Inactive (722)

Segment Number 1
Audio File staying_well/1437sw1a.mp3
Featured Speaker Armand Leone, JR, MD
Guest Bio Armand Leone is a physician attorney who manages the medical malpractice and pharmaceutical/medical device product liability matters at Britcher, Leone & Roth, LLC.

Admitted to the United States Court of Federal Claims in addition to the New Jersey and New York state bars, Armand also works on the vaccine injury compensation petitions the firm files for children and adults who are injured by vaccines.

Armand is admitted to practice medicine and law in New Jersey. He is a Fellow of the College of Legal Medicine and a Fellow of the New York Academy of Medicine.

In addition to his personal injury work, Armand has participated as counsel in hearings before the United States Olympic Committee and the American Arbitration Association on labor and sports law matters.
Hosts Melanie Cole, MS

8 Biggest Retirement Mistakes & How to Prevent Them

What do you need to do to make sure you are able to retire?

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Segment Number 2
Audio File staying_well/1439sw1b.mp3
Featured Speaker Dan Kadlec, Journalist and Finance Author
Guest Bio Daniel J. Kadlec is an author and journalist whose work appears in TIME and MONEY magazines and on their websites, among other outlets.

He has written three books, including his most recent, A New Purpose: Redefining Money, Family, Work, Retirement, and Success, co-authored with Ken Dychtwald and published by Harper Collins. He blogs for Time.com and previously blogged for CBS as the Bank of Dad.

Kadlec has appeared on Oprah, CNN, CNBC, Good Morning America, The Nightly Business Report and Wall Street Week. He is a contributor to World Book. He won a New York Press Club award and a National Headliner Award for his columns on the economy and investing. His writing is prominent in submissions that earned TIME the magazine award for General Excellence.
Hosts Melanie Cole, MS

Debunking the Myths and Facts of Women’s Health

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Segment Number 3
Audio File allina_health/1504ah3c.mp3
Doctors Gurchak, Katherine
Featured Speaker Katherine Gurchak, MD – OB/GYN
Guest Bio Dr. Katherine Gurchak specializes in obstetrics and gynecology and practices at Allina Health Champlin Clinic and Allina Health Mercy Women’s Health Clinic. Her professional interests include specialized pregnancy care and women’s care for all ages.
Transcription Melanie Cole (Host): Women are inundated with media messages. The opinions of friends and family and the myths that are historically taboo when it comes to women’s body and our health are out there so prevalent. We’re getting so many mixed messages and diluted information, and this can prevent women from making really informed decisions about their health. My guest today is Dr. Katherine Gurchak. She specializes in obstetrics and gynecology and she practices at the Allina Health Champlin Clinic and Allina Health Mercy Women’s Health Clinic. Welcome to the show, Dr. Gurchak. How can women’s health issues get mistaken for fact and myth? How can we sort of sort these out in our own minds?

Dr. Katherine Gurchak (Guest): Well, good morning, Melanie. You’re right. Women often take and mistake myth for fact. In fact, they think it has to do with the fact that women by nature have really strong friendships and relationships with other women in their lives and in their families. It makes it so very safe to trust these women’s opinions, and it sometimes makes it easy to mistake the myths that they got from these women for fact because of that trust. Women are also very savvy in accessing information. There’s a large amount of information out on the Internet, and when women do access this information, it can sometimes be very diluted. Sometimes what’s fact gets diluted with what may be myth.

Melanie: Well, us women, Dr. Gurchak, we care for everyone else in our lives. Is it true that women, we have to care for all these other people and we may put ourselves second, third, or even fourth when it comes to healthcare needs?

Dr. Gurchak: It’s commonly true. I see this with the women in my practice all of the time. We are, as you say, by nature, caregivers. And in our busy lives, with our busy schedules, it gets very difficult to put ourselves first.

Melanie: So it’s so important that we, as they say, put on our own masks before we put on the masks of our loved ones, because if we can’t take care of ourselves, we’re not going to be able to care for those others. Let’s dispel some of these myths from facts so that women have really good information and can make informed decisions. Is it safe to dye your hair during pregnancy?

Dr. Gurchak: This is a common question I get asked at my first OB visit, especially in women pregnant for the first time. In fact, it is a myth. There is limited evidence about this during pregnancy. However, what does seem to be true that limited exposure to hair dye or hair products during pregnancy is essentially very safe. There is a limited systemic absorption from that dye to the scalp and this is strongly unlikely to cause any harm or adverse fetal effect. In fact, women shouldn’t necessarily do it daily, but of course, if they are getting their hair dyed or their highlights touched up during pregnancy once or twice, that should be very safe.

Melanie: What about caffeine? Is that cup of coffee in the morning during pregnancy okay to have?

Dr. Gurchak: Absolutely. In fact, it’s certainly okay to have a cup or even two of coffee. However, frequently drinking it all day or taking supplements with caffeine in it would be dangerous. We do know that there is some evidence to show that high levels of caffeine could be dangerous during pregnancy, leading to maybe miscarriage in the first trimester. However, the type of caffeine and the amount of caffeine that gets consumed in a daily cup of coffee, or even two, is about less than 200 to 300 mg a day, which is safe. You don’t necessarily need to avoid your Starbucks, but you certainly don’t necessarily need to add that extra one or two shots of espresso.

Melanie: What about after their period? Are women most fertile for that 14 days after their period? When is the safest time to have sex if you do not want to get pregnant or the best time to have sex if you do want to get pregnant?

Dr. Gurchak: It’s a really good question, and in fact I think women often are a little bit confused. We think of a period cycle being 28 days, and in fact, for every women, that length of cycle is a little bit different. The most fertile time for a woman is precisely two weeks before she gets her period. For a woman who has a longer menstrual cycle, say 35 days, she may be more fertile on day 21 of her cycle, giving that 14 days now until the end of her cycle. A woman with a shorter cycle would be more fertile earlier in her cycle. I often tell women that if they’re trying to predict when or when not to have sex in order to become or avoid pregnancy that they should take several months of information charting their period. The first day of your cycle is the first day of bleeding and the last day of your cycle is the day before the first day you bleed in your next cycle.

Melanie: That’s great information. Women, I hope you heard what she just said because that is great information. Now, what about eating shellfish and seafood during pregnancy? Is that a no go or is that fine?

Dr. Gurchak: No, women absolutely should be consuming healthy fish products during pregnancy. It’s a great source of protein, iron, zinc, and other crucial nutrients for your baby’s growth and development. In fact, the omega-3 fatty acids that are very prevalent in fish are excellent for baby’s brain development. Some type of seafood should be avoided in large quantities during pregnancy, but most fishes are good during pregnancy. Those that should be avoided are large fish such as predatory fish, swordfish, king mackerel, and tilefish are commonly fishes that women should avoid during pregnancy.

Melanie: Now, what about birth control? Does that cause weight gain necessarily?

Dr. Gurchak: Melanie, this is an excellent question, and women are very fearful of weight gain. Most birth control—in fact, all birth control—is safe to take without risking weight gain. Every woman is going to respond a little differently to the birth control she takes. The one that women are most fearful of is actually Depo-Provera. When you look at the evidence about Depo-Provera, there is a little bit of evidence to say that women who take this medication will have a very small amount of weight gain over the course of the year. Now, that’s several pounds, not 30 pounds. In fact, this is only in a very rare woman. We hope women will keep their minds open about Depo-Provera since it is such a reliable and effective form of birth control and the likelihood of weight gain is small.

