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Additional Info
- Segment Number 1
- Audio File valley_pres/1506vp4a.mp3
- Doctors Espensen, Eric
- Featured Speaker Eric Espensen, MD
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Guest Bio
Dr. Espensen is board-certified by the American Board of Multiple Specialties in Podiatry in Foot & Ankle Surgery and Podiatric Medicine. Most recently, Dr. Espensen was the Chief of Podiatry at Providence St. Joseph Medical Center in Burbank. He also is a biomedical consultant for Century City Hospital.
Dr. Espensen earned his Doctor of Podiatric Medicine degree from The Ohio College of Podiatric Medicine in Cleveland. He completed his residency in foot and ankle surgery at the Southern Arizona VA Health Care System, in the Podiatry Division of the Department of Surgery, in Tucson, Ariz. He also completed specialty training in the diabetic foot under the tutelage of David G. Armstrong, a widely known podiatric surgeon, researcher and amputation prevention expert.
Dr. Espensen participates as an article reviewer and contributing editor at several leading medical journals, has been published in numerous research papers, and featured in the press for his specialty. He was voted “Best Podiatrist in Burbank” by the city of Burbank in 2012 and 2013. -
Transcription
Melanie Cole (Host): Have you been told that you’re at risk for limb amputation? You have options, and the Amputation Prevention Center at Valley Presbyterian Hospital is here to help you restore your health and the quality of life. At the Amputation Prevention Center at Valley Presbyterian Hospital, we believe limb preservation begins with early intervention and customized patient education. My guest today is Dr. Eric Espensen. He’s the co-director of the Amputation Prevention Center at Valley Presbyterian Hospital. It’s one of the few clinics in the U.S. that is dedicated to preventing complications that threaten amputation, primarily of the lower limbs. Welcome to the show, Dr. E. Tell us a little bit about diabetes and amputation, and why are they connected? Why are diabetic patients at risk for amputation?
Dr. Eric Espensen (Guest): Well, thank you for having me. Diabetes is an extremely common problem. More than 26 million diagnosed cases in the United States with almost 400 million diabetic people worldwide. This is a growing epidemic. Every year that count is going higher. The most problems that diabetic patients have are known complications including loss of vision, cardiovascular problems, heart problems, and many diabetic patients develop sores on their feet that do not heal. Many of these patients are unaware, so this is a common issue that we see, and we have a clinic that routinely handles patients to help heal these wounds and prevent them from coming back.
Melanie: What can a typical diabetic patient do to take better care of themselves so that possibly they don’t suffer from some of these side effects?
Dr. Espensen: Well, we have a list of three top things that every diabetic patient should do every day. Number one is work on that blood sugar. Follow your diet. Stay healthy. Eat well. Listen to Melanie and her diet tips to help keep that glycemic index down. Watch that blood sugar. Number two, every patient should have a good relationship with their primary doctor and the doctor who cares for their diabetes. Work closely with them to do the best that you can. Diabetes is a lot like a wildfire, and once it gets out of control, it does a lot of damage. But when contained, it can be contained very effectively and help limit these problems. Number three, I urge every diabetic patient every day, take 20 seconds and take a look at their feet, between their toes and on their legs, and just make sure that there’s no bruises or sores that they oftentimes won’t feel. But if they see them, then they’re aware, then they contact their doctor and get over to the right person as soon as possible.
Melanie: What are they looking for, Dr. E, when they are checking their feet? You said bruises and sores and look all around what, between the toes, under the feet, around the ankles, feeling for these things, looking around?
Dr. Espensen: Well, number one is looking. Use your eyes. And if you’re not flexible, get a small hand mirror to look at the bottom of your feet, the sides of the feet. The reason I stress this is one of the biggest complications of diabetes is nerve damage. Many of these patients develop loss of sensation of their feet and, sometimes, their hands. This is very similar to say when you or I have a foot fall asleep and you can’t feel it, well, these patients lose sensation to their hands and feet, and oftentimes they’ll walk around and step on something small, something sharp, and develop a small bruise, blister, sore, or cut that you or I would feel because we have good, strong nerves. But these patients don’t feel it and are oftentimes unaware, and these small nicks and cuts become infected, become large sores, and many times patients are completely unaware that they have a large sore on their foot or ankle.
Melanie: Is there any treatment for that neuropathy you’re discussing?
Dr. Espensen: Well, that’s a continuing field and there’s a lot of new research coming down about how to help slow the loss of sensation and how to help regain a little… now, there’s not a lot of success yet, but the number one key hand in hand, good diabetes care, watching those sugars, translates to a lot less loss of sensation, staying healthier longer. So I urge my patients that before the problem starts, cut it off. Take good care of yourself. Take your medications. Watch your blood sugar. And that really helps limit it. There are some newer treatments and studies right now that I can’t go into because it’s still in the clinical phase, but there’s a lot of promising research in this field to try to help restore the nerve sensation for a lot of these patients.
Melanie: What do you do to help heal those foot ulcers as they do crop up? Are there topical solutions? What are the treatments?
Dr. Espensen: Well, we have a whole spectrum of treatments, including stuff to put on the wound, ointments, creams, medicines. We have some of the newest cutting-edge gauze and topical treatments including foams and sponges and very interesting scientific materials that help boost the rate of healing. The other factor is try to help prevent the patient from walking on the sores, including special shoes, boots, ways to keep them off the sore. Number three, making sure there’s no infection, or if there is one, get that treated as soon as possible and keep the family doctor in the loop. We spend a good amount of time on a daily basis calling the family doctor, working as a team so we can all work together and take the best care of these patients.
Melanie: With all the technology available today, Dr. E, what role does technology play in your practice of diagnosing and treating patients with complications of diabetes?
