Inactive (722)

Segment Number 4
Audio File city_hope/1440ch4d.mp3
Featured Speaker Lusi Tumyan, MD
Guest Bio Lusi Tumyan, M.D., is an outstanding specialist in breast imaging at City of Hope.
Transcription Melanie Cole (Host): Breast cancer screening is an important tool to help detect cancer in its early stages, when it is more easily treatable. As a dedicated team of breast cancer experts, City of Hope focuses on compassionate, patient-centered, leading-edge care to save the lives of women. My guest today is Dr. Lusi Tumyan. She’s an outstanding specialist in breast imaging at City of Hope. Welcome to the show, Dr. Tumyan. At what age should healthy women begin having regular mammograms, and how often should they have them?

Dr. Lusi Tumyan (Guest): That’s a very controversial topic at this point because various different organizations recommend different things. The American Radiology Society recommends starting at age of 40. United States Task Force, which came out in 2009, they recommend starting at age of 50. Obstetrics and gynecology groups are recommending to start at age of 40. I think it should be an individualized discussion between the patient and the referring provider that would determine their overall risk factors and determine their level of comfort of starting at age 40 versus at the age of 50, taking into account the risks and harms of screening mammogram as well as the benefits of mammogram.

Melanie: We’ve all heard about mammograms, and if women have had them, they’re not nearly as bad as you imagine that they are. But what’s the difference between a screening mammogram and a diagnostic mammogram?

Dr. Tumyan: Screening mammogram only does two views of the breast. What we’re actually doing is we’re taking a three-dimensional breast and we are taking two images and recreating in two dimensions. And we only get two views. With diagnostic mammogram, that’s usually for patients that have a specific problem, whether its patient is coming in for palpable lesion or patients coming in for surgical planning or other things. For those, we take additional images. It could be one image. It could be multiple images, but it is a problem-solving mammogram.

Melanie: Women go in for their annual mammograms depending on what they’ve discussed with their doctor, and you sit in the waiting room, make sure that the pictures are all right. That’s a terrible wait. Then you wait for your results, which is also a terrible wait, and you hope that you do not get that call. Then if you do get the call and you have to come back in for a diagnostic mammogram, what happens if something suspicious is found? Then what’s the next step?

Dr. Tumyan: At City of Hope, if the patient comes back for a diagnostic mammogram, they will have additional imaging based on the radiologist’s recommendation. Then they may or may not, depending what the finding is, have an ultrasound of the breast. Once they have all the imaging, the radiologist will review everything at the same time while the patient is still there. The radiologist most of the time will go and talk to the patient and will give them the results. The patients do not leave our department until they get the final result of their diagnostic workup, which helps with anxiety, and our patients are truly appreciative of that.

Melanie: What are some of the potential limitations of screening mammograms? Do we get results? And if someone has dense breasts, for example, Dr. Tumyan, is there a difference in how these results are read?

Dr. Tumyan: Yes. There are different densities of breast parenchyma, and the younger we are, we have more fibroglandular tissue, which means we have denser breasts. Unfortunately, fibroglandular tissue on a mammogram is white. Cancer is also white, which means that with dense breasts, cancer can hide. When they get screening mammograms, we read them and we will give -- every screening mammogram gets breast density, some sense of breast density, what they are, and what the limitations of the mammogram are related to that. If the patient has fibroglandular, heterogeneously dense breasts, they will get a sentence in their mammogram that says that the sensitivity of mammography is lower. In addition to that, since we are living in California, last April, the law was enacted that now patients get a letter. In the letter, it will state that they have dense breasts and that they should discuss this with their referring provider and that the mammogram is not as sensitive for them as previously thought.

Melanie: If you see something, then when does it come to biopsy? What is the followup after a diagnostic mammogram and you see something suspicious? Then what’s the next step. Tell us a little bit about biopsies.

Dr. Tumyan: After we do the diagnostic workup, which includes either a mammogram or ultrasound, I come into the room and I talk to the patient and I discuss all the findings. I will go through every single part of it, and we will discuss what the findings are and what we’re going to do. If there are suspicions and we’re going to do a biopsy, at that point, I will discuss with them what the biopsy will entail. There are actually three different modalities that we can use for biopsy: ultrasound, mammograms or stereotactic biopsy, or MRI biopsy. Majority of the biopsies are done with ultrasound. I will go through with them every step of the way how the biopsy is done. With ultrasound, we will be doing this real time. I will be visualizing the needle and the lesion the whole time. We give them local anesthesia, same thing that you would get at the dentist. It’s going to pinch and burn momentarily, and then the breast is going to be numb. We’ll put in the biopsy device, take a couple of samples, and samples will go to pathology. It takes at our institution about 72 hours for pathology results to come back. The pathology results are going to come to me and to the referring physician.

Melanie: Once the results come back, which doctor does the patient speak with about these results, you or the primary care physician?

Dr. Tumyan: Once the pathology results come back, I look at the imaging and pathology results and make sure that there is concordance. As long as there is concordance, I will give my recommendation, and that report will go to their primary or referring physician. The patients discuss their findings with their referring physician.

Melanie: Tell us about some new techniques being studied to improve the accuracy of breast cancer screening.

Dr. Tumyan: I’m really glad you asked me about that one. The future is digital tomosynthesis. What this does is, as I’ve told you before, we’re taking a three-dimensional breast and we’re taking two images and making them into two dimensions. But, just like everything else that’s three-dimensional, we are getting a lot of overlapping tissue, and if you have dense breasts, there’s a lot of overlap and it may simulate a mass when there isn’t a mass, or it may hide cancer. What the digital tomosynthesis does, it takes multiple x-rays of breast at 15-degree angles, and then it will reconstruct it into three dimensions. Now, we can view this breast in three dimension, which means that even with denser breast, we can see the lesion. This helps us tremendously because it not only decreases the recall rate, which is always a great thing, decreases anxiety, but it also increases our overall cancer detection rate. It also increases our overall detection rate of invasive cancer. That’s our breakthrough so far. There are other new technologies. One of them is whole breast ultrasound screening. In denser breasts, ultrasound is a good modality to supplement a mammogram. The new technology is that it can be done automated, in which case, the technologist doesn’t have to do that. You put in the machine and then it will take all the images and then the radiologist will review it. These are the two big modalities that are making new strides in breast cancer.

Melanie: In just the last minute, Dr. Tumyan, tell people why they should come to City of Hope for their breast cancer screening.

Dr. Tumyan: Well, City of Hope is very unique. We have multidisciplinary approach to breast cancer screening. We have oncologists, primary care physicians; we have surgeons that have dedicated their life and their career to breast cancer only. That’s all they do. In addition to that, we are very cognizant of our patients, and we give them results the day that they come into our facility, and we don’t make them wait. We have just purchased tomosynthesis, so this will be installed in the next month or two. We will be doing tomosynthesis on our patients, so patients that come in with denser breasts will get state-of-the-art mammogram and will get best possible results.

Melanie: Thank you so much. You’re listening to City of Hope Radio. And 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

Better Survival for Acute Leukemia Patients

Additional Info

Segment Number 3
Audio File city_hope/1440ch4c.mp3
Doctors Alvarnas, Joseph
Featured Speaker Joseph Alvarnas, MD
Guest Bio Joseph Alvarnas, M.D. is Associate Clinical Professor and Director of Medical Quality and Quality, Risk, and Regulatory Management
Transcription Melanie Cole (Host): Recognized internationally for its breakthrough treatments for leukemia and other blood disorders, City of Hope is one of the most successful treatment centers for leukemia in the country and has had some of the most consistently best survival outcomes. My guest today is hematologist/oncologist, Dr. Joseph Alvarnas from City of Hope. Welcome to the show, Dr. Alvarnas. Tell us a little bit about acute leukemia. What is it, and what symptoms might someone have that would send them to see you to even get diagnosed with leukemia?

Dr. Joseph Alvarnas (Guest): Thank you very much for the opportunity to be with you today. Acute leukemia is a relatively rare disorder. A total of about 20,000 people are diagnosed annually in the United States with either acute myelogenous leukemia or acute lymphoblastic leukemia. To state it simply, there are many cells within the bone marrow that serve to make all the elements of our blood. The youngest cells that we can identify in the bone marrow are called blasts. In acute leukemia, these younger cells grow out of proportion and soon overtake the bone marrow and blood. And our bone marrow becomes filled with these relatively nonfunctioning cells that over time can take away our ability to fight off infection, drop our red blood cell count that allows us to carry oxygen to our bodies, and drop our platelets. That leads us to bleed. In acute leukemia, what people may experience is progressive fatigue and increasing risk of infection or fever, and people beginning to bruise easily or have bleeding, either under their skin or from their nose or from their mouth. These are the most common symptoms that people experience when they’re developing acute leukemia.

Melanie: How do you diagnose it?

Dr. Alvarnas: Well, the appropriate thing is for people to get expert care quickly. If someone goes to an emergency department or in an urgent care and gets a blood count, then the pathologist or the person reviewing that blood smear may see a series of abnormal cells or blasts present. It really takes an expert review by a pathologist, like a place at City of Hope, to diagnose an acute leukemia and differentiate it from another condition that may be less serious. For many people, this may also require a bone marrow aspirate or biopsy, where a physician may take a small amount of bone marrow, typically from the hipbone, so that we can really see from the place where all the blood is made what is actually going on.

Melanie: Once it’s diagnosed, what are some treatments available, and what is their survival rate? Let’s give the listeners some hope for acute leukemia.

