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Working out at home is convenient and cost efficient, but you still need to know how to safely perform the proper exercises.
Additional Info
- Audio File staying_well/1327sw1e.mp3
- Featured Speaker Joel Harper, CPT
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Guest Bio
Celebrity personal trainer Joel Harper has been developing custom workouts for personal training in New York City (NYC) for 18 years largely due to his simple exercises which produce immediate results.
His clients range from Dr. Oz to Olympic medalists who are striving for break-through performances to 10 year old kids just learning to appreciate their health. With a client list as diverse as his personal training methods, he regularly works with well-known actors preparing for new roles, musicians embarking on world tours and business executives desiring increased energy and strength.
Joel has appeared in various publications from O Magazine and Esquire to Bottomline Health. He has created all of the personal workout chapters for the New York Times best selling YOU: books series and the accompanying workout DVDs with Dr. Mehmet Oz and Dr. Michael Roizen as well as the popular FIT PACK DVD.
Joel's unique personal fitness workouts have been seen on various networks and programs including: ABC, Fox News, Oprah, the Dr. Oz. Show, Good Morning America, and Larry King. Joel is the creator of the PBS best selling DVD, FIRMING AFTER 50 and the currently running SLIM & FIT.
Originally from Texas, Joel earned a BS from NYU. Getting into shape was a necessary component of Joel's modeling career. As a model he has worked for top designers and appeared in magazines, calendars and billboards in the U.S., Europe and Asia. Staying in shape and motivating others to do the same is now a way of life. - Hosts Melanie Cole, MS
All women face the threat of heart disease. 1 in 4 women will die from it. Here are the factors you need to know.
Additional Info
- Audio File staying_well/1307sw1d.mp3
- Featured Speaker James Beckerman, MD
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Guest Bio
James Beckerman, MD, FACC is a cardiologist with the Providence Heart and Vascular Institute in Portland, Oregon and is a Fellow of the American College of Cardiology. He recently chaired the Oregon Governor's Council on Physical Fitness and Sports, and is the team cardiologist for the Portland Timbers Major League Soccer Team. He is a member of the clinical advisory board at WebMD Health Services and serves on the advisory board of Fitness Magazine. He is the author of The Flex Diet.
- Hosts Melanie Cole, MS
Aggressive nutrition can have a major effect on beating cancer.
Additional Info
- Audio File staying_well/1314sw1d.mp3
- Featured Speaker Patrick Quillin, PhD, RD, CNS
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Guest Bio
Dr. Patrick Quillin is an internationally recognized expert in the area of nutrition and cancer. He has 30 years experience as a clinical nutritionist, of which 10 years were spent as the Vice President of Nutrition for Cancer Treatment Centers of America where he worked with thousands of cancer patients in a hospital setting.
He has earned his bachelor's, master's, and doctorate degrees in nutrition and is a registered and licensed dietitian (RD & LD) and Certified Nutrition Specialist (CNS) with the American College of Nutrition. He has appeared on over 40 television and 250 radio shows nationwide and is a regular speaker for medical and trade conventions, including ACAM, A4M, American Association of Naturopathic Physicians, and Integrative Medicine. He has been a consultant to the National Institutes of Health, U.S. Army Breast Cancer Research Group, Scripps Clinic, La Costa Spa, and United States Department of Agriculture; taught college nutrition for 9 years, and worked as a hospital dietitian. He obtained an Investigative New Drug number (48,676) from the Food and Drug Administration in September of 1995 to conduct research on bovine cartilage in advanced cancer patients. His 17 books have sold over 1.5 million copies and include the best sellers Healing Nutrients and Beating Cancer Nutrition. (now translated into Japanese, Korean and Chinese) He edited the textbook, Adjuvant Nutrition in Cancer Treatment and organized the 1st, 2nd, and 3rd international symposia on "Adjuvant Nutrition in Cancer Treatment." He is also listed in "Who's Who in Science". - Hosts Melanie Cole, MS
Additional Info
- Segment Number 4
- Audio File virginia_health/1420vh5d.mp3
- Doctors Manning, Carol
- Featured Speaker Dr. Carol Manning
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Guest Bio
Dr. Carol Manning is a board-certified clinical neuropsychologist who directs UVA’s Memory and Aging Care Clinic and specializes in caring for patients with memory disorders such as dementia.
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Transcription
Melanie Cole (Host): While memory loss is the best known symptom of dementia, it’s not the only symptom, and memory loss alone does not mean that you have dementia. My guest is Dr. Carol Manning. She’s a board-certified clinical neuropsychologist who directs UVA’s Memory and Aging Care Clinic and specializes in caring for patients with memory disorders such as dementia. Welcome to the show, Dr. Manning. What is dementia?
Dr. Carol Manning (Guest): As you said, dementia is not just memory loss that occurs with normal aging. Dementia is an umbrella term for several disorders, and what dementia is, it describes what happens when there’s a decline from normal levels of ability—of when there are changes in memory, attention, concentration, abstract thinking—all kinds of cognition that we rely upon when there’s a decline that’s greater than what we would expect with normal aging. So dementia describes constellation of symptoms, but it doesn’t describe the exact disease process.
Melanie: So these most common symptoms, what would send up a red flag that would signal somebody really, something is going on here?
Dr. Manning: With, for example, normal aging and memory loss, we would anticipate that someone might forget where they parked their car in a parking lot. But if they forget what their car looks like, that would be a signal to me that there’s something wrong. With normal aging, what we might see is that people forget proper nouns. They forget names. That’s very normal. With dementia, people lose the ability to speak fluently altogether—so spontaneous speech decline. Losing your keys is normal, but putting things in highly unusual places and then suspecting that someone else took them, that would be something that would be out of the norm.
Melanie: So, suspecting that someone else took them. Is there a generalized paranoia? Do you start to look for these things if it’s happening in yourself or if it’s happening for your loved one and you start to notice these things?
Dr. Manning: That often occurs later on in dementia, and the paranoia is because people may not be aware of the fact that they put them there and there’s something called confabulation, where people make up things to fit with other things that they can’t put together. For example, they don’t have a memory that they put their keys somewhere unusual, and so they assume that someone took them. I can give you another example of a change that would concern me: someone who’s been making the same favorite dish for many, many years and suddenly gets in the kitchen and can’t remember how to do it. So things that are well-learned, that we’ve known for a long period of time and suddenly can’t do them anymore.
Melanie: What is the difference, Dr. Manning, between dementia and Alzheimer’s disease? Because these symptoms that you’re mentioning, right away, people are going to start to be very concerned that this is not an age-related dementia but something much more serious.
Dr. Manning: “Dementia” is a general term, and Alzheimer’s disease is a kind of dementia. Alzheimer’s disease happens to be the most common kind of dementia, but there are other dementias as well. There is dementia that’s associated with vascular change, vascular dementia. There is dementia that can occur with Parkinson’s disease—so for example, Parkinson’s disease dementia. The umbrella term is “dementia,” and Alzheimer’s disease is a kind of dementia. By far, it’s the most common kind.