Melanie: What about intrauterine contraception devices? Can they cause infertility?

Dr. Gurchak: No. In fact, there is no evidence to say that they promote infertility in the future, and they’re an excellent and extremely reliable form of birth control. The only thing I would encourage women to do is continue to practice safe sex when they have an IUD in place because, of course, it’s effective in preventing pregnancy but not in preventing sexually transmitted infections. And when we look at what does cause infertility, potentially sexually transmitted infections can cause that when they are advanced and scar the tubes.

Melanie: If you’re trying to get pregnant, is having sex multiple times a day the best way?

Dr. Gurchak: Well, that’s a great question. In fact, it is good to have regular sex around the time that you are trying to conceive. However, multiple times a day can limit the amount of sperm. It can actually cause sperm count in the man to drop a little bit. In fact, every other day is the most frequently recommended way of getting pregnant.

Melanie: In just the last minute, Dr. Gurchak, speak to women with your best advice about these myths that we’re seeing out there and taking care of our own health, being our own best advocate, getting rid of that negative self-talk, and being the best healthcare advocate for ourselves that we can be.

Dr. Gurchak: Well, I think that women should allow themselves permission to put themselves first then take excellent care of their bodies first, knowing and trusting in themselves then that will help them take better care of those around them and that women should be cautious in what they take for fact and use their extreme smarts and knowledge to find useful information and just refer to their doctor for the most factual information that they can when they have questions about myths and facts.

Melanie: Thank you so much. You are 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 Debunking the myths and facts of women’s health
Hosts Melanie Cole, MS

Shedding Light on Seasonal Depression; Effective Ways to Treat Seasonal Affective Disorder (SAD)

Additional Info

Segment Number 2
Audio File allina_health/1504ah3b.mp3
Doctors Steed, Alan
Featured Speaker Alan Steed, PhD - Psychology
Guest Bio Dr. Alan Steed is clinical director of Allina Health Mental Health and psychologist at Allina Health Eagan Clinic. Dr. Steed has professional interests in behavioral medicine, anxiety and mood disorders, hypnosis, group therapy, stress management, chronic illness and behavioral therapy applications.
Transcription Melanie Cole (Host): Outside it’s cold and gray and gloomy. Could the way you’re feeling have something to do with the weather? Oftentimes referred to as the winter blues, living with seasonal affective disorder or SAD can put a damper on your mood, but there are several things that you can do to keep your mood steady throughout the year. My guest today is Dr. Alan Steed. He is the clinical director of Allina Health Mental Health and psychologist at Allina Health Eagan Clinic. Welcome to the show, Dr. Steed. What is seasonal affective disorder or SAD?

Dr. Alan Steed (Guest): SAD is a type of depression. Actually, SAD is a qualifier. SAD is a major depression that may be very much related to seasons, and people that experience symptoms of depression during the fall and winter months are said to be affected with SAD.

Melanie: How is it actually caused?

Dr. Steed: I wish we had a really good answer for that, but there are probably many contributing factors. SAD is considered to be light-related, so as the days grow shorter in the fall and certainly in the winter months. We’re exposed to less sunlight, less vitamin D. That’s another possibility that if affects our vitamin D levels, which affects energy. There’s a thought that it is also related to serotonin levels in the brain. Serotonin is a neurotransmitter that creates a sense of well-being for us. And if this is impacted, then obviously we’re going to experience symptoms of depression or just lethargy.

Melanie: How common is this? Do a lot of people experience this, or are some immune from it?

Dr. Steed: There are some that are immune. I wish we had more specific numbers, to be very honest. But it’s estimated that anywhere from 10 to 20 percent of the population experiences some degree of it. However, I think a much smaller percentage of people, maybe 1 percent—and I think that’s an estimate—are very much debilitated by it. Certainly, I’ve dealt with some of those people in my clinical practice who just have difficulty getting up and going to work, lose their jobs, become extremely depressed, and struggle with it for the period of time that the days are shorter.

Melanie: Now, are there certain risk factors that increase chances of developing SAD? If your family has clinical depression in your genetic history, are any of those things contributors?

Dr. Steed: Yes, it’s a contributing factor. Those people with SAD are more likely to have a biological relative that has major depression in their background. If you have a close blood relative that also experiences SAD, it’s more likely, although not determined, that you may also experience SAD.

Melanie: Then what are the symptoms people might experience that would let them know this is what’s going on and maybe I need to take control of it and do something about it?

Dr. Steed: The symptoms are very similar to those of just general depression. If you have a period of a couple of weeks at least where you’re just feeling tired and little energy and feeling hopeless, irritable, you may notice a change in your weight and appetite. You may notice a change in your sleep pattern. You’re having difficulty falling asleep or staying asleep, or possibly sleeping too much. Anything that impacts sleep is related to depression. Some people tend to become more irritable. Now, these are more symptoms that are characteristic of the winter SAD. There is a version of summer SAD, which occurs during summer months for some people and at a smaller percentage. But in that instance, you may have some of the symptoms of depression but probably more symptoms related to agitation and anxiety.

Melanie: Dr. Steed, let’s talk about treatments. First line of defense. If you suspect that this is what you’re suffering from, you’re feeling that hopelessness and you’re feeling sad and tired, maybe gaining weight, lethargy, any of these things, do you start off by trying to do something for yourself, such as exercise, or do you see a doctor pretty quickly?

Dr. Steed: Well, I think doing the exercise and doing the things we would normally do to maintain our physical and emotional well-being during these months is important. But I would also say if you have a pattern of these kinds of symptoms over the last year or two that a visit to your physician would be a very important thing to do. When symptoms are mild to moderate, a very common form of therapy is called phototherapy. And in this instance, you would sit in front of a light box, hopefully first thing in the morning. The light box needs to be a minimum strength of 10,000 lux. That’s the measure of the strength of the light. Most people would need to sit in front of that at a close distance for about 30 minutes. Again, as I said, I think doing so first thing in the morning is the best recommendation. After that, you may want to consult with a physician. Anti-depressants are commonly recommended and can be very helpful, but there are other things that you might do which would not require medication, and that would just be surround yourself and get out in as much light as you can. Go for a walk every day. Work in an environment, if it’s at all possible, where you have windows and light, and open the blinds. I think there is a tendency for many people when they’re feeling down is to just shut the world out a bit and close the blinds, then create a dark, safe space. But to deal with SAD, just the opposite behaviors would be very important. Be very much aware of the tendency to overeat and certainly, one of the telling symptoms is craving carbohydrates, and certainly that leads to some weight gain, especially as people diminish their activity. I would also encourage you to continue to develop social support and get out and be with people. Get to the gym. In some of the gyms, actually, they have mind-body therapies. They have yoga. They can do some massage. Anything that helps you get out and stay active can be very helpful. I remember one person that I dealt with many years ago. Her cure for her winter SAD up in Minnesota was to go to Phoenix every winter for a week or two. That brought her mood back up very quickly, but then she came back and had to maintain all the self-care activities that she’d been involved with in the first place. It’s not the ultimate cure unless she can move there.

