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What are some things you can do to help promote healthy sleep while you're away from home?
Additional Info
- Segment Number 1
- Audio File staying_well/1438sw1a.mp3
- Featured Speaker Lydia Wytrzes, MD
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Guest Bio
Lydia Wytrzes, M.D., medical director of the Sutter Sleep Disorders Center for Sutter Neuroscience Institute in Sacramento, is board-certified in both neurology and sleep medicine.
Dr. Wytrzes' interest in sleep medicine became focused while receiving fellowship training and conducting brain physiology research at the University of Washington Medical Center in Seattle, which included working with patients in the university's sleep lab.
As a neurologist, she works with patients with sleep disturbances that include insomnia, narcolepsy, restless legs syndrome, parasomnias such as night terrors and sleep walking, and other sleep issues related to the brain and central nervous system.
Dr. Wytrzes received her medical training at the University of Cincinnati, College of Medicine and served residencies in internal medicine at the Cleveland Clinic Foundation and in neurology at the University of Massachusetts. In addition, she received fellowship training in EEG and neurophysiology at the University of Washington Medical Center.
Dr. Wytzres is a member of the American Sleep Disorders Association and American Academy of Sleep Medicine. - Hosts Melanie Cole, MS
When you sit all day at work, how can you keep yourself healthy... especially with sneezes and sniffles all around you?
Additional Info
- Segment Number 2
- Audio File train_your_body/1444tb2b.mp3
- Featured Speaker Jordan D. Metzl, MD
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Guest Bio
Jordan D Metzl, MD, (www.DrJordanMetzl.com) is a sports medicine physician at Hospital for Special Surgery, America’s premier orthopedic hospital located in New York City. Regularly voted among New York’s top sports medicine doctors by New York magazine, Dr Metzl takes care of athletic patients of all ages and lectures and teaches extensively both nationally and internationally.
With a practice of more than 20,000 patients, Dr. Metzl is widely known for his passion for sports medicine and fitness. His focus is to safely return athletes to the playing field of their choice and to keep them there.
In addition to his busy medical practices in New York City and Old Greenwich, Connecticut, Dr. Metzl is the author of the bestselling titles, The Exercise Cure (Rodale 2014) and The Athlete's Book of Home Remedies (Rodale 2013) and has also authored three other books including The Young Athlete (Little Brown). Dr. Metzl is also the medical columnist for Triathlete Magazine. His upcoming book, entitled Run Your Best Life, is expected in 2015 (Rodale).
His research interests include the treatment and prevention of running related injury, the effectiveness of preventive wellness programs, and the prevention of youth sport injury. Dr. Metzl appears regularly on media programs including the Today Show, on radio including National Public Radio (NPR) and in print media including the New York Times, discussing the issues of fitness and health.
In addition to his busy medical practice and academic interests, he practices what he preaches. Dr. Metzl created the Ironstrength Workout, a functional fitness program for improved performance and injury prevention that he teaches in fitness venues throughout the country. The workout is featured on www.RunnersWorld.com where it has been performed by more than nine million athletes around the world. A former collegiate soccer player, 31-time marathon runner and 12 time Ironman finisher, he lives, works, and works out in New York City. - Hosts Melanie Cole, MS
Planning your meals ahead of time can make your shopping easier and healthier.
Additional Info
- Segment Number 2
- Audio File train_your_body/1445tb2c.mp3
- Featured Speaker Felicia Stoler, PhD
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Guest Bio
Dr. Felicia Stoler is a registered dietitian, exercise physiologist and expert consultant in disease prevention, wellness and healthful living. She has a bachelors from Tulane University, a masters in applied physiology and nutrition from Columbia University and her doctorate in clinical nutrition from UMDNJ. Felicia serves on many local, state and national committees related to health and wellness.
Felicia is a member of the American College of Sports Medicine and is a Fellow of the ACSM. She is a member of the Academy of Nutrition and Dietetics and is on the House of Delegates.
Dr. Stoler hosted the second season of TLC's groundbreaking series, Honey, We're Killing the Kids!, which took aim at the unhealthy lifestyles of families, across the country, in an effort to motivate them to make positive changes.
She is the author of Living Skinny in Fat Genes™: The Healthy Way to Lose Weight and Feel Great (Pegasus) which was featured in USA Weekend among the top “must have” books in 2011. She has been a contributor for FoxNews.com and written several book chapters. Stoler authored the ACSM’s Current Comment on Childhood Obesity.
Felicia has been on many national and local television and radio programs across the U.S. She is one of the most sought-after nutrition/fitness experts for TV, radio, newspapers and magazines. Felicia is passionate about helping people live healthier lives – and practices what she preaches. She maintains a private practice and provides consulting and public speaking. Felicia is the mother of two children and step mom of one – living in NJ. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 5
- Audio File virginia_health/1451vh5e.mp3
- Doctors Gander, Jeffrey
- Featured Speaker Jeffrey Gander, MD
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Guest Bio
Dr. Jeffrey Gander is an Assistant Professor of Surgery specializing in pediatric surgery.
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Transcription
Melanie Cole (Host): Getting your child ready for surgery doesn’t have to be such a scary experience, and we’re offering you today some tips on how to prepare your child and yourself from UVA pediatric surgeon, Dr. Jeffrey Gander. Welcome to the show today, Dr. Gander. Tell us a little bit about what are some of the most concerns you hear from families before they have to have surgery for their child.
Dr. Jeffrey Gander (Guest): Hi, Melanie. How are you? Thank you very much for having me on. Happy New Year to you. That’s a great question. I hear a lot of concerns from families before surgery. One is, how is their child going to cope with being separated from them, often for a couple of hours at a time? That’s one thing they worry about, having to say goodbye to their child when the child’s taken off to the operating room. Another thing they ask often is because with surgery, there is incision and opening of other skin in some part of their body and they are worried about are they going to have pain during the surgery and are they going to have pain after the surgery? Another thing we get asked a lot is about anesthesia. What kind of anesthesia, what are the side effects of the anesthesia, things like that? It’s certainly understandable. I have a couple of young ones myself. I understand them well to be concerned when your child is going to have an operation.
Melanie: As a parent myself, Dr. Gander, I have been there. Both my children have had to have surgery at some point. How do you address those concerns, like, for example, I was worried about anesthesia myself, how a child tolerates that anesthesia and what’s going to happen afterwards, how lethargic will they be for that day following. I know it’s individual for each child, but how do you answer those questions that you listed?
