Inactive (722)

Segment Number 3
Audio File city_hope/ch100.mp3
Doctors Polverini, Amy
Featured Speaker Amy Polverini, MD
Guest Bio Amy Polverini, MD graduated summa cum laude from Loyola Marymount University in Los Angeles, where she was the recipient of multiple honors and awards, including a scholarship from the Department of Biology Bioethics and Science Research Fellowship at USC Keck School of Medicine. Dr. Polverini went on to receive her medical doctorate from Keck School of Medicine, followed by a general surgery residency at Harbor UCLA. She completed her training in breast surgical oncology at City of Hope.

Learn more about Amy Polverini, MD
Transcription Melanie Cole (Host): If you’ve recently been diagnosed with breast cancer and as surgery is a common treatment option for many breast cancer patients, decisions about what type of surgery may depend on many factors. My guest today is Dr. Amy Polverini. She’s an Assistant Clinical Professor in the Division of Surgical Oncology in the Department of Surgery at City of Hope. Welcome to the show, Dr. Polverini.

Dr. Amy Polverini (Guest): Hi, thank you.

Melanie: Let’s start with this diagnosis of breast cancer and the decision about surgery, how do you speak to patients about the many types of surgery out there and which type might be best for them?

Dr. Polverini: In general for patients, especially with early stage breast cancer, there’s two main treatment branches that I discuss. The first would be breast conserving therapy, which basically means we take out the tumor, but we’d leave the majority for the breast tissue behind so the patient still has their own breast. The other option is a mastectomy, which means removing the breast in its entirety, and we can do that with or without reconstruction. Generally, a lot of this comes down to a personal decision for the patients, especially in early stage breast cancer as they’re likely candidates for both, but other things that would influence this are things like breast size, how extensive is the cancer within the breast, so all of those things come into play when patients have to have this decision.

Melanie: Certainly if it’s a very aggressive type you’re going to recommend one type versus the other, but let’s start with lumpectomy, what is involved in a lumpectomy?

Dr. Polverini: A lumpectomy, or breast-conserving therapy -- and those are used interchangeably -- with the lumpectomy, the patient -- most of the time they undergo some sort of localization preoperatively, especially if the cancer is small, where a Radiologist will place a wire or some sort of localizing device into the cancer that needs to be removed, and the patient will be taken to the operating room, and we dissect down, identify where the tumor is, and remove the tumor. We like to include a small margin of healthy tissue. Following that, the patient’s breast tissue is closed up. Everything is closed from the inside-out. Generally, this tends to be an outpatient surgery as long as the patient doesn’t have any severe other medical conditions going on and the patient’s allowed to return home the same day. Patients tend to recover really well from this operation, maybe some soreness, but overall a lumpectomy is definitely a great option when we can proceed with that.

Melanie: Women hear the word mastectomy, they hear in the media about prophylactic mastectomies, but then they hear things like nipple-sparing mastectomies, so speak about that word, which can be so scary for women, but might not be quite as much as it used to be.

Dr. Polverini: Absolutely, absolutely. With the mastectomy – so we’re talking about removing all of the breast tissue – there’s different ways that we can do that. Most commonly -- there’s something called a simple mastectomy, or a total mastectomy, and in that procedure, we remove all of the breast tissue along with the nipple and the areola, which is the pigmented skin around the nipple, and then most of the skin of the breast. Then we close the breast layers back together so that – the breast tissue’s been removed, the nipple is gone, and it’s basically a flat incision on the chest wall. There’s other types of procedures that we do now, as well. One is called a skin-sparing mastectomy, and the other is a nipple-sparing mastectomy. These are generally mastectomies where we do an immediate reconstruction with a plastic surgeon at the same time.

With the skin-sparing mastectomy, what we’re able to do is, again, we remove all of the breast tissue, we remove the nipple and the pigmented area around the nipple, but then we keep the majority of the skin, so the envelope of the breast is still intact. When we do skin-sparing mastectomies – once the cancer surgeon is done removing the breast and the other things I mentioned, then the plastic surgeon comes in and they can do an immediate reconstruction, usually in the form of an implant, where they lift the muscles off of the chest wall, put in an implant, close everything up, and they are able to match it fairly well with the other breast. Now, with the nipple-sparing mastectomy, what we do is we actually keep everything in place, we do a small incision under the nipple or at the base of the breast, and then we remove the breast tissue, but patients get to keep all of their skin, their nipple, the areola, everything is in place, so it’s removed through a small incision, and again, that’s accompanied by reconstruction generally in the form of an implant. Those are the main types of mastectomy that we do.

Another type that patients will sometimes hear is something called a radical mastectomy. In this case, it’s a simple mastectomy, so we’re removing excess skin, nipple, areola, but we’re also including the removal of multiple lymph nodes in the underarm. That’s the modified radical mastectomy.

Melanie: And does that increase a women’s chance of lymphedema?