Melanie: Some light’s a really big deal. Now, what about vitamin D and taking supplements that help sort of replenish your body of those missing vitamins?

Dr. Steed: Well, that’s another physician’s call. As a psychologist, I don’t and shouldn’t be recommending that. However, I know that there are many people whose vitamin D levels dip significantly, and the prescription written by doctors is not for just the over-the-counter dosage of vitamin D, but it’s massive doses. I would recommend that before they consider anything involving vitamin D that they check with their physician.

Melanie: In just the last couple of minutes, Dr. Steed, if you would, please tell us if we can prevent the onset of SAD before it actually happens, and if you have a friend or a loved one who suffers from this, what’s your best advice for ways to help someone else that might be having this?

Dr. Steed: I think prevention is about doing as much as you can. It’s style-based. It’s keeping yourself active all through the summer and not letting it drop off as the days get shorter in the fall, finding ways to maintain social and emotional connections. Just engaging in those pastimes that you normally would despite the perhaps beginning notice and awareness of lack of energy. Just keep doing what has been working previously. Some people just need continuous treatment, and there are some people that I know who have even used the light box well into the spring and beginning just in the late summer. If you have a friend or loved one, just try to be supportive. Encouraging words about winter is just a couple of months from being over and just a month from being over and keeping them active as much as possible. It’s difficult to force them, but at the same time, one can be supportive. You can encourage activities that they used to be involved in that hopefully they will continue to be involved in, such as getting to the gym, getting their exercise, eating healthy, all of those kinds of things.

Melanie: Thank you so much. It’s really great information. You are 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

Sleep Yourself Healthy

Additional Info

Segment Number 1
Audio File allina_health/1504ah3a.mp3
Doctors Vanumu, Vijay
Featured Speaker Vijay Vanumu, MD - Family Medicine
Guest Bio Dr. Vijay Vanumu is a board-certified family medicine physician with professional interests in mental health, pediatrics and preventive medicine. He practices at Allina Health Oakdale Clinic.
Transcription Melanie Cole (Host): Adults need nine hours of sleep. How much sleep are you really getting? Toddlers, grade schoolers, twins, and teenagers need even more sleep than that. How much are they really getting in this day and age of cell phones and electronics? Are we losing that good quality sleep that we need so badly? My guest is Dr. Vijay Vanumu. He is board-certified and family medicine physician practicing at Allina Health Oakdale clinic. Welcome to the show, Dr. Vanumu. Tell us why sleep is so important to our overall health.

Dr. Vijay Vanumu (Guest): Thank you for having me on the show, Melanie. Well, sleep is pretty essential for the overall quality of life. We need it to look, feel, perform on a daily basis. Just even having lack of sleep has been linked to so many medical conditions, even heart disease, diabetes, kidney disease, high blood pressure. So, it’s pretty important overall. Even in children, you need it for their growth, their puberty, their fertility even. It’s the time where growth hormone is released the most and boosts muscle mass and repair skin cells and even for our immunity. It’s the one big reason why we always advise a good rest when we’re all fighting the common colds or infections.

Melanie: What are our bodies doing while we sleep? Is this a passive event or are they really busy repairing, growing, healing?

Dr. Vanumu: For sure. This is definitely not a passive event. We’re talking about a dynamic process. Really it’s a period of restoration. This is when our muscles are repairing itself, tissue growth is happening and, most importantly, involved in memory function. This is where the steps in learning are made solid and stronger and you’re making neuro connections that form these memories, so consolidation is really big. It’s also involved in what I mentioned, a lot of the hormones controlling your growth and appetite, to mention a few.

Melanie: People have heard about REM sleep. Give us a quick synopsis, if you would, just a little tidbit about what that even means.

Dr. Vanumu: Sure. Physiologically, these are the cycles that are happening during sleep. Most people have probably heard about REM, which is rapid eye movement, and NREM, which is non-rapid eye movement. Majority of our sleep is actually NREM, which is the non-rapid eye movement. It goes through four stages: Stage 1 just being that light sleep, you’re just falling into it. In Stage 2, the body temperature drops a little bit, you start becoming a little bit more disengaged from your surroundings, and at this point, your heart rate and breathing are still regular. Then Stages 3 and 4 are the deepest and most restorative sleep. This is actually where your blood pressure starts dropping, you start breathing a little bit slower, and your muscles get a little bit more relaxed. You can imagine this would be the best time for your body to allocate resources for energizing the body. This is actually where blood supply is increased to your muscles and used for tissue growth and repair and hormones are released at the same time. Then you have the rapid eye movement, which is about 25 percent of your night. This is recognized as where dreams start happening and the brain is a little bit more active, your body immobile and a little bit more relaxed. So, there’s a whole lot going on during sleep. It’s absolutely nowhere near a passive event.

Melanie: Children need a lot of sleep, but in this day and age, Dr. Vanumu, they are not getting enough. I’d like to jump right to the fact of some tips that you can give parents listening on getting their children, their toddlers, their twins, and then of course, their teens, to get a better night sleep.

Dr. Vanumu: Absolutely. This has become a pretty big issue recently. My big tip is you have to establish a system. In this day and age of screens, you have to cut down on screen time. We’re talking about video games, iPads, TV, cellphones, those few hours before bed time. Research has actually found that the wavelength of light emitted from the screens actually depresses your melatonin levels, which we need to start our sleep cycle. Pretty much just half an hour of TV before bed can keep your child up almost an extra two hours. You have to establish a relaxing and consistent bedtime routine so if it’s reading your child’s favorite book, go ahead and do that. Something familiar, nothing scary. If there are bedtime sleep fears and reassurance doesn’t work, you can go ahead and get those special toys for protection: a flashlight, a toy, an air freshener as like sort of a monster spray or something like that. For little ones, I’d probably say try to avoid singing or rocking your child to sleep. You might find these repetitive behaviors that you do every night in the middle of the night, so you have to try to phase this behavior out. Use transitional object, stuffed animals or favorite blanket. Keeping the room a bit cooler can also help promote a deep sleep. The biggest one is over-scheduling. A lot of children these days have a lot of extracurricular activities after school: sports, music, karate. You have to recognize that the later these activities run, the later their schedules run as well to finish chores at home or homework, and eventually a late bedtime. Lastly, actually look out for sleep disorders. Sometimes even after our best efforts, some children have genuine sleep disorders, such as night terrors and nightmares, something you have to get your child’s doctor involved in.

Melanie: Now, adults are suffering from insomnia all over the country. We are so worried about money, finances. We’re so dialed in to electronics. Give us your best advice on sleep hygiene for adults. And does a glass of wine before bed help you fall asleep or hinder your falling asleep?

Dr. Vanumu: Well, the rule of thumb is no caffeine, no nicotine, and no alcohol before bedtime. You have to keep in mind that even chocolate has a little bit of caffeine in it as well. These are all things that can affect your sleep. When you are talking about sleep hygiene, you’re talking about establishing good sleeping habits pretty much, maintaining a regular sleep schedule. Sleep at the same time; get up at the same time – even on weekends. Sleeping-in sort of resets your sleep cycle and makes it that much harder to wake up early morning. Sleep only as much as you need to get de-stressed. Don’t smoke, especially in the evenings. If you can avoid, use your bed only for sleeping and intimate moments. You shouldn’t read in bed, no TV, music, laptops, as I mentioned earlier. Even exercising daily about five to six hours prior to bedtime can help. Avoid naps during the day. Finally, stay away from large meals close to bedtime. These sort of contribute to a good sleeping pattern and habits.