Dr. Gander: Well, a lot of times I reassure the families and I’d say that the anesthesiologist we have here at UVA that are going to be taking care of their children are all fellowship trained in just taking care of children. They have a lot of experience. They’re just some of the best doctors we have in the hospital. They are very used to taking care of premature babies who are less than a pound at birth to adolescents and even to early 20s. They are very used to taking care of children. That’s a good thing, is that they have a lot of experience. What they do, what helps also, is that they often get a little medicine to help them to get into the operating room. I know the anesthesiology team – because a lot of families and a lot of children are very anxious – will even give a little bit of something to sedate them a little bit so they can come into the operating room and be a little bit more comfortable and not be as nervous. The reason I bring that up is because often when a child is less nervous, they often need less anesthesia, so that actually helps them to go to sleep a little bit easier and then actually wake up and not be quite as groggy after the operation. That goes with the families, too. Children as you know read off the emotions of their parents, very much so. If a family or a parent is anxious, then the child is going to be anxious as well. Like I said, that even sometimes makes them have to have more of the anesthesia and even sometimes, more medicine. There’s a lot of different types of anesthesia and depending on what type of the operation is, sometimes, it can happen under just a local anesthetic where we give some medicine into the surgical incision so that they don’t feel anything, so it numbs the area. The anesthesiologist will give just give them a little bit of medicine to make them nice and comfortable so they won’t know what’s going on. Along those lines, what I often tell families is the child is going to have no pain and they are going to have no memory of the operation whatsoever because they’re given a little something before that makes them nice and comfortable. They go to sleep, have their operation, and oftentimes, they wake up and say, “Oh, I didn’t even realize that surgery was done already.” I think that’s certainly a common concern is about the anesthesia, but I can certainly say that here, they are well taken care of. Those children are very well taken care of.
Melanie: As far as that medication to help calm the children down, Dr. Gander, I would think the parents need that even more so than the child. What do you tell these nervous, freaked out parents? I give you so much credit working with parents as a pediatric surgeon, Dr. Gander. What do you tell the parents that they should be doing before, during, and after their child goes in for surgery?
Dr. Gander: Right. Before surgery, I tell them just to ask me as many questions as they can. Because like I said, people are well informed. There’s a lot of information. People will often come in with some of their own concerns and their own anxieties about their child having operation. I do sit down with them and spend most of the visits just going over that. What are your questions about the operation? What are your concerns? I do my best as well as the nurses I work with very closely. Here at UVA, we do our best to answer those questions to kind of make them a little bit less anxious. That morning of the surgery, I just tell them, go through their normal routine. We can talk about it later, but the child is not allowed to eat anything, but how the family makes sure that they eat some breakfast, make sure they got a good night’s rest because they need to be there for the child the next day. During the operation, what I often tell people is go out, grab a cup of coffee, go get something to eat and read the newspaper. Oftentimes, they won’t be able to do that because they’d be so nervous. Just try not to think about it for a period of time. Then for after the operation, I’ll always confine them and just go over everything and often, what I’ll do, as in before, I’ll tell them, give them a rough estimate how long the operation’s going to be because then they can sort of say, “Oh, well, they told me it’s going to take two hours, so I won’t be worried because it’s only been an hour-and-a-half.” At least you give them some period, something to anticipate so that they know that there’s a period of time they may be in during the operation and they can expect to hear from us around that time. Then for after the surgery, what I tell families is that their child will have some pain afterwards, some discomfort, and depending on what type of surgery it is, whether it’s a general abdominal or operation or something on the leg or bones, the pain will be different with each procedure. I assure them that our team, the surgery team as well as the anesthesia team in the recovery room, will do our best to alleviate that pain and help control that pain. I think with hearing all those things and just speaking with the families, it often helps out a lot for them.
Melanie: In just the last few minutes, Dr. Gander, what could parents do or say to their children? Based on a child level of understanding of what’s going to happen to them, what do we tell our children to put them at ease from all those lights and the scary people in white coats and then why should families come to UVA Children’s Hospital for their care?
Dr. Gander: Right. Children are very smart and they understand something is going on. Try to explain to them as best we can what is going on and why they need to have the procedure. What we do in our preoperative visit and as well as sometimes we ask the families to do is we have certain dolls and teddy bears that have devices. If they’re having a feeding tube placed or a Port-A-Cath we call, something that goes underneath the skin to help them get the medicine infused, we show them what these things look like and show them on a doll or a mannequin so that they can at least be used to what’s happening or give them an idea about that. We have a child life specialist who works with them before the operation to try to get them used to a mask sometimes that the anesthesiologist will put on for them. Then, like I said, the medicine that they give beforehand sometimes makes them nice and relaxed for when they go back to the operating room. I always ask them what kind of music they like to listen to, so I will try to put a little bit of music on at the beginning of the operation, anything—I like all kinds of music and I know all the nurses do, too—anything they want to listen to, just to make them nice and calm. We all introduce ourselves beforehand, not only to the families, but there’s typically at least six people in the operating rooms, two surgeons, two anesthesiologists, and two nurses, and we all introduce ourselves by our first name and then once they come back into the operating room, we re-introduce ourselves again. Say, “Remember me? I have a mask on, but we’re going to help and take care of you.” I think all those things really often help out these children. As far as coming to UVA, I think, the nice thing about here is everyone works as a team. The kind of olden days of the surgeon as the captain of the ship are gone, and it’s really everybody works together. Like I mentioned, there’s usually at least six people in the operating room, if not sometimes more than that, all working to take care of children. We all communicate pretty well. If someone has a concern, they bring it up to the group and we try to do our best to do that because our ultimate goal is for the child to be safe during the operation and have the operation be successful so that whatever was wrong with them can be fixed.
Melanie: Thank you so much, Dr. Jeffrey Gander. It’s really great information. You’re listening to UVA Health Systems Radio and for more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening and have a great day. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 4
- Audio File virginia_health/1451vh5d.mp3
- Doctors Hassanzadeh, Hamid
- Featured Speaker Dr. Hamid Hassanzadeh
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Guest Bio
Dr. Hamid Hassanzadeh is an orthopaedic surgeon whose specialties include minimally invasive spine surgery and complex spinal deformities.
Learn more about UVA Spine Center -
Transcription
Melanie Cole (Host): For some patients with spine conditions, minimally invasive surgery may just be an option. My guest today is Dr. Hamid Hassanzadeh. He’s an orthopedic surgeon whose specialties include minimally invasive spine surgery at UVA. Welcome to the show, Dr. Hassanzadeh. Tell us a little bit about the difference between minimally invasive surgery and traditional spinal surgeries.
Dr. Hamid Hassanzadeh (Guest): Thanks very much for having me. Minimally invasive surgery is a newer technique which has been promoted or been evolved over the last decade. The benefit over classic open surgeries is that you don’t need to get cut through the muscle, so it’s a muscle-sparing procedure. By just dilating the muscle, we get an area we want to work and we perform the work we want to do without creating new damage to the muscle and the soft tissue down the spine. You have to know that a lot of related complications of the spine is related to the soft tissue coverage of the spine. We try to minimize that complication with approaching the spine through minimally invasive, not only skin incision, also muscle-sparing procedure.
Melanie: As back problems and spinal pain are such a huge problem in this country, what patients might be candidates for this type of minimally invasive surgery to help them with their problems?
Dr. Hassanzadeh: This is a very good question. Unfortunately about 80 percent of the population will have experienced some type of back pain in their lives. Not every back pain requires surgery. That’s a good thing. The first line of treatment for every back pain is actually non-operative management, but in a patient who has stenosis, disc degeneration or some stability, minimally invasive procedures are very good approach or technique to address the problem, and usually the recovery is a little bit faster, actually much faster. They don’t need that much rehabilitation to return back to work and to activities of daily living.
