthrie.org. That’s Guthrie.org. I’m Bill Klaproth and this is Guthrie Radio. Thanks for listening.
Hosts Bill Klaproth

Get A Leg Up On Varicose Veins

Additional Info

Segment Number 5
Audio File allina_health/1526ah4e.mp3
Doctors Murray, Sara
Featured Speaker Sara Murray, MD
Guest Bio Sara Murray, MD, is board-certified in Cardiovascular Disease. Her clinical interests include office-based cardiology, peripheral vascular disease, and coronary and peripheral interventions.
Transcription Melanie Cole (Host):   Vein disease affects nearly half the U.S adult population and for those who struggle with vein disease, it’s more than just cosmetic. It’s a condition that causes significant leg pain and fatigue which can affect your daily lifestyle. My guest today is Dr. Sara Murray. She’s board certified in cardiovascular disease at United Health and Vascular Clinic with Allina Health. Welcome to the show. Dr. Murray, what are varicose veins?

Dr. Sara Murray (Guest):   Well, thanks for inviting me to the show, Melanie. Varicose veins are actually really common. They are large, ropey, twisted-like dilated veins that many times you can see on the surface of peoples’ legs. Or, it can be the underlying veins that you don’t actually see that are the problem causing those varicose veins. They are typically located--you know, it can be both legs; it could be just one leg, but it’s usually on the thighs and calves are typically where you see them.

Melanie:   So, what causes them?

Dr. Murray:   Varicose veins are caused by improperly functioning veins inside your leg. A normal vein is nice and small and it has a one-way valve to keep blood from going back down into the leg when you stand. With people that have vein disease and varicose veins, those veins become real dilated and it stretches that valve leaflet apart so that it can’t close and then blood pools down into the leg with prolonged standing, sitting, and those kinds of activities.

Melanie:   Is this something that’s genetic? Is it developed over time? You know, is there a hereditary component?

Dr. Murray:   Yes, there is a strong hereditary component. Most of the time, if both parents have them then their offspring are most likely going to develop them as well. And it does slowly progress over time. Things that can trigger it or hasten it are obesity; a standing profession where you’re on your feet for a significant amount of the day; pregnancy; multiple pregnancies; age; female gender. Those are the most common factors that cause it. But, by far, the biggest factor is hereditary, so you can blame your mom and dad for that.

Melanie:   Interesting. Now, people hear about the word spider vein and then they hear the word varicose veins. What’s the difference?

Dr. Murray: Size. Basically, spider veins are real small and flat and sometimes it can look like a spider because it has multiple--not sure of the word--multiple little veins that you can see on the skin, like a starburst kind of pattern. Otherwise, varicose veins are bigger. They are not flat. They are large ropey, twisted-like veins that you can see underneath the skin. Bulging veins.

Melanie:   Is there a risk to not doing anything about them? If they are not painful, is there a risk of blood clots or anything?   Are these something that are dangerous?

Dr. Murray:   Yes, there are risks of blood clots. The clots that would typically form in varicose veins are not the kind that go to other parts of your body, like, say, your lung. If part of the clot breaks off, it tends to cause something called “superficial thrombophlebitis”, which is inflammation and clotting in the superficial vein and that can be painful. It can cause infection, potentially. Sometimes they can bleed but mostly they are very uncomfortable for patients and there’s not a lot of great therapy to treat them other than conservative measures like heat packs or anti-inflammatory medication.

Melanie: So then, what should we do for them? What treatments are available and does something like lifestyle modification—exercise and that sort of thing. Does that help varicose veins?

Dr. Murray:   It can help alleviate some of the symptoms but it’s usually not going to be curative or a long-standing treatment. I do encourage everyone that has veins disease, however, if they are overweight, to try to lose that weight and one of the best ways to do that is to exercise and increase your metabolism. Other treatment options are--medical treatment options--would be compression stockings which are tight knee high or thigh high stockings, for example, that provide compression on those veins. A lot of times, they give people symptomatic relief. I don’t think we’ve talked about the symptoms of vein disease but those symptoms include typically, again, with standing: heaviness, aching, throbbing, swelling, itching. I’ve heard all kinds of symptoms and so the stockings would help alleviate some of those symptoms but it’s not going to treat the veins or necessarily help the progression. Other options include a catheter-based outpatient procedure called an “endovenous ablation”. There’s a couple different catheters, either a radio frequency heated tip or a laser tip that heats up inside the vein and that causes the vein to contract and shrink around the catheter and once we take that catheter out that vein is essentially closed and that does lead to a lot of symptomatic relief. That is considered a medically necessary procedure and that is covered by insurance. Other options that aren’t necessarily always covered by insurance and, in fact, most of the time not covered by insurance, is sclerotherapy. Sometimes, again, we can get insurance coverage but most of the time it’s considered “cosmetic” by the insurance companies and that’s typically going to be an out-of-pocket cost for a person who’s interested in having that done.

Melanie: Dr. Murray with ablation, and the vein wall contracts, the vein closes. Is this a permanent condition and is it okay to close up certain veins? Do we develop that collateral circulation so that the blood goes elsewhere? What happens with that?

Dr. Murray:   Yes. That’s a great question, Melanie. Once we “close” a vein, the blood does get rerouted into the healthier veins in the leg and eventually into the deep veins, which return all the blood flow out of your leg. So, that’s usually not any concern. My thought, when I'm recommending treatment for vein disease is, if the vein is not working properly, if it’s leading to decreased quality of life, daily symptoms for patients. I strongly encourage them to get that treated so that they do get that release and are able to move on with their active lifestyle.

Melanie: So, when does someone contact their healthcare provider? When should somebody be worried about their varicose veins?

Dr. Murray:   I tell people to have a low threshold to contact their healthcare provider about this sort of thing. Again, because it can markedly improve your quality of life. If symptoms are bad in your legs or they keep you from doing your daily activities that would be one indication to contact your provider. If you have an injury that where say, you’re shaving your legs and your varicose vein starts to bleed, that’s definitely an indication because that can be a serious problem. If you have problems with clotting or thrombophlebitis, or, in general, if you have any questions or concerns about the possibilities of having vein disease.

Melanie: So, in just the last few minutes give us your best advice, because so many people suffer from these. Pregnant women start to see them, even men in their 60’s and 70’s start to notice them. So, give us your best advice about those suffering with varicose veins and what they should do about them.

Dr. Murray:   Well, I would tell this population of people that you don’t have to just live it. It’s something that’s very treatable with very safe procedures that can be done. Again, you’re going to have a much better satisfaction with your life if you’re not living with daily discomfort and pain in your legs. So, please seek medical advice to find out more about this if you feel that this is something you struggle with.

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

More Than The Baby Blues: Understanding Postpartum Depression

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Segment Number 4
Audio File allina_health/1526ah4d.mp3
Doctors Edberg, Eydie
Featured Speaker Eydie Edberg, CNP- OB/GYN
Guest Bio Eydie Edberg is a board-certified nurse practitioner specializing in obstetrics and gynecology at Allina Health Shakopee Clinic. Her professional interests include infertility, menopause and prenatal care.
Transcription Melanie Cole (Host): You know, giving birth is such a wonderful event in a woman’s life and everybody’s always so happy about it. But some new moms feel low during such a happy time and they feel something they can’t even quite describe. Why do they feel that sometimes? My guest today is Eydie Edberg. She’s a board certified Nurse Practitioner specializing in obstetrics and gynecology at Allina Health Shakopee Clinic. Welcome to the show, Eydie. So, people hear about postpartum and sometimes the terrible things that mothers do and feel during that time. But, there’s also sort of the more moderate baby blues. Tell us the difference between these two.

Eydie Edberg (Guest): Well, thank you for the opportunity to speak on a very important subject. Pregnancy is a wonderful time and an exciting time. The baby blues tend to show up shortly after childbirth; soon, within a few days, and they usually last less than two weeks. You can experience mood swings and some anxiety and feeling overwhelmed, just as a new mother who is not getting her sleep, normally feels. Little change in appetite, all of these results, all these symptoms, are very short lived--usually less than two weeks. If they progress to a longer time frame and seem to be lasting longer and are more severe, that’s when we get to the concern of post-partum depression versus baby blues, where often times you’ll hear of people hurting themselves and the infant or experiencing lack of interest in bonding with their infant. These are things that should be talked about with another healthcare provider.