Melanie: In just the last minute, Dr. Vanumu, please give your best advice on when people should go to a doctor if they think that they are suffering from sleep disorders.

Dr. Vanumu: Sure. We’re talking about all these points that I’ve mentioned about sleep hygiene. You incorporate all these points. Keep in mind stress can be a big thing. As you mentioned, stress at home, work, financial, these are all things you should look for and these are all things that if they affect your daily activities and your daily life and how the rest of your day goes, this would be definitely time to go and see your doctor about even non-medication and medication that you might need to use.

Melanie: It’s great information about the true importance of a good night sleep and if you are experiencing any of these red flags that Dr. Vanumu has pointed out, then be sure and visit your local doctor and get great information about the ways to get your best night sleep.

You are 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 and have a great day.
Internal Notes sle
Hosts Melanie Cole, MS

Colon Cancer: Why Screening Absolutely Saves Lives

Additional Info

Segment Number 2
Audio File city_hope/1504ch2b.mp3
Doctors Sentovich, Stephen
Featured Speaker Stephen Sentovich, MD
Guest Bio Stephen M. Sentovich, M.D., M.B.A.,is a clinical professor in the Department of Surgery with extensive experience in the surgical treatment and management of colon and rectal cancers. He joined City of Hope from the Boston University Medical Center where he served as chief of colon and rectal surgery and co-director of its Center of Digestive Disorders. Concurrently, he was an associate professor of surgery at Boston’s University School of Medicine, and also served as the associate chair of clinical operations within the Department of Surgery.
Transcription Melanie Cole (Host): Sometimes, hereditary or genetic factors can increase your risk for cancer. City of Hope’s Cancer Screening and Prevention Program is designed to help you understand more about your personal cancer risks, and armed with this knowledge, you can learn how to minimize your risk and stop cancer from developing. My guest today is Dr. Stephen Sentovich. He’s a clinical professor of surgery and staff surgeon at City of Hope. Welcome to the show, Dr. Sentovich. Tell us a little bit about colon cancer and how screening absolutely can save your life.

Dr. Stephen Sentovich (Guest): Colon cancer is a very common cancer. The lifetime risk for both men and women is somewhere around five percent. Consequently, it is recommended that patients undergo screening for colon cancer.

Melanie: What does the screening entail? As women, we get our mammograms, but when people hear screening for colon cancer, Dr. Sentovich, right away they make a face and they’re scared, and really, this screening is, in my opinion, a piece of cake. It’s just the prep that’s not great. Tell us about the screening itself.

Dr. Sentovich: Well, I agree with you. The prep is the worst part of the screening. The essential screening cast is a colonoscopy that’s recommended for patients who are at average risk, starting at age 50 and every 10 years after that. The prep itself is necessary in order to clean your colon of the stools so that we can see any polyps or cancers that might be in the colon.

Melanie: The prep. Let’s start there. It’s a lot of liquid. You feel a little thick to your stomach. Your stomach looks like you just swallowed a bowling ball. That prep is really important. You need a good, clear picture. Is there a prep out there or is one being developed that is less in full volume that people can use or is this just really what gives you the best picture?

Dr. Sentovich: There are low-volume preps as well as high-volume preps. Not all the patients are candidates for the low-volume prep, but most patients are. Many patients who have the low-volume preps prefer the low-volume prep over the high-volume prep. You still have to go to the bathroom a lot and that’s important to clear your colon.

Melanie: It is, and you get that nice, clean picture. Now, the colonoscopy itself, Dr. Sentovich, people get in there, you’re talking to them, whatever, and they say, “When are you gonna start?” You say, “We’re already done.” Tell us a little bit about how quick and absolutely easy this procedure is.

Dr. Sentovich: The procedure itself takes anywhere from 15 minutes to 30 minutes in general. We give patients sedation during the procedure and that’s the reason why they may not remember much of the procedure. Some patients will feel a little gassy, either during the procedure or afterwards. Patients just pass that gas out and feel better.

Melanie: What are you looking for? What is a polyp and if you find polyps, does that mean you’re at risk for colon cancer?

Dr. Sentovich: A polyp is a growth in the colon. They’re relatively easy to identify with colonoscopy. The advantage of colonoscopy is that it can also remove that polyp at the exact same time and get rid of it. Most polyps are benign, but if they are left to grow, they could turn into colon cancer.

Melanie: Most polyps are benign, but what if your doctor tells you that you have a pre-cancerous polyp, would that mean that that one, if left in there, would turn into cancer? And if it’s taken out, do you have to get markers? Is a pre-cancerous polyp the same as if you had a little tiny bit of colon cancer?

Dr. Sentovich: No. Pre-cancerous polyps, if they are removed completely at the time of colonoscopy, present no risk to you because you just do not have cancer. It’s not the same as having cancer.

Melanie: Okay, so what do you do then if someone has a pre-cancerous polyp? You take it out, you send it for biopsy, whatever, and then what? We get those lovely pictures, Dr. Sentovich, where we get to see our colon. Why do docs give us our pictures?

Dr. Sentovich: Just to emphasize the importance of screening and that you made a difference in your life by having that polyp removed. Because you have a polyp though, that means that you may be polyp former and then you would need follow-up colonoscopies, perhaps a little sooner than every 10 years, perhaps every five years, to make sure that all polyps that grow in the interval time are dealt with.

Melanie: Since this is a test that you recommend and it can save a life, when is our first colonoscopy, and then afterward, how often do we have them?

Dr. Sentovich: The first colonoscopy is usually recommended at age 50 and then every 10 years after that. If there is a family history, that could move up anywhere from age 40 to even in the 20s or 30s, depending on how strong the family history is, and then every five or 10 years if there is a strong family history.

Melanie: Now if someone, God forbid, does have a colonoscopy and you say, “We’ve found colon cancer in there,” then is this one of those cancers that people need to be really afraid of? What are the treatments going on and the research going on at City of Hope now?

Dr. Sentovich: Colon cancer is very treatable, even when it’s in its worst stage, Stage IV. There is surgery, which is the primary treatment for colon cancer, but there is also excellent chemotherapy and radiation therapy that is used in combination with surgery to cure many patients.

Melanie: Okay, so what are the outcomes and what’s on the horizon for colon cancer? What’s really exciting in research?

Dr. Sentovich: I think what’s really exciting in research is that now we can do these colon cancer operations with minimally invasive techniques, including laparoscopic and robotic techniques. We can use new chemotherapeutic agents so that patients who have Stage IV disease can actually live, not only live with their disease but get cured from their disease.

Melanie: In just the last minute, tell patients and people listening why they should get their colonoscopy and come to City of Hope for their prevention and screening information.

Dr. Sentovich: Colon cancer is a very common cancer. Screening is recommended. Colonoscopy saves lives. It’s been shown in many studies that colonoscopy can save lives and can actually prevent cancer when you remove polyps before they turn into cancer.

