Inactive (722)

Segment Number 4
Audio File city_hope/1447ch1d.mp3
Doctors Lin, Michael
Featured Speaker Michael Lin, MD
Guest Bio Wei-Chien Michael Lin, MD is an associate clinical professor and staff surgeon at City of Hope.
Transcription Melanie Cole (Host): A diagnosis of gynecological cancer is life-altering. The gynecological oncology program at City of Hope offers a unique approach for women diagnosed with all types of these cancers. My guest today is Dr. Michael Lin. He is an associate clinical professor and staff surgeon in the gynecological oncology department at City of Hope. Welcome to the show, Dr. Lin. Tell us about gynecological cancers. What types are they and who is most at risk for them?

Dr. Michael Lin (Guest): The three most common cancers in this area are: The first most common one is uterine cancer. The second most common will be ovarian cancer. The third one will be cervical cancer. The other minor cancers are vulvar cancer, vaginal cancer, or gestational trophoblastic tumor. But majority is ovarian, uterine, and cervical cancer.

Melanie: What are some risk factors for these?

Dr. Lin: Well, obviously, the ovarian cancer, the most important risk factor is family history. For uterine cancer, the majority is obesity-related and also diabetes and hypertension-related. Cervical cancers are obviously HPV-related. In terms of the age risk, cervical cancer tends to be around late 40s, early 50s. Ovarian cancer tends to be around age 60, 70. Uterine cancer is anywhere between 50 and 70 years old.

Melanie: Then let’s talk about the most common first, the uterine cancer as you said. Tell us a little bit about symptoms. You know, Dr. Lin, patients always want to know symptoms first. Is there something that we would notice as women that would send up a red flag that would send us to see you.

Dr. Lin: Obviously, the post-menopausal bleeding is cancer until proven otherwise. If you’re bleeding post-menopausally, then it should be looked into and we need to figure where the source is coming from. Patient will only require a [Pap smear] of uterine lining to make sure it’s not cancer or pre-cancerous.

Melanie: Okay, so what are some treatments? You know, people hear uterine cancer and, wow, they think it’s a really, really tough one to beat. Tell us a little bit about uterine cancer treatments.

Dr. Lin: Uterine cancer is actually the exact opposite of ovarian cancer. Uterine cancer is actually very treatable and curable. Majority of uterine cancer is early stage because the presenting symptoms are vaginal bleeding. Women tend to show up early in their presentation and they are treated. Majority of treatments is surgically, by removing the source, which is the uterus, ovaries, and cervix, and majority of women will do well.

Melanie: So, you have a hysterectomy. Is this generally followed by chemotherapy and/or radiation? Does the hysterectomy generally take care of most of it?

Dr. Lin: About 75 percent of uterine cancer is stage I and majority of stage I disease are treated surgically and cured surgically. If patient has risk factors, either in stage I or stage II and above, the patient will require adjuvant therapy, but majority of uterine cancer will be treated surgically.

Melanie: Let’s move on to ovarian cancers—and this is an overview of all of these, Dr. Lin, we understand that—speak about symptoms of ovarian cancer because it’s been called the silent cancer. Why is that?

Dr. Lin: Yeah, it’s just because the symptoms are common among women, a lot of symptom mimicking menstrual irregularity, like bloating, abdominal distention, subtle early satiety, and some of these symptoms the woman go through in a monthly basis. These are like very subtle symptoms and unfortunately majority of these patients will present at advanced stage when the symptoms really blossom, when the abdomen is distended and they’re losing weight and clearly this is not right. Unfortunately, majority of ovarian cancers are presented in advanced stage, which is exact opposite of uterine cancer.

Melanie: We get a Pap smear every year, Dr. Lin, and the Pap smear will show us cervical issues, but how is ovarian cancer diagnosed if we only have symptoms such as bloating and bleeding, things that happen to us all the time? When do we ask our gynecologist to check for ovarian cancer?

Dr. Lin: Right. There is no perfect screening test for ovarian cancer unfortunately. Our current screening tools are tumor markers such as CA-125 and pelvic ultrasound, but even those two tests are not recommended on the general population because they are not specific and they can lead to unnecessary surgeries if this nonspecific finding shows up. I would say patient got to pay attention to subtle symptoms and discuss with their physician, and if it’s appropriate, the test can be ordered. In the general population without family history or personal history of breast cancer, screening is not recommended. That is a frustration among patients, that “how do I know?” If you don’t screen for this test, by the time it shows up, it’s too late. So far, there is no standard recommended screening test for ovarian cancer, unfortunately.

Melanie: Now, what about treatments? Hopefully, if you found this and you’ve discussed this with your doctor, what do you do for these patients?

Dr. Lin: Yeah, majority of ovarian cancers are advanced stage and the best treatment modality is aggressive cytoreductive surgery and removing all the visible tumor. That category of patient will give the best outcome when you follow aggressive chemotherapy after cytoreductive surgery. That’s been shown that it can improve overall survival if they’re cytoreduced to no visible disease and followed by chemotherapy.

Melanie: What about preventative surgery, Dr. Lin? If someone is at risk for ovarian cancer, genetic risk, family history, that sort of thing, is there preventive surgery and do you generally recommend that if somebody has that genetic risk for this?

Dr. Lin: Yeah, if the patient, either a personal history of ovarian cancer, breast cancer, or strong family history of breast cancer, ovarian cancer, and they are tested positive for the BRCA gene 1 and 2, the common recommendation is prophylactic oophorectomy after complete child bearing and probably this is recommended after age 40 to age 45 and that’s been shown to decrease the risk of ovarian cancer. Also, our current knowledge is that about 80 to 90 percent of BRCA-related ovarian cancer came from the distal tip of the fallopian tube. There had been a push for taking the fallopian tube out when patient is younger or when the patient is undergoing hysterectomy or preserving the ovaries for women who are BRCA-positive but not ready to take the ovaries out yet because of their age and to take the tube out. These are preventative measures that have been proven to decrease the risk of ovarian cancer.

Melanie: The BRCA gene that we’ve heard so much about for breast cancer is also the gene for ovarian cancer?

Dr. Lin: Yes, they are linked together.

Melanie: Do you recommend women get tested for this gene?

Dr. Lin: You have to refer to the clinical guideline for BRCA testing for any personal history of ovarian cancer, also the strong family history of ovarian cancer or breast cancer, or even a family history of male breast cancer. If you fit all those criteria, then the recommendation is go through testing.

Melanie: Now let’s just finish up with cervical cancer as it’s been related to the HPV, human papilloma virus, and now we’re giving girls this vaccine and boys in their early teens. Those of us who are past that age that we can get that vaccine are still at risk for cervical cancer. Are there symptoms we would notice?

Dr. Lin: For cervical cancer, the best strategy is prevention and screening for cervical cancer with a Pap smear and an HPV testing. The screening guideline has evolved and has changed. Now, the screening guideline is including both HPV testing and Pap smear; that can give the best predictive values. The best prevention other than vaccine in young girls and boys up to age 26, Pap smear, HPV testing is still the best tool we have in terms of detecting pre-cancer to cervix and prevent cervical cancer.

Melanie: In just the last minute, please, Dr. Lin, give your best advice for women that are worried about these gynecological cancers and why they should come to City of Hope for their care.

Dr. Lin: City of Hope is an NCCN-designated institution. It provides a state-of-the-art cancer cure in a multidisciplinary approach. We work closely with medical oncology colleague, a surgical oncology colleague, and radiation oncology colleague, and the approach is the comprehensive way on cancer cure. This is a team approach. The best team approach, comprehensive approach, gives the best outcome in cancer treatment.

Melanie: 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

Caring for Common Day Care Illnesses

Additional Info

Segment Number 5
Audio File allina_health/1447ah5e.mp3
Doctors Celkis, Maried
Featured Speaker Maried Celkis, MD - Family Medicine
Guest Bio Maried Celkis, MD is a board-certified family medicine doctor with professional interests in pediatrics, preventive care and women's health.
Transcription Melanie Cole (Host): Even at the cleanest day care centers, germs are a given. My guest today is Dr. Maried Celkis. She’s a family medicine physician with Allina Health Oakdale Clinic, and she’s here to provide us with some tips on how to care for some of the most contagious day care illnesses and what we as parents can do to help keep our children from getting sick. Welcome to the show, Dr. Celkis. Are kids who attend day care and preschools more prone to infection than kids who do not?

Dr. Maried Celkis (Guest): Absolutely. I think it’s just because of the exposure that they have. More kids, more germs, more chances of getting sick.

Melanie: Okay, so when we think of day care and some of the worst ones—pink eye and yikes, croup—and that’s why I don’t like to take my kids to the big ball pit -- you know, we call that ball pink eye. Tell us a little bit about some of those most common day care illnesses and what you want parents to know about them.