Dr. Polverini: Yes, the more lymph nodes that we remove, the chances of lymphedema are increased especially in the setting of adding any radiation in after surgery. Lymphedema tends to be something that’s very scary, it’s a scary risk for the patient, and rightfully so, but fortunately nowadays we’re becoming better and better in terms of how we treat lymphedema, and there’s a very proactive approach we take towards it. There’s even specialized surgeons now that do a microvascular surgery where they basically are able to help the lymphatic flow from the underarm by adding extra lymphatics for the arm to drain. But yes, lymphedema is something when we’re removing multiple, multiple nodes that we need to be concerned with after surgery.

Melanie: Dr. Polverini, you mentioned reconstruction at the same time that you’re doing surgery, and many patients might be unaware that breast cancer reconstruction surgery is an option.

Dr. Polverini: Absolutely. I always discuss reconstruction in the setting of a mastectomy. There are some patients who do not want reconstruction, and that’s totally fine. It’s a completely personal decision, but all patients are generally eligible to get a reconstruction especially in the immediate setting. When I say the immediate setting – if a patient – if there’s a thought that they will require radiation after their mastectomy, most of the time what we will do is we will do a reconstruction after their radiation is completed, so again, they are eligible for a reconstruction, absolutely, but we wait until after radiation is completed for them to proceed with that because radiating freshly reconstructed breasts increases risk for contraction and infection and things like that, so after radiation they would come back and proceed with a delayed reconstruction.

Melanie: So wrap it up for us, Dr. Polverini about the most appropriate type of surgery, how you discuss it, what you want patients to know about the personality of their cancer, and what’s acceptable to them in terms of a long-term peace of mind when you’re talking about breast cancer surgery?

Dr. Polverini: I approach this, and I always encourage patients to listen with an open mind and reinforce to patients that no two breast cancers are the same. Most of the time, because 1 in 8 women develop breast cancer, patients will come in with multiple friends or relatives that they’ve had experience with in terms of undergoing cancer treatments, radiation, surgery and they come in with this preset notion of how breast cancer acts and how it’s treated. I have to wipe the slate clean for all of my patients, and I just sit down and have a discussion regarding their specific cancer and what options for treatment are open to them.

The most common request I’ll get after speaking with patients is I will give them their surgical options and they say, “What would you choose?” And I always have to decline giving an answer because truly it is up to the patient and both options are there for the patient in terms of a lumpectomy versus a mastectomy. I think a lot of it involves the patient’s own concerns and risks in terms of cancer coming back and we know that no matter what you choose, the survival is the same. They’re both excellent options in the treatment of early stage breast cancer, so lumpectomy and mastectomy, the reason we give patients those options is they’re both great options, but when it comes down to it, some patients want to proceed with an outpatient surgery where the recovery time is quicker, and they get to keep their breast with the caveat that they will require, in most cases, radiation, but they’re comfortable with the fact that they get to keep their breast and it’s a smaller procedure in general.

Other patients, they do not want to undergo radiation, that’s one reason, and sometimes just because they’re so fearful of cancer coming back that they proceed with a mastectomy knowing that this is a slightly larger procedure, but that they do have options with reconstruction and such. It really comes down to a very personal decision, and I think at the end of the day when patients hear and understand their cancer and understand their treatment options, they’re able to come to a really well-thought out decision. I really encourage patients to make their own decision from everything they’ve heard, and they’ve experienced with others, and as long as they’re making a decision that they feel comfortable with, I always reassure them that they are going to be followed and seen by a clinician. I typically see my patients every six months for the first few years after surgery, and that also helps to decrease their anxiety in regards to breast cancer developing or recurring once again, and they know that they’re followed very, very closely. It’s all a matter of the patient’s own comfort level and just reassuring them in terms of their own decision.

Melanie: Thank you, so much, Dr. Polverini, for being with us today. It’s really important, and such great information. You’re listening to City of Hope Radio, and for more information, you can go to CityofHope.org, that’s CityofHope.org. This is Melanie Cole. Thanks, so much, for listening.
Hosts Melanie Cole, MS

The Benefits of a Medical Massage

Additional Info

Segment Number 2
Audio File allina_health/ah128.mp3
Doctors Miller, Jeremy
Featured Speaker Jeremy Miller, BCTMB, massage therapist
Guest Bio Jeremy Miller is an enthusiastic and passionate instructor of massage, and has taught classes at some of the most respected massage schools in the U.S. Combining an easy-going manner, technical skill and humor he enjoys working with clients on any health issue or wellness goal to find the plan that will best address their needs. Jeremy joined the Penny George Institute for Health and Healing, and has worked at Abbott Northwestern Hospital with a main focus on serving oncology and rehabilitation patients. He currently provides massage therapy at Allina Health Minnetonka Clinic. Welcome, Jeremy!

