Inactive (722)
Children categories
University of Virginia Health System (175)
https://docs.google.com/spreadsheets/d/1JkoiKFuCQmWJsu92gIyaRHywp6JgkKouIV5tbKYQk2Y/pub?gid=0&single=true&output=pdf
View items...Saint Peter’s Better Health Update (10)
Saint Peters Health System
Saint Peter’s Better Health Update
Florida Hospital - Health Chat (19)
$current_analytic_report = "https://docs.google.com/spreadsheets/d/1JkoiKFuCQmWJsu92gIyaRHywp6JgkKouIV5tbKYQk2Y/pub?gid=0&single=true&output=pdf";
View items...
You want your doctor to know who you are as a person, not just another patient.
Additional Info
- Segment Number 2
- Audio File staying_well/1421sw1d.mp3
- Featured Speaker Alan Zunamon, MD
-
Guest Bio
Dr. Alan Zunamon is a cardiologist in Evanston, Illinois. He is affiliated with multiple hospitals in the area, including Glenbrook Hospital and NorthShore University Health System Evanston Hospital.
He received his medical degree from Loyola University Chicago Stritch School of Medicine and has been in practice for 30 years. Dr. Zunamon accepts several types of health insurance, listed below. He is one of 28 doctors at Glenbrook Hospital and one of 38 at NorthShore University HealthSystem Evanston Hospital who specialize in Cardiovascular Disease. - Hosts Melanie Cole, MS
The first principle of digital health is to have access to your own data. But what about other people being able to access your data and private information?
Additional Info
- Segment Number 5
- Audio File staying_well/1424sw1a.mp3
- Featured Speaker Leslie Saxon, MD
-
Guest Bio
Leslie Saxon, MD, is a Professor of Clinical Medicine (Clinical Scholar) at the University of Southern California (USC) Keck School of Medicine and specializes in the diagnosis and treatment of cardiac arrhythmias and preventing sudden cardiac death.
Dr. Saxon is the Chief of Cardiovascular Medicine and she was recruited to USC from the University of California San Francisco where she was the Acting Chief of Cardiac Electrophysiology.
In addition to using state-of-the-art resynchronization devices in patients with arrhythmias, such as modified pacemakers and implantable defibrillators, Dr. Saxon also collaborates with medical device companies to evaluate the latest, most innovative interventional wearable technologies for the diagnosis and prevention of malignant ventricular arrhythmias and for patients with difficult-to-treat arrhythmias and heart failure. She is a member of Boston Scientific's Medical Advisory Board.
She also serves as the National Chair of the Boston Scientific ALTITUDE project studying remote monitoring of implantable devices and is a member of the steering committee for the Left Atrial Pressure Monitoring to Optimize Heart Failure Therapy (LAPTOP-HF) study.
Dr. Saxon has completed over 100 publications in various medical journals and is an active member of a multitude of organizations, including the American Heart Association, and the Heart Failure Society of America. In addition, she is a fellow of the American College of Cardiology and the Heart Rhythm Society. - Hosts Melanie Cole, MS
Even if colon cancer doesn't run in your family, it's still important to get a colonoscopy.
Additional Info
- Segment Number 4
- Audio File staying_well/1420sw1c.mp3
- Featured Speaker Dan DeMarco, MD
-
Guest Bio
Dan DeMarco was born in Natick, Massachusetts, on 28 September 1956 and grew up in that area. At age 13, his family moved to Dallas, Texas, where he has lived ever since.
He was accepted at the University of Texas Southwestern Medical School after three years at the University of Notre Dame. His training in internal medicine and gastroenterology was all at Baylor University Medical Center at Dallas (BUMC).
He finished his fellowship in gastroenterology in June 1985 and has been at BUMC ever since. In addition to his extremely busy practice, he participates actively in BUMC's teaching activities and has been twice elected Teacher of the Year.
Not only does he teach the medical residents, but he daily tutors the gastroenterology fellows. He has served as chairman or member of the Institutional Animal Use and Care Committee since 1995, the Liver Transplant Selection Committee since 1987, the Emergency Services Committee since 1992, and the Medical Advisory Committee of BUMC since 1999.
He has published 16 articles in peer-reviewed medical journals or chapters in prominent books. - Hosts Melanie Cole, MS
With care from the time of your cancer diagnosis to the beginning of your acute treatment, prehab helps you prepare mentally, physically and emotionally.
Additional Info
- Audio File staying_well/1429sw1b.mp3
- Featured Speaker Dr. Julie Silver
-
Guest Bio
Dr. Julie Silver is a rehabilitation physician and an associate professor at Harvard Medical School.She is the founder of the STAR Program Certification, the country's only certification in evidence-based cancer rehabilitation and prehabilitation for clinicians and institutions.
There are STAR Program certified hospitals and cancer centers in more than 40 states. - Hosts Melanie Cole, MS
Alzheimer's disease is the sixth leading cause of death in the United States, with no cure currently available.
Additional Info
- Audio File staying_well/1347sw1e.mp3
- Featured Speaker Carol Steinberg
-
Guest Bio
Carol Steinberg is president of the Alzheimer's Foundation of America (AFA). She oversees daily operations, strategic partnerships, advocacy efforts, program development, messaging, and all other aspects of this leading national organization dedicated to providing optimal care to individuals with dementia and their families.
- Hosts Melanie Cole, MS
Additional Info
- Segment Number 5
- Audio File allina_health/1433ah5e.mp3
- Doctors Renier, Budd
- Featured Speaker Budd Renier, MD - Family Medicine
- Guest Bio Dr. Renier is a board-certified family medicine physician with professional interests in concussion management, sports medicine and non-surgical orthopedics. He is also a credentialed ImPACT consultant for concussion management.
-
Transcription
Melanie Cole (Host): A concussion is like shaking a snow globe in your brain. What do you do to cure your brain from a concussive blizzard? Today, my guest is Dr. Bud Renier. He’s a family medicine physician and credentialed concussion expert at the Allina Health Cambridge Clinic. Welcome to the show, Dr. Renier. What happens in the brain when someone suffers from a concussion?