Melanie: So, now what is postpartum anxiety and postpartum obsessive-compulsive disorder? These are two new terms that we don’t hear about a lot.

Eydie: They are new terms and most of us hear about baby blues and postpartum depression. But, actually postpartum anxiety is more common that any of them. The symptoms of postpartum anxiety are worrying all the time and persistent feelings of bad or harm is going to come and feeling restless with uncontrollable, racing thoughts. But, again, a lot of these are symptoms of new parenting, so sometimes they not found out until later on in the year after delivery. So, anytime a woman experiences changes that they are uncomfortable with, they should really talk with their healthcare provider. Anybody can experience postpartum anxiety even if they haven’t had anxiety prior to pregnancy, where postpartum depression usually has some type of history with it. I would guess about a very small amount experience the postpartum obsessive-compulsive disorder changes. That can actually happen in both men and woman and that tends to be a fear of your baby being exposed to germs. So, you have excessive cleaning or you only want certain people to hold your infant or you’re always worried about threats to your infant and that’s a new change for you. About three to five percent experience that and, again, men and women experience that and that’s a relatively new experience. Where post partum anxiety, probably 10 percent of people experience that, where baby blues is 70-80 percent. So, very common baby blues and postpartum depression, 20 percent of people. So, there are many different emotional and physical changes that occur after delivery.

Melanie: Well, there certainly are and parents go through these range of emotions and as you so beautifully pointed out, men as well go through some of these changes. What would you like to tell new parents? We’ll get into some more postpartum depression in a little bit but what would you like to tell new parents? Give them your best advice about dealing with some of these range of emotions. Things they might be able to do, to not only prevent it but deal with these emotions as they crop up.

Eydie: Well, first of all, if you do have a history of depression prior to pregnancy, talk to your healthcare provider about that right away at your new OB visit so that you can plan ahead and be alert to those things. Then you’ve already created the conversation so it’s easier to talk about it. Still during this time, there still is a stigma with postpartum emotional changes. So, if you opened it up when you’re not having symptoms, it’s easier to talk about when these symptoms may develop. But as far as parenting goes, set realistic goals so that you don’t set yourself up doe disappointment and think about ways that you can support each other as you make the biggest changes of your life. Make those plans prior to delivery, such as, think how you will have a date night, or how you will help your partner (male/female) whatever, get that time to themselves that they need to restore and reenergize and take time to listen to your partner and to provide the support that she or he needs. Try not to be shocked with changes in your routine and changes in who you are, because now you’re somebody--there’s a new normal. You are different than you left work. You’re now a mother or father. So, there’s body image changes, there’s the physical changes, there’s the emotional changes, there’s the self changes, a loss of self. So, share those feelings with your partner, your family, your friends. Talk with other mothers so that you can learn from their experiences. Some people find support in a group setting but there are major life changes during pregnancy.

Melanie: So, now what about --we don’t have a lot of time left, Eydie- -but, what about postpartum depression? When does it become so serious? And as you mentioned, mothers can do dastardly things to themselves or their infants or just feel so low that they don’t bond. When does it become something that needs serious intervention and/or medication?

Eydie: Well, you should call your provider if your baby blues don’t go away after two weeks or the symptoms become more intense. There are medications, there are support options that will make a change and improve the quality of your life. Some women don’t tell anyone. They feel embarrassed and ashamed or guilty, when they are supposed to be at a happy point in their life and they have a fear of being unfit. So, stigma still remains, like I said earlier. Don’t suffer. You would not fail to treat diabetes, if you had it. So, please get help and treatment and support for postpartum changes that you might experience.

Melanie: So, in just the last few minutes here, again, please give your best advice and wrap this up about parents and this range of emotions and even some ways that people can help each other get through this and how long they can expect this. Because, I mean, becoming a parent really is the biggest change in your life that you’ll ever experience. So, give them hope that this is a wonderful thing and that those blues won’t last forever.

Eydie: Well, the blues are short-lived, so they should not last forever. You might cry at the Hallmark commercial but that is normal. If you can, get help from a grandparent so that you can get adequate sleep and rest. People do want to help, so ask neighbors, friends, family. They really do want to help. Others want to support and to help you, so rest as much as you can; concentrate on good nutrition and exercise; get out and breathe fresh air and talk with your healthcare provider if you have any concerns.

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

Head and Neck Cancer: Guthrie Can Help

Additional Info

Segment Number 4
Audio File guthrie/1526gc1d.mp3
Doctors Dr. Phillip Pellitteri
Featured Speaker Phillip Pellitteri, MD
Guest Bio Dr. Phillip Pellitteri is the Chief of Otolaryngology at Guthrie.

Learn more about Dr. Phillip Pellitteri
Transcription Bill Klaproth (Host): Head and neck cancer are cancers of the mouth, nose, throat and sinus areas. They are particularly distressing because they affect basic human functions such as talking, eating swallowing, etc. Head and neck cancer requires a multi-specialist approach and Guthrie’s integrated system provides an excellent platform to ensure patients receive the best care. Here to talk with us about head and neck cancer today is Dr. Phillip Pellitteri, Chief of Otolaryngology at Guthrie. Dr. Pellitteri thanks for your time today. Head and neck cancer. How common is this?

Dr. Phillip Pellitteri (Guest): It’s becoming more and more common as people are exposed to tobacco products with a resurgence in smoking, especially in females. We’re seeing it to a somewhat greater extent than we had in the past. The other influence, of course, is those head/neck cancers that may be influenced by a viral infection, specifically, the human papillomavirus infection.

Bill: And when we talk about head and neck cancer that would include the lips, tongue, gums, lining of the mouth, the floor and roof of the mouth, also the throat, voice box, sinuses, nasal cavity as well as the salivary glands. Is there any other part of the mouth, nose or throat that should be mentioned?

Dr. Pellitteri: Well, there are extensions from those areas that you mentioned. Specifically, the lymph nodes of the neck that harbor deposits from these primary areas of malignancy. And, of course, the thyroid gland also can be a cancer reservoir.

Bill: So, out of these areas is there one that’s more commonly affected than the others?

Dr. Pellitteri: I would say that we see more malignancies of the tongue, the tonsil and the back of the throat area more than any of the other cancers that we see in the areas described. In many instances these cancers present as enlarged lymph nodes in the neck with smaller cancers involving the structures that we just talked about. It used to be that we saw these cancers as being very large masses within the structures of the throat and the oral cavity but now we’re seeing a greater incidence of those cancers presenting in lymph nodes which indicate that the cancer has already spread beyond the primary site, the site of origin.

Bill: What type of symptoms do you see with head and neck cancers?

Dr. Pellitteri: Well, it really depends on where it occurs and to what extent it is not attended to in a timely fashion. So called “silent areas” of malignancy can occur in the nose and the sinuses where, you know, the tumor can grow to great dimensions before it obstructs the airway or causes a symptom of bleeding or problems with pain. On the other hand, cancers that occur in the oral cavity, especially the tongue or the inner lining of the mouth, may present fairly early because of an ulceration that becomes painful or, importantly, where a dental consultant or a dental hygienist actually sees the cancer when the patient presents for dental cleansing or some other type of dental procedure.

Bill: With any of these symptoms, at what point should someone come see you at Guthrie?

Dr. Pellitteri: Well, certainly if they have a neck mass, if you’re an adult with a neck mass, they should be seen. If they’re seen by their primary care physician and there’s a strong feeling that the patent has an infectious history, they might be treated with an antibiotic for a week or two and if that neck mass doesn’t resolve, the patient should be sent to see an otolaryngologist and we here at Guthrie can take care of that quite readily. Certainly, if a patient has a growth on the tongue that they can see or feel if they have problems with swallowing and feel as if they have pain on swallowing and notice a mass legion or an ulceration or some type of process that becomes painful and impedes their speech or breathing or swallowing, they should come directly to see us.

Bill: When it comes to diagnosis and treatment Guthrie provides a multi-specialist integrated approach. How does that work?