Learn more about Jeremy Miller, BCTMB
Transcription Melanie Cole (Host): We've all heard about a wonderful massage a friend has had that's relaxed them and even helped them to heal pain, but is there a difference between the types of massage that you can get and even where you get it? My guest today is Jeremy Miller. He's a massage therapist with Allina Health. Welcome to the show, Jeremy. So, what are the differences between getting a massage outside of a medical clinic and, for example, a fitness club, or a boutique salon, or in someone's home? Speak about the differences in those.

Jeremy Miller (Guest): Sure. Thanks, Melanie. Thanks for having me on the show. Yes, those places that you mentioned, those can be great if a patient is just looking for massage for relaxation purposes, which can be wonderful by itself; but, with medical massage, like we offer through the Penny George Institute for Health and Healing, when a patient is recovering from surgery or maybe a work accident, or a motor vehicle accident; if they're dealing with a complex or challenging medical issues, things like cancer, neurological disorders, even pregnancy, we customize the session to the individual patient and to their situation. We take into account their medical history and having a full system, a full health system like Allina Health backing us up, we're able to incorporate recent research and integrate the care that we provide with the solid, traditional, Western medicine that they're getting through their normal providers. We're able to collaborate with the patient's' other providers so that we can make sure that the massage treatment will not just be safe, but will offer the most benefits to the patients that we can as part of their overall healthcare plan. All of the massage therapists that we have here at the Penny George Institute are nationally board certified. That's one of the qualifications you have to meet to qualify to work here.

Melanie: What does that mean--board certified massage therapist? What goes into that type of training?

Jeremy: Oh, sure. So, like I said, we have to have that in place to qualify to work here. To get nationally board certified, it's the highest credential in the massage therapy field. To get that, a massage therapist has to go through rigorous training, not just to learn the massage techniques, which is the fun part when you go through school, of course, but also all the anatomy and physiology and with massage therapy training, we pay, of course, particular attention to the way to the muscles and the bones and the way that those work together to create movement for a person. We have to undergo a thorough background check and complete continuing education every year so that we stay current in our field. As board certified therapists, we're held to a very high standard with a strict code of ethics that involves us putting our patients first and asking, “What's going to be best for my patient?” So, choosing a board certified therapist is really the best way for a patient or a client to know that the therapist they're choosing is a therapist who knows what they're going to be doing when they get into the treatment room.

Melanie: So, let's talk about some of the physical and physiological benefits of a medical massage. People hear deep tissue for various sports injuries, or relaxation, or even mental health and depression. I mean, there are so many ways that massage can help. So, speak about some of those benefits and how you utilize massage to help them.

Jeremy: Sure. Sure. So, as far as what we know through research, massage therapy is still relatively new in the world of what has been researched. So, we know that it feels good and we know that it can help us feel better, but the questions about how that works in the body, what it's actually doing in the body, those questions are just starting to be answered now. We have learned that massage does decrease pain. We have good research backing that up and it can also help, as you mentioned, with increasing the range of motion for people who have restrictions that way or for athletes that are trying to get ready to perform out on the field. It can help patients sleep better, with carries with it a whole cascade of wonderful effects. Neurologically, massage puts a patient into the side of their nervous system where the body does most of its regenerative work, repairing little minor tissue injuries that happen to everybody through the day, and there's some evidence that massage increases the function of certain immune system cells, just to help us stay healthier, in general. You had asked about also the mental health benefits of massage. Massage has been shown to reduce anxiety and depression, particularly when those issues are with regard to pain. So, if somebody has pain and it's sort of causing them to be anxious because they're sort of anticipating the pain happening more, or if there's depression that's in relation to the pain, massage has been shown to help with that. There are some studies that show massage increased the measurements they looked at for mood with patients who have cancer, or during post-partum depression. Those who suffer with post-traumatic stress disorder, such as our heroes coming back from war zones, massage therapy is showing really promising results there as well for some of the symptoms of that PTSD, like the hyper-vigilance that we often see. As I mentioned, just in general, we know that it's working, but we're just now starting to figure out, from a research perspective, exactly how that is happening.

Melanie: Now, what about massages for all ages and even prenatal massage, Jeremy? So, I mean, can kids get massages and can it help them? We've got a lot of kid athletes now and, you know, some of them get injured or even don't get injured but they are growing, they get growing pains and all that. How can massage help kids? Then, even speak about prenatal massage.

Jeremy: Sure. So, for kids, massage can be great really for kids of all ages, but speaking about kids in particular, massage offers the same benefits to children that it does for adults, even for babies--for newborns. We can teach the parents to give their new child a gentle massage. We can teach them real simple techniques that they can do that can help the baby stay calm, can help with things like colic and some of the digestive issues that babies often come with and it can also be a wonderful bonding experience between the parent and the child to be able to do that and help the child get a better sleep, too, which can be helpful for the parent, as well.

Melanie: Absolutely.

Jeremy: For toddlers and adolescents, massage can be great. Typically, we would do shorter sessions, usually 15 or 20 minutes because they just tend to get a little antsy on the table. They don't want to lie still for very long, but massage can be very helpful for, like I say, for kids of all ages.