Melanie: How do you determine whether somebody is a candidate? When they do have this pain, it’s not really working to use anti-inflammatories or whatever else that they’ve tried, then what’s the next step?
Dr. Hassanzadeh: The indication for a spine surgery, few things have to speak the same language. The clinical presentation, the complaints you have, should show the same problem in the imaging of spine in MRI and so on. Once we have the same problem and we know we can help it with a surgical procedure, then it’s usually surgery indicated. In a case where we exactly know we would do this, then the patient will improve significantly, 90 percent chance or higher than 90 percent chance. The first line of treatment is always activity modification. We try to do it non-operative and anti-inflammatory medication and also core muscle strengthening is a huge part of prevention and also treatment of the spine problem. There’s also a point that non-operative management just aren’t enough to provide enough relief, then the next step is obviously after having the appropriate imaging to perform the appropriate surgery.
Melanie: With minimally invasive spinal surgery, how long usually is somebody in the hospital and then what is it like afterward? How soon can they return to activity?
Dr. Hassanzadeh: All this will depend on the extent of the surgery. For just the decompressive surgery for stenosis or discectomy, patient leaves the same day. Patients are able to leave the same day. Eighty percent of all my decompression or discectomy patients will leave the same day and they’re back to work within the week if they’re having just light duty job. In cases of heavy duty job, then it takes about six weeks to return to work.
Melanie: Then how soon should they see results? I know it depends on the type of surgery and what their problem was to begin with, but generally, how soon can people feel a reduction in pain or the shooting pains that go down their legs or whatever reason that they came in to see you?
Dr. Hassanzadeh: This is a very good question. It’s a question asked a lot by my patients. As you said, the pathology differs in outcome. In terms of acute disc herniation and having a disc problem, compression on a nerve, it’s immediately. This is really the patient wakes up and they have no pain really. It’s a very gratifying moment for us as physician to see the patient being pain-free and so very grateful for that. There are some other pathology that would take time. Usually you see the majority of benefits first six weeks to three months, and a complete recovery is about six months. In larger cases, the deformity cases where multilevel fusions are involved and very long surgery, then recovery could take up to a year.
Melanie: Is there physical therapy needed after this type of surgery?
Dr. Hassanzadeh: Again, it depends on the type of surgery and it depends on the patient’s activity levels. When patients are very active to start with, yes, especially after fusion surgery we send them back to rebuild their core muscles to prevent further problems in the future.
Melanie: Let’s talk about some of that prevention and strengthening. You’ve mentioned the core. What do you like people do to keep a really good, strong spine?
Dr. Hassanzadeh: I think working out is very important. It’s not only the back muscles. It’s abdominal muscles, chest muscles, hip muscles, they’re all important to keep a stable core. What I mean by that is you can divide. There’s so much pressure we have when we walk, when we run, when we do things. You can drive the entire pressure to the spine and will have back pain or you can divide the pressure through your muscles and spine. By having a very strong core muscles, then the muscle will take a lot of that pressure or force away from the spine, so it’s a divided work, so you will see less pain as a result. Also as to degeneration, you can decrease the rate of degeneration of the facets, joints, and discs, and so on.
Melanie: Dr. Hassanzadeh, tell us about what’s going on in the horizon picture for minimally invasive spine surgery. What’s really exciting that you’re doing there at UVA?
Dr. Hassanzadeh: I think the beauty of the spine surgery is that we can transfer this to other fields. One of the major advances we have here by collaborating with other teams, not only within orthopedics but also outside the orthopedics department, we start treating some of the complex factors through minimally invasive techniques, and that’s a huge advantage we are currently studying and could affect bio-mechanic study to prove that it’s really as stable as a local procedure. We’re convinced that it’s going to be the future. I think the future will be less soft tissue damage, more precise surgery through small incision. Having the technology behind us, it makes our work much easier. This is the exciting part, to be in UVA, it’s a great place because of the resources that UVA has as a lead institution. Also, people are around… medicine is always a multidisciplinary teamwork. If you have the right people in the right positions, the work is easy and patients benefit the most.
Melanie: Great information. Thank you so much. For more information on the UVA Spine Center, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Have a great day. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 3
- Audio File virginia_health/1451vh5c.mp3
- Doctors Thomas, Matthew
- Featured Speaker Mr. Matthew Thomas
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Guest Bio
Matthew Thomas is a genetics counselor at UVA’s Cardiovascular Genetics Clinic and at UVA Children’s Hospital.
Learn more about UVA Heart & Vascular Center and UVA Children’s Hospital -
Transcription
Melanie Cole (Host): Heart conditions run in some families and genetic testing may help family members better understand their risk for hereditary heart conditions. My guest today is Matthew Thomas. He’s a genetics counselor at UVA Cardiovascular Genetics Clinic. Welcome to the show, Matthew. Let’s talk about genetics and heart disease. How would someone know if they are at risk for an inherited heart disease?
Matthew Thomas (Guest): Melanie, thank you for having me. Someone would know if they’re at risk for an inherited heart disease if there is a pattern of the disease in their family. What you tend to see with heart conditions that are genetic are people that get diagnosed with certain heart problems, like enlarged hearts or cardiomyopathies or heart rhythm disorders, arrhythmia at younger ages than you would expect. The thing that stands out about inherited heart disease is these are caused by genes that are faulty, that you’re just born with and that maybe running in your family for generations. It’s not the result of poor diet or lack of exercise. It’s a genetic predisposition that you have. Some clues that you would see aside from an early age of diagnosis are someone in the family passing away suddenly and unexpectedly at an age younger than would be expected, say, less than 50 years old. Those are a couple of things that stand out.
Melanie: What would somebody do if they find out that their family members, immediate family members, have had heart disease problems before? What would you advise be the first thing that they should do?
Matthew: The patient or person out there who’s concerned that they may have an inherited heart condition in their family, the most useful thing that they can do is just gather their family history, talking with siblings or parents, grandparents, aunts, uncles to find out if there was somebody who passed away suddenly at a young age. What were the circumstances behind that? Was there ever a diagnosis? One thing I commonly see when I meet with patients is that people commonly refer to any death that happens suddenly as a heart attack and what it turns out is oftentimes that heart attack may have actually been a typical heart attack that many people can have, but there are also heart issues, cardiac arrests, that can be caused by an electrical problem with the heart or structural problem that has nothing to do with a typical risk that you would get again from diet and exercise or related concern. Collecting the family history would be step one, and then if the patient has a concern, sharing that information with their primary care doctor. You can even directly call a cardiovascular genetics provider to find out, “Okay, is this a good reason to come in for a concern? Is there something that you might be able to help me with?”
Melanie: What can someone expect when they’re getting a genetic test for heart conditions and does the genetic test tell you anything about their lifestyle risk for heart disease?