Dr. Bud Renier (Guest): Well, as you mentioned, Melanie, a lot of times, what happens is, with the shaking of the brain, it is like a chemical blizzard that occurs and it actually temporarily changes the way that our brain is trying to process the information that comes in. And I think one of the misconceptions is that people think you have to have a loss of consciousness for a concussion, and it turns out that’s not true. Only about 10 percent of concussions have any loss of consciousness with them. But the symptoms that people will often have include anything from fact process issues to physical issues to emotional and even sleep problems.
Melanie: Are concussion more serious in children or in adults? Because we hear in the media today about concussion with our athletes in high school and college, and even younger. Is it more serious in children or adults?
Dr. Renier: Well, it’s a great question. The seriousness of a concussion is actually based on several factors that really are age-independent, if we take it case by case. However, definitely, in younger people, recovery often takes longer, because children still have a developing brain. And then the other issue is that, people under age 25 are at risk for something called second impact syndrome, which is where the brain can get hit a second time while you’re recovering from the first concussion. And unfortunately, that can actually be fatal.
Melanie: When someone suffers a concussion, how do we know? If they’re out on the field, or they come back after we see an impact, what symptoms might we really spot? People always say, “I’m going to look in your eyes and see.” Is that really the best way?
Dr. Renier: Well, if you know the individual, sometimes, looking into their eyes is helpful because you know they’re looking different to you than what you’re accustomed to. But really, there’s a number of things that we’re watching for. Are they mentally foggy? Do they feel like there’s a slowdown in their fact process? Are they having trouble with memory? Sometimes, it’s that their balance is off, they’re extremely dizzy or suddenly they’re light sensitive and they weren’t before. So it can be very subtle sometimes, and sometimes we actually have to watch those patients for a while to see if their symptoms are going to develop over time.
Melanie: And then, what’s the treatment for a concussion, Dr. Renier?
Dr. Renier: Treatment for a concussion. Every concussion is just a little bit different. We need to treat them based on that individual patient’s circumstances. And we always say that there really aren’t any shortcuts. There’s no cookie-cutter approach to managing a concussion. But you do need to be free of any symptoms at rest for several days before starting to go into an exercise mode. And so, we say that only when your symptoms have reduced significantly, after you’ve consulted with a professional who’s trained in a concussion management, should you then return to those activities.
Melanie: Are there any tests that would show whether someone is predisposed to a concussion?
Dr. Renier: Predisposed is difficult. I think that at this point, we don’t have any specific tests that would say they’re predisposed to it. However, there are several tests out there that can help us to manage it after it has happened, and there is a baseline impact test which we will often use, which is a computer-based test, to help us establish what that individual athlete’s baseline function is in their brain. But if they do get an injury, we can then repeat that computerized test and compare them to their own baseline, and that can be quite helpful.
Melanie: Give your best advice, Dr. Renier, to patients who have suffered a concussion to their parents. What do you do once you get someone home? If a child has suffered a concussion out on the field and then they go home, what should parents look for that would signal getting them back to the doctor?
Dr. Renier: Right. I think, initially, if there was a loss of consciousness with the injuries at the beginning, that’s a sign that they should go in and be seen right away. If their mental status, their though process is deteriorating at home, that definitely would make me want that patient to be into the hospital to be seen. But really, what the parents would want to do is to put your child into a shutdown mode, where they really aren’t doing any sort of physical or mental exertion. So we say stay away from video games and things like that.” But definitely, no physical exertion, and absolutely no activity where they could get hit in the head a second time. So we really encourage any concussion patient to be seen within 72 hours for the symptoms of a concussion.
Melanie: And you mentioned video games. It’s not easy for a parent to tell their kids they can’t do that when they’re sitting around at home. They’re not going back to school right away. But it’s really important that mental concentration and that they don’t do things that would stimulate their brain. True?
Dr. Renier: That’s absolutely true. And I think what you’re getting at there is that traditionally, people had just monitored concussions. And now we’ve stepped into the realm of actually managing concussion. And that may mean different accommodations for different people, and for school-age patients that definitely comes into play, and we’re seeing more energy now being directed toward making those accommodations in the school world and the workplace so that we’re not prolonging this patient’s illness.
Melanie: When is it okay for them to return either to play or to go back to school or work?
Dr. Renier: Right. So again, that’s very individualized, and we like to see those patients in order to help determine that. But it is okay to get back into a school setting when they are symptom-free to the point where they would actually be able to function well at school. That may mean half-days. It may mean that they’re only able to certain classes; not able to go to, say, a band class, where there is problem with noise. So we do really take it on a case-by-case basis, and so, we have very close contact with all of our concussion patients in order to determine what’s right for that particular patient.
Melanie: Dr. Renier, is it okay to take ibuprofen or Tylenol if you have a headache from a concussion?
Dr. Renier: Yeah, great question. We typically will initially go with Tylenol for the headache. After you’re out of the initial phases of the concussion, like in the first 24 to 48 hours, where you’re more certain that there’s not any sort of a bleed going on in the brain, then I’m okay with people taking ibuprofen. It comes in the blood, so to speak, prior to that, and we don’t want aggravate any bleeding condition that might be there. A concussion itself is not about a bleed. That would be that we were worried about a more serious injury. One of the drawbacks of medicines like Tylenol and ibuprofen, however, can be that many individuals will get something called a rebound headache. And so, you may be treated for a short time, but when the medicine wears off, you may actually have a worse headache than before you took the medicine.
Melanie: Dr. Renier, I think we’re lulled into a false sense of security with some of the equipment that our children wear out there today—helmets and things. Do we put our faith in those pieces of equipment to protect our children from concussion?
Dr. Renier: Yeah. Protective equipment is an excellent way to help prevent more serious injuries, such as skull fractures and perhaps even bleeds to the brain and lacerations. However, it’s definitely been shown that a helmet is not necessarily going to prevent a concussion. We still, of course, think it’s a great idea to try to continue to improve the technology for those, but I agree with you. There is a certain sense of false security with the protective equipment that is out there, and we need to be vigilant about how we’re training people to tackle and how we’re training people to have better neck strength to protect themselves and not just count on a helmet to do so.
Melanie: That’s great information. Dr. Renier, in just the last minute and a half or so, please give your best advice about concussion and tell people why they would come to Allina Health for their concussion care.