Melanie: So then, what treatments are available? If somebody experiences these symptoms or you notice it in a loved one, and then you go to see a doctor such as yourself, what can you do about it?
Dr. Manning: Well, I think, first, it’s important, extremely important to get a diagnosis and to get an accurate diagnosis, because to assume that it’s Alzheimer’s disease or that it’s a dementia that we can’t treat is doing the person a disservice. There are some dementias and there are conditions that are treatable, and we definitely want to treat them. So if there’s a thyroid problem, or if there’s a vitamin deficiency, we want to treat it. If it’s depression, which can look like dementia, we definitely want to treat the depression. So it’s really important to go to a specialized memory disorders clinic to make sure that you get the right diagnosis. Then, once you have the diagnosis, we want to treat what’s treatable, and we want to also treat symptoms even if we can’t cure. So for example, currently, with Alzheimer’s disease, there’s a lot of research being done to actually try to cure it. At this moment, we can’t. But what we can do is to treat the symptoms, and we have medications that we can prescribe that slow the rate of decline. We also want to work with people on behavioral management because there are behavioral strategies that can be used to help minimize the effects of the dementia or the Alzheimer’s.
Melanie: Some of the medications that you mentioned, Dr. Manning, do they also help to slow the development of these symptoms?
Dr. Manning: What they do is, yes, they slow the rate of decline. And there’s research looking at these drugs, and what they do is slow the rate of decline for about three years. And what they can do is slow the rate of decline such that people may not have to go into facilities, memory disorders, memory units, or nursing homes. It can prolong placement because of the slow in the rate of decline. While they don’t cure, they can be really helpful to patients and the care groups.
Melanie: Explain a little bit about some of the therapies that you mentioned. If you’re giving a behavioral therapy, modifying tasks, or the environment around this person, what’s involved in that?
Dr. Manning: Well, it’s involved when you’re with professionals who can help understand what the behavior is and what’s causing it. There’s a behavior that’s common in Alzheimer’s disease called sun downing, and that is that people with Alzheimer’s disease will often become more agitated or upset late afternoon or late evening. So it’s working with the caregiver and the patient to try to understand what is provoking the person to become more upset at that time of day. For some people, it’s that there’s too much activity. We want to minimize what’s going on around that person and put them in a calmer environment. So turn down the lights and get soothing music or soothing activity. For other people, it can be that there’s not enough stimulation and they have too much energy and they get agitated. We, in large part, work with caregivers to try to strategize to make things easier for both the patient and for the caregiver. This is a disease that affects entire families. And because Alzheimer’s disease is a progressive condition, it’s always changing. It requires ongoing current treatment and working with patients and families to cope with the changes as they occur.
Melanie: Dr. Manning, why should patients come to UVA for treatment of dementia?
Dr. Manning: I think they should come because we have a multidisciplinary clinic with people who are board certified and trained in behavioral neurology and neuropsychology. We have an entire multidisciplinary team involved—social work, neuropsychology, neurology, geriatric psychiatry. We have a nurse practitioner. We also have clinical trials which enable us to give our patients medications that aren’t available elsewhere but are really promising in terms of treating the disease. We have a full family approach, not just for the patient, but we look at the patient and the needs of the entire family and try to help them not just with the diagnosis but with ongoing care as the disease progresses.
Melanie: Dr. Manning, please, in the last minute, give us your very best advice for people who are starting to experience some of those symptoms of dementia, or for if you see it in your loved ones. Give us your best advice for things at home.
Dr. Manning: My best advice is go ahead and go to a memory disorders clinic and get a diagnosis so that you can make plans and understand what’s going on. Sometimes it’s not dementia, and you want to know that. And sometimes, unfortunately, it is, and you want to be prepared. People often try to avoid it and deny it and said, “I don’t want this person to know that they have dementia.” Our experience is that people know that there’s something wrong, and it’s actually a release to get a good diagnosis and to get good care and to be able to plan for the future.
Melanie: So important and such great information. You’re listening to UVA Health Systems Radio. And for more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening, and have a great day. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 3
- Audio File virginia_health/1420vh5c.mp3
- Doctors Modesitt, Susan
- Featured Speaker Dr. Susan Modesitt
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Guest Bio
Dr. Susan Modesitt is a board-certified gynecologic oncologist who serves as director of UVA’s Gynecologic Oncology Division and co-director of UVA’s High Risk Breast and Ovarian Cancer Clinic.
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Transcription
Melanie Cole (Host): US women have a 1 in 72 chance of developing ovarian cancer. My guest is Dr. Susan Modesitt. She’s a board-certified gynecological oncologist who serves as director of UVA’s Gynecologic Oncology Division and co-director of UVA’s High-Risk Breast and Ovarian Cancer Clinic. Welcome to the show, Dr. Modesitt.
Please tell us, what are the most common risk factors for ovarian cancer?
Dr. Susan Modesitt (Guest): Most women with ovarian cancer don’t have a family history of breast or ovarian cancer, but that would be one of the strongest risk factors for developing ovarian cancer. Most of the other risk factors are not something you can modify, but it’s never having been pregnant, having infertility, having endometriosis, being older aged—most women with ovarian cancer are in their 60s or 70s. And again, those aren’t modifiable.
Some things that reduce your risk of ovarian cancer are having been pregnant, taking birth control pills for at least five years in the past; having your tubes tied; or even having a hysterectomy; and obviously, having your ovaries removed. We don’t recommend that for most women.
Melanie: So if women want to reduce their risk factors but they’ve already passed the time when they might have gotten pregnant earlier, taken birth control, any of these things, are there some things that they can do?
Dr. Modesitt: Again, being aware of their risk factors. If they’re past the age where we would recommend doing birth control pills for risk reduction—and we wouldn’t recommend surgery unless they were very, very high risk—there’s not a lot more to do besides the things that we recommend for reducing your cancer risk overall, which are maintaining a healthy weight and exercising. Those are two key factors in a lot of cancer—not as much ovarian as some of the other ones. But those are the things that people can do.
Melanie: Dr. Modesitt, ovarian cancer has been called silent cancer. You know that people have heard that there are no signs and symptoms until it’s progressed a bit. Tell us about the symptoms of ovarian cancer, and what red flags might stand up that would send us to see you?
Dr. Modesitt: So the hard part about ovarian cancer is, unlike some of the other women’s cancers, like breast cancer or cervical cancer, where we have good screening, ovarian cancer doesn’t have any screening—and we’ll talk about that in a minute. But the symptoms are very vague and very subtle, and women mistake them for other things—that they’re just going through menopause, they’re getting older—and kind of let it go to the back burner. So the hallmark symptoms are feeling full—when you start to eat, you feel full very quickly—feeling bloated, and having abdominal pelvic discomfort. And the hard part is, again, these are pretty common symptoms. And if you think about, for example, pregnancy, which a lot of women go through pregnancy, it takes a long time before a mass gets big enough for it to really impair things. And so, women often don’t know that they have a mass on their ovary or their fallopian tubes until it becomes really obvious. Again, the hallmarks are bloating, feeling full, and abdominal discomfort. That happens more times in a month than not—for example, having it at least 12 times during the month. If it just happens once in a while, once in a month, once every other month, that’s not something we worry about. But if it’s a persistent thing, they should come and talk to their doctor.