Matthew: Genetic testing has some good value for people that are concerned about their risk for having a heart condition that’s running in their family. Occasionally, we are able to find a test result that explains exactly why somebody has a given heart condition. For example, if somebody comes to our clinic with a genetic heart condition called hypertrophic cardiomyopathy where a portion of the heart is thicker and it can lead to certain problems with how the heart pumps and send the electrical signals in the heart, we can do a very cutting edge state-of-the-art genetic test on a blood sample to find the gene that’s responsible for that patient’s heart problem. Then, that test can then be used for other people in the family, like if a mother comes to see me when she has children that are about to start playing sports in high school and she wants to know, “I have hypertrophic cardiomyopathy, are my children at risk? Is it safe for them to play sports?” By finding the gene in the mom, we would have the ability to then know whether the children may carry the gene or not and that would determine what their risk is for having that disease. If we find the gene in one of her children, then they may receive some restrictions in their exercise actually. For some people, it’s not safe to be in competitive sports when you have this heart condition because it puts you at risk. On the other hand, if they’re negative for the gene, that means that they’re going to likely be cleared to play with no restrictions whatsoever, and that’s pretty reassuring to the athlete and the family.
Melanie: Besides blood tests, Matthew, what other type of tests do you do for genetic counseling?
Matthew: I work as a part of a team here, and what we typically do is a combination of genetic testing when indicated and cardiology screening. If genetic testing doesn’t provide any answer but we still believe a patient has an inherited heart condition, then we rely on cardiology testing, and that would be things like an echocardiogram or an ultrasound of the heart or an EKG which is looking at the heart rhythm. Sometimes, we do exercise testing and other sorts of heart studies that are not invasive, but they give us a good picture of the heart and its health and that gives us reassurance when you know there is a pattern of disease in the family when you examine somebody with good cardiology testing and interpreted by a cardiologist to determine if there is a current risk and whether that needs to be repeated again as the person gets older.
Melanie: What’s your role within the cardiovascular genetics clinic?
Matthew: I’m a genetic counselor. I work exclusively with cardiovascular disorders, and my role is to do two things. One is to identify patients that are at high risk for or have an inherited heart condition and offer them genetic testing that’s indicated based on their condition. The second thing is to get the word out to family. Even though I may be meeting with one patient in an afternoon, one patient per half hour, hour slot, I help reach the family members that aren’t in the room to make sure they know that they could be at risk for the same thing and they can get protected by close cardiology screening. So I basically work with them to offer genetic testing and then get the word out to family.
Melanie: If someone gets a positive test result, Matthew, does that mean they’re a ticking time bomb? Does that mean that they will necessarily have one of these types of genetic heart disease or are there things they can do to change the outcome?
Matthew: Fortunately, inherited heart conditions are very responsive to treatment. We may not be able to prevent problems from happening in some people, but we can certainly prevent actually the more serious complications like a cardiac arrest. That requires early identification of the disease and that’s what’s critical with this conditions. What we want to avoid is somebody who is at risk for a serious inherited heart condition that predisposes to cardiac arrests from not being aware of it, not receiving necessary medicine or receiving necessary surveillance to make sure that if they needed to have a procedure done to protect them that they don’t miss that opportunity. Fortunately, we feel very positive when we can diagnose the patient with the positive result that we can take good care of them to protect them from serious complications. Each disorder is very unique in the way that it affects somebody, but we are in general very positive about our ability to make sure that we can prevent really serious events from happening in someone.
Melanie: Why should patients come to UVA to address their concerns about inherited heart disease, Matthew?
Matthew: At the University of Virginia, we have a multidisciplinary team. I am a member of that team as the genetic counselor. We have cardiologists that specialize in electrophysiology or heart rhythm, congenital heart diseases, sports cardiology. We have specialists that emphasize heart failure, enlargement of the heart or cardiomyopathy. Whatever the individual condition is that’s running in the family, we have the expertise here to take good care. We all work together to help both patients and their family members who have these conditions, and as a team to make sure that we’re providing the optimal service for the entire family who comes here. This doesn’t happen in a vacuum. You mentioned the idea of this being for some people, when is the next you’re going to drop, what could happen next? We provide as much support as necessary to make sure that when we make these diagnoses, the patients feel that they get the support they need to live the most fulfilling and active life that they possibly can.
Melanie: Thank you so much, Matthew. For more information on the genetics clinic at UVA, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Have a great day.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 2
- Audio File virginia_health/1451vh5b.mp3
- Doctors Kozower, Benjamin
- Featured Speaker Dr. Benjamin Kozower
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Guest Bio
Dr. Benjamin Kozower is a board-certified surgeon whose specialties include esophageal cancer and lung cancer.
Learn more about UVA Cancer Center -
Transcription
Melanie Cole (Host): If you found that you’ve had difficulty swallowing or weight loss without trying, you might want to see your doctor because you do need to be checked for esophageal cancer. My guest today is Dr. Benjamin Kozower. He’s a board-certified surgeon whose specialties include esophageal cancer and lung cancer at UVA. Welcome to the show, Dr. Kozower. Tell us a little bit about esophageal cancer and who is at risk for this?
Dr. Benjamin Kozower (Guest): Sure. Well, there are really two main types of esophageal cancer. First type is called squamous cell and the two main risk factors for that are really smoking and then use of alcohol. In the US, that’s actually not as common now, although it previously was the most common form. Now, the most common form occurs at the bottom of the esophagus close to where the esophagus meets the stomach. That is dramatically increasing in the US. In fact, that’s one of the only two cancers that’s actually increasing in frequency. The cause for that is heartburn. The reflux that we have of contents coming from the stomach and actually moving up into the esophagus is really not good for the lining of the esophagus and that’s what predisposes patients to then have changes in their esophagus that ultimately can go on to cancer.
Melanie: Because we’re experiencing more heartburn, do you advise that people kind of keep an eye on that or get checked for Barrett’s esophagus, things that might increase their risk?
Dr. Kozower: Absolutely. That’s really the key to this whole thing. Unfortunately, as our population continues to kind of grow in weight, that puts us at increased risk for heartburn and for reflux, and then you mentioned that term, Barrett’s esophagus. So patients who have reflux who know they have heartburn, it’s not just enough to take something over-the-counter, and now some of the stronger medications can actually be purchased over the counter. They’re really good at helping with symptoms, but what patients don’t understand is that they decrease the amount of acid in the stomach. That helps patients feel better, but they don’t stop the contents from the stomach from going up into the esophagus. Even though you’re feeling better, you could still potentially have a lot going on that you’re not aware of. So, for patients who really need to be on this medications long term, it’s really important to get checked by their physicians, to have an endoscopy performed which is where a scope can get put in through the mouth and you can actually look at the esophagus. If you find something that shouldn’t be there, then you could actually take a sample of that. Then you can find out exactly what’s going on.
Melanie: Dr. Kozower, does endoscopy, like colonoscopy, if you find something or polyps in there or something and you remove them, does that then reduce your risk as it would in a colonoscopy?
Dr. Kozower: Yeah, it’s very different. You don’t really get polyps in your esophagus like you do in colorectal cancer, so they’re not really analogous. But what you can do is you can identify patients who have Barrett’s esophagus or who potentially have a very early stage esophageal cancer that could be cured.