Dr. Renier: Yeah. I think that’s what people need to be aware of is that there are plenty of individuals out there who will say that they can work with a patient who has a concussion. I think as long as they are monitoring those patients and making sure that they’re safe to return, I think that’s great. I think that Allina Health has taken the next step toward providing concussion management and really patterning it after the work that’s being done out at the Central Impact Center out in Pittsburg. I think that if you can just see an individual who knows and manages a lot of concussions, it will be safer for the child.
Melanie: Thank you so much, Dr. Bud Renier, family medicine physician and credentialed concussion expert at the Allina Health Cambridge Clinic. You’re listening to The Wellcast by Allina Health. For more information, you can go to allinahealth.org. This is Melanie Cole. Thanks so much for listening. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 3
- Audio File st_peter/1435sp2c.mp3
- Doctors Gervasoni, James E. Jr.
- Featured Speaker James E. Gervasoni Jr., PhD, MD
-
Guest Bio
James E. Gervasoni Jr., PhD, MD, and chair of the Department of Surgery at Saint Peter’s University Hospital in New Brunswick, N.J., has seen a rise in these sorts of lifestyle cancers during his career as a surgical oncologist. Dr. Gervasoni also holds a PhD in microbiology/immunology.
For more information about Saint Peter’s Healthcare System -
Transcription
Bill Klaproth (Host): Cancers of the affluent are those associated with good living around the increase across the United States, and those cancers include breast, prostate, liver, colon and pancreatic among the most commonly seen and all are heavily influenced by poor eating habits and the intake of processed foods. And here to explain this is James E. Gervasoni Jr., PhD, MD, and chair of the Department of Surgery at Saint Peter's University Hospital in New Brunswick, New Jersey. Dr Gervasoni also holds a PhD in microbiology and immunology. Dr. Gervasoni, thanks so much for being out with us today. Cancers of the affluent – it sounds like it's a disease for rich people. Is that the case?
Dr James E. Gervasoni (Guest): No, it's not. Actually, early on, I mean, in the 50s, late 50s and early 60s, that was the case because people that were eating high-fat diets, a lot of meat and a lot of animal products were actually people who were able to afford it. And so, early on in this recognition of this process, it was individuals that were able to afford these kinds of food. Now of course, it's not the case. It's a really everyone, all of us are exposed to processed foods and really toxic compounds that are put in these foods that we are just recognizing now.
Bill: I suppose this also includes fast food as well since it's all around us, is that right?
Dr. Gervasoni: Absolutely, fast food, processed food or any food that we as humans alter, and there are different degrees of processing. You can have processed foods that are packaged greens; that's food that has been manipulated in just collection and put in a package. So, that's processed food. You can have food where things are added like increased sugars or other types of minerals or vitamins that are thought to help us but actually may not.
Bill: All the bad stuff is in there. All that stuff we don't want is in there.
Dr. Gervasoni: Exactly.
Bill: So, you know, this food is all around us though and we all lead such hectic busy lives. Sometimes it seems it’s just easier to go through the drive-through, you know, or pop that packaged meal in the microwave or eat something out of a box. How do we get around that?
Dr. Gervasoni: Well, I think that it's a process where the education and communication with people to know what they're actually eating is important. Now, when I was growing up, it was important that you ate your meat, it was thought that all meat was equal, and so fast food wasn't really considered detrimental because it included the meats that we needed and the food that we needed. Now, we're recognizing that any food that's really processed to the point where we are adding supplements and adding things and manipulating the food, that's turning out to be a big problem for us. In addition to that, unbalanced food intake is really the problem.
Bill: So, we're faced with all these food choices and you said we're eating foods, as I put it, with all the bad stuff in it. Is there a simple way to see through that and eat healthier and eat better without having to have a PhD and all of this chemistry to understand what's going on?
Dr. Gervasoni: Yeah. Actually, it's fairly simple and straightforward. Eat your fruits and vegetables. That's what we were told when we were kids but we weren't really fed fruits and vegetables. So, simple and stupid is eat unprocessed food, meaning food that's not been manipulated to the point where supplements had been added and that would mean that it would be really fruits and vegetables for the most part. But you can eat foods in moderation. In other words, a fast food once every couple of months is not going to be a problem. It's when you overindulge in these foods that it becomes an issue where you're over-stimulating your body to produce insulin basically. At an increased rate, that is a problem, so it's moderation that really is what we have to look at.
Bill: So it sounds like it's getting back to the basics, as you said, fruits and vegetables. So when you go to the store, I guess stay out in the middle of the store where you find all the boxed items and spend more time in that produce section. Is that an easy way to look at it?
Dr. Gervasoni: Exactly. And what you have to do is you have to say this is a process that's going to occur throughout my life; therefore, it's not something that you have to do immediately cold turkey where you have to stop eating all of the processed foods tomorrow. Although that would be something I would recommend to my patients, it's not realistic. So people have to look at this as a long-term plan for better health and they have to do it gradually. It's almost like quitting any addictive behavior – quitting smoking, quitting drinking. It's not something that you could do just cold turkey or at least most of us can. And so, it's a gradual process. First thing that you have to do is to educate your patients; educate people to let them know what's good, what's not good. And start telling them, “This is what you need to do: You need to start incorporating more fruits, vegetables. If you can read the package, there are things in your food that has been added that's probably not a good thing.” So, these are the kinds of mechanisms that we can start with – communicating with our patients and letting them know this is a gradual process that we will work with them in order to move them forward.
Bill: Right. So pay attention to things without labels, like a banana doesn't have a label in it. So that would be a good thing.
Dr. Gervasoni: Correct. That's right. Bananas are good and any kind of fruit and vegetables. When I walk in the food isles, most of what we see is processed – canned foods, boxed foods, foods that sugar’s been added. And really let's keep in mind that with all of our processed food items that we have, there are also a lot of unprocessed foods and there is a lot of variety in our supermarkets that we can look at and supplement our lives.
Bill: So, when you talked about unprocessed foods, are you talking about not necessarily a fruit or vegetable, but something that is manmade that is okay for you?