Melanie: Thank you so much. 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

Kidney Cancer: The Latest Life Saving Treatments

Additional Info

Segment Number 1
Audio File city_hope/1504ch2a.mp3
Doctors Pal, Sumanta
Featured Speaker Sumanta Kumar Pal, MD
Guest Bio Sumanta Kumar Pal, MD is an assistant professor in the Department of Medical Oncology & Therapeutics Research and co-director of the Kidney Cancer Program at City of Hope. Having been appointed to the faculty for just over four years, Dr. Pal has been extremely productive, publishing more than 80 manuscripts in peer-reviewed journals. He has presented his work in multiple international meetings.
Transcription Melanie Cole (Host): Patients at City of Hope have access to the most innovative and advanced treatments available for kidney cancer. Because City of Hope offers the expertise of specialists in all fields related to kidney cancer, patients receive greater continuity of care and more coordinated treatment planning. My guest today is Dr. Sumanta Pal. He is a medical oncologist and co-director of the Kidney Cancer Program at City of Hope. Welcome to the show, Dr. Pal. What is kidney cancer, and who is most at risk?

Dr. Sumanta Pal (Guest): Thanks so much for having me, Melanie. It’s a great question. Kidney cancer certainly is not the most common cancer and actually represents just about 3 percent of all cancers out there. But having said that, it’s one of the few cancers we’re actually seeing increase in the risk year by year. Kidney cancer is a tumor that can oftentimes start and end in the kidney, but unfortunately, in many cases, it can spread to the lungs. It can spread to the bones and the brain. In those cases, unfortunately, kidney cancer can be invariably fatal. When I think about who gets kidney cancer, it tends to be a disease of the elderly. The mean age or average age that one gets kidney cancer is around 65. It’s not so different from prostate cancer and some of the other diseases that we associate with older individuals.

Melanie: Are there any known causes of kidney cancer?

Dr. Pal: Great question. And I have to say the science isn’t as fleshed out, for instance, as it might be in the context of breast cancer or prostate cancer, where there’s been a lot more research funding applied to those. One thing that I will say is that we know that smoking seems to be related to kidney cancer. The more you smoke, the higher risk of kidney cancer. In addition to that, we think that obesity is tied in to kidney cancer, and we’re finding that link between obesity and multiple other cancers, as I’m sure you’ve come across in the news recently. Finally, we’re finding that there are a lot of hereditary forms of kidney cancer. These are coming out of the woodwork over the past two or three decades or so. We’re finding multiple families where there seems to be some sort of genetic predisposition from one generation to the next of getting the disease.

Melanie: What are the early symptoms, Dr. Pal? Everybody always wants to know symptoms. Is there anything someone would notice before it’s too late to treat, and is there any screening options available?

Dr. Pal: Yeah, and I’m going to start with your second question first regarding screening options. I personally feel this is probably a matter of funding as well. Unfortunately, a disease like kidney cancer doesn’t garner as much funding as breast cancer research and prostate cancer research. This is my sly way of essentially calling out everybody who is listening to this to support kidney cancer research. We just don’t have a lot invested in understanding predictors of the disease. Whereas in prostate cancer we’ve got a simple blood test that you can take to detect the disease and in breast cancer we can do a mammogram to detect the disease early, in kidney cancer, you only know once you start having symptoms, unfortunately. In many cases, those symptoms can be blood in the urine. It could be pain that’s localized around the back area. These are the things that usually people manifest with first and foremost when they have kidney cancer.

Melanie: When you do go for diagnosis, what’s involved? If you see blood in your urine, everyone worries about that particular symptom. Then who would you go see even if you see blood in your urine, and then how is it diagnosed?

Dr. Pal: I think the most important thing to do is to get in early. That means seeing your internist first and foremost. That’s the wise thing to do. But usually, if somebody has a lot of blood in the urine, the first point of contact is going to be a urologist, somebody who really has a focus on the kidney and the urinary tract in general. The urologist may start with a couple of simple tests. This may involve a CT scan, for instance. I wouldn’t say that kidney cancer necessarily rises to the top of the list when we’re thinking about blood in the urine. We’d always want to rule out urinary tract infection first. We also want to rule out the possibility of kidney stones. Kidney stones can actually often cause blood in the urine. Through a couple of simple modalities, the urologist should be able to determine whether or not it’s a stone or a urinary tract infection or in fact kidney cancer that’s causing your symptoms.

Melanie: Then, what treatments are available?

Dr. Pal: I would suggest that if you have localized kidney cancer – cancer that’s really confined to the kidney itself – in many cases, you can be cured by surgery alone. But I always urge a lot of caution, because in many cases – and this is also true for breast cancer, colon cancer, et cetera – when you have that primary tumor affected, there’s always still some chance that the disease can relapse. That’s one of the things that I’m focused on in my research here at City of Hope. We have a lot of trials that address the population of patients who have their kidney mass removed. We’re testing out new strategies that might reduce their risk from the cancer recurring. Now, if you already have metastatic disease – meaning the cat is already out of the bag and the kidney cancer has moved to the lung or the bones, et cetera – there are a number of new therapies that have been utilized in this setting. We’re not talking about traditional chemotherapy. When I think of chemotherapy that’s applied for breast cancer, prostate cancer, these are drugs that really attack all cells indiscriminately. They certainly are going to fight the tumor, but they’re also going to also work on actively replicating cells like your hair follicles. Your hair will fall out. It will also work against the gut. You’ll develop diarrhea and so forth. In kidney cancer, we’ve gotten a little smarter and we’re actually using targeted treatments. And these are still pills or IV agents, but they’ll actually go straight to the tumor, and they’re specific enough to actually work against the proteins that drive the disease.

Melanie: If you have kidney cancer in one kidney, is there a risk then that that other kidney is going to get it as well?

Dr. Pal: Yeah, that’s a great question, Melanie. The chance of getting kidney cancer in the opposite kidney is actually dependent on your age. If you’re relatively young, the chance of having bilateral kidney cancer or kidney cancer in both kidneys actually rises. On the other hand, if you’re older, that risk falls to about 5 percent.

Melanie: Now they do look for protein in the urine when you get your blood test annually. Does that have anything to do with this?

Dr. Pal: I would suggest that that’s probably not the best indicator. What might be a more subtle indicator is any microscopic blood that shows up in the urine. We always think of blood in the urine as being very frank, red in color, et cetera. Even if you have totally clear urine, you might actually still have a couple of red blood cells that are filtering out. That annual urine test that you’re taking can potentially pick up on that.

Melanie: Dr. Pal, what advice do you tell patients when they are recently diagnosed with kidney cancer, and what are some of the latest research you’re doing there at City of Hope?

Dr. Pal: Right. So I think that the key is to really get into a center of excellence. Kidney cancer, as I’ve mentioned right at the outset, isn’t a very common disease. It’s only 3 percent of all cancers. So you want to make sure that the oncologist that you’re seeing sees a high volume of these cases so they know what they’re doing. I wouldn’t say the same is necessarily true for breast cancer, for prostate cancer, et cetera, where the average oncologist may have substantial experience. What I would propose is that you go to a center of excellence, a comprehensive cancer center like City of Hope, and ask about the possibility of clinical trials. I think that the drugs that we have right now for kidney cancer are better than the drugs that we had 10 years ago, but I’m going to guess that the drugs that we’ll have 10 years from now are going to surpass those that we’re using today. The only way to get access to those drugs is by getting involved in these clinical trials early.