Melanie: As you say, these are common situations for women. We feel bloated sometimes all the time, you know, discomfort. These kinds of things are so common for women, whether you’re younger or older, 12 times a month or all the time. Because that’s the confusing thing, Dr. Modesitt, is that women don’t know when they’re being too alarmist, when do you really go see your gynecologist and say, “I’d like to get checked for ovarian cancer.”
Dr. Modesitt: I would err on the side of caution. If it’s something that is persistent—again, not just happening once a month—I would go and talk to your doctor about it. The things we can do, again, I mentioned earlier, that there is no good ovarian cancer screening method. But if you’re having symptoms, there are very good methods to evaluate that. For example, an ultrasound can look at your ovaries and your fallopian tubes and also look into the abdomen. CT scans can be used—again, only for symptoms, not for screening—and there are some blood tests that can give us a clue that there might be a problem. But again, this is to evaluate symptom.
Melanie: So there are no screening tests, and you can evaluate symptoms. And then what happens, Dr. Modesitt?
Dr. Modesitt: Right. Well, let me talk just a little bit about screening for a second. Because there’s a lot of information in the [lay press] that you should go in and you should ask your doctor for some of these test—for example, an ultrasound to look at your ovaries, or a blood test called a CA 125 to screen for ovarian cancer. And the hard part is these tests are normal, often, in early-stage ovarian cancer, and they can be abnormal in benign conditions, like endometriosis or fibroid or things like that, that aren’t cancer. Again, they’re good to evaluate symptoms, but they don’t pick up a cancer early, which is what we would want for a screening to have. We’re actually doing a lot of research on some other novel things like short RNA fragments, and micro RNAs to try to find another way to screen women for ovarian cancer. But as of right now, there’s not any screening for normal-risk women.
Melanie: So then, what? If you do get in to your doctor and you have been diagnosed with ovarian cancer, what treatment options are available at UVA?
Dr. Modesitt: Treatment options have improved a lot. There’ve been several breakthroughs. We’re still not where we wanted to be, which is why we have a lot of clinical trials to continue to evaluate better treatments. But of some of the new breakthroughs have been using intraperitoneal chemotherapy. So the first step is usually—not always—but usually, surgery, where we remove all of the tumor that we can that is visible. And then sometimes, you can give the chemotherapy right into the abdomen. Ovarian cancer spreads on the surfaces of the organs in the abdomen, so giving the chemotherapy right into the abdomen has been shown to vastly improve survival for women. And so that’s been a breakthrough. Looking at some of the more targeted therapies is something that we’re looking at and have included some in clinical trials. Again, having an advanced surgical procedure, either before chemo or after chemo, improves survival. So those are the key things about treatment for ovarian cancer.
Melanie: Does a complete hysterectomy eliminate your risk then of ovarian cancer?
Dr. Modesitt: So hysterectomy is removal of the uterus. A salpingo-oophorectomy -- we like to make things hard to name so that only doctors know what we’re talking about.
Melanie: Absolutely.
Dr. Modesitt: But removal of the uterus is a hysterectomy. Removal of the tubes and the ovaries is a salpingo-oophorectomy. So to really reduce your risk of ovarian cancer to as low as it can go, you need to have the tubes and the ovaries removed. There’s a bit of a theory now that much of ovarian cancer actually starts with small cells that are abnormal in the fallopian tube that then gets spread into the abdomen as tiny little cells but then all grow up together. That is part of the reason we think the screening that we have doesn’t work. It doesn’t start as a small area that gets bigger and bigger and then spread. It starts as small areas that spread and then all get bigger. It’s just really tough to see it right now, to find early.
One thing we haven’t talked about that I do want to mention is I talked about family history a little bit earlier. For women that are considered very high risk—and these are women that have a family history of breast cancer, ovarian cancer, or carry one of the genes, the BRCA mutations that put those women at almost a 40 percent risk of ovarian cancer and 85 percent risk of breast cancer—women with that situation, we actually do things much more aggressively than we do in women without those risk factors. These women, we follow very closely. We do some screening and we do recommend that they have surgery to remove their tubes and their ovaries once they have completed childbearing—again, because we know the screening doesn’t work very well and they’re just at such high risk. Instead of a 1 percent risk, they’re at a 40 percent risk for ovarian cancer, so we don’t want to take that chance. And so we do risk-reducing surgery.
Melanie: So if women have the BRCA gene, it puts them at a higher risk, and then it’s just a much more aggressive approach to prevention. Please tell us, Dr. Modesitt, why should women come to UVA for their ovarian cancer care?
Dr. Modesitt: Well, there’s been a lot of studies showing that you need to go to someone that’s an expert—so what’s called a high-volume center for surgery—for the option of getting clinical trials or intraperitoneal chemotherapy. These are things that we do every day. And so the benefit of coming to UVA is you see women or men positions who are top doctors for cancer and have access to all of the newest options.
Melanie: That’s really great information. Thank you so much, Dr. Susan Modesitt. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 2
- Audio File virginia_health/1420vh5b.mp3
- Doctors Bickley, Polly
- Featured Speaker Polly Bickley
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Guest Bio
Polly Bickley is a speech language pathologist and director of the Encouragement Feeding Program at UVA Children's Hospital.
UVA Speech Language Therapy -
Transcription
Melanie Cole (Host): Children with development disorders, traumatic brain injury, or throat deformities may have difficulties communicating or problems swallowing and eating. My guest is Polly Bickley. She’s a speech language pathologist and director of the Encouragement Feeding Program at UVA Children’s Hospital. Welcome to the show, Polly. What are some of the most common communication and eating disorders? What are the conditions that would cause children to have these issues?
Polly Bickley (Guest): Well, in this day and age, we’ve had such advances in medical technology that we’re having children survive as early as 24 weeks. So one of the biggest things we see is premature birth, children born at 24th to 26th to 28th weeks. We know that those children’s systems are still immature. The lungs, the heart, the GI system aren’t really ready to be working perfectly coordinated together. And so, a lot of times, we’ll see children who are not able to eat safely, efficiently, effectively; who are not able to breathe very well—so the very complicated kiddos who stay in the hospital for quite a while. That environment, as good as we try to make it, isn’t really the best place for children to start learning and developing their eating skills and their communication skills.
We’re also pretty darn amazing at being able to fix some cardiac anomalies that we were not able to fix even 5 or 10 years ago. So we see a lot of children with very complex heart deformities that are now reparable, being fixed. And so they’re also in the hospital for a very long time, very, very medically fragile, and they’re not able to do the things that most babies do right away—which is eat and start to babble and start to learn language from listening to their parents talk to them. Those things kind of put them behind the eight ball.