Dr. Gervasoni: Well, I like pasta. Pasta is high in sugar, okay? Again, what you have to look at is, this is an age phenomena. In other words, people will come to me and say, “You know, my son is 20 years old. He eats all of these garbage processed foods, pastas, and he doesn’t gain an ounce of weight, his health is very good.” Well, that individual is probably correct because it’s an age phenomena where that individual of age 20 is just finishing their growth spurt and now they have to start watching their diet more closely, and kids that are not processing these foods well need to watch it, obviously. But we’re looking at an age group between really the ages of 40 and 65 where absolutely you have to watch what you’re eating because you’re not going to process the food. The growth stage of your life has ended and now you have to really be careful what you’re taking in. So, even foods, to get back to the question, that seem to be processed may or may not be good for you. Again I was getting back to the pasta I ate. I was looking at ingredients of brown rice pasta which is basically no sugar and gluten-free which has no sugar. It’s good for diabetics but it’s also good for people who are having problems with their sugar or having issues in terms of weight. And so, there are some items that you can look at that are processed that may be better for you than others. Long explanation for…
Bill: Correct, got you. No problem. So the 20-year-old might be burning it off too. They may be exercising so they’re burning it off. I think the other problem is that as we mature and age and have jobs and responsibilities, we’re exercising less we’re sitting more, and we’re eating food with the bad stuff in it, and that’s why we’re becoming overweight as a population and obesity is on the rise in our country. I think you were starting to talk about metabolic syndrome, isn’t that correct?
Dr. Gervasoni: Correct.
Bill: And that has a linkage to cancer too. Can you just quickly explain metabolic syndrome to us?
Dr. Gervasoni: Sure. So metabolic syndrome is really a group of risk factors that raises your risk for heart disease, diabetes, stroke, and multiple types of cancers, some of which you’ve mentioned. So these risk factors, there are several, but in metabolic syndrome, the particular types of risk factors that physicians are looking for would be obesity and that would be a waist line that is, in males 40, inches or greater; in females a little bit smaller, maybe 37 inches at the girth of their abdomen. Also, their glucose is elevated above 100, their fasting glucose levels. Their triglycerides which are their fats, which are greater than a 150, your good cholesterol which is your HDLs, should be greater than 40, and your blood pressure, if it’s greater than 130 over 85, can be a problem. So, it’s really obesity, lipid dysfunction or fat, blood pressure, and sugar poorly metabolizing your sugar. So that puts you at risk not only for heart disease, diabetes and stroke but for these “cancers of affluence” as we call them.
Bill: Right. So it sounds like the 1, 2 combatant punches: one, getting back to the basics, fruits, vegetables, eating unprocessed foods, eating clean as they say, and the other one is exercise right? So, tell us, for that 40 to 60-year-old person you were talking about, what type of exercise should that person start incorporating into their daily routine?
Dr. Gervasoni: So, what I do with my patients is if you’re working with an individual who’s in a metabolic syndrome or pre-diabetic individual which is metabolic syndrome, normally these people are not working out on a regular basis. So again we have to educate your patients and say, “You know, you’re not going to be able to work out 30 to 60 minutes per day where you’re getting up your metabolism so that when you’re speaking to someone, you can barely speak to the person next to you as you’re working out. You can’t do that.” People are not going to be able to do 30-60 per minutes per day right from the beginning. So what I normally do is that I say, “You know, what you need to do is instead of sitting, you need to get up and walk. Walk a mile. That’s a half hour.” And do that for the first month. And then you start gradually bringing the person along so that it’s not a chore. Somebody is not working out and you tell them you have to work out 30 minutes per day every day. Probably your patient’s not going to be able to do that so again, you have to work with your patient to get them where you want them to be. To answer your question, where you want someone to be after they kind of get into the routine is about 30 minutes to 60 minutes per day of cardio vascular working out and you could do that anywhere from 4 to 5 days a week. And the other two days you have to concentrate on kind of strength training and that’s where it’s static lifting, weights or like a step climber or things like this. So, you have to incorporate both cardiovascular workout as well as resistance training. And that’s where you get your patients to be. You wanted to get them to be working out roughly 30 minutes 4 to 5 days a week and then strength training for about a half hour twice a week.
Bill: And like you said not making it a chore I think is key.
Dr. Gervasoni: It’s key, because you have to understand that most people are not going into this routine so you have to gradually bring them into the routine as you bring them into their dietary changes as well. And it’s essential we’re not going to reverse the strength.
Bill: Cancers of the affluent, very interesting. Dr. Gervasoni, thank you so much for spending some time with us today to talk about this. And for more information, please visit saintpetershcs.com. I'm Bill Klaproth and this is Saint Peter's Better Heath Update. Thanks for listening. - Hosts Bill Klaproth
Additional Info
- Segment Number 2
- Audio File st_peter/1435sp2b.mp3
- Doctors Saviano, George J.
- Featured Speaker George J. Saviano, MD
-
Guest Bio
George J. Saviano, MD, is an interventional cardiologist with Saint Peter’s Healthcare System in New Brunswick, New Jersey. Dr. Saviano, a graduate of New York Medical College, owns the distinction of having performed the first cardiac stent in his part of New Jersey. And Dr. Saviano was a leader in expanding the use of low-risk catheterization.
For more information about Saint Peter’s Healthcare System -
Transcription
Bill Klaproth (Host): Coronary heart disease is the number one cause of death for both men and women in the US and chest pain maybe a symptom of coronary heart disease, but a procedure known as cardiac catheterization is the best way to know for sure. Here to explain it to us is Georgie Saviano, MD, an interventional cardiologist with Saint Peter’s Health Care System in New Brunswick, New Jersey. Dr. Saviano, thanks so much for being out with us today. So let’s jump right in, what is coronary heart disease and what are its causes?
Dr. Georgie Saviano (Guest): Okay. To begin with, I don't like the term “coronary heart disease” because blockages in the coronary arteries, which most people refer to as coronary heart disease, is no more unnatural than greying of the hair or wrinkling of the skin. It’s part of aging. No one gets through life without some element of blockage in the coronary arteries. The real issue is sometimes the blockages occur young and they’re substantial and actually jeopardize blood flow to the heart, so physicians and patients like to call it coronary heart disease, but it is natural in the population and the goal is to slow it down and recognize it.