Melanie: Dr. Pal, in just the last minute, give us your best advice for people who may have been diagnosed with kidney cancer and what inspires you daily. Why should people come to see you at City of Hope?

Dr. Pal: Right. I have to tell you when I started out in the field, I was a little daunted by some of the survival statistics. If you look at the data from about 10 or 15 years ago, patients with advanced kidney cancer are only living for about a year on average. But now we’ve improved our prognosis with some of the new treatments multifold and I’m really driven to see that we continue to improve the prognosis of kidney cancer through some of the new treatments that we’re introducing in clinical trials. I’m getting to that point in my career where I’ve had patients that despite that prognosis of one year are alive at six or seven years out. That’s incredibly encouraging. That keeps me passionate about what I’m doing here.

Melanie: Thank you so much, and we can certainly hear that passion and thanks for being with us today. 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

New Prospects for Treating Brain Cancers

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Segment Number 4
Audio File virginia_health/1503vh5d.mp3
Doctors Purow, Benjamin
Featured Speaker Benjamin Purow, MD
Guest Bio Dr. Benjamin Purow is a neurologist who specializes in researching new brain tumor treatments and caring for patients with brain tumors.

Learn more about UVA Neuro-Oncology
Transcription Melanie Cole (Host): If you are someone who has been diagnosed with a brain tumor, what are the potential treatments for patients and what can you expect as an outcome? My guest is Dr. Benjamin Purow. He is a neurologist who specializes in researching new brain tumor treatments and caring for patients with brain tumors. Welcome to the show, Dr. Purow. Tell us a little bit about brain tumors and some of the challenges of developing treatments for patients with brain cancer.

Dr. Benjamin Purow (Guest): Sure. I am happy to. Brain tumors can present in lots of different ways. That is something that people are often curious about, that they worry about. It can present as something like a severe headache, but in most cases by far, headaches are due to other things. Seizures are very common presenting symptom. Those can be much more diverse than people expect. Those can be the grand mal seizure that people are used to hearing about, but also much more subtle things that are very brief, difficulty with speech or numbness or tingling somewhere, sometimes difficulty, weakness somewhere or balance. There really are a plethora of symptoms and it is always good to consult with your doctor. There are a number of challenges once you have diagnosed a brain tumor and typically that happens after patients present with some of the symptoms I have described or one of the symptoms I have described. It usually leads to an MRI, scan of the brain, and these are extremely sensitive scans that can show us these brain tumors. From there, we typically need a neurosurgical colleague to take some of this tissue and we will go on to some of the existing treatments such as initial surgery, radiation, chemotherapy. Unfortunately, for some of these brain cancers, and I will mention one in particular called glioblastoma or GBM for short, that is the most common and most aggressive kind of brain cancer we see in adults and we can see it in children as well. Some of the challenges for that cancer, as well as for some of the other brain tumors that are out there, include invasiveness into critical structures of brain. If they stay as a discrete lump, very often the neurosurgeons can just take that lump out. Unfortunately, glioblastoma and other brain cancers invade elsewhere into the brain. They are fairly resistant to existing treatments such as chemotherapy and radiation. There are a fairly diverse group of tumors. They can be heterogeneous and, worst of all, very adaptable to a lot, if not all, of the existing treatments that we have. They can always evolve and find a way around these treatments. There is also something called the blood-brain barrier, which makes it hard to get some of the treatments that we give intravenously get them into the brain. There is kind of a tight barrier between our blood and our brain itself, where these tumors are lurking.

Melanie: Describe for us some of the research that you are working on right now.

Dr. Purow: Sure. We are excited about a number of things that we are doing in the laboratory right now. I mentioned the adaptability of this cancer. One of the things that we and others in the field are trying to do is tackle these cancers on multiple fronts all at once with one or two therapies at a time. We really need good multi-targeted therapies. We have some work in the lab focusing on what is essentially a genetic approach using very small molecules called microRNAs. There are actually lots and lots of these found normally in our self, but cancers such as glioblastoma and other brain cancers tend to suppress or increase expression of some of these, and some of these microRNAs that are down-regulated in the cancers are actually pretty toxic to cancers if we can go back and deliver them to glioblastoma and other cancers. One of the things we focus on in the lab is exploring these microRNAs, their biology, but also trying to use their delivery as therapy for brain cancers, given that each of these microRNAs can target multiple pathways at once. They tend to suppress their targets and a given microRNA can hit lots of these pathways that are very important in these cancers. We also have another big project in the lab, looking at a fairly new target in glioblastoma, brain cancers, and actually cancer in general. It is a protein called diacylglycerol kinase alpha or DGK-alpha. We think it is a very nice signaling hub in these cancers, such that when we inhibit this, we can actually attack multiple cancer pathways all at once. It got some other exciting aspects that seem to directly kill the cancer cells when we inhibit these. It also attacks their blood supply, may also boost the immune system, so exciting at multiple levels. We also have some new projects in the lab, basically a personalized medicine approach. We are trying to move forward where we can target subsets or subtypes of glioblastoma and other brain cancers. We are also exploring what we hope are some smarter, more rational combinations of some of the existing drugs that are out there.

Melanie: Wow! How exciting is this research you’re doing now. Tell us a little bit about how long some of these things when you talk about the DGK-alpha and these microRNAs, what can patients expect? When are you going to know if these can be used on patients and how long? What is the future of brain cancer care?

Dr. Purow: Sure, that’s a great question. With some of these research fronts that we are working on, it will probably take years to develop. The microRNAs, in particular, there is a major delivery hurdle and we and others are working on overcoming this. There’s some [treading] progress being made there. The DGK-alpha project, it may actually not be that long because we found that there is an old drug that was being used for a different purpose in some clinical trials, not yet FDA-approved, but were safe in clinical trials being used for something else. We find that we can repurpose that drug as an inhibitor of DGK-alpha. We think that is going to really speed up clinical trial of this approach in the not-so-distant future in the next year or two with inhibition of DGK-alpha. With some of our other projects, we are actually using existing drugs that already are being used for cancer or repurposing existing drugs in new ways to use them against brain tumors and other cancers and that’s going to let us go to the clinic much faster. Truly an exciting time more broadly with lots of great new developments for cancer in general and that really extends also to neural oncology to brain cancers. I think we will for a long time be using chemotherapy, although hopefully more gentle ways than is typically thought of, and radiation as well. I think we are getting toward better use of targeted agents. Some of these are more sophisticated, personalized medicine or re-matching the drugs better to the patients who are out there. We will also be doing, I think, better combinations of existing drugs. One of the most exciting areas out there is with immunotherapy, boosting the immune system against cancer, including brain cancer. We used to think that it might not apply to brain tumors, but they really seem to be applicable to glioblastomas and these other awful brain tumors. There was a recent meeting in November in our field, the biggest brain cancer meeting there is, and there were some very exciting new clinical trial results with one immunotherapy. There are some other immunotherapies that looked great. These are kind of nice because they are not very toxic often and they really use your own immune system to fight the cancer. This meeting was also exciting because there were positive results with the really quite an interesting alternative approach to fighting cancer, applying electrical currents to the head against the tumor and that had positive results. So there are lots and lots of exciting things going on right now in this field and throughout oncology actually.

Melanie: Wow, Dr. Purow. Why should patients come to UVA for brain cancer care, if anything else, than just to see you and hear your enthusiasm for the subject?