Dr. Espensen: Technology is a wonderful thing. In my 20 years, I have seen some great advances on the tissues that we’re using. One of the newest fields is stem cell research based where we’re using these new tissues. Now, we don’t harvest stem cells. That’s a lot of science fiction still. But we’re using stem cell derivative tissues and grafts that we can use to put on the wound to help grow skin at miraculous rates. When I first started, we didn’t have a lot of high-tech stuff, but as technology has improved, we have wonderful new machines, devices, techniques, and materials available to greatly increase the speed of healing. These patients can heal, get back to life, and we also have some great technologies to keep them healed so they don’t come back.
Melanie: Tell us a little bit about the Amputation Prevention Center and the team there for diabetic patients.
Dr. Espensen: Well, we’ve focused on assembling a team of a bunch of different types of doctors to make this one-stop shopping. We have a bunch of doctors who work specifically on feet, ankles, and legs to address the sores, take care of these wounds, and help heal. We have an excellent staff of nurses and techs who are specifically trained to work hand in hand with the doctor. We have several other physicians, including general surgeons, plastic surgeons to help with wounds above the waist, kind of out of my scope, but we all get involved in these wounds. We also have what’s called a vascular surgeon, or as I say, a glorified plumber. These doctors help these diabetic patients keep good blood flow to the feet and legs to help heal these wounds. We also have diabetic educators. We work very closely with our diabetes doctors or endocrinologists. They are part of our team. We try to cover all the bases so when a patient comes in, we don’t then send them out to all these different appointments. We try to do it all under one roof to make it as convenient as possible for the patient and for the doctors.
Melanie: Well, it sounds like a wonderful multidisciplinary approach. In just the last minute or so, give your best advice for those suffering from diabetes to avoid some of these complications that we’ve been discussing and what they should do while they’re going to the prevention center, things that you want them to know.
Dr. Espensen: Well, number one is nutrition. Many of our diabetic patients will ask me, “What should I be eating? What should I be doing?” This is when I love to involve one of our diabetic educators and nutritionists to help, because great nutrition is a key to getting healthy and staying healthy. Number two, I can’t stress enough, keep those blood sugars in check. The diabetes doctors are wonderful to help these patients really keep them firing on all eight cylinders staying healthy. Number three is working as closely as you can with your doctor to get these healed, help keep them healed. We have a rotating basis of patients who are well-healed who will pop back in for a checkup or a tune-up every couple of months so we can keep good tabs, and I really like that good relationship we have with these patients because we like to see you, but we’re much happier to keep you healed and keep you out living your life and not have to spend all your time in the doctor’s office.
Melanie: Thank you so much for that wonderful information. You are listening to VPH Med with Valley Presbyterian Hospital. For more information, you can go to valleypres.org. That’s valleypres.org. This is Melanie Cole. Thanks so much for listening. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 5
- Audio File city_hope/1504ch2e.mp3
- Doctors Chen, Mike
- Featured Speaker Mike Chen, M.D., Ph.D.
- Guest Bio Mike Y. Chen, M.D., Ph.D., is a surgeon/scientist at City of Hope specializing in complex operations for the removal of brain and spine tumors. Dr. Chen has an active lab focused on developing next generation therapies for the treatment of cancers that have metastasized to the central nervous system.
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Transcription
Melanie Cole (Host): Being diagnosed with a spine tumor can be frightening, but as a patient at City of Hope, you have a highly experienced and dedicated team to treat your tumor. City of Hope is Southern California’s busiest spine tumor program, and our doctors have the experience to help you when even others cannot. My guest today is Dr. Mike Chen. He is a surgeon/scientist at City of Hope specializing in complex operation for the removal of brain and spinal tumors. Welcome to the show, Dr. Chen. Tell us a little bit about what is spine cancer and what are the types of spinal tumors.
Dr. Mike Chen (Guest): Well, good morning, Melanie. Thank you for having me on. There are two types of spine cancer. The most common spine cancer that we see is when you have cancer, say, of the breast, of the lungs, and the cancer then metastasizes or travels through the bloodstream to reach the spine. This is a very common occurrence, and spine cancer will occur in approximately 50 percent of patients who have metastatic cancer. So it’s quite a common problem. Not all the time does it require surgical treatment. Often, it can be watched, but it can lead too serious consequences if not properly addressed.
Melanie: Is it just its own cancer really very often at all, or is it mostly from a cancer that has spread from somewhere else?
Dr. Chen: Ninety-five percent of the time, spine cancer is spread from somewhere else.
Melanie: How do you find out where it has spread from?
Dr. Chen: Well, the most common presentation of spine cancer is pain. When you have pain, eventually this gets worked up. And in a patient who has cancer, we would attribute the etiology of the cancer to be the primary source.
Melanie: Then someone experiences what kind of symptoms? Now, you’ve mentioned pain, but what else might let somebody know that this is something just a little bit different and you better go see a doctor about it?
Dr. Chen: Well, a lot of it is really common sense. If you have back pain and you have no history of trauma and the back pain doesn’t go away, then that’s the time that you demand that your doctor work up this new back pain that doesn’t have an obvious cause. Other symptoms that can occur include neurological symptoms such as weakness, numbness, loss of control of bowel and bladder function.
Melanie: Is there a relationship between spinal tumors and brain cancer or brain tumors at all?
Dr. Chen: Well, certain cancers do have a propensity to metastasize to the nervous system or to surrounding structures of the nervous system. For example, with breast cancer, we know that breast cancer that many women will have spinal metastasis as well as brain metastasis.
Melanie: Okay. So if this is something that is diagnosed, then how really scary, I think, that it would be. What do you tell people to give them some hope? And then what treatment options are available, Dr. Chen?