Bill: So the build-up of plaque as you age is normal. All we need to worry about it is if it starts to happen really young and too fast and too much. Is that correct?
Dr. Saviano: Exactly right.
Bill: Okay. So when you look at this, how do you determine somebody has coronary heart disease or somebody doesn’t have coronary heart disease? How do you make that determination?
Dr. Saviano: Okay, well, it’s pretty straightforward. The reason why patients walk into my office, a cardiologist’s office, there are two major categories: they either have chest pain, they have some chest pain which either they or their referring doctor think might be coronary artery blockage—I’m going to use the term coronary artery disease which everyone else does—but either they recognized pain or their referring physician recognizes the pain, or simply they feel that they have a high likelihood of having coronary artery blockage. Why do they get that feeling? They go to their primary physician and their primary physician might tell them, “You have high cholesterol; your father had it, you have hypertension, you smoked.” There are generally five well-recognized risk factors, so a lot of people—I don’t call them patients yet—who have a lot of these risk factors either they or their referring physician get concerned. The five risk factors that are proven to be associated with the rapid build-up of blockage is hypertension, diabetes, high cholesterol, smoking and, of course, the family history. So those are the two paths why patients walk to the door: pain or the risk factors. Now, to talk about the pain, everyone gets chest pain. I don’t know anybody that I’ve ever met that never told me that they had chest pain. It could be a muscle ache or pain, they could have exercised too much the day before, it could be gastric reflux, esophageal reflux, and you don’t know for sure. But the pattern that one looks for, the pattern that I look for, is related to exertion. If there is a discomfort—either pain, pressure, squeezing—that occurs with exertion predictably and goes away with rest, that is the sine qua non, so to speak, of angina. Angina is chest pain that is due to coronary artery disease.
Bill: And where does this pain; this squeezing happen? I love the way you describe that, because you are saying, yes, chest pain – well, what that does mean? I love that you said it comes on with exertion, but where is the squeezing – in the centre of the chest, the whole upper body? What should we look out for?
Dr. Saviano: Okay. What the textbooks will tell you is, it begins in the chest and it radiates to the left shoulder and down the left arm. Rarely do you see a textbook case. Very often, it could be just in the chest. It could radiate to both shoulders. It could radiate to the right arm. It could be felt in the jaw or teeth as well. It’s not the quality is important. If patients say the word “squeezing” or if they say “tightening,” the red flag goes up, but more important to me is what the inciting action, which is either emotional or physical stress.
Bill: Okay. Now when you see those symptoms, does that always mean somebody is having a heart attack or has coronary artery disease?
Dr. Saviano: No, absolutely not. We get fooled many times because in the population, people watch television, they listen to their neighbour’s friends, they were doctors, and they’re sort of pre-programmed to think in terms of chest pain and the arm. Sometimes patients will come in with pain that’s obviously a muscle strain. It’s in their left arm, but it’s not exertional, and if they move their arm, it hurts. That’s definitely not chest pain due to coronary artery disease.
Bill: Okay, so if we determine somebody has coronary artery disease and you need to go and treat it. Let’s talk about cardiac catheterization. Is that the same thing as angioplasty?
Dr. Saviano: No. A catheter is a tube, so cardiac catheterization has to be done before taking pictures which is called coronary angiography, before fixing a vessel which is called coronary angioplasty, that’s inflating a balloon. It has to be done before coronary stenting and it has to be done before coronary atherectomy where you remove plaque. So cardiac catheterization just means you put a catheter from the groin or the arm and locate the tip in the coronary artery and inject dye – that’s angiography. So if the catheter is used and coronary angiography is done and then the determination is made, does anything need to be done about blockages?
Bill: So cardiac catheterization is the first step before. You are determining whether or not somebody needs angioplasty or a stent.
Dr. Saviano: Exactly. It really goes back before. I don’t know how much time we have, but I could tell you that if you think of this in terms of flow, this is how I like to think of it. The first step is usually you listen to symptoms and look at risk factors, but don’t go into cardiac catheterization right away. You look for evidence. When you walk into the room, if your patient is going to do a cardiac catheterization you want to be pretty sure it’s there. You don’t want to subject them to that risk. So generally before cardiac catheterization, stress testing with perfusion imaging is done. The way I can liken it to make people understand it is if they’re going to buy a house they go into the house and open up faucets and they look at the water pressure. They look at what the flow is like, and if there is a bathroom or a kitchen, they turn on the faucet, it’s trickling out, there’s low pressure, low flow, then there’s a good likelihood that they have a problem with the pipe leading to that faucet. Then they call a plumber who goes down and dismantles and looks at the pipe. Well, the flow information is got in the doctor’s office from stress testing with perfusion imaging. We look at how the flow goes to various areas of the heart, and if we see an abnormality, if that bathroom, the trickle is slow, then we go in and do some plumbing.
Bill: So, hence, the cardiac catheterization then.
Dr. Saviano: Yeah, catheterization follows.
Bill: Are there any risk factors involved in this?
Dr. Saviano: Yes, there are. The risk factors are numerous, but they are fortunately rare. The risk factors stem from actually having to enter a blood vessel, so that blood vessel naturally can be damaged. You insert a catheter—let’s use the groin for example—you can damage the blood vessel and there could be some local bleeding in the groin area where you are doing the catheterization. That’s a minor problem. Then these catheters actually have to be threaded up and around the arch of the aorta right to the arteries that lead to the heart. Now you have to go past the blood vessels to the head and neck and the brain, so any kind of damage or clot coming from these catheters can embolize and go and cause a stroke, or if any clot is caused, it can go anywhere in the body and cause damage where ever it may go. When you inject dye into a coronary artery, the heart knows that this is not blood, that this is something different, and it might react unfavourably with a bad rhythm. So there could be life-threatening rhythms that are set up and that could result in passing out or even death. Of course, when you are working on the arteries, they could be disrupted and cause a heart attack. So, death is generally about one in a thousand. That’s why we never want to put a patient on the table without a very good reason to put that patient on the table. We have to be reasonably convinced that we’re going to find something to fix because we don’t want to subject them to catheterization without a pretty good indication that we’re going to find the problem.
Bill: And I’m sure you have procedures that minimize risk as well when doing the procedure?