Dr. Celkis: There’s many, many common day care illnesses. I think just thinking about the most contagious ones, you think about just the common cold. Your child’s going to present with maybe a fever, a runny nose, cough, and as a mom of a toddler, I know a cough is the worst thing ever. That’s the most common symptoms for a cold. Pink eye is very contagious. The eyes can get red. They don’t necessarily have to, but the mattiness—they get matted shut in the morning—that’s the one that I want parents to note. Take your kids to the doctor. It’s probably going to be viral, but they may still get an antibiotic drop just because after 24 hours of being on the drop, then they can go back to day care and they’re not contagious anymore. Those are the ones that I’ve seen actually recently.

Melanie: Well, I think you bring up a great point. When do we as parents watch and wait? When do we say we don’t need an antibiotic? Because I’m sure as a physician, you are seeing parents come in and say right away they need an antibiotic even if it’s a virus. How do we know the difference between a virus and a bacteria?

Dr. Celkis: You know, that’s a good question, and it’s kind of hard. Unfortunately, one of the big answers is going to be time. We know that a common cold is going to last about a week and we know that it should be getting better with time. Even if some of the symptoms still last longer than a week, meaning, a runny rose or just a cough, but the child, they should be feeling better and you should see that improvement. If we don’t see improvement in about a week, then that’s when I start thinking, “Could this be something bacterial?” A common question that I get from parents is, “I think they have strep throat.” We need to remember that usually, strep throat does not present with a cough. A lot of the times parents come in saying, “My child has a sore throat, fever, and a cough. Therefore, it’s strep throat.” A lot of the time, it’s just a viral illness.

Melanie: When we think about things like stomach flu -- because you can get that just from somebody not washing their hands. And they’re at day care. It’s going to be a stomach flu extravaganza there. What is stomach flu different than actual flu influenza which we might get our children vaccinated for?

Dr. Celkis: Yeah, that’s a good question because that’s a common misconception. We call it the common stomach flu, but it’s not like the influenza. When you think about the influenza or just the flu, that is high fevers, sneezing, body aches. That’s also very contagious. We try to vaccinate everybody because it’s one of the most common preventable if we vaccinate adults, elderly kids. The stomach flu has a completely different gamut of symptoms. It’s stomach pain, nausea, vomiting, diarrhea, and you are so right, it is oh so contagious. I would recommend that if someone in the household has the stomach flu, clean the bathrooms, everything the child touches. Make sure that you wash the child’s hands—kids don’t do a great job at washing their hands. Use soap and water. Hand sanitizer is great for everything, but soap and water is great for the stomach flu.

Melanie: What do we do? Getting these germs at a young age, exposing these children, does that strengthen their immune system for later?

Dr. Celkis: There’s been many studies done in that same question, and the results have shown that it does. It does improve the immune system because immunity is immunity. Once you get something, you should be immune to it and not get it again. That being said, we got to remember that a lot of the common illnesses are viral, and viruses in nature tend to mutate, which is why we get the colds all the time. That being said, the child will less likely have sick days in elementary school if they’re exposed to these things in day care.

Melanie: Absolutely. Now, what would you like parents to know? What should we do as parents to hopefully prevent our children from getting sick? You mentioned hand washing, and while sanitizer is good -- do we send them with a little sanitizer or we just make sure they wash their hands 10 times a day?

Dr. Celkis: I would just make sure that they wash their hands before they eat and after they go potty. I am not a big advocate of having to wash your hands 20 to 50 times a day just to get the germs off. If they get sick, the body will take care of it, and for the most part, they do okay and now they have that immunity. So we don’t want to put them in a bubble. That being said, like I said, I’m a mom as well and I know the sleepless nights and how much we suffer when they suffer. We don’t want to get them sick just to get them sick, either. So, just good common sense prevention. Wash your hands after the bathroom, wash your hands before you eat, and that’s about all I would recommend.

Melanie: Dr. Celkis, what about disinfecting our surfaces? There are so many anti-bacterial wipes and sprays. Do we keep our house sprayed down, or is it sometimes good for kids to eat a little dirt?

Dr. Celkis: Sometimes it is good for kids to eat a little dirt as long as they have their tetanus shot. But yeah, it’s important to clean our house. But it just depends what we’re doing. If we’re working, of course, the kitchen, I would sanitize it. There’s raw meat. We don’t need to give them a bacteria or salmonella or anything. But we just don’t have to go overboard. The body does an amazing job in taking care of itself, and our immune system is wonderful. We just don’t have to be paranoid. Just use common sense. If there’s raw meat, if there’s blood, by all means, please use sanitizer and anti-bacterial. Other than that, just keep a nice house.

Melanie: Okay, this is an important question, Dr. Celkis, and one every parent asks themselves. When do we keep our child home from day care and/or school? If a stuffy, sniffling nose, or a cough, a fever, what is it that would keep our children at home?

Dr. Celkis: If your child has a fever, absolutely keep them home because they are contagious. If they have a little bit of the sniffles, a little bit of a cough, talk to the child about coughing into your arm to try to prevent the spread of that illness. I won’t necessarily say they have to stay home. But a fever is an absolute has to stay home.

Melanie: What about if they’re suffering from diarrhea or something? Is that a stay home, or…?

Dr. Celkis: Mm-hmm.

Melanie: We know vomiting, we’re not going to send a child that’s vomiting. What if they’re sneezing and coughing? Because coughing is a tough one.

Dr. Celkis: Yeah, coughing is okay. I think it just depends how bad the cough is. If the child can still function, like there’s no fever, they’re coughing and they’re acting normal, it’s okay to go to day care. If it wears them down that they can’t really participate in the day care activities, then I will keep them home.

Melanie: In just the last minute or so, Dr. Celkis, give us your very best advice for what we’re supposed to do as parents to keep our children safe and free from illnesses at day care.

Dr. Celkis: Well, the best advice I would have for parents is just to make sure the kid washes their hands before eating and after going to the bathroom. Please don’t send them to day care if they have a fever. If at any point there’s any question, by all means, please take them to their doctor. That’s what we’re here for. We all have families and kids and we care for them. Even if it just is a 5-, 10-minute visit, and we say, “Hey, the child looks okay,” at least you know and you have that peace of mind.

Melanie: Thank you so much, Dr. Maried Celkis. It’s great information. You’re listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening and have a great day.
Hosts Melanie Cole, MS

Help Your Teenager Manage Stress

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Segment Number 4
Audio File allina_health/1447ah5d.mp3
Doctors Roby, Myriam
Featured Speaker Myriam Roby, CNP – Family Medicine
Guest Bio Myriam Roby, CNP is a board-certified nurse practitioner specializing in family medicine. She has professional interests in family health, pediatric care and geriatric care.
Transcription Melanie Cole (Host): If your child is stressed, they’re not alone. Stress in teenagers is really common, so recognizing this and learning how to reduce the stress your teens experience is an important life skill for them. With knowledge, you can help your child to understand the good and bad stresses and how to talk to them and use tools to help them manage their stress. Today, my guest is Myriam Roby. She’s a certified nurse practitioner, specializing in family medicine. Welcome to the show, Myriam. Tell us what do you think are the biggest stressors in a teen’s life?

Myriam Roby (Guest): Of course, the number one stressor are parents. Parents can cause a lot of stress in our teens. Teens already have goals in life that they want to achieve, but parents sometimes place an extra little expectation on them. Sometimes, that can be unrealistic and that will, inside, cause the teens just to feel a little anxiety, just because the main key is they want to please their parents, they want to please their friends. The whole goal in a teen’s life is to make everybody happy with them.

Melanie: If they are trying to please all these people and they’re feeling like it’s too much on them, what about things like after-school activities? I am a parent, Myriam, who does not like to over-involve my kids, but I do see teens that are over-involved and it stresses them out. What’s a parent to do about this?

Myriam: Parents need to talk to their teens. Ask them, do they like going to chess? Is drama class really for them? Or would they prefer going to play basketball, maybe enjoying communing time with you out on the lake? The key is to communicate with your teen. Your teens can let you know what makes them feel good and what stresses them out. Pushing them to do things that they don’t like to do, that’s what’s going to cause them to have anxiety inside and they may not feel that they can come to you with those answers.

Melanie: As women especially, we have this negative self-talk, you know, we put ourselves down all the time, but we’re learning to tell ourselves positive things. What about teens? Do they kind of give themselves those negative thoughts and feelings? Their self-esteem is suffering. What do we do about helping them through those awkward teenage years?

Myriam: Again, I can’t reinforce enough: communication. We really need to talk to our teens. We ourselves need to evaluate. Are we open? Are we an open book for our teens to be able to come to and say, “You know what, mom and dad, I’m stressed out. I’m feeling this jittery in my stomach. Sometimes, my thoughts are racing in my head and can cause my head to hurt.” We have to make sure that our teens feel that they can come to us and we’re not going to judge them. We’re not going to put them down. We’re not going to yell at them. We’re just going to be there, present, and listen to what they have to say.

Melanie: While the teenage brains, Myriam, are so complicated and different than adult brains, can the stress in teens lead to other conditions such as anxiety or depression?