Dr. Chen: First of all, I think we have to recognize that it is not that. Although it can lead to catastrophic consequences, the vast majority of time, the spinal tumor is something that doesn’t need even need treatment. It would get treated because the detection systems are so good now that we can find these early that the chemotherapy or hormonal therapy will often kill the spine tumors along with the rest of the tumors or cancer that’s in the body. Should it progress beyond that and become symptomatic but not threatening to the health of the spinal cord, then radiation is an excellent option as an additive treatment. In very rare cases, when the structure of the spine becomes compromised or if the spinal cord itself is under pressure from a tumor growing into the spinal canal, in those circumstances, then surgery is a good option.
Melanie: What’s the surgery like, Dr. Chen? Because people think, “Oh, my gosh! It’s on my spine. Am I gonna be paralyzed?” Is there going to be weakness and numbness? What is spinal tumor surgery like?
Dr. Chen: Spinal tumor surgery is extremely rewarding for the patient and the surgeon. The modern techniques that are being developed – that we have helped develop, in fact – they are much less invasive than the previous generation of techniques. Everybody cares only really about one thing: am I going to be paralyzed? The answer is 99 percent of the time, you’re going to be absolutely fine, which is about as good odds as you can ask for.
Melanie: It really is, and I’m surprised and happy to hear you say that. What is the aftereffect? If it is from a metastasis and it’s on your spine and you have decided that their quality of life is not great, so you remove this. Is it likely to come back? Is this something that when you remove a tumor like that, it’s pretty well gone?
Dr. Chen: It is unlikely to come back. We remove the vast majority of the tumor. There’s always microscopic disease left behind. That microscopic disease is attached to critical structures, so we can’t, say, remove the spinal cord along with it. Obviously, that would not be optimal. With the combination of radiation after surgery and chemotherapy or hormonal therapy, whatever other drugs that are given after surgery, the chances of that tumor coming back at that spot are very low.
Melanie: Now, what’s going on in the world of research for spinal tumors and tumors and cancers that have metastasized to the spine?
Dr. Chen: Well, there is clinical research and there is laboratory research. From a clinical standpoint, number one, we are trying to understand what is it that causes these tumors to have a propensity to metastasize to the spine, and can we stop that from occurring. Once it’s there, what do we do about it? From a surgeon’s perspective, the main thrust of the research has been to figure out whether the new modern techniques for spinal surgery are superior to the traditional techniques. The traditional techniques, they are very invasive. They often involve two incisions, one in the back to reach the roof of the spinal canal, and then the second either in the abdomen or through the chest to reach the front of the spine. With more modern techniques, we use a single-incision approach and have an oblique trajectory to the front of the spine. We are able to take out the tumor completely and to reconstruct the spine all through a single incision. These techniques have only been made possible by the advances in modern spinal instrumentation over the last couple of years. The data that we are collecting is still not there to demonstrate superiority. Another thing that we’re working on at City of Hope is a dual surgeon approach, where these cases are traditionally considered to be very challenging. But luckily, my partner, Dr. Jandial and myself, we’re both fully trained surgeons. We tackle these cases together and we’ve significantly been able to reduce op time and patient complications. As far as basic research goes, as I said, we’re looking to see what causes the spine tumors to grow in the spine in the first place. The bone marrow is a very fertile environment, and the spine contains the most amount of bone marrow in adults. There are many stem cells in the spine, and we theorize that there may be interactions between these stem cells and the spine and the metastatic tumor. They may in fact be symbiotic. There’s also a tremendous amount of interest in seeing whether these new molecularly targeted drugs can prevent spine tumors from occurring.
Melanie: In just the last 30 seconds or so, Dr. Chen, give the listeners some hope if they are newly diagnosed with a spine tumor and tell them why they should come to City of Hope for their care.
Dr. Chen: Well, we have the most experience. We operate on many inoperable tumors. We do it through a less invasive approach. The patient outcomes are excellent. You’ll have a highly experienced team taking care of you at a fantastic institution.
Melanie: Thank you so much. That’s really great information. You are listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening. - Hosts Melanie Cole MS
Additional Info
- Segment Number 5
- Audio File allina_health/1504ah3e.mp3
- Doctors Brower, Barb
- Featured Speaker Barb Brower, RD, LD, CTC – Integrative Health and Wellness
- Guest Bio Barb Brower, RD, LD, CTC, is a registered dietician and integrative health and wellness coach for the LiveWell® Fitness Center. She received her bachelor's degree from Mankato State University and her certification in therapeutic coaching from The Meta Institute. Brower has certificates in weight management for adults, adolescents and children. She has experience in hospitals, outpatient clinics, group facilitation, nutrition counseling, coaching, mentoring and is a popular speaker.
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Transcription
Melanie Cole (Host): Gluten is a really hot topic nowadays, and with more and more people choosing to live a gluten free lifestyle, is this the right solution for everyone? Gluten isn’t a one size fits all, and today we’re talking with Barb Brower. She’s a dietician and wellness coach with the Penny George Institute for Health and Healing. Welcome to the show, Barb. Tell us a little bit about gluten. People are aware of it, but for those that are not, give us a little quick snapshot of what it is.
Barb Brower (Guest): Well, Melanie, gluten is a general name for the protein that’s found in most commonly known as wheat, and wheat comes in many different forms. It can be durum wheat or farro or spelt or farina. And it also includes things like rye, barley, and [shuda kali]. Gluten helps food hold their shape. It’s the glue that keeps the bread in place. It’s the glue that holds foods together.
Melanie: So, when and where do you think all this hype about gluten and gluten-free eating came from?
Barb: Well, is an interesting question, and when I was thinking about it and did a little bit of research, celiac disease has been around as long as I’m aware, and people with celiac disease are actually allergic to gluten. But that doesn’t necessarily have to do with the rest of us. So, I came up with the idea that it goes back to the trend of reducing fat and cholesterol. And when we started reducing fat and cholesterol and started increasing carbohydrates, we started gaining weight as a nation. So in 1985, the CDC began tracking body weight, and I think researchers and others looked into possible causes for our significant change in body composition. And some people were astute enough to look at carbohydrates and gluten, and the rest it just kind of trickled down to become a really popular way of eating.