Dr. Saviano: Absolutely. The way the catheters are inserted, a very soft guide wire is passed up into the vessels and the catheter is passed over the guide wire, and that minimizes trauma to the vessel. The other thing that we do before a patient ever goes in for catheterization is we draw what’s called pre-admission blood testing. We want to make sure that they are not anemic. We want to make sure they don’t have any kidney disease, because the dye we use in imaging the coronary arteries can be toxic to the kidneys. So I always check that very carefully and actually have a nephrologist, a kidney specialist, see my patient to help manage his fluids with the catheterization to minimize this risk. The patient’s heart is monitored throughout the entire procedure, pacemakers are available in the room –there are a multitude of things that we do to maintain safety.
Bill: And in our final minute here, Dr. Saviano, is there a type of post-operative care patients should undertake to minimize future problems?
Dr. Saviano: Sure. Immediately when they leave, they should walk easily on their leg. They shouldn’t bend too much on the groin because that can cause cause bleeding. Now cases are done through the arm or even the wrist, and that minimizes it even further. That’s the short-term risk. And then the long-term risk, of course, whether or not we find blockage, we tell them all: Treat diabetes, hypertension and high cholesterol, avoid smoking. Of course, they can’t change their family history, but live a healthy life basically.
Bill: Terrific. Dr. Saviano, thank you so much for spending time with us today. We really appreciate it. And for more information on cardiac catheterization, please visit saintpetershcs.com. This is Saint Peter’s Better Health Update. Thanks for listening. - Hosts Bill Klaproth
Additional Info
- Segment Number 1
- Audio File st_peter/1435sp2a.mp3
- Doctors Abreu, Arnaldo
- Featured Speaker Arnaldo Abreu, MD
-
Guest Bio
Arnaldo Abreu, MD, director of the pediatric emergency department at The Children’s Hospital at Saint Peter’s University Hospital in New Brunswick, N.J., is an expert in treating children suddenly injured or sick and in advising parents about the precautions they can take.
For more information about Saint Peter’s Healthcare System -
Transcription
Bill Klaproth (Host): Children face a wide variety of health concerns during this time of year as the summer starts to fade and shifts into the fall. Arnaldo Abreu, MD, director of the Pediatric Emergency Department at The Children's Hospital at St. Peter's University Hospital in New Brunswick, New Jersey, is an expert in treating children suddenly injured or sick, and in advising parents about the precautions that they can take. Dr. Abreu, thanks so much for being on with us today. So, what are the most common childhood injuries that are seen by physicians in the Pediatric Emergency Department in the summer as it transitions into fall?
Dr. Arnaldo Abreu (Guest): I guess the most common injuries are fall-related, either indoors or outdoors, especially associated with bicycles or skateboards, and anything from minor bruises and scrapes to fractures.
Bill: Okay, so those type of injuries that you see, I mean, it's just common sense at that point, right? You should wear a helmet; you should wear knee pads. What other things would you suggest to keep kids safe from this type of falls?
Dr. Abreu: Right. As you mentioned, wearing a helmet especially while bike riding or being on a skateboard are extremely important. Unfortunately, there's still a lot of kids out there that do not and unfortunately sustain significant injuries, so helmet use is very important. Proper gear, sneakers, just being overall careful is very important, and that's basically up to the parents to make sure that it's done.
Bill: Wearing a helmet for kids can be uncool. You know, "I don't want to wear the helmet, Mom, because that's uncool." As a physician, what type of advice would you give a parent in trying to communicate to their child, "Hey, you need to have this helmet on. This is for your own good." But kids don't want to listen to that. What kind of tips would you have for parents to help them make their child understand they need to have that helmet on?
Dr. Abreu: Well, the most important thing is if Mom or Dad are going to ride a bike, they should wear a helmet as well. You're not going to be too credible in enforcing helmet use if you yourself do not. So the number one thing, if Mom and Dad wear one, then obviously the kids will be more likely to do so as well.
Bill: So leading by example then certainly is one of the better ways to do that.
Dr. Abreu: Absolutely.
Bill: Is there a certain type of helmet that you would recommend or any thoughts on helmets or just any decent helmet you buy in a sporting goods store work?
Dr. Abreu: I mean, they're all safety-rated so I guess in order to make it more, I guess, cool-looking for the child, have the child pick his/her helmet. They come in different colors, design, so pick one that the child will like and you’ll probably get more use out of it.
Bill: Moving from injuries to illnesses, what are the common seasonal illnesses then as kids get into that group environment in school, the contagious diseases, what are the common things that you see?
Dr. Abreu: Well, I mean, once school gets in full swing, the more kids are in contact with each other. Obviously, contagious illnesses such as the common colds, stomach bugs, are pretty much more common. A very good way to prevent that is obviously if a child is sick, don't send them to school, and try to make sure that they wash their hands especially before eating or when they come home from school as well.
Bill: Any other tips to help parents protect their children against these illnesses?
Dr. Abreu: Well, the number one thing is strict hand washing and, as I mentioned, if they are sick, even if they don't have a fever, it’s probably better for err on the side of caution and just keep them home.
Bill: Okay. So kids are back at school now; they're healthy, they're good, they join their baseball team or football team or track team. Can you talk a little bit about sports-related injuries as well as kids go back to school?
Dr. Abreu: Right. Once the kids go back to their school-related sports, we do see an uptake in injuries. So before the season starts, it may be a good idea to get your child exercising again so that it's not something that they just start all of a sudden without being efficient, that would be important. Also, again, the proper gear and equipment, is important.
Bill: Okay, any other specific advice for parents as far as sports-related type of injuries? Obviously, kids playing football run the risk of hurting themselves in different ways versus track athletes, etc. – any other sports-related advice for parents or kids that are in sports or other extracurricular activities?
Dr. Abreu: What I see sometimes is that while they are participating in whatever sport under the guidance of the coach or trainer, they do wear their appropriate gear, but a lot of times, these kids will then go off on their own with their teammates and play in someone's yard or in a park and they don’t use their protective gears such as helmets and I see a lot of things to be that way.