Myriam: Absolutely, it can. Unfortunately, when teens are growing, they have many different hormones that are racing through their bodies. Self-image is really, really important to them, belonging in a peer group or having a social group that they can interact with. All of that combined with parents, the deadlines of homework, of tests, that can cause anxiety and depression in our teens. Stress is something that is natural for us. It can be good in situations when you’re trying to make that basket for your team. It’s good when you’re trying to focus on that history test that you have that you need to take. But when you’re having chronic or long-term stress, it can lead to distress, which that distress is what leads to the anxiety and depression in our teens.

Melanie: What should parents look for, Myriam? What are some red flags that would signal that our child just has maybe a little more stress than they can handle and it could lead to anxiety or depression?

Myriam: It’s really important to focus on if your teen is having problem sleeping. Do they toss and turn more often at night? Are they finding that it’s hard to get to sleep at night because they’re constantly thinking about the day’s events or they’re worried about future events that they have to achieve? You will notice sometimes moods in your teens will change, such as outward aggression or withdrawing from people that they normally interacted with all the time. Maybe you’ll even get a call from school or their job saying that the teens are not themselves or other people have noticed that they’re complaining of stomachaches or headaches or things like that. You really need to just see, is your teen acting normal for them – which every teen has their own version of normal – but it’s normal for them. If they’re not, investigate a little bit more. Interact with your teen and see if there is something that’s troubling them.

Melanie: Aside from keeping good open lines of communication, which, Myriam, you’ve stressed and it is so, so important, how else can we help our teens to deal with these and even kind of nonjudgmentally discussing things that they might try to reduce their stress, like drugs or alcohol?

Myriam: Well, it’s just like you hit on home. It’s very important to communicate, but aside from communicating, you want to make sure that you don’t make your teen your friend. Your teen is not your friend. They’re your teenagers. They’re your child. Sometimes, parents have stress that’s going on in their life, like stressors. We’ve all been there. Bills, or you’ve had to worry about work deadlines, meetings, making sure that the family and your work correlate, but your teen doesn’t need to know about all of those stressors. You need to also find a way to cope without allowing your teens to see that these stressors are bringing you down because they can sense that. They can see that you’re tense. You may not be focused on them. You may not be giving them your undue attention. Nonverbal communication is just as important as verbal communication. Teens look to you to see how you are going to manage your life, and then that’s going to help them grow and manage their life and then they start having positive coping skills instead of leading to drugs or alcohol, which are the negative coping mechanisms that we’re trying to avoid altogether.

Melanie: In just the last couple of minutes, Myriam, please give us some of the healthy outlets for teens to release some of the stress and some resources for online programs, things that parents can use to help deal with their teens and stress.

Myriam: It’s very important we, as health advocates, we push exercise. Exercise is wonderful for teens to relieve those stressors of the day. They just need to really get out there and move for 30 minutes or more every day just to kind of help bring the hormones that cause stress low and then increase the good hormones that give them that really happy, joyful feeling of again helping them achieve goals. You encourage them to look for things that they like to do. If they like to play chess and that makes them feel at ease, try to encourage them to do that. Maybe have a moment at home where everybody gets together and they have a fun game night. Go out to movies if that’s something that your teen enjoys. The key is to try to find things that will help your teen relieve the stress so that when they have to go back to school the next day or if they have that thing that they’ve been worrying about, they can go towards both of those with a really good frame of mind, knowing that they have positive reinforcement from their parents. Another great resource for parents is the Change to Chill program that Allina Health recently launched. It’s amazing to help not only teens but parents to find good outlook to try to help on stress with their teenagers. It’s been tested on a teen-focused group. It’s amazing. Parents can find the information about Change to Chill on changetochill.org. Again, that’s changetochill.org.

Melanie: Thank you so much. You’re listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening and have a great day.
Hosts Melanie Cole, MS

Women’s Incontinence: Making Sense of the “Gotta Go” Commercials

Additional Info

Segment Number 2
Audio File allina_health/1449ah5b.mp3
Doctors Harris, BJ
Featured Speaker BJ Harris, MD - OB/GYN
Guest Bio BJ Harris, MD is a board-certified surgical gynecologist. Her professional interests include pelvic organ prolapse, incontinence, urogynecology, minimally invasive gynecologic surgical procedures and robotic surgery. She was one of the first gynecologists in the Twin Cities to use robotic surgery beginning in 2007. Dr. Harris has also received the Lester J. Bossert teaching award and the V. Bradley Roberts surgical excellence award.
Transcription Melanie Cole (Host): Do you find yourself crossing your legs when you laugh or sneeze? Do you find yourself frequently rushing to the restroom? Do you relate to those Gotta Go commercials? If you said yes to any of these questions, you could be one of over 27 million women nationally who experience bladder leakage. My guest today is Dr. BJ Harris. She’s a board-certified surgical gynecologist with Allina Health. Welcome to the show, Dr. Harris. Tell us a little bit about what is that bladder leakage. What is incontinence?

Dr. BJ Harris (Guest): Good morning, Melanie. Urinary incontinence is a very common thing. I tell my patients it’s not normal, but it’s common. The good news is that it is not dangerous. It is the involuntary leakage of urine. The two most common types are stress incontinence and urgency incontinence or overactive bladder. Stress incontinence is leakage with coughing, laughing, sneezing. A really common one is exercise. Then urgency incontinence is a bit different. It’s leakage when you just cannot make it to the bathroom, like the Gotta Go ads.

Melanie: What causes it, and are there things that would increase somebody’s risk of suffering from incontinence? It’s such embarrassing situation that many women don’t even want to tell their friends that they’ve got this.

Dr. Harris: Yes, I hear that very commonly. Women are finally coming out and speaking about this sort of stuff. Some of the biggest risk factors are childbearing, obesity, chronic cough, whether it’s from asthma or smoking, chronic constipation, smoking itself. Vaginal delivery and episiotomy are particularly high risk for stress incontinence. Family history and repetitive lifting may also play a role.

Melanie: Okay. So what can we do to find out if it’s really becoming something that’s a problem and you just say, “Okay, I’m not comfortable with this,” whether it’s the urge or stress incontinence, if you’re just not comfortable, then what? What are you going to do as a doctor to help us with this?

Dr. Harris: Sure. When you first come into my office, the diagnosis oftentimes is made with simply a history and a physical. If I see a patient in the office and they have straightforward symptoms, it’s generally safe to make a diagnosis without any extensive testing, sometimes maybe a simple urinalysis to make sure that it’s not an infection increasing the symptoms. If somebody has a complex pattern of symptoms, we can do additional tests right in the comfort of our office.

Melanie: Then what? What are the treatments? What’s the first line of defense?

Dr. Harris: Sure. We have lots of conservative options for both stress and urgency incontinence. The main conservative option for stress incontinence would be Kegels. Kegels don’t have great success rates; however, physical therapy does. What I tell my patients about physical therapy is it’s like having a personal trainer for your pelvic floor. Physical therapy can also be a conservative treatment option for urgency incontinence. Bladder retraining, which is timed voiding during the day and watching one’s intake of caffeinated or carbonated beverages or even alcoholic beverages can play a part in management that is conservative for the urinary incontinence.

Melanie: Okay, so bladder retraining or Kegel exercises and then the caffeinated or alcoholic beverages. When we’re looking at how much we drink in the day, what do you want us to know about that? Does it mean stop drinking coffee, one cup is enough? What about wine at night? Are these things contributing to that incontinence, or are they just adding that diuretic effect, which is already making our incontinence harder to deal with?

Dr. Harris: Yeah. No, it actually can be both. For example, it doesn’t mean that you absolutely can’t have coffee. I generally recommend a reduction in your coffee, but I’m not going to take away your single glass of Java in the morning. That would be cruel and unusual. We know that it doesn’t mean that you can’t have these things. It’s just that when you have these sorts of beverages, you might not expect a “perfect behavior” out of your bladder. If you have alcohol right before bed, maybe you’re not going to have as good of a night. It doesn’t mean you can’t have it. It’s a choice.

Melanie: Okay, now you spoke about Kegel exercises. Somebody who teaches this for part of what I do for a living, give us a little lesson here, if you would, Dr. Harris, for women listening that don’t understand how to do it. Because for some people -- and even men can benefit from this exercise. But just give a little lesson on how you should be doing it and how often.

Dr. Harris: Sure. Kegels are classically learned or taught, for women at least, while you’re urinating to stop your stream. Then that’s the correct set of muscles. If you can pay attention while you urinate to what muscles are required in your bottom to stop the flow, then that’s the correct set of muscles. Now, I don’t generally recommend doing your Kegels while you’re urinating all the time because I think it can teach voiding dysfunction. Once you’ve isolated those muscles, to contract them multiple times a day. Now, our physical therapist has a more wide variety so it doesn’t get quite so boring for the actual Kegels. We use it traditionally, useinstead of six, ten times while you’re sitting at the stoplight. And if you’re moving up and down in the car and the person in the lane next to you can see that you’re doing your Kegel, well then you’ve got the wrong set of muscles isolated. It may be better if you do it at a time when you’re actually paying attention and focusing on these muscles rather than trying to multitask, as we all do in this day and age.