Dr. Purow: I think there are lots of reasons why I would encourage patients to see us. We see very many patients who have brain tumors. We have broad experience. We give everyone that we see really the state-of-the-art care, but then we go beyond and really try to go the extra mile. We give compassion to all the patients that we see. We really treat every patient the way that we would want ourselves or a family member to be treated. It is a frequent question from patients. What would you do? How will you want to be treated at this point? I really give the same answer, which is just “I already was talking to you about exactly what I would want to do.” I think we really apply the golden rule or, if you will, the platinum rule, to do for people what we would want for ourselves and our loved ones. We also have here a number of clinical trials in any given point and that is applying, trying things that are in the pipeline to our patients with these brain tumors, glioblastoma, and other brain tumors. Even outside of the clinical trials, though, we have the willingness to, as I said, do the standard of care and beyond, really look for combinations of standard of care with other existing agents that might give a little boost to the therapy, if we have to add on a blood pressure medicine or a seizure medicine for a patient. We are always thinking about medicines that will not only do that function that we need, but pick one that may also give a little boost against the brain cancer. Some of our patients want cocktails, state-of-the-art and other things, and we are very happy to fight as best we can and make those cocktails for our patients. We emphasize not just length of life but also quality of life, and that is really paramount in something that we are always thinking about.

Melanie: Thank you so very much. Really, really great information and very exciting research. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Treatment Options for Early-Onset Scoliosis

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Segment Number 3
Audio File virginia_health/1503vh5c.mp3
Doctors Singla, Anuj
Featured Speaker Anuj Singla, MD
Guest Bio Dr. Anuj Singla is a fellowship-trained orthopedic spine surgeon whose specialties include caring for patients with scoliosis.

Learn more about UVA Spine Center
Transcription Melanie Cole (Host): If you suspect that your child might have a curvature of the spine, what options are available for patients with early onset scoliosis. My guest today is Dr. Anuj Singla. He is a fellowship trained orthopedic spine surgeon whose specialties include caring for patients with scoliosis at UVA. Welcome to the show, Dr. Singla. What is early onset scoliosis and what are the symptoms that parents might recognize in their children that would even send them to the doctor to begin with.

Dr. Anuj Singla (Guest): Good morning, Melanie. Thanks for having me. Scoliosis is a lateral or sideways curve of the spine. Normally, a spine is straight upright, but when the spine starts growing sideways in the shape of a C of S, it is what we call scoliosis and early onset scoliosis is when the scoliosis starts early on, say, less than 10 years of age. That is early onset scoliosis. The most important remarkable symptom of a scoliosis is asymmetry or unevenness. Normally, our spine—and for that matter, the whole of our body—is very symmetrical, very even on both sides, the right side and the left side of the body. But if you notice that there is some unevenness in the kid’s body with regard to spine or adjacent to the spine, like tilted or uneven shoulder, one shoulder blade protruding more than the other or prominence of ribs on one side or uneven baseline or uneven pelvis, one hip higher than the other, or overall, kid leaning onto one side, these are the things that should give you the early clue that the kid might have scoliosis and you should see a specialist.

Melanie: Is this something in a pediatrician’s office during their well visit that might be caught by the pediatrician when they are just doing their normal well visit?

Dr. Singla: Yeah. Actually, most of the time, parents has features of unevenness like I just mentioned, but sometimes, the findings are so subtle, it is so minor difference between the right side and the left side overall asymmetry, that the parents do not notice that and the pediatricians are very good at finding that out and we get a lot of referred patients from the pediatricians all over the region where the pediatrician or the primary care doctor find out about the scoliosis and the patients get referred over to us.

Melanie: Are there certain groups of patients, Dr. Singla, that are at higher risk than others?

Dr. Singla: Yeah, there are certain groups of patients. Early onset scoliosis, we broadly say there’s a neuromuscular type of early onset scoliosis, which is imbalance of the nerve and the muscle function, like in cerebral palsy, CP, spinal muscular atrophy, muscular dystrophies, or paraplegia or a traumatic spinal cord. If the nerve and the muscle band go haywire, then they can get scoliosis. Some kids who have some syndromes in the body like Marfan syndrome or neurofibromatosis or dwarfism, they also have higher chances of getting scoliosis. Some kids who have abnormal bone in the spine, which is present since the birth, what you call as congenital scoliosis, they can also have a big scoliosis deformity early on in their life. At the same time, the biggest chunk of our patient is a group of patients who are otherwise completely normal, no problem with any other system in the body. They just have scoliosis. There is no reason for them to have scoliosis, but they end up having scoliosis.

Melanie: What a scary diagnosis, I would assume, for parents. What treatment options are available and what can they look toward for the future of this child? Are they going to be standing upright after these treatments? What are the options out there and what are the outcomes?

Dr. Singla: Melanie, this is a very interesting question. Because treatment options for scoliosis and especially early onset scoliosis has to be customized for every child’s need, there is no one single answer for all the patients. The treatment has to be individualized. There are broadly three categories of treatment, three steps of treatment. First is observation, where we just look at the child and see if it is progressing, if the curve is getting worse over time or not. We take images of the spine. We take MRI or a CT scan to make sure we understand the problem and we take the consultation with some of the other specialists to make sure there is no other problem in any other part of the body. That is observation. The second step is doing a non-surgical treatment. Non-surgical treatment, we use bracing and casting for that. That is really very effective. That is one of the mainstream treatments for scoliosis especially early on. The third category of treatment is doing a surgery. For the surgery, I would like to mention that there have been some tremendous advances in the treatment of scoliosis and early onset scoliosis in last five to ten years. Earlier, the treatment option for early onset scoliosis and scoliosis used to be only fusing the spine. We used to fuse the spine so the spine does not grow any more crooked or any more curved than it is now. Or we used to correct the spine and then fuse it. That was the problem, especially for early onset, because if you fuse the spine, that also fuses the chest cavity or the thorax. If the chest does not grow, say in a five or six-year-old, the space available for the lungs for breathing gets very compromised or very jeopardized and that has a far-reaching effect and the lungs cannot actually grow to the normal extent for the rest of their lives. But with the newer advances of non-fusing technologies, we can really overcome. It is still early on for the non-fusing technologies for spine, but I guess we have made some groundbreaking achievements in the last five to 10 years. Now we have the groin rods, we have the dissection B system; we have the magic rod system. We don’t have to fuse the spine with the tethering and stapling. So there are a couple of options, which we can customize as per the kid’s age, kid’s growing potential, the flexibility of the curve, and the severity of the curve.

Melanie: Dr. Singla, when you speak about bracing and casting and traction, back in the day, we would see people, young kids walking around in those really severe braces with their heads up. It was something that really restricted that child’s movement, and in school kind of set them aside from the other children. What is it like now if a child has to go through bracing or casting or traction?

Dr. Singla: The principle behind the bracing is we have to push on certain segment of the spine on the convexity or the rounding side so that the spine grows straight. The brace, obviously, has to be worn for quite a significant amount of time, we say, about 16 to 18 hours a day. But that bracing material has changed a lot in the last five to ten years, and people do not notice. If you are wearing a brace underneath your clothing, people do not notice. Kids do not have any major restriction with the brace on. For the kids’ playtime and activity time, we encourage them to take the brace off, say after the school period. We encourage them to take the brace a couple of hours so the kids have time to do all the fun activities as well.