Bill: Great point. Great point. When they're under supervision of a coach, they have all the proper equipment, but you're right, when they get in the backyard or out in the fields somewhere, they're not. So, great tip for parents to make sure that those kids that are in those types of sports are using the proper gear when they are practicing away from school – great point. That's a perfect segue. So now, say they're back at home, are there certain things in the home that kids need to be aware of, as far as a childproofing a home for children?
Dr. Abreu: Oh, that's a good topic. Again, falls are the most common injury that kids sustain while inside the home but there's a lot of things as well that parents need to be aware of. If you have little children, toddlers, obviously small items that they can pick and choke on are very common and you should keep them away from their reach. Things in particular, small magnets, button batteries can be quite dangerous if a little child does ingest them. Keeping medications and cleaning products out of their reach is very important as well.
Bill: And if a child does get injured, when should a parent bring their child to the emergency room? When do you know, yes, I should or, no, I shouldn't?
Dr. Abreu: Well, anything that involves any type of loss of consciousness obviously not just going to the local emergency department but calling 911 as well. Anything that involves any kind of significant bleeding, any kind of extremity injury where you see significant swelling or a deformity, anything that causes a child to be in intense pain for more than just a couple of minutes, anything that causes change in their behavior or alertness shall prompt a visit to the ER.
Bill: And what should parents expect when they arrive at the emergency room?
Dr. Abreu: Well, usually when patients arrive to the ER, there is a process called triage where they are assessed usually by a nurse or an emergency technician to sort of make a determination as to how serious or acute the illness or injury is, and if it's something really important, they usually get brought in right away. If it's something that they determine is not that urgent, they may wait a little bit especially if the ER is packed, which does happen on occasion.
Bill: And, Dr. Abreu, is there anything that I missed that you want to mention to parents about keeping their children safe as a transition from summer into fall?
Dr. Abreu: Well, I guess the swimming pools are still open so we always need to be vigilant in terms of more children being around not just the pool but any body of water, whether it be a pond, a lake, the beach, and keeping in mind that just because your young child has taken swimming lessons does not necessarily make them drown-proof. There should always be close, direct adult supervision whenever you have small children around any body of water.
Bill: Excellent point. So thank you so much, Dr. Abreu. We really appreciate it. And for more information, please visit saintpetershcs.com. I'm Bill Klaproth and this is St. Peter's Better Heath Update. Thanks for listening. - Hosts Bill Klaproth
Additional Info
- Segment Number 4
- Audio File virginia_health/1433vh5d.mp3
- Doctors Scharf, Rebecca
- Featured Speaker Dr. Rebecca Scharf
-
Guest Bio
Dr. Rebecca Scharf is a board-certified pediatrician who specializes in developmental and behavioral pediatrics.
-
Transcription
Melanie Cole (Host): Muscular dystrophy is a genetic condition that can weaken muscles and in many cases can require patients the use a wheelchair. However, there are treatment options available for patients and their families. My guest is Dr. Rebecca Scharf. She’s a board certified pediatrician who specializes in developmental and behavioral pediatrics at UVA Children’s Hospital. Welcome to the show, Dr. Scharf. Tell us a little bit, what’s muscular dystrophy?
Dr. Rebecca Scharf (Guest): Thank you, Melanie. Muscular dystrophy is a genetic disorder that involves progressive degeneration and weakening of the muscles. We often see children with Duchenne muscular dystrophy in our clinic, which is one of the most common types that we see, one of the nine types of muscular dystrophy. This disorder involves particularly the muscles but can involve cells throughout the whole body and tends to lead to weakness over time.
Melanie: Do doctors know what even causes it? Is it something that’s present right at birth?
Dr. Scharf: Yes, we do know what causes it. Duchenne muscular dystrophy is caused by an absence of a protein in the muscle which is called dystrophin. Dystrophin is a large protein in the body encoded by a large gene in the genome, and we know that absence of that gene or dysfunction of that gene lead to less or altered dystrophin in the muscles. Dystrophin is the protein that helps keep the muscles intact and helps the muscles to contract and be used. When a patient has muscular dystrophy, that dystrophin protein is missing or altered, so the protein in the muscle and throughout the body are missing or altered, and this leads to the progressive weakness or muscle degeneration that we see.
Melanie: In Duchenne’s, what might parents notice at the beginning? Is this something that, as I said, comes with birth or is it something you notice once you start noticing developmental or motor delays?
Dr. Scharf: Right, great question. Yes, the muscular dystrophy present at birth is part of the genetic makeup of the child and so it has been there all along. However, oftentimes, it is not picked up until early childhood. The more common story that I see is a little boy who’s brought into the office with a history of falling frequently or being a clumsy child, or having delayed walking, all those types of symptoms that oftentimes will present in our office – being a little bit weaker, having low muscle tone, and this onset of weakness is usually noticed somewhere between two and five years of age. Sometimes, families will notice even earlier and sometimes children don’t present to my office until six, seven years of age. The most common, I would say, is somewhere between two and five years of age. This disease affects primarily boys, but it can be seen in girls in rare cases. Children usually have muscle weakness that first affects the proximal muscles, meaning the muscles that are closest to the body of the trunk. These would be the hips, the pelvis, the thighs, and the shoulders. Calf muscles are usually enlarged and so sometimes someone will pick up on that in the child. Again, these children will be the ones who have difficulty climbing stairs, difficulty with strength involving their legs and arms. By the teenage years, the heart and the respiratory muscles are often affected, and so sometimes children will then present with difficulty with breathing or difficulty with endurance due to their heart muscle.
Melanie: Now when somebody is diagnosed with muscular dystrophy, and the parents are probably quite scared at that point and picturing the worst outcomes, tell us a little bit about treatment options. What do you do for the patients? Do you manage the symptoms? Do you deal with the chronic complications that might end up? What do you do for them?