Dr. Pellitteri: Well, we’ve established what’s called a multi-disciplinary clinic, where patients who either are suspected of having malignancies of the head/neck, head/neck cancer, so to speak, or have already been diagnosed will be presented at our conference. What happens is that a number of specialists in different disciplines, such as surgeons, medical oncologists, radiation therapists, together with some of the supporting professionals in pathology and radiology, come together in a common conference. The patients attend that conference, they’re presented to all of the participants and then the unique aspect of the conference is that these patients are then examined by the participants all under one setting. Really, what that allows for is the patients to meet the people who are going to be treating them, to offer a consensus opinion right on the spot and then be able to direct any kind of scheduling, either for tests or for therapy, right when the patient is there. You know, patients who have gone through this process here at Guthrie have really found the benefit in that because it saves time, it expedites their care and it provides them a one-to-one meeting place with the people who are going to be very influential in their therapeutic program.

Bill: Obviously, the severity and stage of the cancers determine the treatment, but can you briefly tell us about treatment?

Dr. Pellitteri: You know, early stage cancer, that is, smaller malignancies of accessible sites especially in the oral cavity, might actually be treated by surgery and nothing else. On the other, hand larger cancers which may involve important structures that play a role in speech, articulation, swallowing and breathing, those malignancies may be treated up front with both chemotherapy and radiotherapy initially with an intent to cure and then, depending upon the response, the response both by the primary site in the head/neck as well as any lymph node metastasis, they may be candidates for surgical resection of those components, most notably in the neck afterward. The way we’re able to determine the completeness of therapy is not only by clinical evaluation-- actually feeling and looking and seeing where these cancers are--but also in specialized imaging techniques which provide appropriate orientation of the anatomic aspects of the head and neck relative to the cancer as well as the functional aspect of the cancer; that is the ability of the cancer to image through specific metabolic activities. In this way, we’re able to assess response for therapy. Depending upon response, the patient may be able to have either single or double modality therapy, sparing surgery, or surgery only sparing radiation and chemotherapy. It really depends upon the stage. Earlier stages, less therapy. Later stages, more therapy.

Bill: In overview, quit smoking, and if you feel something is wrong get to the doctor right away.

Dr. Pellitteri: There is no question that smoking cessation should be promoted and in younger people, we’re finding that vaccination against the HPV virus, which has been most effectively used in girls can now be extended to boys as well because these are viruses that may be sexually transmitted and may remain latent for long periods of time before becoming active in adult life. Then, of course, as you mention the recognition of symptoms. Changes that require more expedient evaluation and institution of therapy.

Bill: Great advice. Dr. Pellitteri, thanks for your time today. Last question, for someone with head and neck cancer or if someone fears they may have this type of cancer, why should they choose Guthrie for their care?

Dr. Pellitteri: Well, I think as far as our ability to both diagnose appropriately and comprehensively evaluate patients and integrate and institute a complete and comprehensive cutting-edge management program, Guthrie really stands second to none. We’ve been able to develop our program according to guidelines that are set aside for national standards. We, I think, are able to comprehensibly address patients through our multi-disciplinary conferences and, thus far, our outcomes have been absolutely excellent. You know, we stand ready to address those patients who have had neck cancer and we try to do that with the individual in mind and the individual’s family in mind. So we try and provide not only quality clinical care but quality service as well.

Bill: Absolutely. Dr. Pellitteri, thanks for your time today. We appreciate it. For more information visit Guthrie.org. That’s Guthrie.org. I’m Bill Klaproth. This is Guthrie Radio. Thanks for listening.
Hosts Bill Klaproth

Minimally Invasive Spinal Surgery

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Segment Number 3
Audio File guthrie/1526gc1c.mp3
Doctors Dr. Matthew Quigley
Featured Speaker Matthew Quigley, MD
Guest Bio Dr. Matthew Quigley, is the Chief of Neurosciences at Guthrie.

Learn more about Dr. Matthew Quigley
Transcription Bill Claproth (Host): Most people have experienced back pain sometime in their lives. For some, it’s a minor nuisance. For others, it can be debilitating. When physical therapy and medication fails, some are turning to minimally invasive spinal surgery. With us today is Dr. Matthew Quigley. He is the Chief of Neurosciences and Neurosurgery at Guthrie. Dr. Quigley, thanks for being on with us. Guthrie is currently building a new neurosurgery and neurology program which is led by yourself. Maybe you could start off by telling us a little bit about that.

Dr. Matthew Quigley (Guest): Well, the neurosciences composes neurosurgery and neurology and, really, it has to do with the medical and surgical treatment of diseases that afflict the brain, the spine and the peripheral nerves. So, right now, we’re trying to shore up and expand both the surgical as well as medical capabilities in terms of what type of problems that we can handle here at Guthrie.

Bill: So, this will certainly help expand your treatment of those type of diseases and help with those different procedures and treatment that you do?

Dr. Quigley: Right. It will also make things a lot easier for people living in this area because otherwise it would be a 2-hour car drive.

Bill: Let’s talk a little bit about back pain now and minimally invasive surgery. So, like I said, back pain for some is a nuisance. A lot of people get it. For some, it can completely ruin their quality of life. When is it time to consider minimally invasive surgery?

Dr. Quigley: Well, the distinction as to when something goes from, say, conservative treatment to surgery is really a function of a couple of things. One is the severity of the difficulty both in terms of the amount of pain--that is, how disabling it is--as well as the distribution of pain. As it turns out, most of the things that we treat and treat successfully are associated, in large part, with pain radiating into either the back or in the cervical spine into the arms. Pain which is restricted entirely to the midline, if it’s degenerative in nature; that is, it’s not associated with a tumor or a fracture or some other thing--is very resistant to any type of surgical treatment and we try very hard not to go down that route when somebody has simply axial pain. The other thing that decides whether somebody needs surgery or not is their neurologic presentation. Most of the people we see in the office have normal neurologic examinations but sometimes they don’t. Sometimes they have weakness, especially at what we term the foot extensors; that is, they have a dropped foot or, in the extreme cases, may have difficulty in terms of control of bladder function. These wind up being essentially neurologic emergencies.

Bill: So, when you see those, does that signal to you, “Okay. This is a candidate for surgery”?

Dr. Quigley: Certainly. Anyone who has a serious neurologic problem due to degenerative disease--that is, usually disc disease--they’re going to go to surgery usually pretty rapidly. That is the very small percentage of the type of patients that we see. Most of the patients that we see have had back and leg symptoms usually for a few months of duration and they may have very minor neurologic findings or none at all. So, the first line of treatment is going to be as described in terms of therapy, injections, giving things time. In reality, the majority--that is more than 50% of these things--will take care of themselves on their own. So, we want to give nature enough time to take care of these things if they’re going to take care of themselves. After 3 months or so, it tends to be a persistent problem and that’s when we start thinking about doing surgery.

Bill: How does minimally invasive surgery differ from traditional surgery? I mean, it sounds like it’s less invasive but can you go a little deeper on that?

Dr. Quigley: So, the traditional surgery involves making a midline incision which strips the muscles away from the bones. It turns out that this is a very important distinction from what we do with minimally invasive which is to make a skin incision in a transverse way. That is, perpendicular to the long axis of the spine. Then, we use a series of dilators, not to cut the muscle away from the bone but actually just to create a space. The important distinction here is that when you pull that dilator out, all the muscles come back into place. This eliminates what we term “dead space” that’s created with traditional surgery. When you do traditional surgery, you create a space underneath the incision that basically fills up with fluid and that fluid is basically a nice broth for all sorts of organisms and things to grow in; whereas, with the minimally invasive technique, there is virtually no dead space. So, right away, what we can see is a big decline in wound infections. Wound infections complicate anywhere upwards of 3-5% of traditional surgeries. With the minimally invasive technique, it’s less than 1% of the time.

Bill: So, we don’t want the broth, right? We don’t want the broth?

Dr. Quigley: We don’t want the broth.

Bill: Just don’t give me that broth?

Dr. Quigley: The problem is it’s a nice, warm, nutrient rich, dark place for the bugs to grow.