Melanie: We’ve seen those commercials, the women in the golf course and they have to go, they jump in the golf cart and race all the way. They’re talking about medications in those commercials. What do the medications do?

Dr. Harris: The medications affect the nerve and the muscle function in the bladder, causing the bladder muscle to relax. In this way, the meds reduce the frequency and intensity of bladder contractions, thus decreasing unwanted leakage and frequency.

Melanie: So if the bladder relaxes, doesn’t that sound like it would do just the opposite, like it would let loose whatever it is you’re supposed to be holding in there? How do these medications work as far as lifetime? Is it just something you take when you’re suffering, or is it a lifetime thing?

Dr. Harris: Sure. You don’t have to plan on taking it your whole life, not always. If you’re able to make some lifestyle changes, such as weight loss, reduction of caffeinated beverages, able to maintain symptom relief, you can sometimes stop the medicine. In addition, if it’s the reactive bladder that is very, very bothersome and the medicines either aren’t something that you want to take long-term or you have side effects you don’t like, we have some neuromodulators, some things such as InterStim, which would be a surgical option or Urgent PC, which would be something we’d be able to manage the reactive bladder symptoms with in the office. We do have other nonmedical sort of things. It does. It really can vary at different times in women’s lives how much their symptoms are bothersome to them.

Melanie: What about surgery? We’ve heard about the slings and we’ve heard about vaginal meshes. Tell us a little bit about the different forms of surgery. And are they safe? What do they do for us?

Dr. Harris: Sure. The most common type of surgery for stress incontinence is the insertion of a mid-urethral sling. It’s a simple same-day surgery. It’s a small shoestring-sized and shaped piece of mesh that’s inserted via the vagina underneath the urethra. Then it acts like a back stopper, a hand lock to the urethra so that when you laugh or exercise there it’s support to the urethra and prevent the leakage of urine. There are a ton of women out there living a less active lifestyle than they’d like to as a result of stress urinary incontinence. Yes, overall, the surgery is safe. There is no surgery that has zero percent risk, but the FDA does have some warnings regarding vaginal mesh. The main concern is the large pieces of mesh are placed for prolapse into the vagina. The ads you are seeing and hearing are frightening women away from taking treatment for their urinary incontinence. The mid-urethral slings were first developed in 1995. That’s pretty much 30 years ago in Sweden. And since then, they have been an excellent treatment. I’ve continued to use them and still do use them today as one of the gold standards for treatment of stress urinary incontinence.

Melanie: In just the last minute or so, Dr. Harris, give your best advice for women out there who may be a little bit too shy to discuss this with their doctor who might be suffering from one of the types of incontinence we’ve been discussing today. And really, give them your best advice about what they should do about it.

Dr. Harris: Sure. I think that there’s nothing to be embarrassed about. This is very, very common. Come, chat with your gynecologist. Chat with your internal medicine or family practice doctor. Chat with one of us, and we can get you in the right direction. You’ll find that we hear about this pretty much every day, if not every week and we’re going to have some answers for you and at least give you some direction. If nothing else, maybe even some reassurance. The good news is it’s not dangerous and we can work on this together.

Melanie: That’s great information. Thank you so much. You’re listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening and have a great day.
Hosts Melanie Cole, MS

City of Hope on Cutting Edge of Diabetes Research

Additional Info

Segment Number 3
Audio File city_hope/1447ch1c.mp3
Doctors Kandeel, Fouad
Featured Speaker Fouad Kandeel, MD
Guest Bio Dr. Fouad Kandeel is a Professor at the Department of Diabetes and Metabolic Diseases Research.
Director, Division of Development & Translational Diabetes and Endocrine Research.
Chair and Professor, Department of Clinical Diabetes, Endocrinology and Metabolism.
Transcription Melanie Cole (Host): City of Hope’s Diabetes and Metabolism Research Institute offers a comprehensive diabetes and endocrinology program combining groundbreaking research and unique treatments with patient education to help people living with diabetes and other endocrine diseases get the medical care and information they need to achieve an optimal quality of life. My guest today is Dr. Fouad Kandeel. He is the chairman of the Department of Clinical Diabetes, Endocrinology, and Metabolism at City of Hope. Welcome to the show, Dr. Kandeel. Tell us a little bit what’s going on in diabetes, exciting research and treatment today.

Dr. Fouad Kandeel (Guest): Diabetes is a major disease, threatening world-wide in the 21^st century with incidents that is rising very significantly, and unless actually medical institutes and research centers are able to bring about new strategies for diagnosing and treating those Type 1 and Type 2 diabetes, nobody is going to afford the cost of the disease. City of Hope has done a significant contribution to the care of diabetics over the years, starting from the time of Rachmiel Levine, who is one of the fathers of modern diabetes sciences, and who actually clarified the role of insulin in mediating glucose entry into the cell to be used as a source of fuel in the 1940s, to the discovery of hemoglobin A1c by Samuel Rahbar, one of City of Hope scientists, and to the development of human insulin for the first time in the lab by Dr. Arthur Riggs and Dr. Itakura here at City of Hope to actually the development of cell therapy approach for Type 1 diabetes, which started at City of Hope in 2004.

Melanie: With this growing epidemic of diabetes Type 2, mainly, but Type 1 certainly is prevalent, but the growing epidemic with the obesity problem we’ve got going, so we’re seeing so much more Type 2 diabetes, even in children and obese children. Doctor, what do you want the listeners to know about diabetes Type 2 and what’s going on in the country?

Dr. Kandeel: Certainly, Type 2 diabetes is exploding and because of the change in lifestyle of individuals and the adoption of fast food eating, so the lack of physical activity and overeating in general, or open caloric intake in general, has led to the explosion of diabetes Type 2. Also diabetes Type [1] is increasing at a significant rate as well. However, in fact, the CDC has announced approximately three years ago that the level of obesity is leveling off, yet the level of diabetes or the incidents of diabetes development is rising significantly. In fact, by 2015, it’s expected that one out of every three Americans will be diabetic. Today, one out of every three Americans is pre-diabetic. What that really means is no increase in obesity, but there is going to be a significant increase in diabetes. It really suggests to me that we imprinted our genes through the epigenetic mechanisms of regulating gene expression, so that the influence of this is going to be the manifestation of diabetes over the next few decades, well above what is expected from an increase in body weight. We need really to reverse that trend by adopting good dietary and physical activity programs and keep that going effectively for several generations to resolve the effect of the bad food intake habits and the lack of physical activity that we actually incurred over the last two or three decades.

Melanie: Speak about living with diabetes and treatment. If people have already been diagnosed, whether it’s Type 2, insulin-resistant, or Type 1, what is your best recommendation for keeping track of those blood sugars and activity and sedentary lifestyle and nutrition and what role do all of these play in the lifestyle management of diabetes?

Dr. Kandeel: Well, actually, the lifestyle management of diabetes is very, very important. That was panned out in a study that was done in 1990, supported by the federal government, known as Type 2 Prevention Trial. In that trial, diet and exercise management reduced the incidents of development of new diabetes in high-risk group by about 60 percent, whereas actual use of drugs alone was successful in preventing diabetes only in about 28 percent. So, diet and exercise is twice as effective in reducing the development of diabetes as compared to medications. That is very important for everybody to know that actually diet and exercise is a very important aspect of the care of diabetes. It is important for Type 2 and now we are also recognizing how important it is for Type 1 because also some Type 1 patients do have insulin resistance that could actually be helped with diet and exercise.

Melanie: Wow, that’s quite a good statement to make, Dr. Kandeel, that if you’re noticing insulin resistance in Type 1, they can benefit from this type of exercise effect. Exercise has that insulin-like effect.

Dr. Kandeel: Right.

Melanie: That’s a pretty huge way to look at it. Now, what do you want people to know about making those changes in their lives to help prevent this? And tell us about what research you’re doing there at City of Hope.

Dr. Kandeel: Certainly. Well, with regard to what people should do is really physical activity and it’s not required to be a vigorous physical activity. Fast-paced walking for half an hour a day can actually influence insulin sensitivity significantly and lower blood glucose by improving insulin action. As with regard to diet, really adopting some changes in the dietary intake by reducing carbohydrate intake, eating more of vegetables type of food, and limiting the saturated fat content in the food would actually significantly improve the metabolic makeup of an individual. I think diet and exercise should be very important aspect of treating effectively of living in every individual whether they have diabetes or not, but most definitely they are very important in the management of a diabetic individual. What City of Hope is doing for Type 2 is actually developing research to understand the mechanisms of the gene regulation that leads to development of diabetes complications. That’s called metabolic memory. We want to understand how the diet and exercise we do actually imprint our genes or alter the gene expression potentially for a generation or two that leads to a higher increase of complications of diabetes. We have a major program in diabetes epigenetics to understand the mechanisms of diabetes complications and to develop therapeutic targets where we could actually develop new drugs and interventions to circumvent the development of diabetes complications. We also actually are developing electronic systems to analyze patient food intake and physical activity and help them to optimize the physical activity and food intake based on what they prefer and what the limitations that they may have in their lifestyles and physical abilities and then to optimize the drug therapy based on mathematical modeling of the metabolism of that individual. We are not there yet. We are still working on that program. It probably will go into a clinical trial in about a year or so, and we hope actually, if that’s successful, can actually be widely disseminated. Remember, saving of 10 percent of the care of diabetic individual in the US will translate to a national savings of approximately $36 billion a year.