Melanie: So, then tell us a little bit about Allina Health's Minnetonka Clinic and how someone can make an appointment with you?

Jeremy: Sure, yes. So, our Minnetonka Clinic, we're located at the corner of County Road 101 and Highway 7, just across from the Minnetonka Target, and patients can refer themselves, or we're happy to work based on a referral from a provider if they have that. We love working in conjunction with a patient's care team, which can include, of course, doctors, or nurse practitioners, or exercise physiologists, physical therapists, chiropractors, and, generally, we're here Monday through Friday from 8 to 5 and the call center that we have for scheduling appointments is open 24 hours. So, people can call any time day or night to get a scheduled appointment.
Melanie: Jeremy, in just the last few minutes, wrap it up for us with what you want people to know when they ask you about massage therapy and being a board certified massage therapist. What do you want them to know about the benefits of a really good medical massage?

Jeremy: Sure. So, like I say, massage--we're just starting to learn the benefits of massage from a research perspective, but there are literally centuries of anecdotal reports of how good a massage can make a person feel and they can receive the benefits of that no matter what their health status is, no matter whether they've never had a massage or whether they've been getting a massage regularly for years. The benefits can truly be astounding and can help in many areas of their life.

Melanie: Thank you so much for being with us today, Jeremy. It's great information. You're listening to The WELLcast with Allina Health and for more information, you can go to www.allinahealth.org. That's www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Your Brain 101: The Affects of Alcohol

Additional Info

Segment Number 1
Audio File allina_health/ah127.mp3
Doctors Corry, Jesse
Featured Speaker Jesse Corry, MD
Guest Bio Jesse Corry, MD, is board certified in critical care and neurology, and serves as a neurologist at Allina Health’s United Hospital in St. Paul. His clinical interest is in the stroke continuum of care.

Learn more about Jesse Corry, MD
Transcription Melanie Cole (Host): We’ve sometimes heard people joke that drinking kills brain cells, but is that really true? What kind of effect does heavy drinking have on the brain? Here to give us the facts is my guest today, Dr. Jessie Corry. He’s a Neurologist at Allina Health’s United Hospital. Welcome to the show, Dr. Corry. What is generally considered an acceptable level of alcohol consumption? How much does it really take to start affecting a person’s functionality, safety, well-being; all of those kinds of thought processes?

Dr. Jessie Corry (Guest): Well, that’s for having me. It’s actually kind of interesting. When we look at what’s considered a “standard drink,” it actually tends to vary a bit country to country in how they measure as far as the number of beverages a week, or a day, what have you, but in the United States we typically consider a standard drink to be twelve ounces of a regular beer – it’s what, five percent alcohol, or five ounces of wine, which is -- wine typically runs twelve percent alcohol, or an ounce and a half of eighty proof distilled spirits. In the US we typically say for men, two beverages a day, for women, one beverage a day, each beverage typically having about 14 grams of alcohol. Where that number came up with is that it takes about an hour to metabolize that much alcohol and again, that will differ depending on the person’s body size, metabolism, and that sort of thing. When we look at -- as far as then – at what point do people become disinhibited? At what point does a person tend to have it affect their functionality? It varies individual to individual. People who drank more will typically have more of a tolerance. That doesn’t mean they necessarily have a lower blood alcohol content, they’re just able to function with a little bit higher blood alcohol content. Typically we start seeing people having impairment in their ability to operate motor vehicles and to do basic mechanical skills at a blood alcohol content of about 0.08, which is typically what we consider legally intoxicated in most states.

Melanie: Is that one of the ways that it was figured out about intoxication and driving, Dr. Corry? Did they take those numbers and – obviously, as you say it depends on the person’s size and weight and how much alcohol they can actually metabolize and tolerate, but is that how you think they may have come up with those 0.08 blood levels?

Dr. Corry: It’s interesting when they’ve done – a lot of this was probably developed on studies where they would measure a person’s motor skills and reaction time based on different blood alcohol content. Typically, at about 0.08 is about where a person’s reflex time starts to decrease, so I would imagine that’s where these numbers came from as far as how they would say for each state what’s considered intoxicated or not intoxicated.

Melanie: What actually does alcohol do? Based on your metabolism, what does it do to the blood-brain-barrier and to your neurotransmitters? Obviously, for some people, serotonin levels may rise because they feel better, but that’s not true for everybody.