Dr. Alvarnas: One of the things that we’ve seen is that we’ve become far more effective over time treating people with acute leukemia. The therapy of this set of diseases -- and it is a set of diseases of up to 30 different kinds of acute leukemias. In fact, they require treatment sometimes with intensive chemotherapy. So, patients will enter the hospital and may stay hospitalized initially for up to a month. Then, in order to treat the leukemia effectively, they may require a series of treatments over the coming six months with hospitalizations and with the need of supportive care. So, the care of someone with acute leukemia is quite comprehensive. One of the things that we can offer these days for some patients who may be at higher risk for the acute leukemia to not go away is a bone marrow or blood stem cell transplant, or may identify a brother or sister or an unrelated donor or even a unit of cord blood saved when a baby was born as potential stem cell source. So, with acute leukemia, being in an expert place where your doctor can understand the nature of the risk from the disease and tailor the therapy specifically for your needs, you’ll receive the most effective care. Typically, cure rates have ranged from about 30 to 40 percent for adults with acute leukemia; but in expert places, where bone marrow and blood stem cell transplants can be performed, cure rates may exceed 60 percent. The best way to understand your risk and what is the best therapy for you is by having a conversation with the physician who is expert in the care of patients with this kind of leukemia.

Melanie: Are there some factors that affect someone’s prognosis and how well they’ll do with these treatments?

Dr. Alvarnas: Well, I think there are a number of factors. We know that if people are compliant with their therapy, if they take their medications on time and in an appropriate way, they do better. We also know that getting care in a comprehensive cancer center or an expert center also allows patients to have access to more efficient and effective care from the beginning and also allows them to be able to receive therapy that is state of the art and speaks towards the newest and best attempts to cure this disease that exists anywhere.

Melanie: You spoke about stem cell transplants, possibly cord blood and even bone marrow transplants. Is it difficult to find a match if you do need one of these? And if you find somebody who’s willing to donate bone marrow, Dr. Alvarnas, is that a difficult thing? Is it painful?

Dr. Alvarnas: Well, starting with your last question first, I am a tremendous coward, but I’m actually enrolled in the National Marrow Donor program as a volunteer donor. Donating stem cells these days is not a difficult proposition. In fact, for many donors, the cells may be taken from their blood using a machine that filters out the stem cells. I think that isn’t a barrier. What we’ve seen over the last decade is in fact greater access to donors for much more diverse variety of patients. About one in three people have an appropriate matched donor. We’re talking about immunological matching, not ABO red type matching. This is quite a bit different. Many other people though who don’t have a potential donor can draw upon a pool of more than 10 million unrelated volunteer donors that are available through the National Marrow Donor program, and this way, we can, for the vast majority of individuals affected by acute leukemia, find a donor that’s appropriately matched.

Melanie: What about some new advances? What’s on the horizon for acute leukemia?

Dr. Alvarnas: Well, I think there are a couple of things which I find tremendously exciting. On the transplant side, we’re now able to offer transplants using less intensive chemotherapy. Reduced intensity transplants, in fact, are able to extend the usefulness of transplants not just to people who are young but people who may be in their 60s or 70s who are affected by this disease. One of the innovations is that therapy has become more accessible and relevant for those who need it most. On the other hand, when I look at some of the things going on at City of Hope, we’re looking at new T-cell therapies, which can in fact target leukemia cells and lymphoma cells. In this case, what’s done is a T-cell is taken from either the person or from a donor and gene-engineered to be able to deliver specialized care—that is, we actually can target the T-cell against the leukemia or lymphoma cell so that it can augment all that chemotherapy has achieved beforehand. This way, we’re harnessing the power of the immune system and into the power of chemotherapy. Thirdly, we’re working in collaboration with other partners to be able to bring new chemotherapy drugs that are specifically targeted at leukemia in novel ways that had never existed before. This is a wonderful time to be at a place like City of Hope because we’re looking at the future of medicine written anew. It’s absolutely extraordinary, and it provides patients and their families to benefit from novel forms of new therapies, effective therapies that would have been unimaginable even 10 years ago.

Melanie: Dr. Alvarnas, in just the last minute or two—this is such fascinating and exciting information you’re giving today—please tell listeners why they should come to City of Hope for their leukemia or blood disorders care.

Dr. Alvarnas: Well, I think that first it’s how we care that makes a difference. As you walk through the gate here, literally, there’s a gate that says, “What profit is there in saving the body if in the process we forfeit the soul?” We look at people as living, breathing individuals with families and lives around them. What we do begins with the respect for that person and his desire to return them to wholeness. On the other hand, we couple that desire to respect the person with the best technology, the newest treatments, and the most dedicated healthcare professionals anywhere to deliver what I believe is the best care in the world.

Melanie: Well, thank you so much, Dr. Joseph Alvarnas. 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. Thank you so much for listening.
Hosts Melanie Cole MS

Cutaneous T-cell Lymphoma: Overcoming Challenges and Choosing the Best Treatment

Additional Info

Segment Number 2
Audio File city_hope/1440ch4b.mp3
Doctors Zain, Jasmine
Featured Speaker Jasmine Zain, MD
Guest Bio Jasmine Zain, M.D., is one of today’s most respected physicians in the treatment of hematologic malignancies. Triple-board certified in hematology, oncology and internal medicine, Dr. Zain leads a state-of-the-art program for the treatment of T cell malignancies using novel targeted therapeutic agents, immunological approaches and stem cell transplantation. She has developed a focus in the use of epigenetic strategies for the treatment of T cell and other lymphoid malignancies. Her work has contributed to the approval process for key drugs currently in use of the treatment of T cell lymphomas.
Transcription Melanie Cole (Host): For people who are diagnosed with lymphoma, City of Hope is one of the biggest and most successful treatment centers in the nation. My guest today is Dr. Jasmine Zain. She’s one of today’s most respected physicians in the treatment on hematologic malignancies, and she’s triple board certified in hematology, oncology, and internal medicine at City of Hope. Welcome to the show, Dr. Zain. Tell us a little bit about what is cutaneous T-cell lymphoma.

Dr. Jasmine Zain (Guest): Cutaneous T-cell lymphomas are lymphomas that arise in the skin. Lymphomas are basically malignancies or cancers that arise in lymph nodes and from lymphocytes. Skin is one of our largest lymphoid organs, and these are basically diseases or cancers of lymphocytes that reside in the skin. More commonly, lymphomas arise in lymph nodes, but this particular lymphoma actually starts in the skin and usually stays in the skin. The patients usually don’t have internal organ disease. They just have skin manifestations and rashes.

Melanie: What are the symptoms and manifestations of cutaneous T-cell lymphoma?

Dr. Zain: Most of the time, the most common presentation is a skin rash that looks very much like either an eczema or sometimes psoriasis, and the distinguishing part is that it arises usually in areas of the skin that are covered usually and are not exposed to sunlight, like the trunk, parts of the body that we usually cover, unlike some of the other rashes or sunburns that may arise in sun-exposed skin. Most of the time, that’s the usual presentation. Occasionally, patients will present with a more aggressive form of the disease, where they present with tumors or ulcers on the skin. Obviously, these lesions don’t respond to the normal treatments that we use for eczema, and ultimately, the patient ends up going to a dermatologist to have that evaluated further. These rashes basically don’t go away, and they’d continue to progress. That’s the most common presentation.

Melanie: Are there any known risk factors for CTCL?

Dr. Zain: Not that we know of. We don’t really know what causes these lymphomas. The important thing for the patients is that they should know that they didn’t get it from somewhere. Most of the time, people think of skin lesions as being infected, or they feel that they can’t touch anyone because they’ll transmit it. That’s not the case with these lymphomas. We don’t know what causes them, and we can’t transmit them to anyone else.

Melanie: How is it diagnosed?

Dr. Zain: It’s usually diagnosed with a skin biopsy. As I said, most of the time, the presentation is patients will have skin rashes that don’t get better and continue to come back, and ultimately, somebody will do a biopsy and that’s going to have characteristic findings that will help us make the diagnosis. There are ways to diagnose it under the microscope and doing special tests of the skin biopsy. That’s how it’s done.

Melanie: Dr. Zain, is this a very quick-developing type of cancer, type of lymphoma, or is it a slow developing? What happens once it’s diagnosed, and what treatments are available at City of Hope?

Dr. Zain: Sure. It’s one of the indolent lymphomas. It is a slow-growing disease. And usually, the diagnosis can take up to several years. Sometimes, patients have these rashes that don’t get better. Once the diagnosis is made, they’d look back and say, “Yes, I noticed that four or five years ago.” On average, it can take that long to actually come to a dermatologist who knows about this disease. Again, these are very rare diseases, so it’s not going to be the first thing on everyone’s mind. But if the rashes don’t get better over time, somebody will think about it and do a biopsy. The diagnosis can take a while, and overall, the course of the disease remains very indolent as well. For most patients who are diagnosed with this disease, it will be something they will live with. Sometimes it doesn’t affect your life expectancy. They just have these lesions that get treated and are an annoyance. As I mentioned earlier, they don’t don’t spread to the internal organs very frequently. There are cases, about 10 percent of the time, where they become more aggressive. It’s called transformation of the disease. And when that happens, you can have patients who may have internal organ involvement and have a more aggressive course. But for the most part, it’s a very indolent course, and the treatments vary with the type of lesions you have. Most of the time, in the initial stages, these are treated with skin-directed treatments. You don’t need chemotherapy. That’s the most important message I want to give to our listeners, that you don’t need chemotherapy in the initial stages. You can treat it with topical treatments, like topical chemotherapy, or you can treat them with light therapy. There are other medicines, like retinoids that are vitamin A derivatives. They can use them, again, topically as an ointment, or even as a pill form. You don’t really need chemotherapy given through the IV till very late stages of the disease. So, most people don’t require it.

Melanie: What about creams and ointments? Do you use that as the skin around it get dry? Is there any itching with that rash?