Bill: We don’t want that. So, the minimally invasive surgery kind of takes care of that because you’re not creating that pocket of broth, if you will.

Dr. Quigley: Right. The other thing that we are able to do is to do procedures through a much smaller incision, which, again, is just a lot easier to heal up for the patient. So, a typical two-level or three-level laminectomy that, say, an elderly patient would be offered, which is an L3 through 5 laminectomy, involves an incision on the back, which is easily 6 to 8 inches in length; whereas, our incision for the minimally invasive technique is about an inch and a quarter or so.

Bill: Now, would this be considered safer, then, than traditional surgery, too?

Dr. Quigley: Well, it’s safer in the sense that it translates into a much lower infection rate and infections are the most common complication we run into. They can range from being annoying, something that could be treated with oral antibiotics, all the way to the life-threatening if you wind up with a methicillin-resistant staph infection and that staph infection can then become systemic and people can be seriously harmed from these things. So, again, that’s a road you don’t want to go down if you don’t have to.

Bill: This isn’t outpatient surgery, right? There is still a hospital stay with this.

Dr. Quigley: Well, Medicare considers it outpatient because you don’t spend 2 nights. So, you only spend one night. Generally, what we do is plan for the patient to spend 1 night because they have to emerge from the anaesthesia and if it’s not a first case then, generally, it’s 4:00 or 5:00 in the afternoon when they’re waking up and no one wants to take somebody home at that point. We’ve certainly had patients who we’ve operated on first thing in the morning and then by the afternoon they’re like, “Doc, I want to go home!” It’s fine. They can go home. We’re not holding anybody here. But, generally, in order to get over the anesthetic and some of the pain management, initially, right away, it’s just easier to keep folks in overnight in our observation unit.

Bill: Even though this sounds safer, are there still different risks associated with this?

Dr. Quigley: Well, all spine surgery carries with it some very distant possibility of very bad things happening: damage to the nerves, damage to the nerves that go to the bladder, all sorts of possible downsides but the likelihood of any of these things happening are tiny fractions of one percent. You know, one in a couple of thousand. Frankly, it’s a function of the experience of your operator and I’ve literally done thousands of these procedures.

Bill: Then, what is the recovery period like with minimally invasive surgery?

Dr. Quigley: Well, it’s a little bit easier than for the other types of surgery but not dramatically so. You’re still going to be sore and tired for a week or two following the procedure. I generally limit people not to drive for 10 days to 2 weeks, although people violate those rules all the time. By a month, folks are 90-95% back to normal.

Bill: So, this sounds like much better than traditional long incision surgery that you talk about. Why would anybody ever get the traditional surgery? Why wouldn’t everybody just get minimally invasive surgery?

Dr. Quigley: The honest answer is that most surgeons out in the community have not been trained to do it this way. They learned how to do it open and really don’t want to go through the learning process to do it through a series of dilators. It turns out that even though the anatomy is basically the same, it’s very disorientating to a surgeon to look at the same anatomy through a very long, thin tube. It’s easy to get lost. It’s easy not to know your land marks. So, for a lot of surgeons, it’s just a kind of a considerable learning curve that they don’t wish to go through.

Bill: So, it seems a pretty easy question to answer why someone would choose Guthrie for their back care needs, then?

Dr. Quigley: Well, I think it’s two fold. One is, certainly, we have the capabilities as far as the minimally invasive approach but the other part of it is that you have surgeons who demonstrate a lot of judgment and sensibility in terms of who needs an operation. So, it’s not a clinic that goes by that somebody doesn’t come into my office and say, “Oh, doctor so and so from elsewhere said I needed an operation,” and I look at them and I say, “Well, we can do some therapy first. We can wait. A lot of these get better on their own. There’s no emergency. If you can bear the pain for a month or so, we’ll see how things go.” That’s the type of approach that we try to take.

Bill: That sounds like a good approach. Dr. Quigley, thank you so much for your time today. We really appreciate it. And for more information you can visit Guthrie.org. That’s Guthrie.org. I’m Bill Claproth and this is Guthrie Radio. Thanks for listening.
Hosts Bill Klaproth

New Radiological Techniques To Tackle Prostate Cancer

Additional Info

Segment Number 2
Audio File guthrie/1526gc1b.mp3
Doctors Dr. Omar Yumen
Featured Speaker Omar Yumen, MD
Guest Bio Dr. Omar Yumen, is the Chief of Radiation Oncology at Guthrie

Learn more about Dr. Omar Yumen
Transcription Bill Claproth (Host): The American Cancer Society predicts that over 220,000 new cases of prostate cancer will be diagnosed this year and new radiation techniques are available to tackle prostate cancer. Here to tell us more is Dr. Omar Yumen, Chief of Radiation Oncology at Guthrie. Dr. Yumen, first of all, thanks for spending time with us today and if you could, give us a quick overview, what is prostate cancer?

Dr. Omar Yumen (Guest): Prostate cancer is a form of cancer that effects men and it’s a cancer that we discover generally by measuring PSA and often requiring a biopsy of the prostate and when we look at the tissue in the prostate it shows malignant cells. So, that’s how the diagnosis is generally established. More often than not prostate cancer is silent. There are typically no symptoms associated with prostate cancer in the vast majority of circumstances.

Bill: What are the risk factors that promote prostate cancer? Are there things such as lifestyle or heredity or just plain old age? Or maybe it’s a combination of all of them?

Dr. Yumen: Well, I think you’re right. I think it’s a combination of all of these things but by far and away, the most important factor for prostate cancer is age. Some people would suggest that it’s a matter of time before men are diagnosed with prostate cancer and there are some factors that have been associated, some dietary factors which are a little bit soft in terms of cause and effect but by far and away, the biggest issue is aging and the other thing is family history. So, if you have a strong family history of prostate cancer, fathers, brothers, uncles, then your risk of prostate cancer is significantly greater.

Bill: What are the warning signs when they do happen that would point to problems with the prostate gland?

Dr. Yumen: Well, the typical symptoms that many men experience as we age are urinary issues. Difficulty with urination, slow stream, getting up at night more often to pass your urine, things of that nature. More often than not those are not necessarily symptoms of prostate cancer. Symptoms of prostate cancer, if they do develop, often are associated with advanced disease. Those types of symptoms or other symptoms, for example, bone pain or something like that, would suggest that the cancer has already spread. So, typically, as I mentioned before, prostate cancer is often times silent. It’s not necessarily associated with any symptoms that would bring someone to the physician. If you have these symptoms typical of aging, more often than not, they just happen to go hand in hand with the possibility of having prostate cancer but not necessarily as a consequence of prostate cancer.

Bill: What is it that you as a doctor says, “Okay, I think you may have an issue with your prostate gland? Not sure it’s cancer. It may be but now we need to check.” What is that warning sign that makes you do that?

Dr. Yumen: Well, typically, what often happens in a family practitioners office is the fellow will get a digital rectal examination which may show some abnormality which prompts evaluation of the so called PSA test. Some family practitioners will get a PSA test as an annual part of the screen and if elevated often will need to be pursued further. So, those are the typical findings that would prompt us to work up for prostate cancer.

Bill: When does radiation come into play? Who is a candidate for radiation prostate cancer treatment?

Dr. Yumen: Radiation is utilized. It can be utilized for many different stages of prostate cancer. For example, if you were a candidate for surgical removal of a prostate, you’re also a candidate for radiation therapy. Additionally, if you present with more locally advanced disease that might not be amenable to surgery, certainly radiation is useful in that circumstance. Thirdly, if you are older and you are diagnosed with prostate cancer and it needs to be treated, then oftentimes surgery is not the best option because of potential side effects. So, radiation becomes more of the treatment of choice in that situation.

Bill: How does radiation treatment work? Is it a one-time event? Or, does the patient come back a certain number of times? Is it outpatient? What’s the process?