We’re also seeing a much greater incidence of autism, where children don’t really understand the point of communication—that if I point at something, you’ll give it to me, or if I say a word, that’s identifying what I’m wanting. So those are all things that are keeping us busy in the world of speech pathology.
Melanie: So then, what about the eating disorders that go along with these conditions that you’re talking about? What kinds of treatments are available and what are some of the signs and symptoms that parents should be looking out for, red flags, Polly?
Bickley: Right. Well, eating should be effortless at birth. For the first several months, it’s a reflexive behavior that children do. If that is not going smoothly, if your child is not taking a bottle or breastfeeding in an easy manner, if it’s effortful, if it takes a long time, if they’re choking or coughing or changing colors, or if they’re not growing well, that is definitely a red flag that we need to help them. We need to look at them and figure out what is not working, why is this child not enjoying this activity, why it’s not happening smoothly?
The other thing is we want to look at children as they advance through going from bottle to breast, from breast to baby food, and then to table food. That usually happens between four to five to six and nine to twelve months. That should really be smooth and effortless, and children should enjoy eating and they should give you good cues that they’re enjoying eating. And some of our children don’t enjoy eating because perhaps it hurts when they swallow. They might have reflux. They might have something else that interferes with them eating in a safe and efficient manner. So we’re going to want to get some help for those things pretty quickly. We have a saying in the speech pathology world, at least at UVA, that we want quality over quantity. We know that parents really want to see their child eat a good quantity of food, but we want children to eat happily and efficiently and effectively, even if it’s smaller amounts. Those are the things that we would like to look at. So if you’re worried that your child is not eating the volume that they should and the manner that they should because they’re not enjoying it, definitely, touching base with your pediatrician, who then could make a referral to one of us, would be helpful.
Melanie: How are these conditions diagnosed, Polly? Do you do some tests to see what’s going on in there?
Bickley: Mm-hmm. It kind of depends on what we’re seeing from a clinical standpoint. The speech pathologist is going to want to watch the child eat, whether it be an infant taking a bottle or an older child eating some sort of pureed or table foods and we’re looking for signs that they’re having difficulty swallowing, or maybe this food is actually going into their lungs instead of their stomach. That’s called aspiration. We see signs of wet, gurgly vocal quality. We see their eyes tear up, they do some coughing. Or they’ve had respiratory illnesses in the past that are not explained by other lung issues. And so we’re going to want to look at that first. And then we may recommend a video fluoroscopic swallow study, where we actually have a child take food with barium in it and the radiologist takes a picture of the child swallowing so we can see if there’s any physical reason for them not to be swallowing safely. A lot of times, however, it’s more than just a physical issue. It becomes more of a, “This doesn’t feel good. When I eat, it hurts later. Therefore, I don’t want to eat.” And so, we do have some behavioral avoidance of eating or seeing children now that are extremely picky. So it’s not just, “I don’t know how to eat because I was so medically fragile I didn’t get to practice eating,” but, “I can eat fine, but I only want to eat blue food when the moon is full and my mom is singing ‘Happy Birthday’ because I’m very picky and rigid about what I’ll eat because I’m a little overwhelmed by this activity. It’s not as easy as I’d like it to be.” So, with those kiddos, we’re looking at what the diet is, what textures, what flavors, what types of foods they’d like to eat efficiently, and which ones they have a trouble and then reject.
Melanie: Then what treatment options are available? What interventions do you use to get those children to be able to eat and to enjoy it, more importantly, as you say, because then, the behavioral issues start coming in because they’re remembering these things? What treatment options are available?
Bickley: Right, right. Well, from the very get go, my coworkers that are working over in the NICU, again, have that mantra of good quality over quantity. And so they’re looking at babies very young and saying, “How can I make this baby eat efficiently and effectively in a manner that’s comfortable to them?” So they’re going to be looking at what type of nipple to use, how to position the baby, how not to overwhelm the baby, and what type of viscosity of the formula. Should we be thickening it? Should we just use a very slow-flow nipple so that the child can coordinate that suck-swallow-breathe pattern that they feel comfortable eating? When they get a little bit older, my co-workers and I who work in the outpatient setting are looking at what is it about this food that is hard for you. Is it too sharp? Are the crumbs too sharp—because your mouth is a lot more hypersensitive than my mouth would be? Or is the weight of this pureed food, does that end up making you gag, and why is that? And then, how can we gently, consistently, in a playful manner, teach you that this isn’t going to hurt you? We’re going to practice it so many times in a fun, playful manner that it’s not going to hurt you anymore. And again, that’s hard, because a lot of times, we have to get the calories in to get the child to grow and thrive, but we have to do it in a manner that’s not painful, so that they don’t start to avoid more things.
Many times, this particular picky, rigid eating are what we call selective eating disorder, goes along with a bigger picture; goes a long with significant rigidity; sometimes goes along with the diagnosis of autism; goes along with the diagnosis of anxiety, hyper vigilance about the world. And so, we really need to back up and look at those things because the mouth is a symptom. The eating is necessarily a symptom of the bigger picture. So it really takes a whole team. We’re referring back to their physicians. We’re referring to the GI doctors. We’re referring to some psychologists. We’re referring to developmental pediatricians, occupational therapists so that we can look at the whole kit and caboodle to figure out what’s broken and fix the whole child, not just the symptom of feeding.
Melanie: Well, it’s a real multidisciplinary approach, Polly. So why should families come to UVA for treatment of these conditions?
Bickley: Well, I think there’s numerous reasons, I think the first reason being that the clinicians that are currently at UVA have probably pretty much an average of at least 15 to 20 years’ experience among all of us. So there’s many us that have been here for an extremely long time, therefore we’ve been around the block and we’ve seen this quite a bit. The other issue is that UVA is really committed to research and continuing ed, so I feel like we really have some cutting edge opportunities in working in the NICU and seeing the children and the surgeries that they’re doing and some of the research that’s coming out of there. And then, I think that the other big thing is that we really do work well together as a team. And so, when I am puzzled about a child, I have so many resources to go to very close at hand that we can problem-solve together.
Melanie: That is great information. Thank you so much for all you do, Polly. You’re listening to UVA Health Systems Radio. And for more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening, and have a great day./AT/rj/es - Hosts Melanie Cole, MS
Additional Info
- Segment Number 1
- Audio File virginia_health/1420vh5a.mp3
- Doctors Thomas, Craig
- Featured Speaker Craig Thomas
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Guest Bio
Craig Thomas is a certified acute care nurse practitioner at the UVA Advanced Heart Failure and Transplant Center who specializes in caring for heart failure patients.
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Transcription
Melanie Cole (Host): For patients recently discharged from the hospital with serious conditions such as heart failure, preventing them from being readmitted to the hospital is a very important goal. My guest is Craig Thomas. He’s a certified acute care nurse practitioner at the UVA Advanced Heart Failure and Transplant Center who specializes in caring for heart failure patients. Welcome to the show. Craig, tell us. What are the challenges of living at home for heart failure patients?