Dr. Zain: There is a lot of itching with the rash, and that’s really the most difficult symptoms sometimes to treat. We recommend a lot of different skin care methods for patients. We tell them to keep the skin moist and hydrated. Patients who have scaly rashes, we recommend that they take baths with things like chlorhexidine to try to help release the scales from the skin. Whirlpool therapy has been used, again, with patients who have extensive lesions on their body. There are many skin-directed treatments that can be used in the treatment of this disease, and that’s why it is very important to entail the help of a dermatologist in taking care of these patients. It’s best taken care of when there is collaboration between dermatology and oncology, where you can have skin-directed care and skin-directed therapy being suggested or managed by the dermatologist and the oncologist at the same time. At City of Hope, we are planning to have a multidisciplinary clinic for cutaneous T-cell lymphomas, probably starting within the next four to six weeks because we are having a well-renowned dermatologist join our group as well who is an expert in CTCL. When she arrives in November 1—I believe it’s her start date—we are going to have excellent care options at City of Hope for our patients.

Melanie: Tell us about new advances or what’s new in CTCL research. What’s on the horizon for it?

Dr. Zain: Sure. CTCL has been one of those diseases where we had nothing for several years. We had the standard treatments in light therapy. And then, over the last five to six years, there have been multiple advances. There have been at least two new medications approved for the treatment of CTCL, and we participated in those trials that led to these approvals. One of them is something called vorinostat. It’s an oral pill agent. It’s not chemotherapy. It’s a biologic agent. Then there is another drug called romidepsin, which has been approved for the treatment of CTCL. Again, it’s a non-chemotherapy agent. Patients could tolerate it very well. It’s given intravenously, though. Then, there are many new drugs. There is an agent called Adcetris. It’s an antibody directed to CD30 expressed from some of these cells, and that’s also currently in clinical trials for the treatment of CTCL, and the results are very positive. At City of Hope, we are looking at ways to treat these agents with immunotherapy by modifying our immune system to attack the cancer cells using specific T-cells that would be designed to attack the cancer cell. They are called CAR T-cells, and currently, CAR T-cells are in clinical trials for B-cell malignancies. But T-cell malignancies is the next thing, and City of Hope is the pioneer in this area. We have scientists at City of Hope that are looking at mechanistic pathways that go wrong in patients who have cutaneous T-cell lymphoma so we can target those pathways and provide the drug or the agent that can correct that genetic pathway. Dr. John Chen is one of the leading pioneers, molecular biologists/pathologists at City of Hope who are looking into that, and we’re planning clinical trials with novel agents that will target these pathways. And we have several of those that are currently in the planning stages. We hope to have some very exciting, new, targeted agents that can be used in these patients, particularly those patients with advanced disease, and these will hopefully have fewer side effects, and we can avoid chemotherapy in these patients completely. That’s our goal.

Melanie: Dr. Zain, in just the last minute, why should people come to City of Hope for their T-cell cutaneous lymphoma care?

Dr. Zain: One of the reasons is going to be, as I mentioned, the multidisciplinary cutaneous T-cell lymphoma approach. We have world-renowned experts in dermatology and pathology who are going to be a part of this team. We are going to have a team approach to the treatment of these patients. They will get excellent advice and care about their skin as well as systemic treatments that need to be given either by mouth or intravenously to treat the extensive disease. We have innovative research going on here, so they will have access to new clinical trials that are not available at other places. As I mentioned, one of the problems is that there is delay in diagnosis because people don’t think about it or don’t think about this diagnosis. This is the place to be because we have pathologists who are experts in this condition, and they can really just confirm the diagnosis. Even the subtype, they may have within a very short period of time. I think the patients can get an excellent care, and if distance is an issue, we can work with their local dermatologist and local oncologist to advise them about how to proceed with these patients and their care as well. So, I think the multidisciplinary approach and the availability of new, innovative treatments are the two things that will make City of Hope unique.

Melanie: Thank you so much. Great information. 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

Breast Cancer Prevention – How To Reduce Your Risk

Additional Info

Segment Number 1
Audio File city_hope/1440ch4a.mp3
Doctors Bosserman, Linda
Featured Speaker Linda Bosserman, MD
Guest Bio Linda Bosserman, MD, is a premier medical oncologist at City of Hope – Rancho Cucamonga. Her primary interests include women's cancer care, cancer prevention, clinical trials and quality cancer care delivery in community practice. While Medical Director of the Robert and Beverly Lewis Family Cancer Care Center in Pomona, California, she pioneered an integrated psychosocial oncology program and established the Breast Health Center for diagnostic services. She also directed the Comprehensive Breast Health Task Force, a multidisciplinary community coalition to evaluate and promote high quality, coordinated breast health for the diverse and multicultural residents of the Inland and Pomona Valleys.
Transcription Melanie Cole (Host): About one in eight women will develop breast cancer at some point during her life. While one can’t change in some respect, such as genetics and ageing, there are certain things one can do that may lower your risk for breast cancer. My guest today is Dr. Linda Bosserman. She’s a premier medical oncologist at City of Hope, Rancho Cucomonga. Welcome to the show, Dr. Bosserman. Tell us about the risk factors for breast cancer, the ones that we cannot change, genetics and such. Let’s start with those.

Dr. Linda Bosserman (Guest): Well, the fact that we’re women, we know that one in eight women are at risk to get breast cancer if you live to age 90. It’s still a disease that increases after age 50 and 60. Everyone shouldn’t walk around worrying about it, but we want to be aware of our family history and our own physical body exam. Genetically, some families are at higher risk to get breast cancer and particularly at younger ages, and that may be associated with breast and ovary cancer or other cancers. Everyone should know their family history and talk to their doctor and have an assessment if they might be at higher risk than just the background risk of our population. The other risk really has to do with health factors we can control, and that’s diet, exercise, and our weight. We need to really be aware of that and take an active approach to our health.

Melanie: Let’s start with exercise to use it as a prevention for, not only breast cancer, but other types of cancer as well. What do you recommend that people do, exercise-wise, to help reduce that risk?

Dr. Bosserman: Well, the main data shows that if women will exercise 45 minutes at least five days a week, you lower your breast cancer risk, you lower your risk of heart disease and stroke, which we shouldn’t forget are still the number one cause of death in women. You also, after a cancer diagnosis, especially breast cancer, lower your risk of recurrence, which is still important.

Melanie: Okay, we’re talking about a combination of cardiovascular exercise and weight training, just general exercise. Is taking a walk enough for you?

Dr. Bosserman: Well, ideally, the aerobic exercise helps two or three times a week, as well as overall fitness and toning. If you can’t do anything except walk, that’s a good start, but it has to be at a pace that really gets your heart rate up for a period of time. Walking is acceptable. I tell women, if you can’t do anything else, buy a dog and walk four miles a day. It’ll keep your weight under control and you’ll improve your fitness. Ideally, you develop a more well-rounded program that balances cardiovascular and general body fitness and some weight training, especially for osteoporosis prevention, which also goes along as women age and is common in the breast cancer population, especially after breast cancer.

Melanie: What about diet? Because we are hearing more and more in the media today, Dr. Bosserman, about diet and how foods can actually help you fight off so many of these cancers. Can you tell us about certain cancer-fighting foods and other healthy habits that can dramatically lower our risk?

Dr. Bosserman: Yes, food should be our main medicine. Food, if we look at diet information, the healthy diet has to have a foundation that is plant-based. That means emphasizing fruits, vegetables, legumes, nuts, beans, and whole grains. That should be our main foundation. Of course, grains, although important, may increase your carbohydrate load, so you have to be selective in using grains, but they’re very important for nutrient. When we get to vegetables, we know that the main cruciferous vegetables, which are broccoli, Brussels sprouts, kale, and cauliflower, have very important nutrients that help fight cancer; so do fruits. Again, depending on our weight goals, we want to have fruits that don’t have immediate release of sugars. We have to tailor the fruit to… we’ll look at our weight goal. It can’t be used using a lot of juices, which can release a lot of immediate sugar. In fact, I advise my patients to blend smoothies. We get all the fiber that helps slow glucose absorption and really has more nutrients and you get all the fiber with it, or eat the whole orange, eat the whole apple. I don’t really promote juices as much as eating the whole fruit and vegetable.

Melanie: Dr. Bosserman, we’ve heard that alcohol use can increase the risk of breast cancer and that even folic acid may reduce that risk of the risk that’s increased with alcohol consumption. Tell us about that.

Dr. Bosserman: The issue of alcohol can be complex. There’s no simple answer, but overall, alcohol is a significant cancer-causing agent, not just breast cancer but other cancers. We know in women, we should limit daily alcohol intake, if you drink daily, to no more than one alcoholic beverage a day and that’s two ounces of alcohol. Often these wonderful wine glasses with eight ounces are more than one glass equivalent. Certainly, if you have one or two drinks or glasses of wine on a weekend, that’s not going to increase your risks significantly; but daily alcohol intake, more than one drink a day for women and more than two a day for men, starts to increase your risk of cancer. There is data that having folic acid daily can help lower that. Folic acid is important in our diet and to be obtained from, again, a fresh diet of fruits and vegetables. But I think we really have to look at alcohol as we get older and people start drinking more every day, that’s not good for our health and it certainly can start to increase the cancer risk.

Melanie: Dr. Bosserman, what about hormone therapy? There’s been a lot of controversy about that as a risk for breast cancer.

Dr. Bosserman: Yes, it still remains very controversial. The first irony is, of course, that as women age and go into menopause, that’s when the breast cancer risk increases. We know that complex hormone replacement like Premarin, that was horse urine with many kinds of estrogens in it, increased the breast cancer risk over time, especially combined with chemically synthetic progestin that was used in the Prempro combination. Again, it’s a low risk, but it’s significant especially in longer term use. If you look at using estradiol alone, one of the main estrogens, that is a very small increased risk of breast cancer, and overall it lowers your mortality because it helps prevent heart disease. Every woman needs to talk to their doctor about symptoms of menopause, and depending on those symptoms, hormone therapy used within the first five years of menopause below age 60, certainly is a benefit to women if you need treatment. It still remains controversial in women who may have a high-risk family history. We don’t really know the answer, whether we can tailor it to bio identical hormones that are more natural, maybe absorbed through the skin and not through the stomach that may have less side effects and can be customized with the combination of the estradiol or Estrace and natural progesterone. We really need more studies and that information isn’t exact and may not increase breast cancer risk.