Dr. Corry: Correct. What I think is really fascinating about alcohol is that at first – alcohol we evolved with. There’s a big school of thought that agriculture may have come out of man’s desire not for bread, but for beer. I think that’s kind of interesting. And then we look at the brain – alcohol crosses, very easily, into the brain. It has the ability to cross that blood-brain-barrier very easily, so it’s able to get into the brain, but the brain itself does not have a dedicated alcohol receptor. Alcohol, rather, seems to affect how other receptors in the brain work. When we think about alcohol and those feel-good aspects of alcohol, alcohol tends to work on the dopamine receptors in that nucleus accumbens. That’s the little nucleus in the brain that helps mediate reward and pleasure experience. Alcohol also is very good at reducing pain and actually having the brain release them as endogenous opiates, the brain’s own morphine so to say. Probably what is that most known is the alcohol’s ability to stimulate what’s called the GABA receptor -- the GABA-A receptor. This acts to reduce anxiety, and this is the social lubricant aspect if you will, of alcohol. Then you bring up serotonin, there’s lots of evidence that with alcohol, it will stimulate those serotonin receptors making a person have a more pleasurable experience, but it also, at certain levels, will stimulate the third serotonin receptor, which is actually what mediates nausea. That’s why when you’ve imbibed in too much, oftentimes people get very nauseated after they drink.

Melanie: Wow, that’s an interesting point about nauseous and how some people can even have seizures. If you drink too much you get nauseous; you throw up, maybe you get dizzy, you get the spins, whatever it is that you get -- is that our brain, or is that like a poisoning? Is that a blood thing?

Dr. Corry: That’s a great question. When a person’s had too much for themselves where they do feel the nausea and the spinning and whatnot, that’s a combination of a couple of things. That can be the direct stimulation from the alcohol itself, or when alcohol is metabolized, some of its byproducts may cause the effect at various receptors within the brain itself to cause these things. We do know that alcohol itself does seem to have a toxic effect to certain cells in the brain, particularly cells in what’s called the cerebellum. This is the part of the brain that helps control balance both for coordination of your hands, but for walking and eye movements. If this part of the brain is affected – if you’ve had those receptors for nausea affected -- you very well may also have the receptors that help integrate what you’re seeing with what you’re body’s feeling. If there’s a little bit of a mishmash, let’s say where what you’re seeing and your balance isn’t quite working, you feel a little bit nauseated, this can, as you can imagine, have a very deleterious effect to that individual.

Melanie: What about binge drinking? We’re heard about the dangers. I certainly speak to my teenagers about this. What is considered binge drinking?

Dr. Corry: Typically, binge drinking is considered anytime a person drinks more than what’s recommended in a day, so again, for a person who’s a male who drinks more than two or three beverages at a time, or a woman more than two beverages at a time. When we colloquially think about binge drinking, it’s a person who’s going to have many, many drinks at one sitting where they’re going to become intoxicated and then some. Binge drinking is probably among one of the worst things you can do for your person because not only do you have the acute result – the acute complications of alcohol intoxication, which can be everything from just simple nausea to full-blown withdrawal -- but you can also do things that may potentiate other, long-term, more chronic problems of drinking and as well as it – if a person – you are stimulating that reward system, and if you’re binge drinking at a regular level, you’re reinforcing what can be – which is considered a quite bad behavior and you may run the risk of becoming alcoholic long-term.

Melanie: What about food and coffee, Dr. Corry, because people hear, “Well, if you eat, it will absorb the alcohol,” but if this is a brain response, how does that work and then, certain things like caffeine, can they really counteract the effects?

Dr. Corry: Okay, great questions. When people drink, it’s always recommended to consume food with your drink. The food will actually help bind the alcohol and will help it release slower. Further, alcohol is an emulsifying agent, so it’s going to bind to those fats and either pass through your gut unmetabolized, or will be released slower into your blood stream. If a person – if they’re enjoying a good meal with their glass of wine and their bottle of beer, that alcohol will be probably consumed at a slower pace and absorb it a little bit slower so the person may not feel the adverse effects. You asked, then, about caffeine? Typically the main way many of us get our caffeine is through coffee, and there actually has been some evidence that shows that coffee itself may actually help preserve the liver and may actually help reverse some of the effects of long-term alcohol use. In fact, for many guidelines, looking at recommendations for people who have fatty liver disease, regular coffee is actually something that’s recommended.

Melanie: But then they say also that if you drink coffee after somebody who’s imbibed way too much, then you’re just a wide awake drunk?

Dr. Corry: I think that’s something that’s very individual. People will tend to drink those energy drinks with their alcohol. Yeah, they tend to be made more alert, so they’re the alert, less-inhibited individual, so that’s always a possibility, but it really depends on each individual and what they can handle.

Melanie: If somebody is consuming alcohol, and maybe they’re not a binge drinking or maybe they’re not an excessive alcohol drinker, what’s your best advice for them about moderating, keeping track of some symptoms, red flags, that you might want them to know about that lets them know, “Hey, you know what? Maybe you’re just crossing the line a little bit, and maybe you need to dial it back.”