Melanie: So, have you noticed a lot of people coming to you to discuss gluten?
Barb: Yes, and as you probably know, it’s become a real buzzword. However, many people, I find, aren’t aware of what it is and how it affects them, and some people will go use the gluten-free products that have become readily available nowadays. But some of those aren’t any healthier than the ones that contain wheat or gluten because they’re processed. So, oftentimes we forget about the importance of nutrition in our health, and we just go after the current craze without educating ourselves and becoming knowledgeable about how it’s affecting us.
Melanie: So, what are the types of gluten-related disorders, and how common are they, really?
Barb: Well, the most common one is celiac disease, and that’s actually genetically determined. Some people may not have celiac disease when they’re young, but they may go on and develop it later in life. And a recent study out of Australia says that up to 50 percent of their population may carry the genetic markers for associated gluten sensitivity. That doesn’t mean they’ll all have celiac disease but that they’re sensitive to gluten. So that’s about half the population.
Melanie: So now you’re mentioning sensitivity. What’s the difference between gluten intolerance and sensitivity?
Barb: For me, there really is no difference. It’s just a terminology difference. The main difference is if somebody has a gluten allergy as compared to a gluten intolerance or sensitivity, a gluten allergy is a matter of life and death. An intolerance or sensitivity is not, even though it can dramatically improve our health if we leave the gluten alone.
Melanie: So, Barb, what type of symptoms would someone experience if they are possibly gluten intolerant?
Barb: Well, initially we hear about intestinal issues, and a lot of times people will have the gas, the bloating, cramping, diarrhea. Some people will refer to it as irritable bowel syndrome, but then there are symptoms that are more benign and more common, like acid reflux or fatigue or poor sleep, getting a rash, having brain fog and inflammation around your joints, joints swelling and pain, and for some people, even wheezing. And so some of the chronic disease stuff, or as I believe, really have positive results by following a gluten-free diet, and they reported lessened symptoms, even though initially a person wouldn’t put two and two together and think that their joint pain is a result of gluten intake.
Melanie: So when would a person determine that they need to talk to someone about this?
Barb: Well, for many people, unfortunately, it’s when they’re tired of not feeling well. Or they may talk to a friend who has a similar story and they may start to compare notes. Unfortunately, this can lead to a lot of false information. So, I frequently encounter individuals who have a lot of questions. They want to figure out what is accurate, what might work for them. So they come in and we discuss their nutrition habits, their history, and any symptoms they think they might be having. And sometimes it’s as much as just that brain fog, that they can’t think straight anymore. And so then, we put together a plan that works for them. We talk in general, like, “Maybe this is going to work. Have you ever thought about going gluten-free?” And a lot of times people will say, “Well, that was one of my questions.” And so, we might determine no, we’re not goingto do gluten-free right now. We’re just going to focus on improving your nutritional intake and see if some of those symptoms go away. Send them home for a couple of weeks, they’ll come back, and some of them say, “Yeah, eating better has made all the difference in the world.” And others says, “No, I’ve got the same symptoms, and I’ve thought about going gluten-free, and I think I’m ready.” So I think being ready is really important for people. And sometimes they just have to have time to think about how it’s going to work into their life. And generally, once they try eating gluten-free, after about seven to ten days, they’re feeling so much better that they’re amazed and they think, “Why didn’t I ever do this before? Why didn’t anyone ever suggest this before?” So, if you have any questions, I would say go talk to somebody, find out, try it.
Melanie: Now, if someone doesn’t have issues with gluten, are there pros and cons to going gluten-free? Because some people are equating cutting out gluten with losing weight, and it’s also hidden, Barb, in so many foods. So, discuss if you don’t have problems with gluten why you should go gluten-free or not, and what foods it might be hidden in that you might be surprised about.
Barb: Well, I don’t see any cons to going gluten-free, and just because a person doesn’t have any issues that they’re aware of, that doesn’t mean that they’re tolerating the gluten well. There are people with autoimmune disorders that we know they don’t have maybe even any digestive issues, but once they go gluten-free, they begin to feel better. So, as we mentioned earlier, all of those symptoms may be attributed to gluten intolerance, or it may not be. But then there is also a school of thought out there that most of us don’t need gluten, that we’re not meant to digest it, that our wheat sources and gluten sources have changed over the years and that our health as a nation would improve if more people would endorse a gluten-free lifestyle. But that’s really difficult in our society. So you alluded to hidden sources of gluten. It can be in the form of different additives. It can be hidden in sauces. There can be different words that, if used, mislead the individual. Now, the government has beefed up their standards for gluten-free labeling, and so frequently nowadays, the manufacturer will say this product contains gluten. A couple of years ago, that wasn’t available, and it’s not on all ingredient lists. It’s left up to the company whether they want to determine how much gluten is in their product. But in order to call it gluten-free, it has to meet some standards. So, a person really has to become a detective if they’re going to truly follow a gluten-free lifestyle.
Melanie: In just the last minute or so, Barb, give us your best advice to people with questions about gluten.
Barb: I’d say to talk to a nutrition expert, to do some research on your own so you’re at peace with it, and don’t believe everything you hear. Try it, but like you talked about earlier, read the labels, look for the hidden ingredients. It could be even in your cosmetics, your lip balm, your supplements. And like every trend, some stick around for a while and then fade away, but I think in this case, the evidence is becoming so intriguing that gluten-free is here to stay.
Melanie: Thank you so much. You’re listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 4
- Audio File city_hope/1504ch2d.mp3
- Doctors Kang, Robert
- Featured Speaker Robert Kang, MD
- Guest Bio Robert Kang, M.D. is a highly skilled surgical expert at City of Hope specializing in advanced facial reconstructive and microvascular procedures for patients with complex and challenging head and neck cancers.