Dr. Scharf: Currently, we do a lot of treating the symptoms of muscular dystrophy to the best of our ability. We manage muscular dystrophy through a variety of specialties. The first line is therapy. Children benefit from physical therapy to keep their muscles in use, to keep them active, to keep stretching their joints so they don’t get contractures. They also benefit from occupational therapy which helps with adaptive and daily living skills. It can allow them to continue to move around, to get in and out of their bed, to get through the house in order to feed themselves. All those things are things that an occupational therapist would work on with the child. Children with muscular dystrophy also sometimes have delays in their language or their cognitive ability, and so speech and language therapy can be very helpful in helping with communication, as well as in terms of feeding. We certainly benefit from having them in our team. Pulmonary specialists are also very important in treating muscular dystrophy. They help monitor the children’s lung functions and to keep their lungs functioning at best possible. The children will have pulmonary function test at each clinic visit to keep an eye on how their lungs are functioning, and sometimes we’ll give medications or different lung exercises to keep the lungs as healthy as we can. Next, children see cardiologist to monitor their heart function. This dystrophin is a protein that’s also found in the heart muscle, and so we keep a close eye on the children’s heart functions and then are able to provide treatments as needed, if there’s any difficulty with the function of the heart. Next, children will see the orthopedic team, and that’s very important to assess for things like scoliosis, contractures in the ankle joints, fractures, and they will provide treatment when necessary. Currently, the medication that we use for muscular dystrophy is prednisone. It’s a medication that has been shown in many, many studies to allow boys to walk longer, use muscles for several years longer. So it really has shown to be a life-sustaining medication that allows for functions for several more years in many boys. The Muscular Dystrophy Association and other groups are actively involved in research and development for new drugs to treat muscular dystrophy. I’m really excited about that. I’m thankful to the Muscular Dystrophy Association and the NIH and everyone else who funds research in muscle disorders. I think it’s so important and it’s so needed. We need many more medications to help treat children with muscular dystrophy.
Melanie: Tell us how these children grow. What happens as they grow – the changes that parents can look toward? And while you’re speaking about that—you mentioned the Muscular Dystrophy Association—tell us what research is going on out there.
Dr. Scharf: Sure. Over time, we follow children in our clinic and we keep an eye on many things including how they’re growing and developing and learning and thriving. Are they able to do everything they’re supposed to do throughout their day, the things that kids do? Are they able to play and go to school, or be part of their families? We monitor things closely to see if we can provide any help or any assistance to allow those things to happen on a daily basis. A lot of times, we’ll see that children will continue to make good developmental progress through those first two years of childhood. Sometimes, often around five, six, seven, we’ll see a little bit of plateau in skills where children aren’t able to continue to learn new motor skills and sometimes begin to lose some skills. Usually, somehow around that time is when some things become harder like running, jumping, walking, and so that’s often when we treat this prednisone, if we haven’t been already, to try to prolong some of the muscle function that we have. And then, we often do need some aids for mobility. Sometimes, children need to use crutches or walkers or wheelchairs to enable mobility, and those can be really helpful things. I think using a wheelchair to enable a child to go out and be in the park and go to school is really great. It allows them to participate in the community so much better, and I think those things are very important. We try to keep an eye on what equipment would be most helpful for each child and how we can help them function to their fullest. The Muscular Dystrophy Association is doing new research into different types of medication that can be used in order to treat muscular dystrophy. Some of these target the gene particularly. Some target the dystrophin protein, seeing if they can make that stronger or replace that within the muscle. And some come about trying to make other parts of the muscle function better, so that it can account for that lack of dystrophin in the muscle. And all of these things, I think, have some promise in terms of what will be able to be helped. There are trials going on for some early-phase medication, which I’m very hopeful will soon to be somewhat effective for this children, because we certainly need a lot more medication options than we currently have for children with muscular dystrophy. So I encourage everybody to support the Muscular Dystrophy Association, or just medical research in general. I think it’s very needed.
Melanie: Thank you so much. And, Dr. Rebecca Scharf, tell us why patients and families should come to UVA Children’s Hospital for their care.
Dr. Scharf: Sure. Here at UVA, we have a multidisciplinary clinic to help care for children who have muscle disorders. We have recently opened the new UVA Children’s Battle Building, and that’s where our clinic is located. So when children come for their appointment to the Battle Building, they’re able to see first the developmental pediatrician and we’re the ones who take responsibility for overseeing the medical care as well as to be sure that children are receiving the therapies and the services that they need in their communities. We’re the ones who monitor the children’s developmental progress. We monitor their growth to make sure that’s going well, and we keep an eye on their learning over time to see if they’re receiving all that they possibly can in school. At UVA’s Battle Building, the children are also able to see physical therapists, occupational therapists, speech-language pathologists, and our therapy area has a gym, which are a fun way for children to connect with our therapist and sometimes develop plans for therapies back in their neighborhoods or schools, as well. We also have evaluations for the equipment needs that children have and they can come to equipment clinic and try out various pieces of equipment to see which would be best for them. We also have orthopedic surgery in that clinic and Dr. [Evan] did a wonderful job of caring for our children’s orthopedic needs. We’re very thankful to have that all-in-one place. When children come to clinic, they are also able to get their pulmonary function test done at that visit, so we can keep an eye on their lung function, and pulmonology as well cardiology are also in our Battle Building. Therefore, children could see those specialists if needed on the same day and monitor their heart and their lung function.
In addition, we have nutritionists in the clinic. They often help us with monitoring growth and providing some good input for healthy diet and exercise for our children. We also have endocrinology and a fitness clinic, which is a wonderful resource to have for children. Oftentimes, one side effect of prednisone is weight gain, so children can be monitored with our fitness clinic and our nutritionist to see how well they’re doing them. We also have teachers in this clinic who help us with education and interfacing with the children’s schools so we can make sure that they’re receiving the appropriate services in school and so we can communicate with schools about how this is going on, like is there anything we can do to support this child being able to participate fully in school, which has been wonderful. And we also have members from our Department of Neurology who come to this clinic and have been helping manage some of the other neurological symptoms that children may have, such as headaches or seizures, which not all children with muscular dystrophy have, but when they do, it’s nice to be able to have neurology there. Some of them are neuromuscular specialists who have been coming, which has been wonderful. We work together and care as best as we can for these children. So, I find the UVA Children’s Hospital Battle Building to be a great place to work as a team and be able to care for a child in a very multidisciplinary setting, which has been helpful for me and helpful for, more importantly, the patients to be able to receive a more comprehensive care.
Melanie: Thank you so much, Dr. Scharf. What a wonderful approach for patients with muscular dystrophy and their families. You’re listening to UVA Health System Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thank you so much for listening.
- Hosts Melanie Cole, MS