Craig Thomas (Guest): Certainly, Melanie. Thank you for having me today. Well, there are many challenges for patients with heart failure living at home. It is a chronic condition, and the nature of that alone means that this is a condition that these patients, most will live with for the remainder of their lives. There was the medical treatment for heart failure patients. There are at least four drug classes that we’d like to have patients on—that is, if they only have heart failure only. Many of our patients will have multiple other comorbidities, other disease processes that have led them to the heart failure, be that a coronary artery disease, uncontrolled hypertension, high blood pressure. All of these things would also, in addition, require other medications and such that would make it more challenging for these patients. But many of the people that I take care of will be on an excess of eight medications, specifically for their heart and their heart disease. That alone means that you have to take multiple medications every day several times a day. That can be challenging.
Also, with heart failure, there are a lot of diet recommendations; things, such as restricting fluids. That’s just one of the major problems with heart failures, the fluid accumulation, and things such as reduced sodium content in your food as well, which is quite difficult in our Americanized diet to avoid those high-sodium foods. And there’s a lot of monitoring. The symptoms of somebody’s heart failure becoming worse for them can be different between different individuals. And so, folks being able to understand what their heart failure symptoms are, being able to recognize those and alert a care provider in an appropriate, timely manner is hugely important to managing heart failure at home.
Melanie: So, Craig, how does the Heart Health at Home Program work to help patients with heart failure? And does it help their families? As you say, it can be a very confusing situation with the medications and the diet, fluid and sodium restriction, adherence to all the protocol that you set out for heart failure patients. How does this program work to help them coordinate all of this?
Dr. Thomas: Certainly. Our Heart Health at Home Program is set up to introduce this program to patients as they are hospitalized for heart failure. We know that when folks are in the hospital with heart failure that that is sort of the worst state of their condition when they need to be hospitalized for that. And so, we know that these people that are there are at very high risk for having relapses in their condition. And so, we contact patients as they are admitted to the University Medical Center and ask them about this program and if they feel like they could benefit from having additional resources at home to help them. Like you’d mentioned, this program helps the patient for sure. And also, note that families are very happy to have some extra eyes in the home and to have a skilled healthcare provider there. Our program works essentially -- I meet and enroll patients while they’re in the hospital. Once they are discharged, a member of my team, they have certified nurse aides that are specifically trained in heart failure and cardiac care. Those are the folks that make our home visit to these patients once they’re discharged.
Our program is set up to see the patient first in their home about 24 to 48 hours after they’ve been discharged from the hospital. And then we make those home visits three to four times the first week at their home, and then maybe two to three times the week following that. And we stage our visits down over time based on the patient’s understanding, the patient and the family’s need for our support. Now, we know with this patient population that hospitalization is an indexed or acute events that mark significant concern for their heart failure, and the further they get out from the hospitalization, the less likely it is that they will have trouble. Now, our program is set up to meet with them frequently and early post-discharge and then taper off as needed.
We’ll follow patients for up to one year in our program, and certainly, if people have additional re-hospitalization, then they’re eligible to restart their services with us. We’ve been in operation going on a year and a half now and have over 100 patients that we’ve enrolled in helping manage their heart failure from home.
Melanie: Craig, are there certain prerequisites for participation in the Heart Health at Home Program?
Dr. Thomas: Sure. We do have some criteria—certainly, being in the hospital as the enrollment location. Our program is set to help people that don’t have any other services to help them. There are other services other than the Heart Health Program that are options for patients at UVA Medical Center—things such as Home Health. So if the patient already has Home Health or is in need of Home Health services, which is different from us, then we would not follow that patient in this Heart Health at Home program. They also must live within 60 miles of the medical center just due to our traveling and schedules and trying to keep my team with patients making an impact rather than on the road so much.
Melanie: Just wondering if the program has improved outcomes for the heart failure patients.
Dr. Thomas: It certainly has. We track the outcomes of our patients. We know that nationally, currently, the re-admission rate for heart failure patients is running around 18 or 19 percent. With the Heart Health at Home program, last year, in the calendar 2013, our re-admission rate was just under 9.5 percent. We are at least a 50 percent reduction in patient care for our program that are returning back to the hospital within that 30 days.
Melanie: Craig, why should patients choose UVA for their heart failure care?
Dr. Thomas: UVA has a very skilled and dynamic advanced heart failure center. We have multiple options for advanced therapies. We have a large skilled team that can work with patients and their families through their chronic care of the heart failure—things such as ventricular assist devices. We are a heart transplant center as well. And then, having these unique programs, such as the Heart Health at Home Program, are hugely beneficial to the patients and their families. I cannot see any other reason why you should not choose UVA for your heart failure care.
Melanie: Give us, please, in the last minute here your best advice for patients living with heart failure and things that they can do to make their lives just a little bit better.
Dr. Thomas: There’s a lot of focus currently in the heart failure care world. Many hospitals like UVA are coming up with different ways to support patients in their home. The challenge, as I mentioned at the beginning, is it may seem simple and seem like something that would be very easy to do. My advice would be to accept any assistance programs that the hospital or medical center may offer. These programs are set up so that we can support you. We know what the needs are of this patient population, and those programs are set up to do that.
Melanie: That’s great information about the UVA Heart Health at Home program. For more information, you can go to uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole. Thanks so much for listening, and have a great day. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 5
- Audio File virginia_health/1408vh5e.mp3
- Doctors Upchurch, Jr, Gilbert R
- Featured Speaker Dr. Gilbert R. Upchurch Jr.
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Guest Bio
Dr. Gilbert R. Upchurch Jr. is a board-certified vascular surgeon and chief of the Division of Vascular and Endovascular Surgery at UVA Health System.
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Transcription
Melanie Cole (Host): Millions of Americans are at risk for vascular diseases, which can lead to serious health conditions such as stroke. My guest is Dr. Gilbert Upchurch, Jr. He’s a board certified vascular surgeon and Chief of the Division of Vascular and Endovascular Surgery at UVA Health System. Welcome to the show, Dr. Upchurch. Tell us a little bit about vascular disease. What are the most common types?
Dr. Gilbert Upchurch (Guest): Well, thanks, Melanie, for having me on. The two most common types, really, are atherosclerosis or hardening of the arteries, as it used to be called, which is really plaque buildup in an artery over time. It could be really almost in any artery. The arteries that it most commonly occur in are arteries to your brain, which, if you have a plaque going in your carotid artery, you may end up having a stroke; atherosclerosis in your coronary arteries, which are more centrally, and that can lead to heart attack; or blockages going to your legs, which can lead to pain when you walk, all the way from pain when you walk to gangrene and loss of limb. That’s really number one. The second most common vascular disease we see is an aneurysm. An aneurysm also can really occur in almost any artery in the body, most often occurs in the abdominal aorta, which is relevant to this vascular screening conversation we’re going to have. You think about aneurysm as sort of a worn-out tire. Your blood vessels are a certain size when you’re born and they get somewhat larger as your grow, but the inner tubes give out over time. And so, an aortic aneurysm, for example, can grow from two centimeters or an inch to five, six, seven, ten centimeters. With that growth, there’s always the risk of rupture and if patient -- depending on what bed it is, if an aneurysm ruptures, often, it’s lethal. So I would say atherosclerosis, blockage in the arteries, and aneurysms are the two most common diseases we treat.