Melanie: What about our weight? This is a controllable risk factor for breast cancer, Dr. Bosserman, and when people hear controlling your weight and being overweight, we deceive ourselves a little. “Oh, I’m not that much overweight,” or “I only have a few pounds to lose.” What do you really think is an ideal weight? How can we figure out our ideal weight so that we are really reducing our risk for breast cancer where weight is related?

Dr. Bosserman: Well, we know if we increase weight, we increase the fat content in upper body and fat tends to release and certainly women hold more of the toxic estrogen, estrone, and certainly increases the risk of cancer as well as heart disease. It’s definitely toxic to have excess fat, especially as you get older, and put that fat in our central abdominal area. I think it’s really important that we maintain a healthy weight if we want to lower our risk of cancer and heart disease.

Melanie: In just the last minute and a half or so, Dr. Bosserman, tell people why they should come to City of Hope for their breast cancer care.

Dr. Bosserman: City of Hope is really unique in having reached out from this nationally known academic national comprehensive cancer center to build an extensive community network where all of us have the advantage of a multidisciplinary team that can take every patient’s unique presentation with cancer or a concern for cancer and make sure they have a comprehensive treatment plan that includes every option for their best long-term health and outcome. That’s really now available throughout all the counties in Southern California as well as people around the world who can come to this center and to the networks to make sure that each patient has access to the best treatment plan, but also to the latest research and availability of clinical trials to test new ideas in addition to all the standard treatments as we continue to improve the survival rate and cure rate for women with breast cancer and other cancers.

Melanie: Thank you so much, Dr. Linda Bosserman. You are listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks for listening.
Hosts Melanie Cole MS

Advance Care Planning: Making Your Health Care Wishes Known

Additional Info

Segment Number 3
Audio File allina_health/1438ah1c.mp3
Doctors Karimi, Sonia
Featured Speaker Sonia Karimi, MD - Family Medicine/Palliative Medicine
Guest Bio Dr. Sonia Karimi is a physician board-certified in both family medicine and palliative care with professional interests in palliative medicine, adolescents, nutrition, sports medicine and geriatrics. She is an exercise enthusiast, having completed many triathlons and an Ironman finisher. Dr. Karimi's approach to care is one of shared-decision making and says she takes the time to listen to her patients concerns, develop treatment plans and provide education instead of rushing them out the door.
Transcription Melanie Cole (Host): It can be pretty unpleasant to think of a time when a loved one, or even you, are very sick or injured. And because we can’t plan for those unexpected moments, it’s much more important to have a healthcare plan in place. My guest today is Dr. Sonia Karimi. She’s a family medicine physician and palliative care specialist with Allina Health. Welcome to the show, Dr. Karimi. What is advanced care planning?

Dr. Sonia Karimi (Guest): Thanks, Melanie. Well, I think of advanced care planning really as a process rather than an event. It’s a process that involves the discussion with your healthcare provider, your family, and the patient, and it’s the process of designing your goals, values and hopes for not only your health but how you want to live your life and what you want to see in your future as you age.

Melanie: This is a tough thing to do. As we said in the intro, it’s a tough subject to bring up. What are the steps involved in advanced care planning and how specifically do you bring it up to your loved ones?

Dr. Karimi: Well, I agree that’s a very hard thing to bring up. I’ve tried to get my parents to do it – and I’m a specialist – and it’s still been a challenge. There are multiple ways you can do it, and I think you can just start that with a discussion. Often, these discussions can be prompted by a health event that happens to someone close to you. That can be a good chance for children to say to their aging parents, “Hey, mom, if you were in this situation, what would you want?” Or, “What do you think about this?” So, they can often be a way to approach the subject in a manner that’s more natural and feels less intimidating to our aging parents. But it’s a discussion, and your healthcare provider can help facilitate it with you in the office. You can also go to classes, but just starting the discussion about what’s important to you as you age, what you would or wouldn’t want if that event happened. And then, the final piece is just documenting that discussion. I really think that the conversation is more important than the actual filling out of the form.

Melanie: The types of questions, the ones that are so difficult, and there are some barriers to advanced care planning, in that there is denial, and as you even say, your relatives and mine as well. There are these barriers. They are in denial. They don’t want to talk about it. It’s not going to happen to them. So, what types of questions should you be thinking about during these discussions and you said, “Keep track. Write down these questions and the answers so that you have them all.” What are the questions?

Dr. Karimi: Well, I think the most important ones, if you had a big health event in which you were, for example, in the ICU requiring life-sustaining interventions like a ventilator or things like that, if you couldn’t speak for yourself, what would you say? When people don’t want to talk about it, I tell them, “It’s a way of honoring your goals and wishes even if you can’t tell us what they are.” And sometimes, I’ll try to make light of it by saying, It’s like getting flood insurance. You hope that you never have to use it, but you’re really happy when you do have it. But it’s a way of really being able to honor you even if you can’t communicate what you want.” And so specifically, it would be around, something very bad happened and you needed kind of intensive life-sustaining treatments: Is that something you would want to continue? Is that something that you would want to be able to be allowed to die naturally? Those sorts of things are very important. And also, things like if the doctors are able to tell your loved ones or your decision-makers that your life is not going to be anywhere near the same it was before this health event or this accident, is that a life that you would want to continue to live, or would you want to be allowed to die naturally, rather than live in a debilitated state, or depending on machines to keep you alive; things like that?

Melanie: If you think about those final days, and this is an important one, I feel, because you’re talking about, would you rather be at home? And then, organ donation is an important one, funeral arrangements. I mean, how do you ask somebody “What type of funeral would you like?”?

Dr. Karimi: Yeah, exactly, it is a hard thing. And that’s why sometimes it’s just not something that’s going to be an easy conversation that’s going to happen between children and their parents, or the patient and whoever their healthcare agent would be. And in all situations, we – Allina, for example, has classes that you can come to and it makes it a little bit less serious. Like, “Okay, I’m just filling out a will where you…” People don’t seem to have a problem filling out wills at first. Like if something happens, who would get my house? And things like that. But when it comes to their health, obviously, it makes them a lot more nervous. They’ll be able to just go to a class and say, “Here’s a bunch of other healthy people. We’re all going to go through it: fill out this form together.” It can make some of the decisions easier to do and make the process seem less morbid. But otherwise, it’s also something that your doctor should be bringing up as well, because patients don’t want to bring it up. And so, your primary care physicians, oncologist, the ICU doctors, they should be bringing it up as well, because it is a hard thing for children to talk about to their parents with. But, yeah, I agree. It’s important to be able to document things, especially with our cancer patients. One of the things I always as them is, “If you know your time is limited, which unfortunately is going to be limited, how do you want to spend it? Do you want to be home? Do you want to be in the ICU? And then, after you’re gone, how do we want to honor you? For a lot of people, organ donation is one way of being able to honor their loved one and can provide a lot of comfort to families when they’ve lost a loved one. Those things are very important and a lot of it is just the language that you use in approaching these topics.

Melanie: Dr. Karimi, when you’re picking your agent -- because you mentioned picking your agent, and I’d also like to ask you how long these directives last – but when you’re picking your agent, suppose you’re the one who’s making your advanced care planning and you have more than one child, how do you decide who’s the toughest, who’s going to be able to make those tough decisions, or not be overemotional about it? That’s going to be important as to who you pick to make these decisions for you.

Dr. Karimi: Yeah, you’re exactly right, Melanie. Often I’ll have patients say, “I want all my children know what I want and they can just make a decision together.” I love the idea behind that, because family is important as a unit. But what I usually say is, “It’s going to be a lot easier on your children if you just pick one. And obviously, you hope that that healthcare agent kind of looks to the rest of them and makes a decision that everyone feels good about, but it is easier if there’ just one.” And I always say, “Which of your children, or whoever you want for you healthcare agent – it’s often children – is going to be the best under stress and, most importantly, maybe the least emotional?” Because when your parents are sick or your loved ones are sick, it’s very hard not to be emotional and it’s so hard to make decisions in that state. But thinking about which of your children is going to be able to step back, kind of look at the big picture and make a decision, and more importantly, make decisions based on what they think you will want and not what they would want, because none of us want to lose our parents, and so, it’s really hard to separate. As healthcare agents, one of the hardest things to do is separate what you want and what you think your loved one would want. That’s a hard thing to do. So thinking about the child that you feel would be best able to do that.

Melanie: That’s a great point to make sure that it’s what your loved one wants and not what you yourself, based on emotions, want. Give us some resources, Dr. Karimi, for additional information about advanced care planning.

Dr. Karimi: And in quick response, your healthcare directive doesn’t expire. It’s something that lasts as long as it’s there, but you can change it at any time. As far as resources, at Allina Health, we have trained facilitators that will meet with you, like I talked about, either one-on-one or as part of classes. You can also go to the Allina website, allinahealth.org/ACP, which stands for advanced care planning. Sometimes, you can talk to your primary care provider about. If you google advanced care planning, there’s a lot of different good sites, like Honoring Choices. There’s a lot of great resources out there. It’s just a matter of asking for them.

Melanie: So you can get some free classes at allinahealth.org/ACP, or you can call 612-262-2224 to register for the free classes to help set up advanced care planning directives. And in just the last minute or so, Dr. Karimi, tell us why listeners should come to Allina Health for their primary care.

Dr. Karimi: Well, I think Allina is very patient-centered. I think whenever you’re looking to get a good healthcare outcome, whether it’s for a minor illness or something significant, it’s a way of having two experts involved; having the medical provider, who’s an expert on the medicine, and then the patients themselves is the expert on their goals and their values. And when you combine these two things, you’re going to get the best outcome for your health. I think Allina really values that process and really looks at the patients as experts themselves.