Dr. Corry: Excellent, great question. I think the first thing is to try to make alcohol when you’re using it, part of something else, such as a meal, something where you’re going to be consuming and doing other things other than drinking. The focus shouldn’t be just on the consumption of alcohol. That’s first. The next thing is that when you’re consuming alcohol, make sure you take some time off. If you’re going to have, let’s say, a celebration, a wedding, what have you, make sure the next day or two you try to limit or abstain from alcohol. Give your body a chance to recover. The symptoms that people can look for that say, “Maybe you need to start worrying about this. Maybe you need to start drawing back,” is if that person can’t remember the last time they went without drinking or that person who says, “Well it’s five O’clock, and I’m starting to get the shakes right now,” or when you start to associate too many things with alcohol consumption. Those are things where you may want to say, “Okay, do I have a problem here and what should I do about that?” Another big thing is looking for why you’re drinking. Is it to help alleviate problems with depression, anxiety? Oftentimes, people use alcohol to medicate for other problems and so the solution may be to identify those problems and then treat it with an agent better than alcohol.

Melanie: And it certainly is important to keep hydrated both during and the next day, for sure.

Dr. Corry: Absolutely.

Melanie: Now, Dr. Corry, if someone has been consuming too much alcohol – wrap it up for is – and if they want to quit, what do you recommend as a way to take charge of the situation and get started?

Dr. Corry: I think the first thing is to find a support group, be it – talk to your physician. Find a group l like Alcoholics Anonymous. Find some group who’s going to help you keep on the straight and narrow, so to say. The next thing you need to do is you need to have an understanding of how much you’re drinking and understand what’s your baseline consumption and if your goal is to wean off that. If you’re a person who drinks excessively – we’re talking 15, 20 drinks per day or more – then you very well may need professional help, such as a detoxification center. It’s again, great advice to get to your Psychiatrist, get to your Primary Care Doctor and help you either enroll in this or work with somebody in the medical field because often times if you’re going through withdrawal, you may not know when you are withdrawing if, in fact, you are having problems with hallucinations or seizures, what have you. If you’re not drinking to that extent, but you still want to cut back, knowing your baseline will help you then say, “Okay, I’m going to reduce by 25, 50% every so many days.” It’s not as though you’re drinking for fun is a matter that you’re drinking for medication to help you come down for a gentle landing. The goal then is bringing your body down to where it’s no longer alcohol-dependent and then, hopefully with that support group, with people around you who care for you, be able to maintain off of alcohol for the time being.

Melanie: Absolutely. Excellent advice. Thank you, so much, Dr. Corry, for being with us today.

Dr. Corry: No Problem.

Melanie: It’s always a pleasure to have you on.

Dr. Corry: Well, thank you.

Melanie: You’re listening to the Well Cast with Allina Health, and for more information, you can go to AllinaHealth.org, that’s AllinaHealth.org. This is Melanie Cole. Thanks, so much, for listening.
Hosts Melanie Cole, MS

Cancer Center Learning Resource Center

Additional Info

Segment Number 5
Audio File virginia_health/1649vh3e.mp3
Doctors Witman, Lydia
Featured Speaker Lydia Witman, MLIS
Guest Bio Lydia Witman, MLIS is the manager in the Patient and Family Library at UVA Medical Center.

Learn more about Lydia Witman, MLIS
Transcription Melanie Cole (Host): The UVA Cancer Center treats patients for their disease but places equal emphasis on their well-being throughout the process. As they’re going through the process, many patients want to learn about what’s going on in their body, what is chemotherapy doing, what is radiation, what is this cancer really all about. My guest today is Lydia Witman. She’s the manager of Patient and Family Library at UVA Medical Center. Welcome to the show, Lydia. So, the Cancer Center Learning Resource Center, tell us about that and what it is doing for cancer patients and their families?

Lydia Witman (Guest): Well, the Learning Resource Center is a new location opened on the third floor of our Cancer Center building here at UVA. It’s a new way for patients, and not only patients but--especially with cancer but really all diseases--the families, the caregivers, the people bringing patients to appointments and helping them get through, they also have a lot of questions. This is something that’s done at other cancer centers, too, and it’s a way for patients and families or caregivers to be self-engaged and empowered to do their own research with good information. So, we make sure that the information that is there is reliable and good. We worry sometimes about what people find on the internet or what they hear from their friends. So, this is a trusted source of good information when people have questions.

Melanie: So, Lydia, if people go there to get this information and, yes, you know, sometimes the internet can be--you know there are forums and things you can necessarily trust. But people don’t always want to sit down with a book either. So, what are you talking about when you’re talking about information resources? Where are you directing them?

Lydia: Well, they have excellent quality printed pamphlets from the National Cancer Institute which is one of the federal agencies. They provide really excellent information both in print and electronic on the computer. So, our learning resource center has a computer that if people want to do more clicking through things on the computer and finding information that way, they can do it that way, and then print things out to take home. Then, there’s also a collection of printed materials. I’m not sure they actual have any books over there. I think it’s all--you know, with adult learners, we’re often more interested in very specific and actionable information that is very specific to us, and something we can do something about. While the book link information, it tends to be some background and too big of a picture sometimes for some of the patients and families.