Melanie: What people are at risk, Dr. Upchurch? Who would be the people that would want to get screened?
Dr. Upchurch: We divide the risk factors into non-modifiable and modifiable. The non-modifiable ones are people as they get older, people who have a strong family history of either atherosclerosis or aneurysms, people who, for instance, have atherosclerosis in other beds, or people who have high cholesterol. Those are sort of the people who are most at risk. There’s another group of people that I think the ones you can do the most about. That is the group of people who smoke. Smoking is a risk factor for causing both atherosclerosis or hardening of the arteries as well as aneurysm formation. It’s a big-time inducer of both of those things. And I think high blood pressure is another thing that induces both atherosclerosis as well as aortic aneurysms, and so having your blood pressure well-managed and being on the right cardiovascular protective medications are really important.
Melanie: We have the controllable risk factors and the uncontrollable risk factors. So what’s involved in the screening process? If somebody has high blood pressure or diabetes or they smoke or a family history of heart disease, any of these things, vascular disease that might put them at risk, what’s involved in the screening process?
Dr. Upchurch: The screening process is really just a non-painful ultrasound, and this particular screening process involves taking a snapshot of the blood vessels going to your neck or your carotid arteries looking at the carotid bifurcation to see if there’s plaque there. It looks at your infrarenal aorta and does a snapshot of that to see whether there is blockage and/or an aneurysm in your infrarenal aorta, and then it uses a blood pressure cuff on your arm, in your legs, to check the amount of blood flow going to your legs. And your arms. But most of the time, peripheral vascular disease affects the legs. These are non-invasive tests that’s done rapidly, relatively inexpensively, and will give you a good snapshot of what your cardiovascular health risks are.
Melanie: Dr. Upchurch, do you feel that even people that are not necessarily at risk should have these done? And how often? Is this part of our yearly physical? Is it something that’s only done if it needs to be done?
Dr. Upchurch: I think a lot of it depends on how old you are when you’re screened. The aortic aneurysm is just in your infrarenal aorta. There is pretty good literature looking at your aorta once at the age of 60 or 65. If there’s no aneurysm there, you’re likely never going to develop aneurysm in your lifetime. Carotid disease, especially if you’re a non-smoker, a single look at your carotid bifurcation is probably adequate. And really, unless you have worsening symptoms of what’s called claudication or pain in your calves, hip, or buttocks when walking a reproducible distance, if you have a normal screening ABI or ankle brachial index, then you should be capable of not needing to be screened again—unless you develop symptoms, of course. And then, of course, you could always have another test done.
Melanie: Let’s speak about symptoms for a minute, Dr. Upchurch. When does chest pain -- people want to know -- or pain in their arms, or, as you described, pain the legs, claudication during activity, when does that warrant seeing a doctor versus saying, “Oh, it’s probably gas or muscular,” something like that? People are never quite sure about those symptoms.
Dr. Upchurch: Yes. The coronary symptoms are actually -- in my own biases, the chest pain, especially with exertion, radiating down the left arm, those should always be evaluated and taken very seriously. The lower extremity pain in your legs, the blockages in your arteries can often be confused, and these patients are sort of taken aback a little bit by this. It can also be confused with what’s called neurogenic claudication or pain from having your discs, your spinal roots compressed by your vertebral column, so you end up getting pain shooting down the back of your leg when you walk or when you stretch or whatever. It’s a test like this, this ankle brachial index, where we use the blood pressure cuffs, that often helps us to distinguish whether it’s some radiation pain from your back or whether it’s actually legitimate blockage in your legs. What people fear—and this is with the peripheral vascular occlusive disease or atherosclerotic disease or PAD—is that when they’re having pain when they walk, that means they’re heading towards gangrene and losing a limb. The truth is that people who have pain when they walk, only about one percent per year will go on to require an amputation, which means 99 percent of people will be fine. And the truth is, especially in the beginning, the best therapy is exercise and stopping smoking and getting your diet under control. Our job as vascular surgeons and care providers with patients of vascular disease is to help them modify what they’re doing. And to be honest, exercise works almost all the time in these patients if you can get them to, as I said, stop smoking, start exercising. So that’s the first line therapy—no stent, balloon, et cetera are needed.
Melanie: Why should patients come to UVA for their vascular screening and come to see you?
Dr. Upchurch: I think we have an amazing group of experts as good as anywhere in the country at taking care of patients with vascular disease. We have vascular surgeons, cardiac surgeons, cardiovascular medicine physicians, physicians who are specialist in management of your lipids, smoking sensation, and we’ll help you from that critical transition if you need it—from lifestyle changes, et cetera, to more invasive imaging, perhaps an angiogram or just a CAT scan, all the way to the most invasive options, which are ballooning, stenting, and open bypass surgery. So I think you’ve come to a place like this, you will find an amazing group of care providers. And really, for the whole spectrum of your needs, not just making the diagnosis but also taking care of you should you require something to prevent you from having a stroke or prevent you from having your aneurysm rupture or prevent you from losing a leg. That’s one of the things that we in the Heart and Vascular Center here at the University of Virginia pride ourselves on. It’s just sort of one-stop shopping.
Melanie: Thank you so much, Dr. Gilbert Upchurch, Jr., Chief of the Division of Vascular and Endovascular Surgery at the UVA Health System. You’re listening to UVA Health System Radio. For more information on the UVA Heart and Vascular Center, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 5
- Audio File virginia_health/1416vh5e.mp3
- Doctors Bergin, James
- Featured Speaker Dr. James Bergin
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Guest Bio
Dr. James Bergin is board-certified in cardiovascular disease and is medical director of cardiac transplant/heart failure at UVA.
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Transcription
Melanie Cole (Host): For patients with heart failure, recent years have brought an increasing number of treatment options for this serious condition. My guest is Dr. Jim Bergin, he is board certified in cardiovascular disease and is medical director of Cardiac Transplant Heart Failure at UVA. Welcome to the show Dr. Bergin, please explain for the listeners, what is heart failure because they always associate this with heart attack, two different things.
Dr. Jim Bergin (Guest): Yes, thank you for having me, on the difference between or the problem with heart failure is that heart is not able to meet the demands of the body, so the primary issue with that most people consider it as a weak heart pump and so that’s the easiest way to think about someone just not getting enough flow to their body to do the natural things that they would like to do.
Melanie: Okay, so what would be some of the symptoms that would signal that this is what they have?