Melanie: Well, that is fascinating. Thank you so much for being with us, Dr. Kandeel. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org/diabetes. That’s cityofhope.org/diabetes for information on the Diabetes, Endocrinology, and Metabolism Institute at City of Hope. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole MS

The Latest in Life Saving Lung Cancer Research And Treatment

Additional Info

Segment Number 2
Audio File city_hope/1447ch1b.mp3
Doctors Reckamp, Karen
Featured Speaker Karen Reckamp, MD
Guest Bio
Karen Reckamp, MD is the Co-director, Lung Cancer and Thoracic Oncology Program
and an Associate Professor, Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA.
Transcription Melanie Cole (Host): Each year, 220,000 Americans are diagnosed with lung cancer, making it one of the most common cancers in the United States. However, with timely diagnosis and appropriate therapies, the disease can be effectively treated with minimal impact to quality of life, and there is extensive collaboration between lung cancer clinicians and researchers to develop and evaluate new therapies designed to improve new survival and quality of life outcomes. My guest today is Dr. Karen Reckamp. She is the co-director of lung cancer and thoracic oncology program at City of Hope. Welcome to the show, Dr. Reckamp. Speak a little bit about what you think are the most exciting and innovative research and techniques going on in the lung cancer world today.

Dr. Karen Reckamp (Guest): At this time in lung cancer, we’re exploding in our knowledge of the biology of lung cancer, and that includes both genomic aspects—so the genes that are involved with the development and progression of lung cancer—and also the immune system and its relationship to lung cancer and the development and progression of lung cancer. So those are probably the two biggest areas of excitement in research of lung cancer right now.

Melanie: So why don’t you start with immune treatments and immune therapy? Because the immune system is seen in so many diseases today and it’s such a powerful part of our physiology. Speak about what’s going on in immunotherapy.

Dr. Reckamp: So in general, the immune system is suppressed in a person who has lung cancer, and the lung cancer has developed mechanisms to hide itself from a person’s immune system. There are new therapies now that can activate a person’s own immune system against lung cancer, so blocking these mechanisms that the cancer has had to evade the immune system. Now, most of them are antibodies. They block that evasion and activate a patient’s own immune system against the specific of the cancer that that patient has. So it’s pretty exciting. And generally in lung cancer, we don’t think of it as a highly immune type of disease, but these new therapies have shown some substantial responses in tumor shrinking, and also long-term, durable improvements for patients with otherwise incurable lung cancer. So it’s an exciting time for understanding this therapy.

Melanie: What about targeted therapies? How are they being used in lung cancer research today, and treatment?

Dr. Reckamp: Targeted therapies really get to what drives the lung cancer. Again, in the genomic era of cancer and understanding the human genome, we now know that there are specific genes that drive lung cancers. These happen more commonly in people who have had less smoking exposure, but it can happen in people with smoking exposure also. Some of these mutations are what we call driver mutations, so a specific mutation in the gene causes the growth and progression of a cancer. And when that’s the case, we have specific targeted therapies. Most of these are oral therapies. Some of them are IV, but most of them are oral. They can go in and block the cancer where the signaling is happening right inside the cell to stop the cancer growth. And there are probably about 60 percent of people with an adenocarcinoma type of lung cancer that has some specific mutation, and most of these have some specific target that can be used. And some of these are still in clinical trial and some of these are available today. And each year we have new developments and new treatments that are available for these types of targeted lung cancers.

Melanie: Now, when we’re speaking about treatment and even diagnosis, Dr. Reckamp, what about real-time tumor imaging? What’s going on that is very exciting in being able to diagnose, catch it early, and spot lung cancer?

Dr. Reckamp: One of the most important areas of lung cancer is, first, stopping smoking if you smoke. But even beyond that is finding it early. Because lungs are deep inside your body, they are difficult to biopsy and difficult to -- you don’t see anything or feel anything generally until lung cancer is far advanced. In the past year now, the US preventative task force has recommended low dose CT screening as a screening method for people with high risk of development of lung cancer. So those are patients with a history of smoking and patients over the age of 55. But if we can detect the cancers early, then we have a better chance of finding something early that can be cured. I know from a randomized trial that by doing these low-dose CT scans on an annual basis, we can improve survival from lung cancer. We can also improve overall survival from all cancers that cause mortality.

Melanie: And where does screening fit in? Who should get screened, Dr. Reckamp?

Dr. Reckamp: So right, now it’s the people that are at highest risk for developing lung cancer. Because still, when you’re getting a scan, there is a possibility of getting what we call a false positive, so that would be some kind of nodule or something that they would see on the scan that has nothing to do with lung cancer. But if found, it may need further follow up, may need biopsies, may need some kind of intervention. So the higher risk you have—and that is generally people that have a what we call 30 pack year smoking history. So somebody who’s smoked a pack a day for 30 years, that’s how we calculate the pack year. So more than 30 pack years and over the age of 55 are kind of the general guidelines for people who should get screened. And patients, people who have less than that, they have a higher risk of finding these false positives and maybe having to undergo a procedure or multiple scans that won’t end up finding lung cancer.

Melanie: And if lung cancer is diagnosed, what are some of the techniques that you’re using at City of Hope for surgery and radiation therapy to help combat the disease?

Dr. Reckamp: We are more and more able to do targeted types of treatment even with surgery and radiation therapy. So, surgery is becoming less and less invasive and smaller incisions, then robotics being used to take out tumors. And this decreases the time a person is in the hospital and improves the recovery rate for people and gets them back into their lives quickly. It used to be that people had to be in the hospital for many days to a week or more and would have to take a significant amount of time off of work, and now they’re back into their lives and into their work and what they need to be doing. For radiation, it’s a similar story. We have modalities that can do short courses of radiation effectively. So what may have taken several weeks now takes a day or several days. They can target the radiation. Of course, in the lung, as you breathe, there is movement. And radiation is targeting a specific area, and it’s much harder to target as you’re breathing and the lung’s moving. You can get radiation to areas that may not be involved with the cancer and cause damage to the lung, which we don’t want to do. So by doing these targeted therapies over short courses of time, we can improve the functioning of the lung and decrease the amount of damage that’s done, and again, improving patients’ lives.

Melanie: So in just the last minute, Dr. Reckamp, please give your best advice and hope to those listening who might have a loved one with lung cancer for the most exciting things going on there today in treatment and research.

Dr. Reckamp: The most remarkable thing to me is that we know things today about lung cancer and how it grows and how it progresses that we didn’t know even a year or two ago. So the progress is being made. We need to make more, there’s no doubt, but we will have new drugs, we are going to learn how the immune system fits into the development of lung cancer, and we may move some of these immune therapies earlier on to try and cure more people with lung cancer. And that’s always our goal. So we’re getting more targets, we’re understanding the genes and the biology, we’re understanding the immune system, and then, again by getting screening out to more and more people, hopefully we can prevent these advanced stage lung cancers. So I think there’s a lot to be excited for and a lot to hope for for people who are dealing with lung cancer, which is such a challenging disease.

Melanie: 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, and have a great day.
Hosts Melanie Cole MS

I Have Knee Pain, Do I Need To Worry?

Additional Info

Segment Number 2
Audio File allina_health/1447ah5b.mp3
Doctors Peters, Jamie
Featured Speaker Jamie Peters, MD - Sports Medicine/Family Medicine
Guest Bio Jamie Peters, MD is a board-certified family medicine and sports medicine physician who has received Top Doc designation by Mpls. St. Paul Magazine for multiple years. He treats patients for non-surgical orthopedic care, management of musculoskeletal chronic conditions, preventive care for runners, and sports conditions. Dr. Peters enjoys caring for the weekend warrior and anyone dealing with chronic orthopedic conditions. His goal is to help patients achieve their goals for activity and prevent further injuries. He has over 30 years of experience and is a member of the American Academy of Family Physicians, American College of Sports Medicine and American Medical Society for Sports Medicine.
Transcription Melanie Cole (Host): At some point in your life, you’ve probably experienced knee pain. We all have. But how do you know when that pain is something that you should be worried about or see a doctor about? My guest today is Dr. Jamie Peters. He’s board certified family medicine and sports medicine physician with Allina Health. Welcome to the show, Dr. Peters. How common are knee pain and/or knee injuries?

Dr. Jamie Peters (Guest): Well, knee pain is very common, something that I see every day in the clinic. And really, the cause varies you know with the mechanism or how people actually injure their knee, and also, it varies with age group.