Melanie: What are some treatment options if you do find that they have early stage esophageal cancer?
Dr. Kozower: Yeah, the most exciting treatment option is now to treat it endoscopically. In this kind of injury that takes place to the esophagus, you first develop Barrett’s esophagus and then you go on to something called dysplasia, and you can get as complicated as you want, but just keeping things fairly simple, then dysplasia goes on to cancer. The most exciting treatments now are treatments that are endoscopic. The first thing for patients who have bad dysplasia, which is a strong risk factor for cancer, is you can actually ablate that endoscopically using radio frequency ablation. That dramatically reduces the risk for cancer. The other exciting thing is, for patients with a very early cancer or very small nodule you actually can take it out endoscopically. That combination of treatments is quite effective. Unfortunately, most patients are not identified that early. For the majority of patients, the primary treatment is surgery; you have to remove the esophagus. It is a big operation so patients have to be fairly healthy, but we can do that in all different ages. Then the other treatments are chemotherapy and radiation therapy. One of the things we’ve learned over the last 10 years is for the majority of patients who present with symptoms – when you started this segment, you said for patients having trouble swallowing or patients who have lost weight. Unfortunately, when you get those symptoms, it’s typically not an early stage cancer, meaning, that the cancer has kind of gone through the wall of the esophagus and also involves some lymph nodes close by. The best treatment for those patients is combine therapy using essentially all three of those treatments. Radiation and chemotherapy first, followed by surgery. It’s a lot of treatment for patients, but fortunately, we’re having more and more success with it.
Melanie: If somebody does have to have a portion of their esophagus removed, tell us how that affects their daily life because this is a scary type of cancer and so people don’t know what to expect if they had to go through this type of treatments.
Dr. Kozower: It’s a great question. When patients heal, they ultimately can eat anything they want. What they can’t do is they can’t eat the same quantity of food. Typically, we have patients eating six smaller meals a day instead of having three large meals. Unfortunately, with Christmas coming up, you’re probably never going to have a huge plate of food like you used to, but ultimately when everything heals, you can eat all types of foods. The other problem is that everybody gets some reflux. We talked about reflux being the cause for esophageal cancer, but we actually when you take the esophagus out, you make a tube out of the stomach and you bring that tube up and you’d reconnect it with the esophagus. You really have to have patients sleeping with their head of the bed elevated. You don’t want to eat right before bed. Those lifestyle changes along with smaller and more frequent meals are things that we have patients do for the rest of their lives.
Melanie: Tell us about some of the really exciting advances in esophageal cancer today and things you’re doing at UVA.
Dr. Kozower: I think the most exciting treatment is really the endoscopic resection. That’s when you can identify these patients at an earlier stage. That’s why it’s so important for patients with symptoms of heartburn who need to be on medicines, whether it’s the proton pump inhibitors that most people take and there’s many different names for them now, it’s really important to get that endoscopy early and make sure that there’s nothing bad going on. The most exciting treatment is instead of the big surgery that I was talking about is to treat it from the inside. From a surgical standpoint, we now do at UVA about a third of our surgeries in a minimally invasive fashion, and so we’re able to accomplish the same results but with a lot less pain and decreased time in the hospital. The third major change is this use of kind of multimodality therapy or the combination of the therapies. It’s a lot easier for patients to get the chemotherapy before surgery than it is after. That’s really important. God forbid any cancer cells are out of the esophagus in the blood stream. The purpose of the chemotherapy is to be able to attack those early.
Melanie: In just the last minute, Dr. Kozower, tell the listeners why patients should come to UVA cancer center for their care.
Dr. Kozower: At the University of Virginia, we really do have the latest in multidisciplinary care, so we have a dedicated team of gastroenterologists and they’re the ones who handle the endoscopic side, doing things with the scopes. Then we have three dedicated thoracic surgeons who do all, what we call, general thoracic surgery. So we don’t do heart surgery, we don’t do general surgery, we just do thoracic surgery, and our outcomes even compared with national benchmarks are quite good. Then we have a dedicated team of both medical and radiation oncologists who are used to taking care of patients who unfortunately have esophageal cancer. I think that’s part of the main advantage that we can offer is that we have a team including our nurse coordinators, who can really help guide patients through this whole process. When I meet people the first time, I tell them that it’s a long journey. It’s not a sprint. You really have to kind of understand that you’re buying into this, and in the end, you’re going to have a pretty good quality of life, but it does take some work to get there.
Melanie: Thank you so much. For more information on the UVA Cancer Center, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole. Have a great day. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 1
- Audio File virginia_health/1451vh5a.mp3
- Doctors Miller, Mark
- Featured Speaker Dr. Mark Miller
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Guest Bio
Dr. Mark Miller is board certified in orthopaedic surgery and sports medicine. He specializes in treating sports injuries, including injuries suffered by skiers.
Learn more about UVA Orthopaedics -
Transcription
Melanie Cole (Host): As winter begins, skiers are going to take to the slopes for the ski season. What are some of the most common injuries that they will face and how do you prevent those injuries in the first place? My guest is Dr. Mark Miller. He’s board certified in orthopedic surgery and sports medicine at UVA. Welcome to the show, Dr. Miller. What are some of the most common injuries you see with skiers?
Dr. Mark Miller (Guest): Thank you, Melanie. Yes, there’s a variety of injuries we see with skiers, ranging from knee injuries to hand and wrist injuries to simple overuse injuries. Prevention really is a matter of conditioning yourself ahead of time and taking lessons so that you’re a qualified skier and ski under control at all times.
Melanie: That’s great advice, certainly advice that I’m hoping that even snowboarders will take from you, Dr. Miller. Let’s just start with can we prevent injuries by having proper fitting boots, binding skis, as you said ski in control and take lessons if you need to, but does the base of support have anything to do with our injury prevention?
Dr. Miller: Absolutely. Bindings have gone through quite an evolution in even my ski lifetime. Used to be you just strap on whatever bindings happen to come on that particular ski, but nowadays, there’s a lot of technology in bindings. You should caution people not to set their bindings so tight that they won’t come out of the bindings. That’s the whole idea, to come out of those bindings when you have a significant injury. Otherwise, you can very likely get an ACL tear in your knee, for example. That’s how the bindings are designed, so you shouldn’t over-tension them, thinking that you’re a better skier than you really are.
Melanie: What about maintaining a certain level of fitness or pre-training if you’re going to start skiing? Just hitting the slopes can predispose someone to injury, too, can’t it?
Dr. Miller: Absolutely. There’s something to the fact that most of these injuries occur late in the day. That’s because at that point, your quads are tired and you’re really kind of not in control as you’d like to be and therefore, conditioning is critical. Also, take breaks and quit early if you’re tired. Never ski tired. You’re at risk for injury.
Melanie: Do you happen to have some advice on how they’ll know if they’re tired? Because it is certain, I’m right there with you and I’m always stopping my kids and saying and they say, “No, we’re not done yet.” What do you think are some signs that you might be fatigued and that’s the time to stop skiing?