Dr. Bergin: The most common symptoms are going to be fatigue, they just get playing tired doing everything they want to do, shortness of breath, and those two often times go hand in hand, other symptoms that we can talk about are going to be things like early satiety, so they eat and fill out very quickly and despite that they continue to gain weight and the reason behind that would be that they are gaining fluid and so they gain fluid in their liver, gain fluid in their feet and so they will see those puffy ankles.
Melanie: Now, you know, it tends to affect older patients, who is at risk for heart failure?
Dr. Bergin: So, in my opening comment, I mentioned that’s weak heart pump and so often times you are right, it is the older patients and about 60% or so the people that we see or that are seen nationally are going to have had a prior heart attack, so its related to heart attack, but prior heart attack because of the damage to the heart muscle, so you see a big group of those people are at risk, so someone who has had a big heart attack involving the front wall of their heart will be at risk for heart failure in the long term, there are people who have multivessel coronary artery disease or diabetic that tend to have diffuse disease, but the other group that is quite common and makes up about 50% of all the heart failure patients we see are the older patients who have had a long history of hypertension and diabetes and so their problem is their heart muscle is quite strong, but it just doesn’t relax, so you get this thick kind of muscle bound heart or heart is infiltrated with some protein for example and it just cannot relax and so the pressures inside the heart go up and cause the exact same symptoms.
Melanie: So, someone has had high blood pressure for many years or diabetes, that is going to predispose them to have.
Dr. Bergin: Exactly right.
Melanie: So, in the recent years, what has come up for treatments for people that are suffering from congestive heart failure?
Dr. Russel: So sadly, the last script that we just talked about those with diabetes and high blood pressure who have the thick heart muscle that squeezes well and they have a lot of symptoms and unfortunately that group, not a whole lot of advancements have been made. The other group, that weak heart muscle group, is really where we have done much better and the advancements are the medical therapies to help the heart muscle unload the blood that comes into it and that would be drugs like what are called ACE inhibitors or angiotensin receptor blockers and then we tend to use a lot of beta-blockers with drugs like for example carvedilol and metoprolol and those help out the heart muscle and try to keep it from continuing to dilate and weaken over time. We use a lot of diuretics to help out with symptoms, so if someone doesn’t have shortness of breath or doesn’t have swelling then they don’t need a diuretic, but otherwise we like to use those to keep the fluid off of those people and so those are the kind of mainstays of therapy and then a drug that has been around forever is a drug called spironolactone, its kind of a weak diuretic and we use that also and that’s also been shown to be very helpful in those group. The other things that have come out has been around for about a decade now that’s going to be the pacemaker, so defibrillators to prevent heart rhythm disturbances and then pacemakers in selected patients, they can improve the heart function. Those are patients who have what are called bundle branch blocks and then often times in that group of people, we can significantly improve their symptoms by putting in a pacemaker.
Melanie: What would you like patients to do at home whether or not they have got a pacemaker and they are adhering to their medications, are there some lifestyle management things you want them to be aware of?
Dr. Bergin: There are, we preach a lot in clinic about salt reduction. There is some controversy about that, but I think that a controlled salt diet would be helpful for anyone who has congestive type symptoms, so what you want to shoot for is about 2 g of sodium or less per day. You want to limit the amount of fluid you take in because the more fluid you take in, the more you have to get rid of, otherwise it just builds up in your system and causes congestion whether it’s the weak heart muscle or the strong heart muscle, so we like people to do that, we really like people to weigh themselves daily so that they can keep an eye on whether fluid is creeping up on them, we really like people to exercise. Exercise is really a key part. It doesn’t really strengthen the heart so much but keeps the rest of the body in much better shape and so that patients do much better long term with that kind of approach.
Melanie: How would someone know if fluid is building up a little bit?
Dr. Bergin: The symptoms really are just going to be that early satiety and so they start to fill up, so they are eating less precariously, they are gaining weight and that just doesn’t go along well together and so that often times means fluid is building and then we also ask people, you know, to weigh yourself if you have gained more than 3 pounds over a 24-hour cycle or more than 5 pounds in a week that more commonly is fluid rather than calorie type weight gain and so you can look for those and then often times people will notice their sock lines, you know, where the sock is on your leg, it starts to leave a line or you have to let the belt out another notch or two because your belly is expanding from fluid, so those are the primary things we ask people to watch for.
Melanie: And should they reduce their fluids, I mean, it would seem that’s a little bit confusing if they think that they could be building up fluids in their body, you know, and should they stop drinking so much water.
Dr. Bergin: So, often times people feel like if they drink more, they will go to the bathroom more and so they will not try to flush the system, but that really works against you. Its actually kind of remarkable that if you add up, just take those space of a month for example if you, everything that you drink in or everything that you eat that has fluid in it has to be matched by what you get rid off, so whether you sweat or spit or go to the bathroom, all of that has to be equal, otherwise you are going to gain or, you know, gain too much fluid or dehydrate, so the body is just remarkable on that control, but the more you drink in, if your body is not able to control that, so your kidneys are not quite getting the same amount of blood flow or they are not working quite as well because the heart congestion is leading to kidney problems then you are not going to eliminate the fluid the same ways if you take in, you know, lots of fluid and you don’t get rid of it then you just fill up, so we do like to try to limit people to about 2 liters of fluid a day or less.
Melanie: And what are some of the newest treatments available now at UVA?
Dr. Bergin: The big areas that we, you know, for a long time, we have been doing heart transplantation, bigger area that is coming along now is using these left ventricle assist pumps. We put them into people for either is a what’s called the bridge to transplantation or we put them in as a sole therapy which is called destination therapy, so a lot of the research now has been in these heart pumps to make them smaller, make them better, make them easier to live with and eventually those will continue to improve, so it will be fully implantable and so that’s really the direction that everyone is headed with these assisted devices. The other thing that we have been doing have been part of studies to put in monitors for example, so you can put a pressure monitor within the heart and that can help alert you to the fact that someone is gaining fluid or losing fluid too rapidly and you can make more kind of day-to-day or moment-to-moment adjustments in their fluid intake, so those are probably the big areas where the monitoring in the assist pumps.
Melanie: And Dr. Bergin, please give us your best advice for people living with congestive heart failure and why should patients come to UVA’s Heart Failure and Transplant Center for their care?
Dr. Bergin: I think my advice would be to don’t give up, often times with therapy we can take people who are feeling poorly and limited and improve their quality of life and you never know when new advancements will come along that will revolutionize how we treat, so I say don’t give up, keep socializing, keep getting out there and try to do the best you can with your heart failure disease and I think the reason to come to UVA is because we do have a fully comprehensive center, so its from the nurses that greet you, the nurse practitioners that help out with the care, the physicians that put the care along side the surgeons to putting the new pumps and taking care of these patients, we really offer a full service network.