Dr. Yumen: There are different forms of treatment for prostate cancer. The one form that many people associate with prostate cancer is multiple repetitive treatments Monday through Friday over the course of about 8 weeks. Generally, that’s often reserved for a bit more advanced prostate cancer. In addition to that, there is a technique called a “seed implant procedure” or a “prostate brachytherapy” which is a very effective treatment. The cure rate seems to be equivalent for having your prostate removed. It’s reasonable for men of any age group, even younger individuals and it’s a one-time situation under anesthesia where the radioactive seeds are directly implanted into the prostate. So, that’s a very effective technique. Additionally, there’s a technique called “SBRT” or “stereotactic body radiation therapy” which delivers very, very high doses of radiation per treatment and that’s usually given over 5 treatments, twice a week, for about 2 ½ weeks. So, that’s also a very effective and very convenient form of therapy for the patients.

Bill: Does radiation help eradicate it? Or cure the patient? Or put him into remission? Or is this just help stave it off a little bit?

Dr. Yumen: Well, any time I give radiation therapy, the vast majority of instances, the intent of treatment is curative. In some situations where radiation’s given, it’s being given directly from the outset with control or palliation in mind but the vast majority of situations where radiation is administered I’m giving it with the hope of curing the patient of their disease permanently.

Bill: Are there side effects and the risks of radiation techniques?

Dr. Yumen: There are but the good news is that with more modern techniques that are available to us the risks are reduced substantially, like damaging the rectum or damaging the bladder. So, permanent damage risk is much, much less than it was, say, a decade ago because of improvement in techniques that are available.

Bill: And this improves the recovery time, then?

Dr. Yumen: It improves the recovery time and it certainly improves the patient’s quality of life long term because sometimes these side effects from radiation can develop months or even years after the treatment is administered. So, by minimizing the potential side effects, we improve upon the patient’s quality of life.

Bill: Speaking of quality of life, I think this is an important question that all men would want to know. Prostate cancer is not the cause of erectile disfunction. Treatments for the disease can cause the problem. Do radiation techniques help reduce the effects of potential erectile disfunction?

Dr. Yumen: The risk of erectile disfunction is, unfortunately, a real concern no matter what technique is utilized, surgery or radiation, but there are some techniques which appear to be better at preserving erection capacity, at least for the short term and that can be years. Prostate seed implants or brachytherapy seem to have a particularly good track record with respect to control of erection capacity or maintaining erection capacity. When we have to use more extensive radiation techniques or certainly combine them with hormones, then the risk of erection disfunction certainly increases.

Bill: Although no one wants to hear a diagnosis of prostate cancer and it certainly can be serious and scary, many men, with proper treatment, live a long and normal life after prostate cancer. Is that correct?

Dr. Yumen: Absolutely. Absolutely. I think that prostate cancer therapy has come a long, long way over the last few decades and the most important thing is to make sure that if a diagnosis of prostate cancer is made, then you are seen, not only by a surgical specialist in urology but oftentimes, it’s important to be seen by a radiation specialist as well, just so that the patient is aware of the entire gambit of choices.

Bill: Why should someone choose Guthrie for their prostate care needs?

Dr. Yumen: Guthrie is fortunate in having state of the art radiation equipment. We have expert surgical staff who are very, very good surgically and are using robotic techniques with the da Vinci robot, which I’m sure our listeners have heard about. From the radiation perspective, we are very fortunate in having the best equipment and state of the art techniques so that we can try and cure folks with minimal long-term side effects related to treatment.

Bill: Doctor Yumen, that sounds great and thank you so much for your time today. We really appreciate it. For more information visit Guthrie.org. That’s Guthrie.org. I’m Bill Claproth. This is Guthrie Radio. Thanks for listening.
Hosts Bill Klaproth

What You Need To Know About Your Fertility In Your 20s, 30s and 40s

Additional Info

Segment Number 3
Audio File allina_health/1526ah4c.mp3
Doctors Klebs, Bradley
Featured Speaker Bradley Klebs, MD - OB/GYN
Guest Bio Bradley Klebs is a board-certified physician specializing in obstetrics and gynecology at Allina Health Hastings Nininger Road Clinic. He has professional interests in gynecologic surgeries, pregnancy and prenatal care, delivery, laparoscopic surgery, contraception, menstrual issues, infertility and urinary stress.
Transcription Melanie Cole (Host):   If you’re trying to get pregnant, it’s import to know how age impacts fertility. My guest today is Dr. Bradley Klebs. He’s a board-certified physician specializing in obstetrics and gynecology at Allina Health Hastings Nininger Road Clinic.

Welcome to the show, Dr. Klebs.

Tell us a little bit about how a woman’s fertility changes as she ages.

Dr. Klebs (Guest): Well, it’s certainly better the younger you are and the healthier you are when you’re thinking of conception. There is about an 85% success rate and that diminishes with age. So, the difference in age, they say you can have a decrease of 11% up to age 34; 33% decrease by age 50; and an 87 decrease by age 45.

Melanie:   So, let’s start with women in their 20’s, when our bodies are still able to recover quickly and it’s not as difficult to have a pregnancy. Tell us about what they can expect in terms of fertility and if there are any tips that you would like to give women in their 20’s to improve their fertility.

Dr. Klebs:   Well, I think the biggest tip I could give is that women in their 20’s are usually healthy and they have a very good likelihood of conception meaning that they don’t have to worry too much and we recommend that they give a good 12 months of trial before seeking medical evaluation for a problem and that’s assuming they are in good health.

Melanie:   What about some tips to helping them, you know, if they really are trying to get pregnant and they get a little stressed out in that 12 months before they see a specialist, what would you like them to know about behavior and lifestyle modification?

Dr. Klebs:   Well, it is important, again, if they’re focusing on the technical aspect that we want the egg present, we want the sperm present at the right time and we want a healthy passage where they can meet and conception take place. So, what I recommend is that they stay in good health; that they exercise and maintain a stable weight; minimize stress in their life; maybe use a condom when they’re not trying to get pregnant to avoid sexually transmitted disease. Having an annual exam is always a good idea so that screening can be done and proper vaccinations administered. If there is a condition that the doctor picks up, then treat that condition so they’re in the best of health at the time of conception. Also, I think it’s real important that they take a pre-natal vitamin that contains folic acid because that can be nutritionally beneficial as well as prevent birth defects like spina bifida.

Melanie:   That’s great advice. What are some reasons a women in their 20’s might have trouble getting pregnant?

Dr. Klebs:   Well, the most common reason is anovulation where the egg is not being released in a timely manner. So, maybe during the year, they have less chance to conceive. Other problems that could be encountered involve blockage of the fallopian tubes which could have occurred of scarring of a past infection or past surgical procedure. You can have uterine abnormalities such as polyps or fibroids present; pelvic endometriosis; polycystic ovarian syndrome and, from a male perspective, a semen analysis that is not normal.

Melanie:   Now, as we move into our 30’s, and more and more women are waiting a little while to get pregnant, what happens with your fertility in your 30’s?

Dr. Klebs:   Well, as mentioned, it does decrease in the 30’s. Well, just 11%, so not a great deal but it’s important, again, to maintain your health. As we age, we have medical conditions that occur such as diabetes, hypertension, thyroid disease, fibroid formation of the uterus and then we mentioned pelvic endometriosis and previous surgery could have occurred such as ectopic pregnancies or a ruptured appendix that could interfere with fertility.

Melanie:   So, what tips would you give a woman in her 30’s? That’s considering if she’s 35 and she really wants to get pregnant. What is some of your best advice for women to get pregnant in their 30’s?

Dr. Klebs:   Well, I think it’s important that they see a healthcare provider for their annual check-up; that they maintain an appropriate lifestyle that we talked about. Again, that includes keeping a stable weight; avoid excess use of alcohol; limiting tobacco and not taking illegal drugs. Also, medications that sometimes people are on for various health conditions that may not be healthy or safe during pregnancy that would need to be substituted or discontinued when conception is planned.

Melanie:   How long would you ask a woman in their 30’s to wait before they see a fertility specialist if they’re trying to get pregnant and haven’t yet?

Dr. Klebs:   I think 12 months is still reasonable. I think when you get into your 40’s, then it’s maybe going to be shortened to 6 months or less depending on the situation, I think, if there’s good timing, which we typically think of a 28-day menstrual cycle. In mid-cycle, around day 14, would be an ideal time to be trying to conceive on day 12, 14 or 16 of the cycle, counting day 1 as the first day of menses.