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Transcription
Melanie Cole (Host): For patients with the diagnosis of cancer of the head or neck, the priorities are always the same: getting the very best treatment that affords the best outcome possible and finding hope in the process. My guest today is Dr. Robert Kang. He is a highly skilled surgical expert at City of Hope specializing in advanced facial reconstructive and microvascular procedures for patients with complex and challenging head and neck cancers. Welcome to the show, Dr. Kang. Tell us a little bit about what are the causes of head and neck cancers.
Dr. Robert Kang (Guest): When we talk about head and neck cancers, we’re talking primarily about not just their anatomic location in the head and neck, but we’re talking about where the cancers arise from in terms of cell lines. So when we’re talking about head and neck cancers today, we’re going to talk about when they arise from what are called squamous cells, which are cells that line the upper aerodigestive tract in the mouth, in the throat, the sinuses, things like that. Traditionally, the head and neck cancers are caused by lifelong habits of smoking, tobacco, and ingesting alcohol. That was the traditional risk factors independently and also synergistically. There have been some developments in terms of what causes head and neck cancer—namely HPV, sexually transmitted disease—which has risen over really the last 10 years.
Melanie: What are some symptoms that people might experience that would send them to see somebody to even worry about these?
Dr. Kang: Head and neck cancers, as you can imagine, can affect us pretty early on. If you have cancer in the tongue, you’ll notice a sore, an ulcer, pain in your tongue when you speak, when you swallow. The same occurs for other areas in the throat. If the cancer’s arising from the cells that line the vocal cords, then you’ll develop hoarseness fairly early on. And we’re talking pain that does not go away, pain that gets worse, hoarseness that does not go away, hoarseness that gets worse. When the ulcers become a little deeper, then you can have bleeding as well.
Melanie: Talk about that HPV link that you mentioned as we’re seeing cancers of the head and neck increasing or decreasing, which are they? And how is HPV linked to it?
Dr. Kang: The HPV-related cancers usually occur primarily in the oropharynx, and that’s the part of the throat that includes the base of the tongue and the tonsils, primarily. Those types of head and neck cancers that are related to HPV in that particular area, the frequency of that is increasing. And as we have less smokers, the traditional head and neck cancers linked to smoking is decreasing.
Melanie: Also, when people go to see a doctor, how is this diagnosed, and then what treatments are available? People get afraid if they have a head and neck cancer that they’re going to be deformed or they’re not going to be able to eat or talk. Speak about the treatments just a little bit.
Dr. Kang: Right. As you can imagine, any of these areas that we just talked about in the head and neck can… if you have treatment related to those areas, you can imagine there might be some deficit in your ability to speak or swallow. The key is to really diagnose this early. When the symptoms occur, having someone take a look at the specific areas and then take a biopsy if necessary, if there appears to be something abnormal, then that’s how the diagnosis is ultimately established. Obviously, there are other things that are involved. Just getting imaging studies, CAT scans, PET scans, MRIs that kind of show us what’s below the surface. In the office, we also use an endoscope, which slips through the nose while you’re awake and we just sort of numb the area and you can get a good bird’s eye view of the entire throat that you can’t see just through the mouth. That’s primarily how it’s diagnosed. In terms of the effect on the quality of life, then we’re talking about speaking and swallowing. The earlier that we can catch these things, the smaller the tumors, are and we’re moving smaller tumors, which means smaller defects and smaller deficits in these things.
Melanie: How are they treated?
Dr. Kang: The main treatment is surgery or radiation. Those are the two types of treatment that are used when cure is the intent. Sometimes, chemotherapy is added to radiation in order to increase its efficacy in more advanced cancers. As there is a small tumor in the tip of the tongue, for example, or the side of the tongue, which is a common area of head and neck cancer, it can be removed surgically. If there are no lymph nodes involved, if it was a small tumor, surgery is all you need. If there are multiple lymph nodes involved or the tumor was a little bit larger, then you can remove those things with surgery and then add radiation in order to prevent or decrease your chance of recurrence. Then again, if there is the tumor in an area that’s hard to remove surgically, such as in the back of the throat and it’s involving kind of a broad area, you can’t simply remove that all surgically without a major impact. In those scenarios, we can use radiation where nothing needs to be removed, but that entire area can be treated. Obviously, radiation doesn’t remove anatomy. A surgery does, but it also has its own side effects. Those are the main types of treatments that we have.
Melanie: Does the HPV vaccine that’s being given to younger girls and boys right now protect one from developing that HPV-related throat cancers?
Dr. Kang: That is unknown. The HPV relation to oropharyngeal cancer is fairly recent, but we do know that exposure to HPV doesn’t result in head and neck cancer in the time frame that we’ve known about it. It can linger for 10, 20 years before the person ever develops head and neck cancer as a result. Now that we know, certainly in the next 10, 20 years we’ll have more information about that.
Melanie: Tell us about the research that you’re doing at City of Hope, Dr. Kang, for people with head and neck cancers.
Dr. Kang: Well, there are a lot of different types of molecular and cell studies that are being done here. We looked at recently the effect of people who have undergone treatments for other type of cancers, like leukemia with bone marrow transplant, and whether that relates to people developing higher risk of developing HPV-related head and neck cancers later on down the line. That’s something we’re writing up right now.
Melanie: Okay, so give advice in the last couple of minutes here, your best advice for patients that are newly diagnosed with head and neck cancers and why they should come see you at City of Hope.