Melanie: That’s such great information. You’re listening to The Wellcast by Allina Health. And for more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thank you so much for listening.
Hosts Melanie Cole, MS

Childhood Cancers and Blood Disorders: Information and Treatment

Additional Info

Segment Number 5
Audio File st_peter/1435sp2e.mp3
Doctors Calderwood, Stanley
Featured Speaker Stanley Calderwood, MD
Guest Bio Stanley Calderwood, MD, chief of pediatric hematology/oncology at Saint Peter’s Healthcare System in New Brunswick, N.J., is an expert if the care of children with cancer.

For more information about Saint Peter’s Healthcare System
Transcription
Bill Klaproth (Host): No medical diagnosis is more frightening for a parent than those chilling words that your child has cancer. But there is hope, hope in the form of an ever-new and effective treatment for all manner of childhood cancers, including those of the brain, the blood, and other parts of the body. Dr. Stanley Calderwood, Chief of Pediatric Hematology and Oncology in Saint Peter's Healthcare System in New Brunswick, New Jersey, is an expert in the care of children with cancer. He joins us to talk about some of those latest techniques and the prospects for families confronted by cancer. Dr. Calderwood, thanks so much for being out with us today. So, what are the most common forms of cancer among infants, children, and teens?

Dr. Stanley Calderwood (Guest): You're welcome, Bill. It's a pleasure to be on the show. Childhood cancer is an ever-changing landscape. The most common malignancy we see in childhood is leukemia, which really is a cancer of the blood-forming elements. Over the last several decades, we've had very dramatic improvements in treatments and survival for leukemia so that almost all kids -- in some subsets of leukemia, we're now looking at about 90 percent survival. In kids younger than a year of age, brain tumors are actually even more common than leukemia, and we still have a lot of work to do to cure brain tumors. And throughout childhood, there are various types of solid tumors that we can see—tumors of the kidney, the liver, the nervous system. In adolescence and young adults, we see a lot of lymphoma and bone tumors and muscle tumors. We're making slow but steady progress in all of those fields.

Bill: Are these cancers on the rise, or do you see a decline over time?

Dr. Calderwood: Well, the data from the National Registry suggests that there actually is a slight increase in the incidence of cancer over the last several decades. We don't really know the reasons for that. Some of them are we've identified, for example, that children who have been extremely premature at birth and are now surviving longer, for example, may have a higher risk of certain tumors, like liver tumors. Children who have been exposed to various environmental agents, viruses and so on, are more prone. So it does look like over the course of time there is a slight increase in incidence or occurrence of tumors. On the other hand, treatments are getting dramatically better. So, death rates from childhood cancers have been dropping dramatically. In fact, if you look through, starting about 1960 through the 1990s, a very dramatic annual decrease in the mortality rate in childhood from cancer, 5 percent or 10 percent per year. Unfortunately though, since about 2000, the end of the 1990s, that rate of improvement has dramatically declined. So we're looking at about 2 percent per year decrease in mortality rate from cancer. And so, we have a lot of challenges still to face and a lot of research going on to help us understand what's behind that decline and maybe some new therapies coming down the pipe that will be helpful.

Bill: So you mentioned 90 percent survival rate in leukemia. That sounds like good news to me. It sounds like you're winning the war, to a certain extent.

Dr. Calderwood: Yes. So I think when you look at survival rates in pediatric cancer, starting in around the 1960s and then through the rest of the 1900s, and maybe into the year 2000, the standards of therapy were combinations of surgery, radiation, and chemotherapy. And we've, I think, learned how to use those tools optimally, and those tools are sufficient for curing the majority of children. But there's still 10 percent to 20 percent of kids, and in some disease-types like infant brain tumors are much high percentage where those standard tools are not doing the job. And I don't think that revising chemotherapy protocols or surgery treatments or radiation are going to dramatically improve that. So what we need is new types of therapy, and certainly, there's a lot of things coming online, and we're very excited about the so-called small molecule inhibitors, immunotherapies, and then proton beam as a new type of treatment that may all be helping to get that decline in the annual mortality rate to a level where, hopefully, within the next 10 or 20 years, we're able to offer a cure to almost any child or every child who develops cancer.

Bill: So we hear a lot about proton therapies, speaking of these breakthrough treatments. It has been talked about as a safer, more effective method of battling cancer. Can you tell us what proton therapy is?

Dr. Calderwood: So, protons are charged particles. I think if we start with conventional radiation as a sort of a lead-in point, conventional radiation, you might think of it as something like a laser beam where the beam leaves the gun. It has energy and basically, that declines the farther it goes away from the gun. But if you're aiming at, say for example, a tumor in the middle of the head, there's going to be a certain amount of energy that hits the skin, the skull, the normal brain, in front of the tumor and on the other side of the tumor. And so, there's a lot more collateral damage with radiation. We’ve tried to get around that maybe by, for example, splitting the radiation beam into a number of different beams from different angles that overlap at the tumor. But there's always going to be some surrounding tissue, normal healthy tissue damage. Protons are different. They're more like bombers. So when they leave the airfield, they don't drop their payload or discharge their energy until they get to the target. So the advantage to that is that there is a lot less collateral damage. We're getting very tight fields around the tumor so that the healthy structures in front of and behind the tumor are not exposed to quite as much damaging energy.

Bill: So you're really able to really pinpoint the tumor with proton therapy.

Dr. Calderwood: Pinpoint the tumor and target the tumor, specifically. So it's not like the tumor is in the path of the radiation beam, but the tumor is actually the target of the proton particle beam. So I think what we're finding, especially in younger children, and especially in children who have brain tumors, where the damage from conventional radiation has sometimes been unacceptable and has not allowed us to use that modality or that form of treatment than with the proton beam radiation, we're able to use that form of treatment in younger children and spare vital surrounding structures—so, less impact on their growth and development, less impact on their hearing and school performance and things of that nature.

Bill: Certainly a worthwhile breakthrough. It sounds like an important developing tool in the war against cancer. And doctor, can you talk about the physical effects of cancer treatment? So we're talking about treatments and what sort of therapies are recommended and available to ease the physical ill effects of the cancer treatments.

Dr. Calderwood: Yes. So I think we can think of the side effects of treatment as being those that children experience immediately and things that can occur much later on in life, the sort of late effects of the treatment. The immediate side effects are the things that most people are very well aware of—the hair loss, the nausea and vomiting, the mouth sores, changes on the skin, decreased blood counts so there's a need for transfusion and platelet support, and an increased risk of infection. So we have been using chemotherapy for three or four decades now. So we've gotten very good at controlling those side effects. There's a very good antiemetic medications that can prevent nausea and vomiting in most children. There are growth factors that help the marrow to recover and reduce the risk of infection. There's blood and platelet transfusion and other forms of supportive care that really make chemotherapy much more tolerable. So the misery that kids go through during the course of their treatment is now substantially reduced from where it was even a decade ago.

Bill: Very good news. Excellent. And so, let's talk about the mental effects of cancer. Cancer is traumatic for anyone, but I would imagine it's especially traumatic for children. Are there cancer support groups available for kids and their parents?

Dr. Calderwood: Yes. I think trying to imagine the impact of a diagnosis of cancer on a child is very difficult. There's a loss of autonomy. There's the change in body image with hair loss and mouth sores and nausea and vomiting. There's isolation from peer groups. Parents and doctors, they're appropriately concerned about things like increased infection risk, so kids often end up isolated and out of school and out of their usual activities. And it's really just devastating. And a child impacts on the whole family; the whole family structure has to change. Maybe mom or dad needs to start taking time off work to be with the child. And it impacts the whole community. That family is part of a community; the community is touched with the cancer, and schools and parents of the schools become concerned because their child gets this if they come in contact. So there's a whole range of psychosocial impacts that are very hard to gauge. So I personally think that every child who is diagnosed with cancer needs to be evaluated by a psychosocial supportive care and counseling team. At Saint Peter's, we have a program called New Vision, which is headed by our clinical social worker, Irena Mariano Brown. So we do an evaluation in all children. And families have different coping skills. They have different abilities to adapt to situations. So some just need a little touch base, and is everything fine, is there anything we can do, and other families need a great deal more support and intervention. And I think we try very hard to address that whole dynamic that the child and the family are going through.

Bill: So there is support and support groups, and it's something you would recommend depending on the level of care or treatment the family may need. Dr. Calderwood, go ahead.

Dr. Calderwood: What I was going to say is I believe that most pediatric oncology centers have that sort of written in. At Saint Peter's, we have a program called New Visions, which really tries to emphasize those psychosocial aspects of the care of a child with cancer, which are really critical to adaptation and cure—and ultimately, happiness and adjustment to society. And those are the things that we really have to be concerned about.

Bill: Dr. Calderwood, last question. What's your best advice, then, for a parent who has a child with cancer?

Dr. Calderwood: My best advice is if you don't understand what's going on, make sure you pin your doctor down and talk with them and talk until you do understand what's going on. And your child, no matter what they're expressing, is going to be experiencing some upset, and probably having your child at least talk with social workers, psychologists, make sure that they have an opportunity to deal with the grief and stress that they're going through with the loss of autonomy, removal from the usual roles, you just can't overestimate the impact of those things on a child. The help is there. Get it if you need it.

Bill: Absolutely. Dr. Calderwood, thank you so much. I can't imagine any more heartbreaking than having to have a child with cancer. And luckily, we have people like you on the case to help us through it. So thank you so much for your time today. For more information, please visit saintpetershcs.com. That's saintpetershcs.com. I'm Bill Klaprock. This is Saint Peter's Better Health Update. Thanks for listening.
Hosts Bill Klaproth

Lung Cancer

Additional Info

Segment Number 4
Audio File virginia_health/1438vh5d.mp3
Doctors Lau, Christine
Featured Speaker Dr. Christine Lau
Guest Bio Dr. Christine Lau is a board-certified thoracic surgeon who specializes in treating lung and esophageal cancer.