Melanie:   Now, as a woman gets closer to her 40’s and starts thinking about her biological clock and time is running out and she may or may not be able to have a child in her 40’s, tell us a little bit about what happens with fertility in your 40’s and what are some possible risks of getting pregnant?

Dr. Klebs:   Yes. Fertility in the 40’s is more of a concern and as we mentioned, women should seek medical help sooner and that can be by an infertility specialist. Actually, a reproductive endocrinologist could be used in that capacity and sometimes genetic counselors are useful. Once again, you really are running out of time so to speak. The eggs may be limited—the reserves there and you want to get things going as quickly as possible. Again, you want to maintain good health and be evaluated so that everything could be in the best condition possible to achieve the pregnancy. If a problem is diagnosed, then it can be addressed so that a successful pregnancy can be achieved.

Melanie:   And, what would be some risks? Is it more dangerous for a woman in her 40’s to get pregnant? Is it more dangerous for mom and/or baby?

Dr. Klebs:   Yes, it is. Dangerous meaning once they’re pregnant, they have higher incidence of conditions, so during the pregnancy, the doctor would have to watch for things like gestational diabetes, pre-eclampsia, chronic hypertension, fetal growth restriction, pre-term labor, chromosomal anomalies and so forth, but it’s certainly manageable. I think people are very thrilled and with our population, the way they are having longer careers and taking educational courses, conception is occurring in the 40’s more frequently now than in the past.

Melanie:   So, in just the last few minutes, Dr. Klebs, if you would, give your best advice for women of any age that are considering getting pregnant; trying to get pregnant and cover fertility and even pre-natal vitamins. Should they start even before they’re thinking of getting pregnant? Just give us your best advice.

Dr. Klebs:   Yes. I advise women to have their annual check-ups or a pre-conception clinic visit where they can be evaluated and if there is a health condition found, then it can be addressed so that they are in the best of health when they do try to conceive. Again, that includes vaccinations that need to be kept up to date and just screening for diabetes, possibly, so that that is recognized and treated in advance. We mentioned the importance of taking a pre-natal vitamin when you’re planning on conception and that it should include folic acid and that women in their 40’s should think of seeing an infertility specialist sooner in the course of trying because their time is limited.

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

Preventing Common Running Injuries

Additional Info

Segment Number 2
Audio File allina_health/1526ah4b.mp3
Doctors Barie, Shannon
Featured Speaker Shannon Barie, PT, MS, OCS – Physical therapy
Guest Bio Shannon Barie is a RunSMART physical therapist at the Courage Kenny Rehabilitation Institute in New Ulm. She is an outdoor enthusiast who finds enjoyment in running, walking, bicycling, sports, gardening and playing with her children. Her goal is to stay fit to keep up with her children and help them foster a lifelong love of exercise.
Transcription Melanie Cole (Host): Runners are a determined lot and often adopt that mantra, “I can push through this” which is fine when you hit that mental wall during a race that you’ve prepared for, but not when it comes to ignoring your body’s warning signs and addressing those aches early and often. My guest is Shannon Barie. She’s a RunSmart physical therapist at the Courage Kenny Rehabilitation Institute in New Ulm. Welcome to the show, Shannon. So, tell us about the most common running injuries that you see as a physical therapist.

Shannon Barie (Guest):   Yes. Hello. We see Achilles tendonitis, iliotibial band syndrome, plantar fasciitis, runner’s knee and shin splints very frequently.

Melanie:   So, there’s a difference between the acute injuries and these chronic, overuse injuries. So, I’d like to start with plantar fasciitis because it’s pretty common, it’s really painful and it can keep you from being able to even walk, much less run. What do you tell people about avoiding these overuse injuries?

Shannon:   Well, some of the best advice I can give them is about proper training. We see too much too soon come from most runners. They want to get out and really tackle the mileage but what would be a better plan would be to increase, say no more than 10%, per week of mileage or intensity. So, if I’m running 10 miles this week, I should not run more than 11 miles next week. Those numbers have kind of proven to keep our body able to adapt to all of those stresses we’re putting on it with running.

Melanie:   How important are shoes to the whole runner thing and what goes on with them and the pains and aches that they feel?

Shannon:   Running shoes are our best piece of equipment we can put on. They have to be comfortable. I can’t specify a brand that would work the best. Are they comfortable? Are they doing what they need to do? Runners nee to replace them often, too—every 400 miles or so—and they are very important. It’s what’s going to hit the ground first. I suggest different types of shoes for different reasons. If someone is coming in with plantar fasciitis or Achilles tendonitis and it’s an immediate or an acute problem, I might actually suggest more stability or a stable running shoe compared to someone who has been running longer and isn’t having any problems getting them into a minimalist or a cushion shoe works great. You know, the runners that are treated with the plantar fasciitis and such, I’m suggesting a bit more stable shoe. I’m actually trying to get those runners back into their running trainers and things, too.

Melanie:   I’m glad you mentioned the 400 mile shoe thing because people tend to say, “Oh, I’ve had these shoes a long time. They’re very comfortable.” So, that’s why they wear them. And yet, they’ve got Achilles tendonitis or plantar fasciitis. Do you ever recommend orthotics like a Spenco or one of these products be added into the shoe?

Shannon:   I first like them to replace the shoe. You know, if the soles are running down after just 125 miles already. So, replacing the shoes is the smartest way to go. If they love their shoe, just buy the same make and model every time because if it’s working for them, I don’t switch them. As far as orthotics, often over the counter ones, yes. They work really well. It doesn’t need to be a custom one and we use them, maybe more temporarily, to help them through an injury—maybe 6 weeks, 10 weeks—and then try to wean them out of them unless there’s something severely wrong with their foot.

Melanie:   Tell us a little bit about iliotibial band syndrome, ITB, and what causes that and how can it be prevented?

Shannon:   The person often says, “I have got pain and burning down that outside of my knee” and it’s caused, a lot of times, by too much downhill running or running on one side of a track or a street where the ground is angled or even just really increasing your mileage one week. Then, we’ve noticed, too, that weak side hip muscles, called the hip abductors or gluteus medius and maximus muscles, those contribute and we PTs find that these runners might even do better running faster or sprinting workouts while they’re trying to recover. It just doesn’t put that knee in that same angle that jogging does. That can help them get by sometimes.

Melanie:   What about runner’s knee?

Shannon:   The most common pain that a runner is going to feel at the knee is also called patellofemoral pain—that pain around the kneecap—and the muscle imbalances that control the kneecap can contribute; weak outside hip muscles and, again, overuse, and form mechanics. Yes, I treat it a lot. We see it every week in here and one of the best ways that we can help people with runner’s knee is to watch their training regimen. I suggest keeping a training log so they can track what they’re doing and their body’s responses and also, there’s something called cadence manipulation. So, a lot of times, people who have pain at the front of their knees are probably those same runners who are pounding every time they hit the pavement. You know, that really bowed runner and they probably are running a rather low number of steps per minute and that’s called cadence. We see maybe 140-150 steps per minute compared to our more efficient runner who is running 170-180. Then, those forces from that heavy heel striking have to come up somehow and they often kind of hit the knee and so we work a lot with people with changing their cadence, kind of a gradual approach to help them run more comfortably.

Melanie:   One of the first things that new runners experience is shin splints. Are there stretches or anything that can prevent shin splints before they happen?

Shannon:   Well, shin splints are often caused as well, by a runner who’s running too many downhills or that’s running too much volume, too many runs, at high mileage. They might even be doing too much speed work and these runners also might not be switching their shoes enough. So, the old shoe phenomenon is what it’s called. As far as stretches and that sort of thing, I’d first change their overtraining that they’re doing to their body. I’d make that switch first and then I’d even look at that cadence manipulation we were just talking about with the front of the knee pain and try to get them to decrease their hill work and decrease the amount of pounding they’re going to do. Sure, it’s important that the ankle and the calf have mobility and that they have proper strength and that sort of thing. But, often that’s, again, those people that just pound too much when they run or, even if they’re playing sports like basketball and they’re stopping and starting all the time, that can contribute, too.