Dr. Miller: Well, I like to call it quad burning. When you’re doing the bump for even just making a lot of turns and your quadriceps in your thighs start burning, that’s a pretty good sign that you’re getting pretty tired. That’s a good warning sign also if you’re having to stop frequently to catch your breath. Mountain altitude is sort of part of that issue. All of these come into play. If you’re tired, take a break.
Melanie: Now, suppose you do get injury, whether it’s ACL injury or lower back or really anything, quad pulls, what treatments are available for skiing injuries?
Dr. Miller: Well, it depends upon the individual injury, but obviously, if you tear your ACL, no matter what sport you tear your ACL, then you’re out for the season and then you need to have an ACL reconstruction. If you have a back strain, then that requires just some rest and time, more than anything else. It’s simply a matter of taking care of whatever problem there is and there’s experts available in every area to do that for you.
Melanie: Where do you stand on braces, Dr. Miller? If somebody has previous knee, maybe instability, or just they had had a previous injury, do you advise wearing a brace when they ski?
Dr. Miller: That’s an interesting question, and actually this is the one area in all of orthopedics that this has been shown to be effective, that is in preventing recurrent ACL injuries after ACL reconstruction in skiers, and so this has been proven that there is some benefits to that. It’s also beneficial to wear a brace just for proprioception feedback in people that need that. Braces are a very reasonable thing to wear in skiers.
Melanie: What about icing afterward? Do you advise using ice after you’ve hit the slopes or is the hot tub the better place to go?
Dr. Miller: I always tell people heat before and ice after. Ice is a very reasonable option after your skiing, particularly if your knee or your joint swells because this is a very effective modality after your activity. So, it’s “heat before, ice after.”
Melanie: Now, what about things like just meniscus problems or really anything that may not be something that require surgery? How long if you have one of these injuries can you wait before you get back on the slopes?
Dr. Miller: Well, I think it’s a matter of returning gradually, and I tell my patients this all the time. It’s wise to just kind of take things incrementally. Try some conditioning. Try some cross-training. Try elliptical trainer and then increase a little bit. Try to do more things or do some activities or you change direction, and as you progress, then you can progress accordingly. The first day you go back, maybe ski just a few hours, take a break, assess how you’re really doing and then gradually get back. Start on the easier slopes and then work your way back. Once you have an injury, you gradually work your back to the level you were before. It doesn’t happen immediately.
Melanie: What about stretching before you ski? Do you stop mid-skiing halfway through the day and stretch out your muscles? Where do you stand on that?
Dr. Miller: Stretching is somewhat of an individual thing. Some people get tremendous benefit from that and they’ve done that as part of their exercise regimen all along. Those people should continue to do that. Other people don’t require it as much. In general, it’s a good idea to stretch before you do exertional activities.
Melanie: What about things like plantar fasciitis? If you’re somebody who suffers from this, Dr. Miller, you step into those boots in the morning and it’s pretty painful for the first, maybe, hour. Do you have some advice for people?
Dr. Miller: Sure. For some reasons technology really hasn’t caught up with ski boots. They are uncomfortable no matter what for everybody. I think it might be reasonable for people who have suffered from foot injuries to maybe have their own custom boots and it’s maybe worth the investment for those people. You can also use inserts just like you use in your ordinary shoes. Try to not skinchon the boots and get more comfortable boots.
Melanie: You mentioned cross training, which is so really important to avoid those overuse injuries. What other types of activities would help you become strong for skiing?
Dr. Miller: Yeah, I think more than anything else, it’s aerobic conditioning, so it depends upon the status of your knees and your hips. If you’re a jogger, then I think that’s a good thing to do for conditioning. It’s more a matter of building up your endurance and your aerobic capacity. Because when you’re skiing at an altitude, it’s more difficult to catch your breath and stay fit.
Melanie: It absolutely is. In just the last few minutes, if you would, Dr. Miller, please give your very best advice for preventing ski injuries and also why should patients come to UVA for treatment of their sports-related injuries.
Dr. Miller: Sure. We can prevent ski injuries by being prepared – the old Boy Scout motto. In other words, be fit. Get your aerobics fitness together. Get your equipment together. Don’t skinch on safety items. Ski under control. When you get tired, rest.
As far as UVA, we offer a whole variety of orthopedic treatment options for people from nine to 90 and we have all certified and specially trained orthopedic surgeons to take care of every need you have. In our sports division, we have surgeons that cover the entire gamut of sports medicine, from hip arthroscopy to multiple ligament knee injuries to complex shoulder problems. We’ve got it all covered with experts in their field and nationally and internationally known surgeons, so come to UVA.
Melanie: That is absolutely great information. Thank you so much, Dr. Mark Miller. For more information about UVA Orthopedics, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole. Have a great day. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 4
- Audio File city_hope/1451ch1d.mp3
- Doctors Sudan, Nimit
- Featured Speaker Nimit Sudan, MD
- Guest Bio Dr. Sudan is board-certified in internal medicine, hematology and oncology, and is also certified in acupuncture.
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Transcription
Melanie Cole (Host): Deodorant, plastic bottles, grilled foods, cellphones, artificial sweeteners, herbs and supplements, is cancer contagious? All of these questions are what we call cancer urban legends, and we’re going to answer that question today, if any of these products and legends are really true. Do they really cause cancer? My guest today is Dr. Nimit Sudan. He is board certified in internal medicine, hematology and oncology at City of Hope. Welcome to the show, Dr. Sudan. Tell us about some of these. Let’s start with cellphones because people are thinking now, Bluetooth and cellphones, holding them up to your head is causing brain cancer. Do these radio waves cause cancer?
Dr. Nimit Sudan (Guest): Well, a lot of cancer myths and cancer legends start on very good data, and when we do bigger studies, we find maybe some of the carcinogens, for example, with cellphones that emit radio waves, you know, when the rubber hits the road, we find actually that some of this is not true or it may not be as bad as what we thought. For example, cellphones do emit radio waves which is part of the spectrum of radiation, and radiation does cause cancer, but the radio waves or radio frequencies that cellphones emit are actually non-ionizing radiation. The tissues can absorb this energy and certainly cancer can occur, but a lot of studies have shown that this is actually not that harmful. A lot of studies have shown that there may be some increase in incidence of cancer, but it’s not enough to say, “Do not use cellphones.” It’s not enough to promote other technologies, which take the cellphones away from your head. With that said, what do I do at home? I have kids and I tell them, “Don’t use cell phones, they cause cancer.” In reality, studies really have not proven that cellphones will cause brain cancer.
Melanie: Okay, so what about contagious. Is cancer contagious?
Dr. Sudan: No, cancer is not contagious. Other than a few instances, I tell my patients, “There’s nothing you did that could have caused this, there’s nothing you did that could have prevented this.” For example, breast cancer. There’s not much in life any woman ever did that cause this. Now, a lot of this is family history. A lot of this is the environment. A lot of it is aging, etcetera. A lot of other reasons why cancers occur, but a cancer is not contagious. I sit in a cancer center with lots of patients who have cancer. It is not contagious. I’m not afraid I’m going to get cancer from a neighbor or friend or a patient. That truly is a myth. There are some exceptions to that. There are some viruses that can cause cancer. If you get the virus, you can get cancer. I suppose if you stretch it, that’s really the only exception to that rule. Even that is really stretching it.