UVA Cancer Center
Transcription Melanie Cole (Host): Is smoking the only way to get lung cancer? Learning more about this disease and the available treatment options will help you get the answers that you need. My guest is Dr. Christine Lau. She’s board-certified thoracic surgeon who specializes in treating lung and esophageal cancers at UVA Cancer Center. Welcome to the show, Dr. Lau. Most people associate lung cancer with smoking. Is that the only cause of lung cancer? Are there other causes?

Christine Lau: It’s really great to be on the show. Smoking is by far the leading risk factor for lung cancer. In the early 20th century, lung cancer was much less common than it is today, because of the manufacturing of cigarettes. At least 80% of lung cancer deaths are thought to be a result of smoking. But other things can cause lung cancer. Cigar smoking, pipe smoking – that’s obvious. That’s very similar to cigarette smoking. Second-hand exposure smoke can cause lung cancer. Radon which is in very small levels outdoors, but inside, higher levels of radon have been associated with lung cancer. Asbestos exposure in the workplace has been associated with lung cancer, and other types including mesothelioma with asbestos aren’t just the standard types of lung cancer that we see. There are other things that are more, you know, rare. Diesel exhaust has also been somewhat associated with it. Radioactive ores, such as uranium, other types of chemicals and minerals have been associated with it. More commonly now, we’re seeing cities with air pollution have higher risks of lung cancer. People who have been exposed to radiation to their lungs, and then a personal or family history of lung cancer have a higher risk of developing a second lung cancer, or developing lung cancer.

Melanie: So what are some of the best steps? You mentioned smoking as one of the main causes, but what are some of the best other steps that we can do to prevent lung cancer? Exercise, for example, Dr. Lau, does that help to reverse some of the effects that smoking or radon or any of these other pollutants might have had on our systems? Are there ways to actually prevent it?

Christine Lau: There have been a couple of studies looking at various minerals and vitamins to prevent lung cancer. None of them have panned out. Exercise and a healthy kind of lifestyle is always good for any person, but really the big thing is to avoid smoking and then to get your health tested for radon. Asbestos is much less common in the workforce today, but we still see it in patients who were exposed to it even 30 or 40 years ago. So, there really isn’t good prevention other than avoidance of the risk factors.

Melanie: So what are some of the common symptoms? People always think of the coughing and they vision people with oxygen. What are some symptoms that might send someone to the doctor to even get that lung cancer found?

Christine Lau: That’s a great question. Usually, symptoms of lung cancer don’t appear until the disease is quite advanced and usually non-curable by the time patients present with symptoms. Symptoms such as weight loss, even hemoptysis, bone pain – these can be signs that the tumor is quite advanced. Even something like an infection, where they come in, they have had a chronic infection, they may have a lung cancer that’s actually been the cause of that. It’s unfortunate, but those patients are often quite advanced by the time they present. When we see cancer that’s curable, it’s often found by just a routine chest X-ray for another reason. They come in for a hernia surgery and they get a chest X-ray. There is new evidence that lung cancer screening in patients who meet very specific criteria that does help detect it early. I think the best thing to do is, if you have smoked or you are currently smoking, that you let your doctor know and you talk with them about lung cancer screening, because that’s relatively new. It’s a CT scan and it’s relatively new on the horizon. I think it has been shown to decrease deaths from lung cancer.

Melanie: What’s involved in the screening?

Christine Lau: The screening is done in most centers. UVA has a lung cancer screening program. You basically call our number and if you fit in a certain criteria, they will get you in for a CT, a low-dose CT scan. That scan will scan your lungs and look for any small nodule. So patients who have smoked for 30 packs a year and they’re over 55, they still smoke or has smoked, they should really be contacting their primary care doctor to arrange to get a lung cancer screening study.

Melanie: That’s really great advice, because if you’ve been a smoker, even if you’re a reformed smoker, it’s something to ask your doctor about getting lung cancer screening, because it could help you to find it early enough. You mentioned the word “cure,” Dr. Lau. At what point and stage, if lung cancer is found early enough, can it be treated successfully?

Christine Lau: It sure can. I mean that’s the goal, if we can find lung cancer as early. There are four stages of lung cancer. Stage four is the most advanced. It is considered not really curable but we can palliate patients with stage four lung cancer. Stage 1, 2 and some 3, we can still go after cures for the patient. And if it’s found early, if it’s a very small nodule, with no lymph nodes spread and no other spread, we often will be able to treat them with surgery.

Melanie: Wow. That’s amazing. So tell us some of the treatment options you mentioned. Surgery – does this usually also involve chemotherapy radiation? When it’s the lungs, people, you know, get a little bit more wary of these types of treatments. Tell us how these treatments affect the lungs.

Christine Lau: Well, there are several options for patients who are diagnosed with lung cancer, and that’s the big thing. I always tell my patients, “The first thing we need to figure out is: What are we dealing with? How advanced is it?” And then, we can really sit down and go through all the options that they have. I know it’s very hard to hear. I’ve had my own family members diagnosed with cancer and the first thing you hear is that word and it’s really hard to focus on anything else. The best thing you can do when you get a diagnosis is to really figure out, where do you fit in and what are your treatment options? There are several options for patients with lung cancer. Surgery is for relatively early stage lung cancer: Stage 1, stage 2 and some stage 3-A lung cancers. There are other new options: the radiofrequency ablation, also called stereotactic radiation. It’s a type of very focused beam radiation treatment, and that’s been very successful and is relatively new in the armamentarium of what we can use to treat lung cancer with. There’s also standard radiation and chemotherapy. Then finally, there’s targeted therapies that are very specific for the type of cancer you have. I think the big thing is to get in with a group that’s multidisciplinary and can really approach you based on what is the best plan, individualized plan for you if you have lung cancer, because it can really vary based on: 1) what you want; 2) what your health is, how good your health is; and 3) what options are available at the institution that you’re being seen at.

Melanie: Give us a little advice about some of the lifestyle things if somebody is diagnosed with lung cancer, Dr. Lau. Coping with some of the symptoms, like shortness of breath, can be very scary. Give us some of your best advice on dealing with some of those things at home.

Christine Lau: Yeah. I think that is really hard. It’s a very difficult time and often they are still smokers and then everyone tells them, “You know, you really need to quit smoking.” It’s a very stressful time. I will tell you that my own father smoked until the day he died, and I’m a thoracic surgeon. So I do understand what a habit and how addictive tobacco is to my patients and to people, in general. I think the first thing is to recognize a lot of these patients are already short of breath and some of them are on oxygen. But to really just take a step back and know that it’s not always that this lung cancer stuff is causing additional symptoms. It’s really just the stress of knowing you have this diagnosis and how it’s going to be treated. So, the thing I really tell patients is it’s going to take some time to put together your treatment plan and we need to just be very thoughtful about that.

Melanie: So, in just the last minute, tell the listeners why patients should choose UVA for their lung cancer treatment.

Christine Lau: Well, I think UVA has a lot of options that other places also do have, but they’re a fairly unique one. We are a big multidisciplinary group. There are three thoracic surgeons at University of Virginia, which is a very large group of thoracic surgeons, and we all communicate with each other. We discuss cases together. We have conferences where we meet and discuss various options. What would you do? How would you handle this? We also have three thoracic oncologists, that all they do is thoracic surgery. That’s the only type of chemotherapy that they actually provide. They’re experts specifically in lung and esophageal cancer. We also have a radiation oncology program that is very specific to lung cancer. We have nurses that all they work on are patients who have lung cancer. And so, I think the thing that we have that’s very unique is that we have a multidisciplinary group. I actually go over to Augusta. We also have collaborations with the community hospitals, as well. So we have the option to do some things over at Augusta Hospital and also over at UVA. I think we have an outreach, a pretty big, broad group or area that we can cover. I think the biggest thing is that we’re also affiliated with a major cancer center and so we all the resources that are offered from the cancer center. So, big clinical trials – there’s a lot of clinical trials that are coming out that we can offer, that other centers just don’t have the ability to, because we are affiliated with such a topnotch cancer center.

Melanie: Thank you so much, Dr. Christine Lau. For more information, you can go to uvahealth.com. That’s uveahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Have a great day.
Hosts Melanie Cole, MS

How is Heart Disease Different for Women?

Additional Info

Segment Number 3
Audio File virginia_health/1438vh5c.mp3
Doctors Patterson, Brandy
Featured Speaker Dr. Brandy Patterson
Guest Bio Dr. Brandy Patterson is board-certified in internal medicine and cardiovascular disease; her specialties include women’s heart health and general cardiology.

UVA Heart and Vascular Center
Transcription Melanie Cole (Host): Heart disease isn’t just a man’s disease. But heart disease symptoms are often different for women. Would you know the signs and symptoms of heart disease when they happen?My guest today is Dr. Brandy Patterson. She’s board certified in internal medicine and cardiovascular disease. Her specialties include women’s heart health and general cardiology. Welcome to the show, Dr. Patterson.Let’s start with heart disease in women: number one killer. Tell us about heart disease in women and why it’s so different than it is in man?

Dr. Brandy Patterson: Well, every minute in the United States, somebody’s wife, mother, daughter or sister dies from heart disease, stroke or another form of cardiovascular disease. Every year, more than 400,000 women in the United States die from heart disease. It is the leading cause of death in women and kills six times more women than breast cancer alone. Right now, more than one in three women is living with some form of cardiovascular disease, including nearly half of all African-American women. Although heart disease death rates among men have declined steadily over the last 25 years, rates among women have fallen at a much lower rate. There are many potential reasons for this. However, women may not always recognize that they are having a problem with their heart because their symptoms may be much more subtle.