Melanie:   Is there any way to convince runners to cross train to avoid some of these chronic overuse injuries and get them, because they are that determined lot and running is their focus, but can you get them to swim or, God forbid, walk sometimes? Or do they feel that that just takes down their running ability?

Shannon:   That is a hot topic with runners. You know, as a running physical therapist, I never want to take them out of their sport, but we do have to make modifications and if I can reduce their running a little bit, we still have to keep up their cardiovascular fitness by trying things like you just suggested: bicycling, running in the water. That is a great activities for runners. They have that compulsion to run. We can get them in the pool and they can still run and not increase their injuries. Cross training is a wonderful thing to do and it just decreases the stress on the body during that time. I like also trying to fit in some strengthening programs with these runners and stretching for the people who need it. Definitely a piece of the puzzle to the rehabilitation of a runner.

Melanie:   We don’t have a lot of time left but where do icing and bracing play a role in some of these chronic injuries?

Shannon:   All injuries, in their first week, can be partly managed with ice a bunch of times a day. If it’s a chronic injury, ice isn’t going to be as helpful any more. So, it’s really essential, in the first few weeks with an injury. With bracing, it’s the same kind of the same thing. In the beginning, when you want some support for the injury, if you put a brace on it, the body part won’t have to do as much work; won’t have to feel as many forces but since that probably isn’t going to be something that you keep as a permanent fix, we want to wean off of the braces over time as well.

Melanie:   So, in just the last minute here, give us your best advice for preventing running injuries before they start for these runners that. This is just so important for them.

Shannon:   I would say be gradual. Integrate these changes--whether it be new shoes, mileage, intensity, hills, terrain; whatever -- slowly. Runners returning from an injury or even beginning runners, novice runners, might do very well also with a walk/jog interval program. I love those. That’s how I get a lot of my runners back is to use a gradual return to running. But, my first and foremost suggestion is be gradual with your training.

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

Chronic Tendon Injuries: How Are They Diagnosed and Treated?

Additional Info

Segment Number 4
Audio File virginia_health/1525vh5d.mp3
Doctors Pierce, Jennifer
Featured Speaker Jennifer Pierce, MD
Guest Bio Dr. Jennifer Pierce is a board-certified radiologist who specializes in musculoskeletal radiology.

Learn more about UVA Radiology
Transcription Melanie Cole (Host): Chronic tendon injuries or chronic tendinosis can cause constant pain. However, there are new treatments that are available. How is tendinosis different from what you hear about, tendinitis, and what are some of those symptoms of chronic tendinosis, and what treatments are available? My guest today is Dr. Jennifer Pierce. She’s a board certified radiologist who specializes in musculoskeletal radiology at UVA. Welcome to the show, Dr. Pierce. What is a chronic tendon injury or chronic tendinosis, and how does that differ from what people have heard so much about, tendinitis?

Dr. Jennifer Pierce (Guest): Well, thank you for having me, yes. The answer to your question, what is tendinitis and tendinosis, tendinitis means inflammation. And they found on a cellular level a lot of these damaged and degenerated tendons don’t have inflammation. So doctors use the term “tendinosis” because it just means that there’s disease or tendon pathology. So it really is the same term or two words for the same entity. Chronic tendon injury, this means that you have tendon-related symptoms like pain and burning and weakness for a certain timeframe, and that usually means longer that three to six months. Chronic tendon injury can be from a single traumatic event that lasts that long, the pain and the symptoms, or it can be brought on by just long-term repetitive overuse. That kind of typically happens unfortunately as we age.

Melanie: Are there certain areas that are more subject to these kinds of injuries than others?

Dr. Pierce: Well, tendons can degenerate as we age due to overuse, and I would say kind of going from head to toe, first the shoulder is a common area, the rotator cuff. That’s an area that we overuse and you can have a tendinosis there. The elbow, especially the outside or the lateral aspect of the elbow, commonly called tennis elbow. And that’s due to become an extensor tendonitis. It actually involves 1 to 3 percent of our population. Some other tendons would be hamstring tendon, Achilles tendon, and also the plantar fascia, which is on the sole or the heel of your foot.

Melanie: These are painful conditions and ones that I deal with daily myself, Dr. Pierce. What’s your first line of defense? What do you recommend people do? For example, they’ve got plantar fasciitis, which can be incredibly debilitating and painful, or rotator cuff tendon problems that just make them wake up in the night when they roll over on their shoulder. What do you tell them?

Dr. Piece: Well, they should go see their primary care doctor to make sure that that is really the issue, that it is the tendon issue. Because joint pain can be somewhat cryptic. It can be from the tendons. It can be for something inside the joint, like the cartilage, those kind of things. So once it’s decided it is the tendon, really asking questions and a physical exam so that we can pick out the tendon that’s causing the pain is really the first line of diagnosis. If there is a need, imaging—and that’s where radiologists come into play. They’re the doctors that look at imaging, such as x-rays, CTs, MRIs, and ultrasound. And sometimes those imaging modalities can really help their clinician diagnose tendinosis and tendon problem.

Melanie: Then what treatments are available? Because people tend to think, Dr. Pierce, of cortisone shots, and anti-inflammatories and ice, which is always a good one. What do you recommend for treatments? And as a radiologist, what do you see as some good long-term outcomes?

Dr. Pierce: Yes, tendon problem is a huge industry, and that really involves a lot of patients in our society. And you mentioned a lot of them. I think the first line, for example, like you mentioned is that RICE therapy—rest it, ice it, put that compression, and maybe elevate to that joint or tendon. But here at UVA, we are doing some other things. You mentioned the steroid injection and radiology. We are using image-guided techniques to actually make sure that needle is placed right in the tendon and placing the steroid. Another thing we’re doing is what’s called Tenex. That’s a company name, but it is called Percutaneous Needle Tenotomy. I don’t know if you’ve heard of that, and with ultrasound guidance. And what we do is we can look at the tendon with ultrasound and see actually the areas of degeneration, the true pathology in the tendon. And then with those areas, we can target it and place our needle right there, and that’s why it’s called image guidance. And when we place that needle there, what happens is this specialized needle has an inner needle and an outer needle, and that inner needle oscillates at a really high frequency, basically at 28,000 times per second. And it sort of acts like a jackhammer, if you will, but gently removes that area of disease or degenerated tendon that we can spot on our ultrasound imaging. And we put some saline there, and it helps to breathe and irrigates that irritated tendon. And people are doing very well, very good outcomes and long-term outcomes. You mentioned steroids. That has been good for patients but really short-term, maybe six weeks, maybe three months. But we found with this new procedure, patients are pain-free, for example, with tennis elbow problem, even one year out, maybe even two years out on some studies.

Melanie: Wow, Dr. Pierce. That’s absolutely fascinating and if someone is suffering from a soft tissue injury, whether it’s tennis elbow or golf elbow or tendinitis of the Achilles, this Tenex, how fast would they see results? Are they going to be pain-free? Does it take a couple of weeks for it to kick in? We know that cortisone shots may take a few days or up to a week. How fast does Tenex work?

Dr. Pierce: That’s a great question. Tenex is completely different than the steroid. It doesn’t respond as quickly. However, what I’ve noticed in my patients is that there’s a lot of variability. I’ve had patients that say that night it felt so much better, I didn’t need to take the pain medication. Most patients however are noticing that their strength, their decrease in pain and increase in flexibility really start kicking in about three to five weeks after the procedure, and then it even gets better and better. The pain-free situation, it’s usually even at a year and two-year follow-up, which is really incredible since a lot of the treatments that we’ve talked about before are more short-term.

Melanie: And what about prevention altogether? We only have a few minutes left, but is there prevention, or are some of these just age-related, tendon breakdown soft tissue from chronic overuse and various things that we do? Is there prevention?

Dr. Pierce: That’s a great question. I think if you keep doing the activity, you can start getting degenerated tissue, especially if there’s no strengthening. So what I recommend at the first signs of tendon pain, really go in, maybe get some physical therapy. There’s a lot of great information online to start strengthening that tendon and that kind of thing, but sometimes we can’t eliminate what you do on a daily basis, because we do use our tendons and our extremities, especially if you do a lot of labor and that kind of thing. So I would just make sure that you’re strengthening, you’re staying fit, and that kind of thing. And we can’t sometimes stop the degenerative process.