Melanie: That is really great information that gives hope to parents. Dr. Singla. Why should patients come to UVA for their care?

Dr. Singla: That’s an interesting question. I am fellowship trained and I have the training in the latest and cutting-edge technologies like the non-fusing methods I was just mentioning. If you combine that with the extensive experience of my mentor, Dr. Abel, over here, it makes up a great pediatric spine surgical team. Spine and scoliosis treatment is not just pediatric spine surgeon; it is a big team effort. It involves pediatric surgeons, team of intensive care intensivists, ICU nurses, anesthetists, therapists, orthotists who work with the braces, neurologists. I feel we have a great team taking care of kids with scoliosis over here at UVA. We also have low-dose imaging modalities. Because, like I mentioned, these kids need frequent and repeated imaging of the spine, and over a long period, the radiation amount in the body can have impact on the overall growth potential on all the glands and on the reproductive function later on. If we can cut down on the radiation dose, it can significantly impact the overall growth of the kid. We also have a one-stop solution to the problem over here. We have the imaging, our clinic, and our bracing shop all under one roof in our clinic setup.

Melanie: Thank you so much. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Is Bariatric Surgery Right for You?

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Segment Number 2
Audio File virginia_health/1503vh5b.mp3
Doctors Hallowell, Peter
Featured Speaker Peter Hallowell, MD
Guest Bio Dr. Peter Hallowell is a board-certified surgeon and director of bariatric surgery at UVA Health System.

Learn more about UVA Bariatric Surgery
Transcription Melanie Cole (Host): Are you severely overweight? Have you ever considered bariatric surgery? Who is really a candidate for this weight loss surgery and what does it involve? My guest today is Dr. Peter Hallowell. He is a board certified surgeon and Director of Bariatric Surgery at the UVA Health System. Welcome to the show, Dr. Hallowell. Tell us a little bit about bariatric surgery. What does it involve?

Dr. Peter Hallowell (Guest): Bariatric surgery involves an operation on the patient and it describes a field of surgery where there are multiple different procedures that we do, all with the goal to help the patient lose a significant amount of weight and to improve the medical problems that are associated with carrying a significant amount of weight.

Melanie: What are the different kinds of bariatric surgery out there now? Some of them are permanent and some of them are not, correct?

Dr. Hallowell: Yes. In a general sense, what we found is that even the procedures that are somewhat temporary, once that procedure is withdrawn, there is a tendency to regain weight. So there tends to need to be a procedure, in effect, to maintain this weight loss. The procedures that are commonly done in the United States include the gastric bypass, the sleeve gastrectomy, and the lap-band, as far as common surgical procedures.

Melanie: Who are candidates? Who really should be considering any of these types of bariatric surgery?

Dr. Hallowell: Excellent question. Patients who are severely overweight and in medical terms, we measure that by a tool called the body mass index. This is essentially a ratio of your height and weight, so that taller people can carry a lot more weight. Think of a person like Shaquille O’Neal, who is nearly 7 feet tall versus somebody who is 5’ 4”. Shaquille O’Neal can carry a lot more weight on his frame and not be unhealthy. The body mass index is something that you can easily calculate in your head. Most places have a calculator on a website and we use that in our own clinic. What we are looking to see is if your body mass index is greater than 40, you would be a candidate for surgery, or if your body mass index was greater than 35 and you have a significant medical problem like hypertension, diabetes, obstructive sleep apnea. The body mass index in those ranges translates to roughly 80 to 100 pounds over your ideal weight.

Melanie: Dr. Hallowell, explain a little bit about these types of surgeries. People think of a stomach getting smaller and limiting the amount of solid food, but does that also make it like malabsorptive? Does it make it so that you cannot retain that food? Explain a little bit about it.

Dr. Hallowell: Each of the main procedures that we do works in a slightly different way. I’ll take them kind of each in and of itself. In a gastric bypass, we will take the upper part of your stomach and staple that off and make it into what we call a small pouch. It is generally about the size of an egg or smaller and holds pretty much up to about an ounce to an ounce-and-a-half of food or fluid. We then take part of your small intestine and attach it to that pouch. The food you eat will go into the stomach and then into a part of the small intestine that is usually further down. Then we make another connection, even farther down the small bowel, where the rest of the body’s juices from the liver and pancreas, and the rest of the stomach come in to help you digest. In a traditional sense, we think of that operation as sometimes limiting the amount of food that you can eat because of the size of the pouch and also inducing a little bit of malabsorption because of where the digestive enzymes come into the system and shortening your intestines a little bit. Some of the newer research into bariatric surgery indicates that some of the effects that we are having may be more hormonal or biochemical than pure restriction of food or malabsorption, and that while it hasn’t been fully fleshed out, it’s one of the most interesting areas in the field. The next procedure that is commonly done in the United States and, in fact, the most common operation performed these days, is called the sleeve gastrectomy. Simply put, that is taking the stomach and turning it into a thin tube, about the size of your esophagus. If you think of your stomach as a big reservoir that can stretch out, especially around Thanksgiving time when you may overindulge in food and it becomes a big reservoir, the sleeve gastrectomy turns that into a much smaller reservoir, much smaller tube, and you cannot hold as much food. Then the last procedure that is commonly done in the United States, the lap band, we take basically a plastic belt with a balloon on the inside and put that around the upper part of the stomach, right by the entrance to the stomach, and by inflating the balloon, we cause that area to narrow down and allow patients to feel hungry earlier than they would when eating food, so it gives a lot more restriction.

Melanie: What questions would you advise patients to ask their doctors when they are considering these types of surgery?

Dr. Hallowell: They need to ask their doctor, if they are considering this surgery, which operation may be best for them. They should ask their doctor how much experience have they had in the various operations that they propose. It would be very prudent to ask what the risks of the surgery that they are thinking about entail, what the potential benefits for them are, and if the surgeon is a member of an organization that specializes in bariatric surgery, if the hospital and center they are going to is recognized as the center that performs this and a high volume with good outcomes.

Melanie: Tell us a little bit about the recovery. We don’t have much time left, but what can patients expect afterward?

Dr. Hallowell: Again, it depends on the procedure that they have, but in general, it is about a two-day hospital stay. Most of the procedures in the United States are performed in a minimally invasive surgery fashion or what we call laparoscopic surgery. There will be multiple small incisions on the patient’s abdomen. This allows it to have a lot less pain than a traditional open surgical incision. The patients will generally recover pretty quickly from the surgical side of the equation. However, they begin losing weight, especially with the gastric bypass or sleeve, sometimes up to a pound a day, so they may feel a lot of fatigue up until six weeks after surgery. Those should be some of the expectations going in that they may be out of work for a week or two after the surgery and then they may feel tired for up to a month to a month and a half.

Melanie: Dr. Hallowell, why should patients come to UVA for their bariatric surgery?

Dr. Hallowell: UVA has been doing bariatric surgery for the longest period of time in Central Virginia and we have the most experienced team taking care of our patients. We are a recognized center of excellence for bariatric surgery and we’ve held that designation since the beginning of the program to designate hospitals as centers of excellence. It is really our experience, our knowledge, and our skill at doing these operations that should drive patients to come and see us.

Melanie: Thank you so much. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

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