Dr. Kang: When you are diagnosed with the cancer, it’s imperative that, number one, you get multiple opinions, because different centers will treat cancers differently and it’s best to get as much information as possible. Number two, you definitely want to present to an academic institution where the latest in research, the latest in radiation treatments, the latest in surgical techniques are available. Because if these things are not available, then you will not even hear about that in the discussion. If you come to City of Hope, we have folks who are heavily involved in research. Everything that we do is related to our knowledge of the latest research and outcomes available. In terms of surgical procedures, specifically here at City of Hope, we perform weekly or biweekly robotic surgery techniques as well as the latest surgery techniques, which are also gaining traction now that these oropharyngeal tonsil-based tongue cancers are arising. Because these allow us to remove these areas of cancer that we previously were unable to remove and used to relegate to chemotherapy and radiation only, the advantages of coming to academic cancer centers such as the City of Hope is that you have all of these tools at our disposal, and we can make the best decisions accordingly.
Melanie: Thank you so much, Dr. Kang. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening. - Hosts Melanie Cole MS
Additional Info
- Segment Number 3
- Audio File city_hope/1504ch2c.mp3
- Doctors Han, Ernest
- Featured Speaker Ernest Han, MD
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Guest Bio
Ernest Han, M.D., is a surgical oncologist at City of Hope specializing in the treatment of gynecological cancers. He is a foremost authority on cervical and ovarian cancers.
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Transcription
Melanie Cole (Host): Cervical cancer is one of the more common cancers of the female reproductive system, and many cervical cancers are linked to an infection of the HPV, human papillomavirus. My guest today is Dr. Ernest Han. He is a surgical oncologist at City of Hope specializing in the treatment of gynecological cancers, and he is the foremost authority on cervical and ovarian cancers. Welcome to the show, Dr. Han. First, tell us. What is cervical cancer, and how common is it?
Dr. Ernest Han (Guest): Yeah, cervical cancer is basically worldwide probably one of the most common cancers that women will have. In the United States though, it’s not quite as prevalent. But still, it is a very significant cause of lots of distress for physicians and the patients themselves. I have to say that cervical cancer is, when you think about where it is, it’s actually located at the mouth or the opening of the uterus, which is something that gynecologists and physicians like myself can see. That’s where you can use Pap smears to screen patients. It’s been a very effective means to screen for cervical cancers and detect these early.
Melanie: If a Pap smear is what helps to detect them early, what is the cause of cervical cancer? Are there many causes, Dr. Han, or just a few?
Dr. Han: Well, the studies thus far seem to indicate that the human papillomavirus is probably the main cause of cervical cancer. I have to say that probably over 90, 95 percent of cervical cancers are caused by this. We haven’t really made any associations with genetic causes or any specific other types of viruses or other things that have been clearly linked. But the HPV virus really is coming out as the dominant player that’s involved for cervical cancer.
Melanie: If someone gets a test, if you’ve been having your Pap smears regularly and then your doctor checks for the HPV virus and you test negative, do you still get a Pap smear every year? Do you wait and do it every three years or so?
Dr. Han: Yeah, the guidelines for Pap smear screening have really changed in probably the last five or ten years. Our guidelines have been constantly being adjusted over this period of time. And recently, about 2012 or so, there has been another major shift in Pap smear screening. We used to do Pap smears once every year for patients, and there was not even an HPV test that we could even do. Over the last many years now, actually, at least five, ten years, we’ve been really adding on these extra tests with HPV testing in addition to the Pap smear. In fact, there’s been some thought about even getting away with not doing the Pap smear but just doing an HPV virus test. That’s still somewhat controversial. Right now, really, if a woman comes in and has a negative HPV and a Pap smear test and they presumably would be between the ages of 30 to 65, they’re going to be able to get another Pap smear with another HPV test in five years. Some physicians still elect to just do a Pap smear without doing HPV testing, and then for that case, you’re going to be doing that every three years.
Melanie: How long does it take cervical cancer to develop? Is this a quick moving cancer if someone does have it?
Dr. Han: Generally, I would say that no. And that’s what’s really great about Pap smears is because you can detect these pre-cancerous changes early. Typically, cervical cancers are going to be things that evolve within five to ten years, and maybe even longer. These are not something that I would say that develops overnight. Again, that’s why Pap smears are very effective. Unfortunately, as an oncologist, we will see patients who never had gone to their gynecologist or had a Pap smear examination. Unfortunately, these women, if they haven’t had exams over five, ten years, you see unfortunately these kinds of cancers in these patients, and they’re unfortunately very advanced. This is not something if a woman’s been getting a Pap smear on a routine basis, as per our guidelines, the chances that you’re going to miss a cervix cancer is going to be very, very uncommon.
Melanie: Now, what about the symptoms? If someone does have some unusual symptoms, what would send them to see a doctor?
Dr. Han: Well, with cervical cancers, it is a mouth or opening to the uterus, and this is essentially in communication with the vaginal area. Very commonly, patients can develop bleeding or they can have discharge, sometimes even pain. Sometimes, these things occur during having intercourse. They sometimes notice some bleeding or spotting during intercourse. There are generally symptoms that patients may see. Unfortunately, if it’s become very advanced, we will typically see sometimes changes to even the bowel, the bladder. Bleeding and discharge are very common symptoms.
Melanie: How is it treated if you are diagnosed with cervical cancer?
Dr. Han: Well, nowadays again, the treatment paradigm has really been changed in the recent years. We went away from going to very aggressive surgical techniques to now maybe doing less aggressive surgical techniques. We’ve gone from doing surgeries from an open type of procedures now going to minimally invasive. We’ve even talked about fertility sparing options for women as well. I can say so depending on how early the cancer has been diagnosed, we really kind of tailor the treatments. Generally speaking, for more locally advanced cancers, typically those patients will actually undergo a combination of radiation with chemotherapy. That’s been shown to be a pretty effective treatment for cervical cancer in more advanced stages. However, in early stages, patients can often be candidates for surgery where you can remove the tumor. And if the patient happens to be a young woman who still desires to have children potentially, you can actually do fertility sparing options where you’re just taking out the cancer with a margin around it and still be able to preserve the uterus, which is what holds the pregnancy in place, and doing some special techniques to try to maintain that in place. Several centers across the country and even the world are doing these types of fertility sparing treatments and having some reasonable pregnancy outcomes from that.