Melanie: We certainly can’t, but this has been such great information. In just the last few minutes, your best advice for people with soft tissue injuries and tendinosis treatments and why patients should come to UVA for their care.

Dr. Pierce: Yes. Well, at UVA radiology, we have lots of specialists. In fact, we have every specialist for all the medical specialties. Medicine is so vast, and so to have a specialist really focusing on that branch of medicine is important. At UVA, the radiology specialists are really working hand in hand with the clinical specialists. You have doctors talking to each other, and that’ll really give you the best care. In terms of MSK radiology, we offer comprehensive radiology, so from x-rays to CTs to ultrasound to MR. We read it all, and we can really use all those modalities to help diagnose things. And, especially with the procedures that I’ve been talking about, whether it’s steroid injection or the Tenex, we actually see where we place that needle so that image guidance is really great. We’re not blindly injecting. Especially for deeper tendons, it’s really helpful to see where you’re putting that needle.

Melanie: What great information. Thank you so much. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thank you so much for listening and have a great day.
Hosts Melanie Cole, MS

Evidence-Based Weight Loss Tips

Additional Info

Segment Number 1
Audio File allina_health/1526ah4a.mp3
Doctors Merz, Roxana
Featured Speaker Roxana Merz, MD - Medical director, Medical Weight Loss Program
Guest Bio Roxana Merz, MD is the medical director for the Medical Weight Loss Program at Abbott Northwestern Hospital. She is a bariatrician with certification through the American Board of Obesity Medicine and a board-certified internist. Having also practiced as a primary care internist, Dr. Merz understands the importance of approaching her patients holistically, taking into consideration their unique medical, emotional and social needs.
Transcription Melanie Cole (Host): Every day you hear about trending new diets or workouts that promise weight loss success, but very few actually work in the long run. And even weight lost surgery requires significant and permanent changes in dietary patterns in order to be successful. My guest today is Dr. Roxana Merz. She’s the medical director for the Medical Weight Loss Program at Abbott Northwestern Hospital with Allina. Welcome to the show, Dr. Merz. Tell us a little about this obesity epidemic that we’re experiencing in this country and what are you seeing as a medical weight loss expert.

Dr. Roxana Merz (Guest): Well, thank you. I’m delighted to be speaking with you today. We really truly do have an obesity epidemic in the United States and actually throughout the world. More than one third of the US adults are obese, and that’s about 78.6 million people in this country. And two-thirds of our population is overweight. I have a medical weight loss clinic here at Abbott Northwestern Hospital, and I see patients struggling with this disease and disorder on a daily basis and also see the difficult medical problems that result from overweight and obesity on a daily basis.

Melanie: There are so many comorbidities, as they were, to being obese. Just give us a quick rundown on some of them so that we can then talk about really the ways to combat that.

Dr. Merz: Okay, sure. The most typical comorbid or associated health conditions that I see with the weight struggles are type II diabetes, hypertension, high cholesterol, sleep apnea, and even heart disease. There are many, many more, but those are the most common ones.

Melanie: How do you calculate whether you’re a healthy weight? How does somebody know? Is it waistline? Do you use BMI? What do you use?

Dr. Merz: Well, typically you really want to know your BMI, and that is a calculation that stands for the weight in kilograms divided by a person’s height in meters square. You can come by this number in several different ways. You could certainly ask your primary care provider what your number is for this, because all primary care providers now do record this number in your health history. There are also a number of online BMI calculators through the NIH. And Allina Health has its own calculator. Figure it out that way as well. BMI calculator can be found at allinahealth.org/medweightloss, and then look under referral resources.

Melanie: If you’re trying to lose weight, if you’ve determined that you are overweight or even obese, what do you think is the first step? Do you look to diet and what you’re eating, or do you look to exercise and getting active to start burning some of those calories?

Dr. Merz: Well, it’s really a combination of both. Both are so important, actually controlling portion sizes, developing healthy eating patterns, and keeping a general eye on the calories that you’re taking in is probably the most important first step. However, exercise is absolutely critical in order to keep weight off that has been lost. So it’s really a combination of both.

Melanie: When we’re talking about dieting and eating—and there are so many diets out there Dr.Merz—are you a fan of journaling? Are there any diets out there that you particularly want people to follow, or is it more portion control and what you’re eating?

Dr. Merz: Well, I really do believe in journaling, writing down what you’re eating for at least a period of couple of weeks in order to just become more self-aware of where the calories are that you’re eating. When you’re eating, what conditions you’re eating under, are there emotional reasons why were eating, that sort of a thing. I don’t adhere to any specific or promote any specific diet. It has been shown that just about any diet can work for an individual. But really, what we find is that overall, in order to stick to a diet and keep weight off, it’s really about portion control and healthy choices in the long term.

Melanie: People see so much in the media and late night television about belly fat and cortisol levels and diet pills. Do you believe in any of those? Do you prescribe any kind of diet medications?

Dr. Merz: Well, I guess I do. That’s part of what I do with my medical weight loss clinic. However, I would like to state I do not recommend any over-the-counter diet pills, and I do believe that weight loss medications can work and be successful but patients do need to be medically monitored when they’re on weight loss medication.

Melanie: Tell us a little bit about some of the weight loss medications that really do work, and why somebody would come and talk to you about them, because it is a little bit confusing.

Dr. Merz: First of all, there are many or at least several new weight loss medications in the last few years that have come out, and they really are approved for long-term use, which is something new in this area. And so, I have worked with most of those medications and find most of them to be very helpful for patients. But patients do need to continue to work on their diet and exercise as well in order to see significant weight loss.

Melanie: Well, how do these medications work? What are they intended to do? Do they help decrease the appetite or cravings? Do they help burn fat? What do they do?

Dr. Merz: That’s a great question. Medications typically fall into either the category of being an appetite depressant, or they can fall into the category of helping cravings, reducing cravings. And there’s even one newer medication that works on decreasing the cravings and that sense of reward that people get from eating. So it can be a combination of factors.

Melanie: As far as exercise, what do you recommend to your patients when they begin an exercise program? For how long?

Dr. Merz: Well, we recommend as the ideal goal that patients are exercising most days of the week, so that’s probably six days a week, and that they’re working up towards 30 to 60 minutes per day. Most of our patients who are starting at much, much lower levels are really not having routine activity in their days. It’s a gradual process, but the goal long-term is to hit that 30 to 60 minutes most days of the week.

Melanie: And what do you tell someone Dr. Merz when they feel so frustrated? Maintaining weight is much easier than weight loss. So what do you tell people that are frustrated or fall off the diet wagon as it were, and getting them back on? Please give us your best advice.

Dr. Merz: Well, we really want to encourage people to, first of all, get back on that wagon immediately. Don’t tell yourself I haven’t done well today, I’m going to start over tomorrow or next week. Get back on board right away so that a majority of your time is really doing the best job that you can. Every day will pose challenges. Life is stressful. There’s a lot of things that can get in our way. But just really getting back on track is as soon as possible is very, very helpful. Also realize that weight loss and weight maintenance are really a long-term journey and a long-term goal. Obesity is recognized as a disease now, and it’s a chronic disease, like many of our other health conditions that we see in medicine, and it really needs to be approached as such so that we are looking at the big picture, the long picture. And so, really take little steps, make small, sustainable goals, and this will help add to your long-term success.

Melanie: What other resources can you recommend for people on that weight loss journey?

Dr. Merz: Well, if you’re feeling that you have done everything you can do in your own power, you’re running out of ideas, certainly talk to your primary care provider about any additional resources that they have. Another thing that you can do is seek out the care of a bariatrician. And this is a physician who specializes in weight loss, and this is what I do in my clinic. I’m a certified bariatrician, and these physicians are trained in the use of weight loss medication as well as pre- and post-weight loss surgery care. And you can certainly come and see me in my clinic at Abbott Northwestern Hospital or our weight loss clinic as well.

Meanie: Thank you so much, Dr. Merz. You’re listening to the WELLcast with Allina Health. For more information on weight loss, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thank you so much for listening.
Hosts Melanie Cole, MS

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