Melanie: So if you have surgery to remove a cancer or a biopsy or something, does that then spread the cancer through your body? Also, women hear that mammograms, because of that compression, that if you did have a breast tumor, it’s going to break it open and spread it through your body. Is that true?
Dr. Sudan: Some of what you’re saying is partially true. Mammograms, just like cellphones, have radiation. It’s really that radiation that causes cancer. If a woman starts getting mammograms at age 20 and stops at age 80, that’s a lot of radiation over a lifetime. That was the debate several years ago. When should women start getting mammograms, at what age? Is 32 young? Are we exposing women to too much radiation over their lifetime? Should we start at 50? Should we start at 40? It’s not the actual compression, but it’s actually the cumulative dose of radiation throughout their lifetime. As far as biopsies and surgeries, most of the time when the patient goes in for surgery and the cancer is more advanced than before surgery, it’s because we really didn’t see it on CAT scans. The CAT scan is a picture. Any imaging is a picture. When you take a picture, there are certain details you don’t see. Sometimes, when a patient has pancreatic cancer and we just see a mass in the pancreas, we open them up and then we see little tiny cancer nodules on the liver that just was not seen on the CAT scan. It wasn’t the surgery that caused it to spread that fast. There are certain exceptions. There are certain cancers we do worry that if we biopsy, maybe we can see the tract where the needle is. For the most part, that’s not the case. For day to day, most of the cancers that I deal with, I have no concerns that either surgery or a biopsy will spread the cancer.
Melanie: Okay. So, Dr. Sudan, what about things like artificial sweeteners or grilled foods? We’ve heard that grilled foods and smoky foods, smoked turkey, smoked salmon, that these smoky foods and grilled foods with the char on them, can also contribute, that they’re carcinogenic.
Dr. Sudan: Yeah, now we’re walking into an area where certainly grilling foods and smoking, they are carcinogens that end up on your food. But, again, it’s the same thing. For the most part, when we do the studies, we don’t find there’s a huge increase or any increase in cancer. When you grill food, there’s a lot of char that may be left over on the grill itself from the last time if you don’t clean well and some of that gets on your food. Again, for the most part, these things do not and have not been shown in studies that increase cancer. There are compounds on the foods that are carcinogenic, but again, these have not shown an increase in incidence with people who eat grilled foods.
Melanie: What about standing behind the bus out on the street? Is smog just as cancerous as if you were smoking a cigarette?
Dr. Sudan: Well, that’s a good question. Again, smog, smoke, secondhand smoke, grilling foods, they all have similar carcinogens. Depending on where you live, there may be certain industries that there were smoke stacks, etcetera that put a lot of carcinogens in smoke and chemicals in the air. Again, I think some of that you have to take into account where you live and what the actual carcinogens are. There are towns that I have been in that I look around that has industry. I grew up in the Midwest. There are small towns that are just based on the auto industry and there may be a factory there that makes a certain compound or a chemical for plastic or what have you. Now, if you’re working in that factory, you need to wear protection because the concentration of chemicals there are very high. Outside, it’s not as high. Now, again, I told you I have kids. What do I do at home? Would I live in a clean city or a city with lots of smog? I would prefer a clean city. I think some studies are not powered enough, meaning, they’re not big enough to really show a difference in harm. Sometimes, things like secondhand smoking or smog is really hard to study. You have to study millions and millions of people over decades. Those kinds of studies are actually very hard to do.
I think a lot of studies have shown no significant increase in cancer incidents with smog and even secondhand smoking, but when it comes to my family, my kids, I would prefer to live in a clean city without secondhand smoke.
Melanie: In just the last few minutes, Dr. Sudan, please tell the listeners some cancer facts that are true and that do matter. We only have a minute or two, but just share some really interesting and very important information, the best advice you would give somebody on hopefully preventing or dealing with cancers.
Dr. Sudan: We do know a few things. For example, smoking causes cancer, so stop smoking. If your lifestyle is better, we can lower the incidence of a lot of different cancers. For example, diet and exercise, the usual mantra of any physician, will lower your incidence of cancer. For example, eating less red meat and more fiber will lower your incidence of colon cancer. I think living a healthy, active lifestyle with a good diet will help. Now these days, cancer treatment and prevention has gone night and day in the last 10 years. It has progressed so much. So much research is being done. Fifteen, twenty years ago, cancer usually was a death sentence. We found cancer too late, we didn’t have a good screening method, and the treatment wasn’t that great. Today, we find cancer early. We cure a lot of people with cancer. Even people we can’t cure, we can treat and keep them around for a long, long time sometimes. The treatment of cancer is changing. It’s not the old chemotherapy where you’re in the hospital and sick and throwing up for weeks. These days, we have pills, we have antibodies. If you sit in my waiting room in our cancer center here in City of Hope, I bet you couldn’t even tell half of the people are getting treatment for cancer. Things have come a long way. I urge patients and people, I urge everybody, to make sure they’re up-to-date, they see their family doctor to get screening and not be afraid to seek treatment if they indeed have cancer.
Melanie: That’s great information and really great advice. Thank you so much. 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/1451ch1c.mp3
- Doctors Mandelin, Paul
- Featured Speaker Paul Mandelin, MD
- Guest Bio Specializing in radiation oncology, Paul Mandelin, M.D., is a board certified radiation oncologist. He is educated in radiation psychics. His motto is: “I treat the patient, not the symptoms. It’s a team approach that helps patients deal with their treatment course and recovery.”
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Transcription
Melanie Cole (Host): Radiation oncology is one of the three main oncology specialties involved in the successful treatment of cancer. This specialty provides expert opinion on whether radiation therapy will be used for your cancer and how best to safely and effectively deliver it. My guest today is Dr. Paul Mandelin. He’s a board-certified radiation oncologist with City of Hope. Welcome to the show, Dr. Mandelin. How does radiation therapy work and what is radiotherapy?
Dr. Paul Mandelin (Guest): Basically, radiation therapy is high-energy X-ray, so it’s very similar to what you would get with a CT scan or a standard chest X-ray, but it’s very high energy and very focused and just on the area that we’re treating.
Melanie: Are there different kinds of radiation?
Dr. Mandelin: There are several different types of radiation available. The main type that is used is called the photon and that’s basically a high-energy X-ray. There’s also particle types of radiation called electron or in certain centers, proton, and all used for different things, treating different types of tumors or different locations in the body.
Melanie: Give us some examples of what types might be used for what types of cancer.
Dr. Mandelin: The typical cancers like breast cancer, prostate cancer, lung cancer are treated with standard photon radiation, which is a high-energy X-ray that penetrates right through the body. The best way I like to describe radiation therapy is it’s similar to pointing a whole bunch of flashlights all across the paper where those flashlights meet in the center is very bright. That’s the area we’re concentrating on, the tumor and the regional lymph node. Around the outside of the area is dull because we have to get the radiation in there somehow, but we’re not aiming at the other critical structures that could be in the way.