Melanie: So what generally happens as we age to our knees? They’re such an important joint, and they do so much for us. What happens as we age?

Dr. Peters: Well, the one of the processes that occurs to knee is the lining of the knee can actually start to wear over time. And as people get into their fourth and fifth, sixth decade of life, you can actually get thinning of the cartilage. And that can vary from individual to individual. Some people have family predispositions or injured their knee in football earlier in life, and for those people, they may have that particular kind of problem occur earlier.

Melanie: What parts of the knee, Dr. Peters, are most commonly injured?

Dr. Peters: Well, I would say, again, it depends on the decade of life. I see a lot of teenagers with knee pain, and for those individuals, it often ends up being discomfort from the underside of the kneecap itself, where there’s some very delicate cartilage where it glides on the knee on the track. So that’s fairly common in younger individuals and can be addressed in a number of different ways depending on the cause. But often it’s something we can either have people do exercises or see a physical therapist, and that can be very helpful. As people age, certainly injury, twisting, turning, that can injure ligaments. So those are the structures that hold the knee from each side and in the middle. ACL is one of those ligaments that can be injured, and when that’s completely torn obviously that’s something that we would consider sending to a surgical colleague to repair. And then as people get older, as I mentioned already, wearing down of the lining of the knee, or it’s also called osteoarthritis or degenerative arthritis. It has different names. That tends to be more common in the older individual, the older athlete who’s trying to stay active.

Melanie: Is there anything we can do to prevent or at least delay the onset of that natural wear and tear?

Dr. Peters: Absolutely. And this is one of the really important points I think to get across to your listeners is that cartilages like to be used. So anywhere in the body, whether it’s a shoulder or ankles or elbows, and especially the knees, a healthy use of cartilage does keep it healthier than being more sedentary. At the same time, cartilage doesn’t like to be abused, so finding that sweet spot using the knee. Even if someone has arthritis already developed in the knee, regular use is important. The other part is appropriate use of the knee and the body. So as someone does develop some issues with wearing down or arthritis on the knee, having appropriate use means that you are keeping your whole body stronger. And a lot of people are familiar with the term “core strength,” and that’s strength around the glutes or the butt muscles and strength throughout the abdominal muscles. Keeping those stronger, doing various -- not real high impact but medium or lower impact activities and then cross training so that all those muscles around the mid part of your body stays strong, that can actually help the knee have less stress on the knee over time and can help people maintain their knee health and have less pain and can be more active.

Melanie: And Dr. Peters, if people do experience knee pain, do you recommend ice? Do you recommend rest, stretching? Are things like lunges bad for the knees if you’re experiencing pain? Speak about a little bit about pain management for us.

Dr. Peters: Sure. There’s different scenarios. So one scenario is someone’s out there, they’re doing a weekend warrior thing, they twist, they turn, they have a tweak in their knee or basically a sprained knee, that’s something you don’t need to go to the emergency room or you don’t need to -- as long as you can still weight bear, it may be a little uncomfortable, maybe some slight swelling, that’s something where, as you say, ice can be very helpful. And when we recommend ice, we usually recommend going with 50 minute duration, bag of frozen peas or a soft ice pack works just great, and repeating that every several hours. That’s something that you can watch that. Hopefully it improves in the next day or two. And certainly by three or four days, knee should be feeling good. Now, if it’s not, or if someone can’t actually weight bear on the knee after an injury like that or if the knee gets very swollen, those are indications that you need to seek some additional evaluation. That could be from someone like me, a sports med doc, or your primary care doctor as long as the primary care doctor is skilled and experienced in dealing with this kind of problem.

Melanie: When does a cortisone shot come into play with knees?

Dr. Peters: Well that gets more to the -- I just mentioned the injury type knee problem. But when you’re starting to get into that pattern where that knee cartilage is worn down, that’s actually something that can be seen on a regular x-ray. Usually weight bearing x-ray you can see the thinning of the lining of the cartilage. As that begins to wear down, there’s things that we can do to help. And I’ve already mentioned the core strengthening, which is really important, the regular use of a lower medium impact. So biking tends to be very helpful. But if these things aren’t enough and the pain is persistent, we have different kinds of injections that we can actually put medicine in the knee and help the knee feel better, allow people to stay more active. And one of the most common types of injection is use of steroids. So that tends to be relatively inexpensive as a medication, and it can be very helpful and last for four months to keep the knee swelling down and the knee -- you can be more active. When that is less effective, then we start to think about some of the other medications such as -- it’s called [visco] supplementation, or people know it as ground up [rooster cone] medicine there’s different names for them. Now it’s more commonly synthetic ground up -- well, it’s just like ground up [rooster cone] material. But that can also every effective for a period of time. It doesn’t last forever. And that does tend to be much more expensive, which is why we usually offer going with the steroid as a first step when we start to think about injections to help people be more comfortable with their knee and use it in healthier ways.

Melanie: And what about bracing? The weekend warriors we were discussing or teenagers that’s been experiencing some knee pain has some weakness, does bracing contribute to that weakness and take the pressure off the knee, or does it help keep that knee secure?

Dr. Peters: Well, my answer would have to be it depends. So if there is a knee sprain, which means that one of the ligaments was partially torn, then bracing to help prevent -- like a hinge brace, so something that’s stiffer, not just the neoprene. That can be helpful as people are getting back into sport. So I think that’s helpful. I mentioned that kneecap kind of pain I see with younger individuals, sometimes you can get a knee sleeve that actually can help guide the kneecap a little bit, and that can decrease pain and help people rehabilitate through kneecap discomfort. And then on the other end of the spectrum, when someone has wearing down on the inside or outside part of the knee compartment, we actually have some very nice bracing that’s called un-loader bracing, and that can help individuals with arthritis of the knee help keep the pressures away from the painful compartment, and that would be the inside or outside part of the knee and allow them to be active with less discomfort. So different kinds of braces for different kind of problems.

Melanie: And how important are good shoes in helping our knees to stay stable, whether you are a runner or a walker or just your basic weekend warrior? How important is a good pair of shoes for that stable base?

Dr. Peters: Melanie, that brings up a really good point. I see this all the time. So I see a lot of runners, a lot of marathon runners, and depending on their foot structure, that, as you just alluded to, that can cause discomfort and actually significant problems on the knees. So if someone has what we call hyperpronation, where their foot -- usually they have flat feet, and when they run, their foot goes way to the inside, that can then cause vibration back in the knee. And if you’re running long distances or even medium distances, that can create a problem for the knee. So having someone who has proper shoe wear that’s proper for their feet, appropriate arch support -- a lot of those can be over the counter now that they make very good over the counter shoe inserts or supports, that can be very helpful in alleviating that kind of pain. Someone with knee problems who’s wearing -- and this is something I don’t know if you personally are familiar with it, but people that sometimes wear high heels and they are always on high heels because they work in that kind of environment, if they had a knee problem, that can lead to problems both with the feet and in the knees. So we certainly advise sometimes trying to find something that’s still fashion reasonable but may not be so unhealthy for the feet or the knees. So, very good point. I’m glad you brought that up.

Melanie: And in just the last minute, Dr. Peters, if you would, give your best advice for people suffering from knee pain or have knee injuries in preventing and keeping good strong knee joints.

Dr. Peters: Well, I think using some [phrases] sometimes is helpful, and I actually type those out for patients and hand it to them as part of their summary of the visit. But the things I mentioned are use but don’t abuse. So listen to your body is number two, so use but don’t use abuse, listen to your body. If you’re getting persistent swelling, it’s getting worse, you need to get it evaluated before it gets worse so we can do some treatment and prevention. So those are probably the key things. And I think as part of listening to the body, if you are a runner and you are having persistent pain or swelling, a lot of these things, there are answers, and there’s great answers that can actually help you stay active. And in the end, in the bottom line is we want all of our patients to stay active over a lifetime that does create health over time. So there are usually answers, but sometimes it takes a professional opinion to get the right information so you can take care of your knees over time.

Melanie: Thank you so much. You’re listening to the Well Cast with Allina Health. And for more information, you can get to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening, and have a great day.
Hosts Melanie Cole, MS

Diabetes and Eye Health

Additional Info

Segment Number 3
Audio File allina_health/1447ah5c.mp3
Doctors Backer-Palmer, Kristi
Featured Speaker Kristi Backer-Palmer, OD - Optometrist
Guest Bio Dr. Kristi Backer-Palmer is a board-certified optometrist whose professional interests include diabetes, glaucoma, macular degeneration and children's exams.
Transcription Melanie Cole (Host): Diabetes can cause serious damage to the eyes, and it’s a leading cause of blindness in the US. But there are ways to prevent permanent damage and preserve your vision. My guest today is Dr. Christie Becker Palmer. She’s an optometrist with Allina Health Coon Rapids Clinic, welcome to the show, Dr. Becker. So tell us a little bit about how diabetes affects vision and eye health.