Melanie: Well, I do still love books, especially to do my research and such, but I can understand because sometimes as the information changes, you want the real-time, and a book, as you say, can be historical or how something came about or how a particular technology came into existence. You want maybe what the new technologies are or the real-time information, yes?

Lydia: Yes, that’s a good point too. It’s hard to keep the printed books current with the newest information because of the book publishing cycles. Even now, with computer aided book publishing, it still takes, sometimes a year, especially with higher quality medical information because it’s very dense information. It sometimes takes a year or more to get a book out in print. With health information, everything can change in a year sometimes. Especially with cancer, this is a topic where the information needs to be very current, and the computer-based web-accessed information is the easiest to keep current. So, we like that. But we also understand that it’s still not comfortable for a lot of people to use a computer to get information. They might have no problem using their handheld cell phone which is really a computer if it’s a Smartphone, they love that but they might not want to have anything to do with a desktop-based computer. So, we do envision it as a touch screen which is a little bit easier to use than a mouse. We had an equipment failure with the first touch screen so another one is on order. We’re just trying to reduce barriers to make it easy for people to find information in a way that they can understand, that’s written in a way that makes sense and is readable and is good quality and current information.

Melanie: And, is there a support staff available or people to help you or even to set up groups or things where they can come to the resource center and meet with other people and discuss things that they’re hearing about or learning about?

Lydia: That’s a great question. I don’t actually manage the Learning Resource Center. I’m sort of a consultant as a librarian and this is essentially a library without a librarian in it, so there’s no full-time staff at the Learning Resource Center and the Cancer Center. They do have education specialists who manage the space, and I know they would love to see groups using it. They also have volunteers coming and helping with making sure the printed material is organized. We, at the Patient and Family Library, which is in a different building at UVA, we are always available, and that’s also what we envision for the Cancer Center Learning Resource Center is the librarians from the Patient and Family Library support it. We just aren’t physically present there in the Cancer Center. We can't be in two places at one time. We’re getting there--maybe someday soon

Melanie: Well, it’s a real wonderful program. Now, tell people in the last few minutes, Lydia, where they can find the Cancer Center Learning Resource Center at UVA Medical Center.

Lydia: Yes, it’s on the third floor of the Cancer Center building, the Emily Couric Clinical Cancer Center, and when they take the elevator up to the third floor, it opens into a large waiting area, and you can't miss the learning resource center. It’s in the large open space there. You’ll see the shelves that have the printed material and the computer and the desk that are there as well.

Melanie: Thank you so much for being with us today, Lydia. You’re listening to UVA Health Systems Radio. And for more information, you can go to www.uvahealth.com. That’s www.uvahealth.com for more information on the Cancer Center Learning Resource Center. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

A Prescription for Information? The UVA Patient and Family Library Is There to Help

Additional Info

Segment Number 1
Audio File virginia_health/vh176.mp3
Doctors Witman, Lydia
Featured Speaker Lydia Witman, MLIS
Guest Bio Lydia Witman, MLIS is the manager in the Patient and Family Library at UVA Medical Center.

Learn more about Lydia Witman, MLIS
Transcription Melanie Cole (Host): Well, if you’ve ever wanted information or to be educated to be your own best health advocate which is just so important, whether you are somebody who’s suffering from disease or whether you’re looking for prevention information, now you can really find it. This is like a prescription for information. My guest today is Lydia Witman. She’s the manager of the Patient and Family Library at UVA Medical Center. Welcome to the show, Lydia. What is meant by information prescription? How are we using this term?

Lydia Witman (Guest): This is a phrase that was originally developed by the National Library of Medicine to describe when the clinical team that’s taking care of a patient believes that a bit of information from the library or from a library resource would be helpful to the patient. So, it’s a prescription in the way medicine would be, and that’s what it’s based on. Just like if your doctor thinks that a medicine would help you and write you a prescription, then they can also think maybe a trip to the library or a visit from the librarian would help you. So, they can write a prescription for that.

Melanie: And so then, when people get a prescription, is this so that they can then educate themselves a little bit more on whatever their condition is or whatever information that they’re looking for?

Lydia: Yes. So, at UVA, our process is a little different whether you’re an outpatient--someone who is not acutely sick in the hospital. If you’re going to a clinic or you maybe have a chronic illness but you’re not in the hospital, then we would hope you would be able to come into the library and talk with one of the librarians and have that conversation about the information that you need. If you are in the hospital, you or your family member--because a lot of times it’s not just a patient but it’s also their partner or their family who are involved--and the librarians will go to the hospital room and have a discussion with the care team about what information could really help this patient understand.

Melanie: I think that’s a great point that you bring up especially for their caregivers and families because a lot of times these people want information so that they know how best to help their loved one, and they want to understand the disease process or they want to understand caregiver stress in the case of Alzheimer’s or what they should be looking for. So, I think that that’s a real great piece of the puzzle here. What do you want people to know about getting that information and getting that prescription that we want them to get?