Melanie: Speak about the symptoms, because, really, Dr. Patterson, we, women, are always taking care of everybody else in our lives and we get our men to go to the doctors and we take our children and we do everything for everybody. But, you know, we can’t take care of everybody else. I always say, we have to put our own mask on before we put the other kids’ masks on. We have to know these symptoms. They’re so important but we don’t recognize them for what they are. We usually dismiss them as something related to stress or tension. Tell us these symptoms that differ in women.

Dr. Patterson: That’s right. All of us have seen the movie scenes, where a man gasps, clutches his chest and falls to the ground, and it’s always a man. But in reality, the heart attack victim could easily be a woman, but the scene may not be that dramatic. Instead, women may experience symptoms of dizziness, sometimes cold sweat, lightheadedness, sometimes just shortness of breath, pressure pain in the lower chest or upper abdomen that they may think is reflux. They may have caught a GI, a virus going around with some nausea and abdominal pain, sometimes upper back pressure, or pain in one arm or both arms, in the jaw, or just extreme fatigue. And so, as I said, women may attribute these symptoms to reflux and upper respiratory infection, GI virus going around, or just getting older. The signs and symptoms can be subtle but the consequences are deadly, especially if the victim doesn’t get help right away. So it is very important for women to understand what their risk for coronary artery disease and for heart disease in general is. They need to learn what their personal risk is for heart disease.

Melanie: What are some steps that women can take to protect themselves and things that we can do to prevent heart disease?

Dr. Patterson: That’s a good point. Heart disease is preventable. There are a few non-modifiable risk factors, meaning, risk factors we can’t change. Number one, that’s our age. We don’t have a choice. We’re getting older and as we get older, plaque does build up in the coronary arteries and we’re more likely to have a heart disease as we get older. We can’t change that. We can’t change our gender. We can’t change our family history. We are born with the genes that we have. If you do have family members that have had heart disease, you are more likely to have it yourself, especially if they had it at a younger age.
The risk factors that you can change, that you can modify, are those reasons why heart disease is largely preventable:
1. Smoking. Smoking really makes the plaque progression much more rapid in the coronary arteries. So don’t even start smoking, and if you are smoking, quit. After quitting for just about a year or so, you really cut your risk by about half of having plaque progression that is accelerated.
2. Your blood pressure. Control blood pressure. Know what your numbers are.
3. Your weight. Obese patients—or obese women in general—tend to have accelerated plaque progression.
4. Your cholesterol. Know your cholesterol.
5. If you have diabetes, try and control it as best as you can. Get out and start an exercise program. Just walking at least 30 minutes a day, five days a week, at moderate intensity can lower your risk for heart attack and stroke.
6. Modify your family diet if needed. Follow a heart-healthy Mediterranean diet.
So, as you can see, there are a number of risk factors for heart disease that are modifiable, and women do have the ability to adopt positive lifestyle habits. And as you mentioned, women tend to take care of everybody else in the family, so if women tend to adopt the positive lifestyle habits in their life, they’re more likely to have their significant others as well as their children adopt those positive healthy lifestyle habits, as well.

Melanie: Absolutely great information, so well put, Dr. Patterson. What is Club Red? And how can someone get involved?

Dr. Patterson: Club Red is a UVA Heart and Vascular Center initiative that is designed to help women understand and manage their risk factors for heart disease. It’s free and it’s an online program, and it inspires women to live a heart-healthy lifestyle by providing them with health tips and recipes, as well as fun community events throughout the year. You can go online at clubreduva.com to learn more information.

Melanie: Give us really some of your best advice about women who may already have heart disease. So we spoke a little bit about prevention. But now, if they’ve already come up with it, whether it’s genetic or just something that they’ve had, what can they do to treat it? What do you do for them?

Dr. Patterson: I’m a firm believer in regular healthcare provider appointments to ensure that the blood pressure, heart rate, cholesterol, diabetes are well-controlled. And again, I can reinforce it enough, walking, exercising, anything that you can do to get up and active, will help prevent the progression of coronary artery disease, as well as eating a healthy Mediterranean diet. In general, for women that have already had the diagnosis of coronary artery disease, whether it’s obstructive or non-obstructive, we prescribe the same regimen: controlling blood pressure, cholesterol, diabetes, exercising, living a healthy lifestyle by eating a Mediterranean diet, and not smoking. The things that we do to prevent heart disease are the same things that we do to help control progression as well. Of course, once women are diagnosed with non-obstructive or obstructive coronary artery disease, there may be more medications involved in treating and helping to prevent the progression, as if you did not have any coronary artery disease. But it’s something, again, that the healthcare provider follow-up on a regular basis can keep track of and tailor your medication according to your situation.

Melanie: Dr. Patterson, in just the last minute or so, give us your best advice for women and heart disease and why someone should come to UVA for their heart care.

Dr. Patterson: Well, UVA provides wellness and health for all women, whether or not they have coronary disease or are just looking to find ways to prevent coronary artery disease and heart disease. Their standards of care are amongst the best in the nation and it truly is a wonderful place to come to for the best healthcare in the country.

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

Learning More About Neurofibromatosis Type 1

Additional Info

Segment Number 2
Audio File virginia_health/1438vh5b.mp3
Doctors Dhamija, Radhika
Featured Speaker Dr. Radhika Dhamija
Guest Bio Dr. Radhika Dhamija is a board-certified neurologist – with a special qualification in child neurology – whose specializes in neurocutaneous disorders such as neurofibromatosis.

UVA Neurosciences: Brain & Spine Care
Transcription Melanie Cole (Host): Neurofibromatosis type 1 is a genetic disorder that affects one in every 3,000 to 4,000 Americans, according to the National Institute of Neurological Disorders and Stroke. My guest today is Dr. Radhika Dhamija. She’s board-certified neurologist, with special qualification in child neurology, who specializes in neurocutaneous disorder, such as neurofibromatosis. Welcome to the show, Dr. Dhamija. Tell us, what is neurofibromatosis type I?

Dr. Radhika Dhamija (Guest): Thank you for having me on this show. I’d love to tell you about neurofibromatosis. neurofibromatosis type 1 is a genetic, neurologic disorder and it is caused by mutations in a particular gene that we call neurofibromin. The normal function of this gene is to suppress tumor growth or help normal cell growth. And when this gene is not functioning, then we see abnormal cell growth in the form of tumors. So that is, in summary, what a neurofibromatosis type 1 is.

Melanie: Who does it most typically affect?

Dr. Dhamija: It can affect really anybody. It affects children. It affects adults. It affects people of all races. It doesn’t have any sex predilection. It affects females and males equally. As I said, it’s a genetic disorder, and oftentimes, in at least half of the individuals, we can trace it to other members of the family; it is inherited from their mom or dad. But probably in about half of the patients, it is caused by new mutations, so we are not able to find a family history and that individual is the only affected member in the family.

Melanie: What are some of the most common signs and symptoms that would either signal a parent to take their child to see you or that someone might notice?

Dr. Dhamija: Oftentimes, a common cause of referral is café au lait macules. They are brown spots on the skin. They start developing in the first few months of life and keep increasing in number as a child is growing. The other common symptoms are neurofibromas. Neurofibromas are benign tumors of the nerve. Nerves are present really anywhere in our body. They’re present in the skin, under the skin, the nerves, except the spinal cord. So once those neurofibromas or tumors form around those nerves or in the nerve, they cause symptoms such as pain or weakness in a limb. Those would be common signs and symptoms that a patient can present with. These neurofibromas can also be found under the skin, so they can be of some cosmetic issues depending on where in the body they are. The other symptom that we worry about in this disease is this disease, as I said, is caused by mutation in a tumor-suppressor gene, so it increases the chance of an individual to develop other kinds of tumors. One particular tumor we worry about especially in children is called optic glioma. It’s a brain tumor and it affects the optic nerve or the eye nerve that goes to the brain and its pathway. We do recommend that all patients with neurofibromatosis type 1 see an eye doctor annually so that we don’t miss it. We also worry about blood pressure issues, because there’s a specific kind of tumor that can happen in this disease. It’s called pheochromocytoma that releases hormones that can increase one’s blood pressure. Those are, I guess, the common things that we worry about in this disease.

Melanie: As you’re facing these medical challenges that this disease can cause, do you treat each of these things as they come up, Dr. Dhamija? Or do you treat this as a whole disease in the child? Or do you take each one of these challenges and deal with them as they come?

Dr. Dhamija: We try to look for those things in an individual whether they have it or not, and as the challenges come, we offer specific therapy for them. I recommend that anybody with neurofibromatosis type 1 to see a physician who’s very familiar with this disease every year, because even within the same family, if they have the same mutation, the manifestations of this disease are very different. Some individuals can have really minor signs and symptoms, like only skin changes and fibromas under or over their skin; however, other individuals can develop more serious kinds of problems, like tumors, and so would probably need different management. So it really depends on what manifestations or what sign and symptoms an individual develops, and then we try to manage those. Annual follow-up in a neurogenetics clinic with somebody who’s familiar with this disease would be the key, and then the other things sort of follow it.

Melanie: So speak about the treatment options that are available now for neurofibromatosis type 1. As you’re dealing with the high blood pressure and the optic nerve tumors and any of these things, what treatments are out there?