Melanie: Thank you so much Dr. Jim Bergin, board certified in cardiovascular disease and medical director of the Cardiac Transplant and Heart Failure Center at UVA. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening and have a great day. - Hosts Melanie Cole, MS
Additional Info
- Segment Number 4
- Audio File virginia_health/1416vh5d.mp3
- Doctors Russell, Mark
- Featured Speaker Dr. Mark Russell
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Guest Bio
Dr. Mark Russell is a board-certified dermatologist and who specializes in treating skin cancer.
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Transcription
Melanie Cole (Host): What are the best ways to protect yourself against skin cancer and what symptoms should lead you to see a doctor. My guest is Dr. Mark Russell, he is board certified dermatologist who specializes in treating skin cancer. Welcome to the show Dr. Russell, tell us what are some of the best ways to protect ourselves from skin cancer.
Dr. Mark Russell (Guest): Well, I think there are three areas that you should focus on prevention, early detection, and effective treatment. Along lines of prevention, sun exposure is the most preventable risk factor for all skin cancers including melanoma and you can prevent your risk by seeking shade whenever appropriate and usually the sun’s rays are strongest around 10:00 am to about 4:00 p.m., so if you are out in the sun at this point in the day then you should try to seek shade whenever possible, wear protective clothing such as a long sleeved shirt, pants, broad brimmed hat and sunglasses whenever possible. The use of sunscreen is also very important and we generally recommend the sun protection factor of 30 or greater as well as a broad spectrum sunscreen and this should be applied evenly and about 20 minutes before going out into the sun and re-apply it about every two hours even on cloudy days and may be more frequently when you are swimming or in the water. You should also use extra caution when you are around water, snow, or sand because you not only get this sun coming from the sky but you can also get reflected ultraviolet radiation coming from below and finally you want to avoid tanning beds because there are ultraviolet radiation rays that come from tanning beds as well which have been shown to increase your risk for not only sunburn, but also skin cancer.
Melanie: Dr. Russell if people were to give themselves a check and to see a dermatologist regularly to get themselves checked out for skin cancer, what would we be looking for? What are some of the signs, you know, that would send us to a doctor? What do they look like?
Dr. Russell: Well, you want to be aware of new growths on the skin. We do have the potential to get spots on our skin. They come especially with aging and the vast majority of these are not cancerous, but new growths that come up that may bleed or the crust or that are painful or tender that don’t heal or they heal and then recur in the same area would warrant further examination by a physician. Spots that may come up that look different than other spots on your skin, those should be checked out. A spot that has a change in sensation or develops sensation such as itchiness, tingling, burning, crawling sensation that could be suspicious, moles that change, that become larger, darker or irregular at the border would be a reason to get checked by a physician.
Melanie: So, what treatment options are available. If you spot something, we go to see you and you say yes this is something that we really need to take a second look at, what is the first thing that you do with patients?
Dr. Russell: Well, the first thing we do is we look over the entire patient to make sure we know what we are dealing with and how many potential spots are suspicious. We would move into doing biopsy if necessary to help confirm our suspicion and to develop the most specific diagnosis of skin cancer that we can get and then we move into a variety of potential treatment options and those will vary depending on things such as the type of skin cancer, the location of skin cancer, what if any previous treatments have been used and the patient’s age. We have fortunately a large number of treatment options including topical medications, various types of surgery, photodynamic therapy, laser treatment, radiation treatment, chemotherapies, and immunotherapies if necessary and really the best treatment plan is developed by a physician or even a team of physicians experienced in dealing with skin cancer.
Melanie: When you do a biopsy and you are checking to see if this is something more serious like melanoma, is there a chance that it’s going to come back right in the same place, do you do a mohs where you are really getting those markers very well, how does a patient kind of assess that this is what you are doing?
Dr. Russell: Well, we start with a biopsy to figure out exactly what the diagnosis is and then we may go further to do a surgical excision or procedure that will definitively remove the remainder of the cancer and it really depends on what type of cancer as to what type of treatment is best and the patient has to confer with the physician to understand exactly what it is the physician is treating and what the endpoint is in terms of removing the cancer. Generally, we try to remove all the cancer, get the margins clear and make sure that there is no cancer remaining and then put the patient into a surveillance routine where they are coming back checking with the physician periodically just to monitor for not only recurrence of the spot that was treated, but also potentially new spots that come up because when a patient has skin cancer, they are at risk for future skin cancers.
Melanie: So, Dr. Russel, you mentioned, you know, skin protection and there are so many sunscreens on the market, its so confusing, what do you want us to know when we are looking for these to protect ourselves from skin cancer, should we be reading the labels?
Dr. Russell: Absolutely, there are some components of a sunscreen that have been designated as being more effective. I would like to think of designation of BW30 when I am deciding on sunscreen, the B stands for broad-spectrum that means it protects not only against the ultraviolet B rays, but also with ultraviolet A rays. You would like to get a sun protection factor, an SPF of 30 or above and you also want it to be a water resistant sunscreen which is a designation that implies that it stays on longer in water when you are either swimming or participating in water sports or even out in the hot weather and sweating. An SPF of less than 15 would not be considered effective at preventing skin cancer or photoaging merely reducing your chance of sunburn, so you would like to look for those three factors, broad-spectrum, water resistant, and an SPF of 30 or above.
Melanie: Do you care if it’s a spray or a cream?
Dr. Russell: As long as is applied uniformly and evenly, both sprays and creams have been found to be effective.
Melanie: Because, you know, I mean for parents especially when they are trying to keep their kids from getting sunburn, those sprays are really one of the better inventions and they get much easier to get the kids as long as you say we get really good coverage and we make sure to put it on pretty thick.
Dr. Russell: Exactly, you just want to make sure that with those sprays, you are not doing it in a windy area because that can make it less effective, but once the spray or the cream or the lotion or whatever the type of sunscreen is put on, as long as it is put on evenly, it should distribute and be protective and it should be put on about 15 minutes before you actually go out into the sun to allow it to stabilize and settle.
Melanie: Dr. Russel, why should patients come to the UVA Cancer Center and please give us your best advice for preventing skin cancer.
Dr. Russell: Well, I think the physicians at the University of Virginia Health System are well-prepared to deal with everything from the relatively simple and uncomplicated cases of skin cancer to the most complex and when the need arises, the team at the University of Virginia can come together to gather their collective wisdom. There are many experts as are needed to develop a comprehensive plan for the patients and there is an outstanding team of physicians in UVA Health System with excellent training and substantial experience dealing with skin cancer. I think its this training and experience that leads the best outcomes for our patients, so in terms of best advice protect yourself, be prudent when out in the sun, try to minimize your ultraviolet exposure both from the sun and from tanning beds, monitor your skin monthly, any changing or suspicious spots on the skin, get those checked out early with the physician because the best chance of effective outcomes or good outcomes are to detect skin cancer early and treat it effectively.
Melanie: Thank you so much Dr. Mark Russell, board certified dermatologist, specializing in treating skin cancer. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening. - Hosts Melanie Cole, MS