Melanie: Is there anything you can do to prevent cervical cancer?
Dr. Han: Yeah, so because of the HPV virus being very highly associated with this, a lot of patients have come in and asked how do you prevent getting HPV. Well, right now, again in the field of cervical cancer, vaccinations have become a really important part, I think, for trying to prevent patients from getting cervical cancers. Now, have we been able to show that clearly in studies? Probably not for some time will we maybe see a shift in our cervical cancer incidence rates. But there are a lot of studies to show that definitely you can reduce your exposure to HPV with these vaccinations, which are done in young women before exposure to the HPV virus itself. I think we don’t know if we have to do any additional boosters or other things right now, but at least a sort of a one-time set of injections, I think, is at least recommended at this point. That’s probably one of the main things that have come out as a very important piece to preventing cervical cancers. I guess we will yet to see, I think in the future, how cervical cancer rates, if there are any significant changes that occur with this.
Melanie: In just the last minute or so, Dr. Han, tell us what research for cervical cancer on the horizon is being done at City of Hope, and give some hope to people that are worried about cervical cancer.
Dr. Han: We’ve been very much interested in both surgical and therapeutic options. One of the major things that we’ve been looking at is immunotherapy. Immunotherapy has become very, I think, an interesting area of research that has not been really explored very much, but newer drugs are now coming online for things like melanoma and other types of cancers. I think this is another unique opportunity where immunotherapy is maybe important. In addition, surgical options have been pretty much standard for a while. Again, we are trying to go to less aggressive surgeries and maybe doing procedures that can try to reduce some of the potential side effects for patients. For example, we often take lymph nodes out in patients to assess for the cancer spread, and there has been some shift now thinking that maybe we can do this more precisely with robotic surgery and special dyes that can actually detect what we call the sentinel lymph node in the patients in the lymph node areas, just like for breast cancer, where patients have a sentinel lymph node biopsy to prevent what they call lymphedema to the extremities. Similar things are being looked at also now for even pelvic cancers like cervical and uterine cancers. This may be a way to try to reduce potential side effects such as lymphedema, other kind of quality-of-life issues. But yes, still getting pertinent information for patients for their treatment.
Melanie: Thank you so much, Dr. Ernest Han. You are listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening and have a great day. - Hosts Melanie Cole MS
Additional Info
- Segment Number 4
- Audio File allina_health/1504ah3d.mp3
- Doctors Leow, Choy
- Featured Speaker Choy Leow, AIA
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Guest Bio
Choy Leow is the director for design & construction at Allina Health. He and his team plan, develop & build healing environments for Allina Health patients, visitors, guests and staff.
Choy is a member of the MN chapter of the American Institute of Architects. He integrates his feng shui awareness into design consideration & planning where appropriate. -
Transcription
Melanie Cole (Host): Images of a white sand beach or secluded forest stream, the sound of waves and water can really help some people feel more relaxed and calm. There are also things that you can do to help make your home a calm, comfortable, healing environment. My guest today is Choy Leow. He is a director for design and construction at Allina Health. He and his team plan, develop, and build healing environments for Allina Health patients, visitors, guests, and staff. Welcome to the show, Choy. Tell us a little bit about feng shui. What is it, how long has it been around?
Choy Leow (Guest): Very good. It is my pleasure to be on your show, Melanie, and I thank you for having me, first and foremost, on behalf of Allina Health. Feng shui, for all intent and purposes, is a kind of a way of life that the Chinese have been practicing for many, many thousands of years now. It’s essentially a mindfulness to kind of acknowledge the environment of which we play, work, and live in, and to make sure that whatever we do, we do what we can to make sure that our awareness of the environment that we are in, acknowledge and put to the best use the way we can to provide the kind of a conduciveness that we need to function in. It is not a religion per se. It’s essentially a way of life. So, the way the Chinese go about managing it, so to speak, is to first and foremost frame it up in terms of giving nature its place, rightfully so, in our life. Nature is addressed in two components in terms of “feng,” which is wind, and “shui,” which is water. And these two forces in nature are as powerful tool as they can be. And the way the Chinese look at it is so long as we find ways to reconcile with what impacts the power of wind and water have on our life, then the rest essentially is relatively easy to work with as long as our respect, acknowledgment, and mindfulness with working with these two powerful forces in nature are at peace with each other.
Melanie: Choy, how can feng shui be used to create that calm, restful environment? Tell us a little bit about architecture and design elements that you’ve used to create a healing healthcare environment.
Choy: To incorporate feng shui into this architectural practice or create a living environment that is conducive for us to function in is essentially a sense of good site planning. In architecture, first and foremost, placing the building on the site is one of the first key elements to ensure a successful performance of whatever the building is. For example, in our hospital in Wyoming, to make sure that we optimize on locating the building, the way that we receive our patients and families is first and foremost done correctly. Then, in essence, the first task of making sure that the building relates to the placement on whatever the property that we are working with is taken care of. So the rest would be paying attention to details that we can continue to work with.
Melanie: So, does that include, as you walk through the building, that flow of natural light? Choy, does it -- the feeling that you get as you walk through a very sterile building, where there is no natural light or no nature feeling coming in, as you walk through, what is that feeling you want people to get as they walk around the halls?
Choy: One key successful effort that we constantly work with is to make sure that we contextualize the environment that we create in our healthcare environment. And the nature of healthcare environment is such that it is always immense, big, and large in scale, so to speak. So, incorporating elements of nature, of which natural light is one component of it, is certainly a helpful key to make sure that we anchor our healthcare environment with elements that our patients and families are familiar with, lighting being certainly being one component. But the fact of the matter is, in our immense and large environment and multi-storey structure, gaining natural light is not always feasible beyond the exterior wall condition. So, a lot of our interior space to incorporate natural light sometimes is not viable, and in place of lighting then would be artwork and materials and colors that can emulate the attributes from nature in terms of colors of greens and earth tone, and textures in terms of things that we see in leaf forms, for instance, or part of a pattern of such that are being carved into our design considerations.