Dr. Dhamija: Sure. Optic glioma – we can start with that. Optic glioma is very unique in neurofibromatosis type 1. It can actually be present in up to 25% of kids with this disease, especially under the age of 8 years. This is very different from optic glioma in an individual who does not have neurofibromatosis type 1. Typically in this disease, we think that it regresses actually, and may not even need chemotherapy or radiation therapy. And so we oftentimes follow them very closely with a serial MRI scans of the brain, do their vision assessment, and only treat if it’s really rapidly going or it’s affecting their vision to a certain extent. As I said, it can often regress, but behaves very differently, and so they would rarely need a physician who knows about optic glioma in this particular disease, versus if it occurred without neurofibromatosis type 1. Coming to blood pressure issues, it is more about detecting high blood pressure in an early stage so that we can look for that one kind of tumor that I talked about, pheochromocytoma, and that would be managed like any other pheochromocytoma. If the blood pressure is unrelated to pheochromocytoma, again, the management would be similar to hypertension, otherwise. The neurofibromas can be removed oftentimes easily especially if they’re over the skin or in the dermis. However, there is a particular kind of neurofibromas that can happen in this disease, called flexi-form neurofibroma, which is a very complex neurofibroma involving multiple nerves. Oftentimes, the skin over that neurofibroma is discolored, has a patch of hair, and so we get an idea that there might be a flexi-form neurofibroma underneath. So those neurofibromas are somewhat challenging to manage because if you cannot do surgery and take the whole tumor out, as they are large, in about 10% of the time, those flexi-form neurofibromas can turn malignant or turn into neurosarcomas. Unfortunately, we don’t have very good therapies for those kinds of cancers yet. However, as I said, they’re very rare and most of the time, 90% of the time, the neurofibromas are benign and the symptoms that really come out of it are because of the location of them and are more related to pain and cosmetic issues, and worrying that they’ll turn into cancer.

Melanie: And doctor, in just the last couple of minutes, please give the listeners your very best advice about kids that have neurofibromatosis type 1 and the outcome for the rest of their life and why should patients come to UVA for their care.

Dr. Dhamija: I should tell the listeners that most patients of neurofibromatosis type 1 have mild to moderate challenges in their life. Their longevity, for most part, is not affected because, as I said, cancers in this are not malignant. They’re benign. I think UVA is uniquely positioned. We offer a multidisciplinary care. We have neurologists, geneticists, neurosurgeons, plastic surgeons, oncologists, genetic counselors who work very closely with both adults and kids, and we have a dedicated neurocutaneous clinic and a neurofibromatosis type 1 clinic. And so, all the physicians who are involved in this multidisciplinary clinic are very familiar with the latest research, the latest technology, and just the latest knowledge of neurofibromatosis type 1.

Melanie: Thank you so much. For more information, 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

Caring for Mother and Baby

Additional Info

Segment Number 1
Audio File virginia_health/1438vh5a.mp3
Doctors Dudley, Donald
Featured Speaker Dr. Donald Dudley
Guest Bio Dr. Donald Dudley is board-certified in both obsetrics and gynecology and maternal-fetal medicine; he is director of UVA’s Division of Maternal-Fetal Medicine.

UVA Children’s Hospital
Transcription Melanie Cole (Host): Expectant and new parents are full of questions. Here to answer some of those common questions is Dr. Donald Dudley. He’s board certified in both obstetrics and gynecology and maternal-fetal medicine and he’s the director of UVA’s Division of Maternal-Fetal Medicine at UVA Children’s Hospital. Welcome to the show, Dr. Dudley. What are some of the most common questions that you get from parents and new parents?

Dr. Donald Dudley (Guest): Well, thank you and thank you for having me on this show. I’d say some of the more common questions that I receive are questions about the labor process and what they can expect in labor. Especially for first-time moms, it can be quite a time of anxiety because they just don’t know what it’s like and what’s going to be happening and they’re concerned about dealing with pain issues and all about just the practical things, like ‘what’s the hospital like,’ and the like. They often ask how long they have to stay in the hospital. Another common question is ‘when is the baby going to come,’ which is a hard question for us. We never really know. In some cases, we actually are able to schedule labor inductions, but we usually reserve that for obstetric or medical problems that require delivery at a scheduled time. So, new patients often come in with many questions on many topics, and our role really is to help educate patients about what they can expect during their pregnancy.

Melanie: Dr. Dudley, [what do you] tell them about the pain that they can expect? I’ve had two babies. I loved labor and delivery. I did. I loved it. But what do you tell them about the pain threshold that they can expect.

Dr. Dudley: Well, I actually really very much encourage that they undergo some form of labor education at our hospital, and really all hospitals where they have delivery services usually offer prenatal classes to teach ways to manage pain. Pain is a very subjective feeling. It’s the same pain, and yet there’s a wide range of responses to the pain. But for the most part, women tolerate this very well. There are options for pain control, for example, epidural analgesia, which a majority of our women tend to have. And I encourage, if they’re not able to cope with the pain, that there’s no reason to suffer through this much pain later in their labor process. And so, we have a number of options available to help manage this, but we really much prefer patients who can come in and manage the pain on their own.

Melanie: What are some of the most important things a new parent can do to get their newborns off to a great start in life?

Dr. Dudley: Well, I think the most important thing first is to eat a healthy diet. There are new weight gain recommendations during pregnancy that we try to follow as best as we can, but certainly eating a healthy diet. Avoiding any unnecessary medications or exposure during pregnancy is also important for the developing baby. There are some medicines that need to be taken during pregnancy and our role as obstetricians is to try to provide safe medication for the mother and for the baby. Also, avoid unnecessary exposures to things like pesticides and cleaning agents and things such as that that potentially can be toxic. It’s amazing how many chemicals are in the world that we just don’t know if they’re safe during pregnancy. I like my ladies to have the chance to exercise and, more importantly, to be aware of changes in their body and look for warning signs of problems such as preterm labor or high blood pressure. We spend quite a deal of time educating patients about the warning signs for these conditions.

Melanie: So what are some of the most challenging things that a new mother is going to face after giving birth?

Dr. Dudley: Well, in my experience in seeing patients soon after they deliver, probably one of the most challenging things is finding enough time for sleep. Fatigue is a very common problem early in the newborn period for the mother. I always ask my patients to be sure to sleep when the baby sleeps, which is easy to say and awfully hard to do sometimes. So, I’ll often see patients in after two weeks and ask them how much sleep they’re getting, and they’re getting maybe three to four hours of sleep in a 24-hour time period, which is really not enough for a healthy start for a new baby. So we work out strategies to try to help them improve their sleep. There are common challenges with nursing. We very much encourage women to breastfeed. Especially here at UVA, we have a very active program to try to help women learn all the tools for breastfeeding. Sometimes, that can be a challenge too, with getting a new mom and new baby to learn how to breastfeed together. Another common challenge is kind of the baby blues. It’s very common for women after having a baby to have some mood swings early after taking the baby home, where they’ll just be standing the sink, crying for no clear reason. And typically, this clears after about a week or two, and our patient’s moods get better. But in a substantial proportion of patients, they will develop a postpartum depression, and that’s something that we’re very much aware of and very often we will screen for all of our postpartum women about a couple of weeks to six weeks after their delivery to make sure that they’re not suffering from a post-partum depression.

Melanie: Dr. Dudley, what’s your best advice for new parents to be prepared to welcome their newborn home? Are there things that they should do before they go into labor to get ready to bring that little baby home?

Dr. Dudley: Yes. I think one of the most important things is to create an environment that’s safe for the baby and also safe for the mother. One of the most common problems that occur after they take the new baby home that can be devastating is this Sudden Infant Death Syndrome, and they often occur because of unsafe sleep practices in the home. It’s really important for parents to work with their pediatricians and their obstetricians to create a safe environment in the home and to emphasize safe sleeping habits for the baby. Another issue is to be sure to try to have as much help as they can get at the home the first few weeks, whether or not it’s their mother or mother-in-law, for the new mom, her mom, or her mother-in-law or sister, someone to help out around the house. I think it’s really important just so they can get some of that sleep that they need after they take the baby home.

Melanie: Now, what about things like car seats and getting that kind of thing ready and organized? You have to have a car seat before you can even leave the hospital, correct?

Dr. Dudley: Correct. If they can get their own car seat, that would be great. If they cannot afford one or cannot get one, most hospitals have a car seat program. You certainly have to have a car seat to take the baby home. Again, that’s the whole issue of safety, providing a safe environment for that baby. We need to take the baby home and that the baby be safe in all aspects from the minute you leave the hospital to the minute you get to the house and really for the rest of their lives.

Melanie: Dr. Dudley, we have about two minutes left. If you would, just tell the listeners your very best advice for new mom, new baby, bringing a newborn home, and then why parents should choose UVA for their care.

Dr. Dudley: Well, my very best advice is to keep a healthy lifestyle and to be very aware of what’s going on with their body and to really emphasize both the mother’s and the baby’s safety as they get started off with a new family. We really emphasize this at the University of Virginia. We have a “Be Safe” initiative throughout the hospital for we truly work to provide the safest environment for patients when they come in to the hospital. As many of the listeners may know, patient safety is of paramount importance and the healthcare system can sometimes, in the past, have not been emphasized as much as now. So we really do go the extra mile to provide a safe environment for mothers when they’re in labor and for their new babies. At University of Virginia, we have a very patient-friendly center. We’re a baby-friendly hospital. We emphasize skin-to-skin contact, rooming in. We’re going to be beginning a midwifery service in recognition that we not only provide outstanding care for mothers with high-risk conditions, but also that we’re a fabulous place to deliver for a low-risk baby, for completely normal pregnancy where there are no problems. We’re going to be embarking on a remodeling project to provide a much more patient-friendly atmosphere here at UVA. We anticipate that all these changes that we’re going to be doing are going to be providing what the patients need and what they want in order to have a wonderful start to having a new family.

Melanie: Thank you so much. It’s such an exciting time for the whole family. For more information on UVA Children’s Hospital, 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

More...

Sleep Disorders in Children

Tis The Season; Best Treatments For Cold vs. Flu

Antibiotics: When You Need Them And When You Don't

Biology of Beating Stress: How to Change Your Environment, Body & Brain

Start
Prev
40
41
42
43
44
45
46
47
48
49
Next
End

Page 45 of 52