Dr. Becker (Guest): Diabetes can impact the eye health in lots of different ways. First of all, it can cause variation or fluctuation in your vision, which can cause blurring. And sometimes you may need to change your glasses prescription. But secondly and most importantly, the eye is considered an end organ, kind of like your hands and your feet, and so diabetes can affect that area most prominently, and it can cause damage by causing changes in the blood vessel and reducing blood flow to the back of your eye and even can cause damage to the retina. And this is called diabetic retinopathy and is one of the leading causes of blindness in the United States.

Melanie: So explain a little bit more about diabetic retinopathy.

Dr. Becker: Sure. Diabetic retinopathy is caused by damages to the blood vessels in the back of the eye, or the retina. These blood vessels sometimes can swell or become blocked, and in some cases these blood vesselseven leak. The diabetic retinopathy comes in three different forms. It comes in mild, moderate, or severe. Most of the time, mild diabetic retinopathy can be reversed, but moderate or severe diabetic retinopathy will need to be treated either with some laser treatments or sometimes injection into the eye.

Melanie: And how would someone know if they’re starting to suffer from diabetic retinopathy?

Dr. Becker: With the mild diabetic retinopathy, there’s really not a lot of symptoms. But with moderate and severe diabetic retinopathy, sometimes it can create vision changes, such as blurring of your vision. You can get blind spots in your vision. You can even have changes in your peripheral vision, or sometimes you can actually have rapidly declining vision, where one moment you see really good and the next minute everything’s blurry. And a lot of times though, really, the only way to find the changes in the back of the eye is to have your diabetic eye exam.

Melanie: Before we get to treatments, how often do you recommend someone with diabetes, whether it’s type one or type two, get an eye exam?

Dr. Becker: It’s recommended that you have an eye exam if you’re diabetic every year, and that would be a dilated eye exam.

Melanie: So now, what kind of treatments are available if somebody is starting to suffer some of the symptoms you’ve spoken about?

Dr. Becker: Well, if we find that there’s justsome mild diabetic changes going on in the back of the eye, sometimes it’s just getting better control of your diabetes. And by getting better control of your blood sugar, that will reverse mild changes on the retina. But if you have more severe or moderate changes where you actually have some leaky blood vessels on new blood vessel growth, we would refer you to an optomologist or a retinal specialist, where they would some laser work on the back of the eye to help reduce the new blood vessel growth, or they may inject some anti-inflammatory medications into the eye to reduce swelling of your retina.

Melanie: Who’s most at risk for these types of problems?

Dr. Becker: The people who have type one diabetes probably have the highest risk of having retinopathy just because they’ve had the diabetes for so much longer, whereas the type two diabetics are also at risk if they are not managing their diabetes. However, their risk level is relatively low compared to type one.

Melanie: So what other types of eye problems can diabetes cause?

Dr. Becker: Diabetes can actually increase your risk for glaucoma as well as it can increase the chances of having cataract form at an earlier age. And it does also relate to having a drier eye.

Melanie: So give us a little bit of prevention, Dr. Becker, to prevent eye problems and keep healthy eyes if you’re somebody with diabetes.

Dr. Becker: One of the most important thing in prevention for somebody who’s diabetic is just basically controlling your diabetes, keeping your blood schedules as stable as possible and continuing to follow up with your primary care doctor or your diabetic doctor as well as having your annual dilated diabetic eye exam.

Melanie: And what about somebody with type two diabetes? Obviously, trying to get it under control. Can the medications, insulin, whatever you happen to be on, help prevent diabetic retinopathy?

Dr. Becker: The medications that they take for diabetes are basically to help them control your blood sugars and to keep them as stable as possible. And by keeping your blood sugars as consistent as you can and keeping your diabetes as controlled as possible, that’s what's going to help give you some leverage at preventing diabetic retinopathy. There are some cases with type one diabetics where they’ve just had the disease for 25, 30 years where their risk is just higher even with control, but the best thing to do is just, again, to control the blood sugars and keep the disease as controlled as possible.

Melanie: Is blindness something that is going to happen, or can it be stopped in the process?

Dr. Becker: Blindness is not inevitable, so it is something that can be controlled if you’re having your diabetic eye exam every year. It’s one of those things that it is treatable. The retinopathy is for the most part is treatable. So I would say no, it is not inevitable.

Melanie: So speak about the laser treatments that you mentioned that might help somebody that’s starting to get into more than mild retinopathy. What can they expect? What is it like?

Dr. Becker: In no situations -- I actually don’t perform that procedure, but I do have a retina specialist that does those procedures for us. What I’ve heard about the procedure is that with one of them to help control and reduce leakage of the blood vessels in the back of the eye. They will go in and do what are called spot laser treatments, called TRPs, and this is where a series of laser treatments are done inside the eye. Most people report that it’s uncomfortable to have it done, but that’s the biggest complaint about it.

Melanie: And Dr. Becker, when should you see a doctor?

Dr. Becker: Well, we recommend that anybody who is recently diagnosed with diabetes should have a baseline diabetic eye exam, and then we recommend having that eye exam every year to help maintain an idea of where things are happening with your eyes. The other times that it’s very important is that you will start noticing a sudden change in your vision or a sudden loss of vision, then I would recommend contacting your eye care professional right away. Or if you start noticing symptoms like blurring of your vision or changes in your side vision or anything like that, it would be recommended that you get in to see your eye care professional and have them check you out to make sure there aren't any changes happening on your retina.

Melanie: So in just the last couple of minutes, Dr. Becker, give your best advice for people with diabetes in terms of the health of their eyes, and where can people go if they have questions or want more information.

Dr. Becker: Well, just to reiterate, the most important thing when you’re diabetic is just to maintain control of your blood sugar levels and to maintain control of your disease. That’s the best thing that you can do for prevention. If you have any questions, feel free to contact your eye care professional. I know that they would be happy to answer any questions for you as well as your primary care doctor or your diabetic educator are very good sources of information as well.

Melanie: Thank you so much. You’re listening to the Wellcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening, and have a great day.
Hosts Melanie Cole, MS

How a Pediatric Neuropsychologist Can Help Your Child

Additional Info

Segment Number 5
Audio File virginia_health/1447vh5e.mp3
Doctors Brenner, Laurie
Featured Speaker Dr. Laurie Brenner
Guest Bio Dr. Laurie Brenner is a pediatric neuropsychologist who specializes in assessments of neurological conditions such as epilepsy, traumatic brain injury, stroke, central nervous system tumors, and genetic disorders.

Learn more about UVA Neurosciences: Brain & Spine Care
Transcription Melanie Cole (Host): In select cases, a neuropsychological evaluation can help families learn how to support their child’s healthy development into adults. My guest today is Dr. Laurie Brenner. She is a pediatric neuropsychologist who specializes in assessments of neurological conditions such as epilepsy, traumatic brain injury, stroke at the UVA Health Systems. Welcome to the show, Dr. Brenner. When would a child benefit from a neuropsychological evaluation and what does that even entail?

Dr. Laurie Brenner (Guest): Hi. Thank you for having me. The neuropsychological evaluation helps us understand how the medical condition is affecting the child’s ability to process information, learn new skills, and use the skills he or she has. When we have a better understanding of the child’s strengths and weaknesses, we can now plan for the child’s future and also identify services that might be helpful for the child. In some cases, that also helps the child’s doctors to make more informed decisions about treatment.

Melanie: What’s involved during a neuropsychological evaluation? Is this an easy thing for the child? Or is it harder for the parents?

Dr. Brenner: Good question. Some children actually enjoy it because the tests that I do are more like puzzles or games oftentimes, as well as an interview with the parents and the child. I ask a lot of detailed questions so that I have a good understanding of the child’s history and how they’re currently doing and what’s happened up until this point in time. I ask a lot of questions to make sure that I understand what the parents’ concerns are, and then I spend between four and five hours with the child and that’s when we do assessment of attention and memory and problem solving and language and visual spatial skills, executive functioning to really get a sense for how this child thinks and learns and feels. Then the family comes back for a feedback and that’s when I construct a coherent summary for the family so that they really understand what their child’s strengths and weaknesses are and what they can do to help their child.

Melanie: Dr. Brenner, do you get any pushback from parents when you say maybe that your child has a little aggression or that they had a little problem solving issue? And do parents ever not want to hear that kind of information, because you have a delicate situation there when you are telling parents about attention and intellectual capabilities of their child?

Dr. Brenner: Sure. It’s very much a discussion. Oftentimes, the parents know that there are concerns and that’s usually why they’ve come to me. This is really helping them to understand the nature of the child’s difficulties. Sometimes, it can be hard for parents to hear, but because we’re working together to identify the problem and then figure out how to fix it, it’s much more of a constructive approach, so most families leave their feedback, feeling hopeful that they now know what they can do.

Melanie: What do they take away from these evaluations and what are the next steps based on your findings?

Dr. Brenner: They oftentimes will report feelings that are clarity. They have a plan for the future. They have a better understanding of their child and how their child thinks and learns and interacts with the world and what will be helpful for their child going forward. It’s like providing a blueprint for them so they know where to devote time and energy to optimize their child’s development, and this oftentimes does include concrete steps that they can take to address their child’s needs, whether that be services in the community, a revised education plan, or changes in the medical treatment.