Melanie: Okay, is this a safe type of procedure to have?
Dr. Mandelin: Nowadays, radiation therapy is very safe. We use multiple imaging modalities including CT scans, MRIs, PET scans, to help us really focus radiation on the tumor and stay away from those critical structures like the spinal cord or normal tissues and normal organs that are in the area.
Melanie: What about skin problems, Dr. Mandelin? People are worried about the skin around the radiated area.
Dr. Mandelin: Skin can be an issue in radiation therapy if we’re treating something on the outside. The most common thing in breast cancer therapy is getting a skin reaction and we actually expect that to some degree. When we treat something deep inside the body, like the prostate and the lung, it’s uncommon to actually get a skin reaction. We have multiple medications and creams and recommendations to help make that skin reaction less and more tolerable.
Melanie: Tell us about some of the side effects that result from radiation therapy. Is fatigue – people know about chemotherapy side effects, but what are the side effects from radiation therapy?
Dr. Mandelin: The side effects from radiation therapy really depend on the area that we’re treating, or the local therapy. That’s why I like to use the flashlight analogy. Chemotherapy, as you mentioned, goes through the whole body, and that can have side effects like hair loss and nausea and vomiting and things like that. With radiation, we affect only the area we’re treating. If we’re treating in the breasts, it’s really the skin. If we’re treating in the head and neck, unfortunately, it can be pain and difficulty with swallowing or sores in the mouth and things like that. From the radiation standpoint, all of the side effects are well tolerated depending upon if you’re getting chemotherapy at the same time or the area that we’re treating.
Melanie: Now, radiation, just the word scares some people, Dr. Mandelin. Are there late side effects or external side effects that come from using radiation on somebody?
Dr. Mandelin: Long-term side effects are the things we try and avoid the most. The acute side effects like skin reaction, pain and difficulty with swallowing, or the urinary symptoms if we’re treating the prostate, typically go away about four to six weeks after radiation is completed. Again, I like to use a sunburn type of analogy; when you see that skin reaction, the same thing is happening on the inside and that can cause them irritation. Once that sunburn goes away, you can have some residual tanning and then the tan slowly fades and kind of blends in with the normal skin color, but sometimes that can take a little longer than the standard sunburn to go away.
Melanie: Now, tell us a little bit about what radiation therapy really is intended to do and give a little bit of what people can expect if they are going in for radiation therapy for breast cancer, for example.
Dr. Mandelin: Taking the breasts as an example, the way we plan radiation therapy is we do our own CT scan and that’s again we want to mark the area that we’re going to treat. We want to use all the information we can, the mammograms, the biopsy results, the pathology results, and really focus in just treating the breast tissue and exactly where they took the tumor out. There’s multiple appointments before we’re actually able to start. We do that CT scan to plan it. It goes into the computer. We can draw in the area that we want to treat and we draw in the areas that we don’t want to treat so we can avoid those with the radiation. Then there’s the setup session where again we’re kind of double checking everything to make sure everything matches from the CT scan to the computerized treatment plan to the real setup in the actual treatment room. Then usually there’s a marking process involved, too, and that can be prominent marks where we can line you up with lasers every day to make sure we’re only treating the area that we want and able to avoid those critical areas. The unfortunate thing about radiation is that we do have to give it in little pieces. If we give radiation in larger amounts, the side effects go up. We just fractionationate it, meaning that we give daily, Monday through Friday, and that can take up to four to six weeks, and depending on the area we’re treating, sometimes longer and of course sometimes less.
Melanie: Now, prostate cancer is so common, but there’s a few different types of radiation you use for prostate cancer. Explain a little bit about the external beam and then what the seed is, how that differs from something you might do for say a woman with breast cancer.
Dr. Mandelin: Right. The prostate, you can treat with surgery or you can treat with radiation therapy, and with radiation therapy, there’s the internal type which is the seeding and then there’s external beam and also proton. The seeding involves an operative procedure so it’s under ultrasound-guidance. Again, it’s all based on a CT plan. You draw in the prostate, you estimate the amount of those radioactive seeds which is a little grain of rice you’re going to need and then you implant those seeds into a prostate and afterwards you do another CT scan to see where they actually wound up. That’s basically the opposite of the flashlight analogy. Instead of having all these beams coming from the outside pointing towards the middle, you’re putting the light bulb right into the prostate and then the dose fall off for the range of that radiation is very short so you can protect both the bladder and the rectum, which are the two structures right adjacent to the prostate. External beam radiation therapy, again, is that flashlight analogy where you’re taking multiple angles and coming around the whole pelvis focusing in just on the prostate. Again, being able to release the exact dose with the computerized planning and the CT scans that we use to avoid the bladder and the rectum.
Melanie: The main goal is to spare all the surrounding tissues. Does radiation actually kill the cells, Dr. Mandelin? What happens once they’ve been radiated?
Dr. Mandelin: With radiation, that’s the goal. We want to kill the cancer cell. We want to make sure that the cancer doesn’t grow back or doesn’t spread. Again, we’re the local therapy, so when we treat with say, prostate cancer, we’re treating the whole prostate gland. We want to eradicate the tumor cells and give the least amount of radiation we can to the bladder and to the rectum, which is where we get our two main side effects after radiation therapy is done, urinary symptoms or rectal symptoms that typically go away in about four to six weeks. Then we follow with PSA or other tests to see how effective we’ve been. There’s a very good control rate for early stage prostate cancer.
Melanie: What happens to the cells once you’ve killed them?
Dr. Mandelin: Basically, when you eradicate the tumor cells, you have scar tissue left behind. Sometimes, if you were to get an imaging study, you wouldn’t see any kind of tissue left behind. If it’s a little bit of a larger tumor or something that’s more invasive, you might see some scar tissue left behind. I like to describe radiation as like doing surgery without a knife. There are some side effects. You can get scar tissue and you can get changes on imaging studies but the main goal is that you have no active tumor cells left behind.
Melanie: In just the last few minutes, Dr. Mandelin, if you would, please give us your horizon. What’s going on in the world of radiation and why people should come to City of Hope for their radiation oncology services?
Dr. Mandelin: Basically, radiation is a very technology-driven field, so our main goals are to be able to focus the radiation in exactly where we want and again, reduce the dose in all the critical structures in the area and decrease the side effects. We do that with advancing imaging techniques, advancing treatment techniques, and enrolling people on clinical trials. We have clinical trials that involve different types of radiation, different amounts of radiation, different techniques of delivering radiation and we also enroll people in clinical trials that use chemotherapy concurrently and also using different imaging studies to follow tumor and try and do early detection and screening studies.
Melanie: Thank you so much, Dr. Mandelin, for such great information. For more information on radiation oncology, you can go to cityofhope.org. That’s cityofhope.org. You’re listening to City of Hope Radio. This is Melanie Cole. Thanks so much for listening. - Hosts Melanie Cole MS