Melanie: What are some things people can do, some great tips you could give right now to make their homes more restful and calm?
Choy: One doable effort that we can constantly practiced is to simplify.In architecture, we have a saying that says less is more, meaning that we have to be very mindful about the effect of accumulating too much. And as such, a mindful effort to make sure that we declutter the area once in a while to make sure that we walk the talk about less is more is helpful, because the saying that I like to use often is that too much of a good thing is not a good thing. So, that kind of draws back to the essence of balance in the feng shui practice in achieving a sense of essential needs versus the wants that we tend to accumulate. So, decluttering and simplifying in terms of working with the bare essentials of what is most important to our lives is essentially a good way to go about achieving a good feng shui practice.
Melanie: What about in our office spaces? Those bright lights, how can we use some quick fixes to be more productive but also have that sense of calm while we’re working with the fluorescent lights? Our work furniture, how about that, and the plants and artwork? How can people make their office space that more calm environment?
Choy: Well, one way to do it is to make sure that within the consistency of the environment that we bring in in terms of making sure that corporate-wise that we have a set of standards that they work with. In our individual space, a good way to customize our space is to bring in items that we can relate to that we can have a good sense of contextualizing the space that make it meaningful for us in terms of florals, plants, and pictures that simulate an environment that we desire to be in would be one way to kind of help our work environment be a little bit more conducive. And from an office standpoint, there are lighting options now that we deliberate in in terms of making sure that the lights are soft, the lights are warm to provide a consistency so that all our staff are is not being subjected to a harshness of a light glare throughout the day.
Melanie: And then just in the last minute, please give your best advice on feng shui and how we can incorporate it into our lives for a more healing sense of calm.
Choy: Sure. The one suggestion that I would like folks to be aware of is that feng shui practice essentially centers around adjusting our physical environment to appease our mental state of mind. By that I mean to go back to the resonance of feng shui as our two primal forces, that we work with them and know that we can significantly influence our life choices and wellbeing by making sure that we simplify as often as we can, we declutter as often as we can, and make sure that the environment that we work, play, and live in is in alignment with what our desire is to make sure that we create a space or an environment that works for us and not be too overly burdened by things that we can’t control, and do little things that make a big difference in terms of our state of mind. So that essentially, I think, would be a good way to work with it, meaning adjusting the physical environment to work with our mental state of wellbeing that we so desire.
Melanie: Thank you so much. You’re listening to the WELLcast with Allina Health. For more information you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.
- Internal Notes Feng Shui: Creating a Mindful Environment For Healing & Living
- Hosts Melanie Cole, MS
Are you feeling your age? Perhaps it's time to let out your inner child.
Additional Info
- Segment Number 1
- Audio File train_your_body/1424tb2a.mp3
- Featured Speaker John P. Higgins MD, MBA
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Guest Bio
John P. Higgins MD, MBA (Hons), MPHIL, FACC, FACP, FAHA, FACSM, FASNC, FSGC is a sports cardiologist for The University of Texas Health Science Center at Houston, Memorial Hermann-Texas Medical Center and the Harris Health System.
His research interests include the effects of energy beverages on the body, and screening for underlying cardiovascular abnormalities in 12-year-olds (6th graders), and steroid effects on the cardiovascular system. - Hosts Melanie Cole, MS
Being physically active may contribute to your overall health and minimize or delay the effects of aging.
Additional Info
- Segment Number 1
- Audio File train_your_body/1442tb2a.mp3
- Featured Speaker John P. Higgins, MD
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Guest Bio
John P. Higgins MD, MBA (Hons), MPHIL, FACC, FACP, FAHA, FACSM, FASNC, FSGC, is a sports cardiologist for the University of Texas Health Science Center at Houston, Memorial Hermann-Texas Medical Center and the Harris Health System.
His research interests include the effects of energy beverages on the body, and screening for underlying cardiovascular abnormalities in 12-year-olds (sixth graders), and steroid effects on the cardiovascular system. - Hosts Melanie Cole, MS
Working out for as little as 20 minutes can enhance memory by about 10 percent in healthy young adults.
Additional Info
- Segment Number 2
- Audio File train_your_body/1442tb2b.mp3
- Featured Speaker John P. Higgins, MD
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Guest Bio
John P. Higgins MD, MBA (Hons), MPHIL, FACC, FACP, FAHA, FACSM, FASNC, FSGC, is a sports cardiologist for the University of Texas Health Science Center at Houston, Memorial Hermann-Texas Medical Center and the Harris Health System.
His research interests include the effects of energy beverages on the body, and screening for underlying cardiovascular abnormalities in 12-year-olds (sixth graders), and steroid effects on the cardiovascular system. - Hosts Melanie Cole, MS
Boosting your metabolism and keeping your workout new and balanced helps keep your look tight.
Additional Info
- Segment Number 1
- Audio File train_your_body/1451tb2a.mp3
- Featured Speaker Allison (Ally) Bowersock, PhD
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Guest Bio
Ally Bowersock is an assistant professor and the director of the Health and Exercise Science program at Jefferson College of Health Sciences in Roanoke, VA.
Ally received her Bachelor of Science degree in both Allied Health and Nutrition from Bridgewater College, her Master's degree in Kinesiology from James Madison University, and her doctorate in Education with a cognate in Health Promotion from Virginia Tech.
Ally is an active member of both the ACSM and the NSCA. In her free time, Ally enjoys training for and competing in running and triathlon events ranging from 5k's to Iron-distance triathlons. - Hosts Melanie Cole, MS