Melanie: This can be an ongoing thing, such as early intervention might drop off at three. What are the general ages that the parents would bring their child in for a neuropsychological evaluation?

Dr. Brenner: It really depends and it can be helpful to have this evaluation at points of transition in the child’s education and in their development. Because oftentimes, we see the medical condition affecting the child differently depending on what the environmental demands are and the changing expectations for the child, so usually we recommend reevaluation every two to three years. I see ages all the way down to age two up to 18, early 20s. It really depends on the referral question.

Melanie: Then what? How is this evaluation going to help them? Do the parents tell the school what happened? Do you work with the school to help the child work on some of these situations in the school environment? How does it all tie together for the child?

Dr. Brenner: A comprehensive report is generated as a result of the visit. I write up all of the findings so that they have with them a written document that they can share with other providers, certainly with the school, and then the school works with the family to develop an appropriate treatment plan for the child or intervention plan for the child. In some cases, yes, I would talk to the teachers and talk to the school to help make sure that they are interpreting my findings accurately and providing the child what they need.

Melanie: That’s where I was going with that, to match those specific strengths and weaknesses to what the school can give them. Now, what if what you’ve identified, Dr. Brenner, the school cannot provide that level of care? Do you then provide that extra care? Do you recommend them to somebody else to help work on maybe anxiety, depression management, any of the other things that you might have found?

Dr. Brenner: Yeah. Oftentimes, the treatment plan or the intervention plan is really comprehensive in the sense that it takes community services, and that may include therapy. It may include a visit to a psychiatrist in addition to detailed school plan. It usually is a combination of different resources and I help put the family in touch with the resources that would be beneficial for them.

Melanie: Then do you keep an ongoing record and see how the child is progressing when they’ve been seeing another specialist?

Dr. Brenner: The evaluation is usually only every two to three years, but I am certainly available for consultation. If the family is having trouble translating my recommendations into the reality of the services available in their community, I certainly am available to help problem solve and figure out what might be helpful.

Melanie: Give your last bit of advice to parents, Dr. Brenner, on if they think that their child might be having issues and why they would come see a pediatric neuropsychologist and why families should come to UVA for their evaluation.

Dr. Brenner: Yeah. The first step would be to talk to your doctor, or if you have a neurologist, definitely speak to the neurologist. Then in terms of why come to UVA, I think the main thing is the collaborative nature of care here. There are a lot of experts here who work well as a team, a lot of resources at their fingertips, and we can really be committed to each child and their individual needs.

Melanie: Thank you so much, Dr. Laurie Brenner. You’re listening to UVA Health Systems Radio. For more information on UVA Neurosciences, Brain, and Spine Care and on pediatric neuropsychological evaluation for your child, 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

Advances in Heart Imaging

Additional Info

Segment Number 4
Audio File virginia_health/1447vh5d.mp3
Doctors Kramer, Christopher
Featured Speaker Dr. Christopher Kramer
Guest Bio Dr. Christopher Kramer is board certified in internal medicine and cardiovascular diseases and serves as director of UVA’s Cardiovascular Imaging Center.

Learn more about UVA Heart & Vascular Center
Transcription Melanie Cole (Host): Radiologists and heart specialists are developing new ways to identify heart disease through imaging. My guest today is Dr. Christopher Kramer. He is board certified in internal medicine and cardiovascular diseases at the UVA Health System. Welcome to the show, Dr. Kramer. Speak about, what imaging tests are used to diagnose certain heart conditions and how easy is this process?

Dr. Christopher Kramer (Guest): Thank you for having me, Melanie. There are actually five different tests that we use on a daily basis to evaluate heart conditions, and they all have their individual strengths and applications that we use them for. We can discuss each of them in turn. The most commonly used heart test is echocardiography or ultrasound to image the heart. It is frequently used to assess the function of the heart muscle as well as the function of the heart valves. It is frequently used to screen patients for the first time who may present with shortness of breath and to look for reasons why they may be short of breath, whether there is a problem with the heart function, cardiomyopathy, or problem with a heart valve, either it’s blocked or leaky. That’s the most frequently used reason for echocardiography or ultrasound of the heart. Another commonly used heart imaging test is SPECT, which stands for single-photon emission computed tomography. It is a nuclear technique that involves taking images of the heart and looking at blood flow to the heart muscle. This is very commonly used to again assess blood flow in a stress test. Typically, a patient will walk on a treadmill until they’re exhausted and can get no farther and we will image the patient with SPECT at rest and after stress to look for problems with blood flow to detect blockages in the heart arteries that might lead to reductions in blood flow. That’s a very commonly used cardiac imaging test. A relative of SPECT is a test called PET or positron emission tomography. It is somewhat less used. It is, in a sense, a better version of SPECT, but it is more costly and less available. It is used to again detect abnormalities in blood flow, but is much more quantitative than SPECT. It’s particularly used in certain types of patients, especially those who are on the obese side. Another commonly used cardiac imaging test is MRI of the heart. MRI is a newer test that’s only been available the last 10 or 15 years in heart patients and it is used both for stress testing, but not with an exercise treadmill. For this, we’d use an infusion of a medication that simulates the effect of exercise on the heart and we measure blood flow. In addition, MRI is often used in patients who have reduced heart muscle function or cardiomyopathy, because its best indication is really to understand what has caused the heart muscle to decline in function. That’s a very common use of MRI in 2014. Lastly, a very exciting cardiac imaging test is computed tomography or cardiac computed tomography or CT. CT is an anatomic test. Many of the other tests we’re talking about assess the function of blood flow. CT is really best at imaging the anatomy of the coronary arteries. It gives us a three-dimensional snapshot of the coronary arteries and it enables us to look at any blockages in the heart arteries. CT is best used as a test to exclude coronary artery disease in patients who are at low or maybe intermediate risk of having heart blockages because its best use is to show when those arteries are completely normal.

Melanie: Does somebody, Dr. Kramer, have to be symptomatic to get some of these imaging tests or are any of them sort of a yearly or an every five-year screening process?

Dr. Kramer: We have something called appropriate use criteria in cardiovascular imaging and we assess whether tests are appropriate to use as screening test. Most of the tests I’ve talked about are really reserved for patients who are symptomatic, either having chest pain or shortness of breath or some symptom that points to an abnormality in their cardiac condition. There are a couple of these tests that can be used for screening. I mentioned CT. There is a test called CT coronary calcium scoring, which is a test that doesn’t use dye. It just looks at the heart with a little bit of radiation, but no dye, and looks for calcium in the heart arteries. It turns out that calcium is a marker for the amount of atherosclerotic plaque in the heart arteries. This test is useful for screening in patients who are at intermediate risk of heart disease and asymptomatic. Because if they have a very high calcium score, that points to the need for very aggressive risk factor modification, and if one has a very low or zero calcium, then one can be less aggressive about risk factor modification. Overall, among those tests, in terms of screening asymptomatic patient, calcium scoring is the one that is best used.

Melanie: Speak about your research into improving cardiac imaging and how that’s leading to better diagnosis for patients.

Dr. Kramer: Sure. We’re very fortunate at University of Virginia to have a very strong team in cardiovascular imaging research with individuals in cardiology, radiology and medical imaging, and biomedical engineering, working together to improve cardiac imaging, make it more patient friendly, faster, safer, with improved diagnostic accuracy. One of our major areas of research is in improving cardiovascular MRI, especially stress testing MRI, making it more quantitative, more accurate, and faster and safer. Another area that UVA has worked on over many years is improving nuclear cardiac imaging, in particular, SPECT and PET. That’s an area that we’ve had strong efforts for decades here at the University of Virginia.

Melanie: Tell the listeners why someone should come to UVA for their heart imaging and heart care, and also really your best advice for people who might suspect that they might have heart disease and what they can do about it.

Dr. Kramer: Yeah, as I mentioned, we have a very strong team in cardiology, radiology and medical imaging, not only in making the correct diagnosis using these imaging tests that I’ve described, but taking outstanding care of the patient once heart disease is diagnosed. I think in addition to having excellent care, we also have the latest imaging equipment in all of the imaging modalities that I mentioned: echo, SPECT, PET, MRI, and CT. We have the very latest in technology, and our physicists and engineers are improving the technology on a daily basis to make it even better at making the diagnosis. If a patient has symptoms that they think might be or their primary care doctor thinks it might be a problem with their heart, the best is for their primary care doctor either to refer them to a cardiologist at UVA or may primarily refer them for a test to evaluate their heart, which, if the patient is presenting with chest pain, some sort of stress test either with SPECT or echocardiography or MRI might be indicated. If the patient is short of breath, then perhaps a screening echocardiogram may be the first test that is ordered to look for problems with the heart muscle function or the valves of the heart.

Melanie: Thank you so much. It’s very exciting information. You’re listening to UVA Health Systems Radio. For more information on the UVA Heart and Vascular Center, 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

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