Lydia: Well, I do want to just follow up with one thing you said about the families really wanting to understand what’s happening to their loved ones. Aside from the prescriptions, people are also of course welcome to use the library whenever they wish, and we see twice as many family members as we actually see patients themselves. And, I have seen it many times where someone feels very reassured when we look up a health topic, like you said, Alzheimer’s or whatever it is, people are reassured when they see, “Oh, my husband or my son is just like all these other patients.” It is reassuring for them to see that they’re not alone in what they have to work with, and how they’re trying to help. So, what I’d like people to know is that this is available and, hopefully, the doctors and nurses and anybody on the care team who is able to write a prescription might think of it but, you know, they’re very busy, they have a lot going on. Even if they don’t think of it, you’re always welcome to come into the library or call the library or ask your clinician about, “Is there some way I can get good information? I just feel like I want to know more about this topic.”

Melanie: So, they don’t necessarily need that prescription from their healthcare provider?

Lydia: No.

Melanie: They can come in to the library. Now, tell us where it is.

Lydia: The library is called the Patient and Family Library, and it’s located right in the main hospital lobby. This is the main building of the medical center. The primary care clinics are there. So, we serve outpatients going to the clinics and their families, or day-stay procedures. We’re not too far from the surgical family waiting lounge, and we see people there. We’re very easy to get to--right by the cafeteria.

Melanie: Well, it certainly is a quiet place to study, read or wait. You can go to the Patient and Family Library and find that information on www.hsl.virginia.edu. You’re listening to UVA Health Systems Radio. And for more information on the Patient and Family Library, you can go to www.uvahealth.com. That’s www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Understanding Health Information and Terminology

Additional Info

Segment Number 2
Audio File virginia_health/vh177.mp3
Doctors Witman, Lydia
Featured Speaker Lydia Witman, MLIS
Guest Bio Lydia Witman, MLIS is the manager in the Patient and Family Library at UVA Medical Center.

Learn more about Lydia Witman, MLIS
Transcription Melanie Cole (Host): What does it mean to be your own best health advocate--information literate as it were? It’s the knowledge, ability and confidence to find and evaluate information about your own health. My guest today is Lydia Witman. She’s the manager of the Patient and Family Library at UVA Medical Center. Welcome to the show, Lydia. How important, in your opinion, is it to be your own best health advocate and to be information literate when it comes to your disease?

Lydia Witman (Guest): I think it’s probably the most important quality that we can have when we are trying to either prevent illness or manage an illness that has already occurred or a situation that has already occurred. Ideally, we can educate ourselves enough to prevent anything from going wrong.

Melanie: Well, I think so. Okay, so there’s information about prevention--childhood obesity or heart disease or lung cancer or any of these things. There’s information on prevention. And then, if you do come up with a disease, then there’s information about that particular situation and then following treatment. So how does a patient follow that, sort of, timeline of information from prevention to possible treatment?

Lydia: Well, in the context of the hospital library, the medical center library where I work--and we often see families and patients in the treatment phase, and a lot of information questions really come up in the treatment phase; or, maybe somebody is doing research because they think they might have something or they’ve just received a diagnosis, they haven’t started any treatment yet but they’re curious what some of the treatments might be. Every day we use a wonderful resource called “www.medlineplus.gov”. It’s from the National Library of Medicine, and it’s freely available on the internet to anybody who has the internet. One thing you can see, if you click on a topic--maybe it’s heart failure or diabetes--you can see that each topic is arranged by symptoms, diagnosis, treatment, outcomes, prognosis, what they expect might happen; and then, they also, if you go to the National Library of Medicine site, have a little bit about research. Maybe, someone has tried all of the regular treatments and they really need to try something cutting edge that’s being researched right now, they could possibly be eligible for a clinical trial. Those will be listed there, too. So, you’re right. At all stages of the process, there’s wonderful information available. There’s also bad information available out there especially on the internet, and even some books. So, in the library, we really steer people toward current and reliable information that’s written in a way they can understand because medical information can get to be like a foreign language very quickly.

Melanie: Well, it certainly can. I agree with you about Medline Plus and also the National Institutes of Library because the National Health Library, I use that when I research these shows, and so I can tell the listeners that these are very credible places to get information on research and such. So, how can you help them to be that good advocate and find these sites with your resources at the Patient and Family Library?

Lydia: Well, I really think of it as, you know, people don’t know what they don’t know. It’s just a natural state. I’m not aware that I don’t know something. I love showing people--I and the other librarians who work here--love showing people, look you can get this resource anywhere there’s the internet. Now, we still have patients and families who aren’t comfortable using that, and so we do maintain a small print collection in the library. It’s not the most current--we like the internet because it’s where things can get updated right away. If a study changes something the government changes a recommendation, you can't go an update a book on the shelf that’s already on the shelf. But, we help people in whatever way they feel most comfortable. Sometimes, we are using the computer for them, finding something, and printing it out so that patients and families have something in print that they feel comfortable using, even though we have used the computer to get the information.

Melanie: Another thing I’d like to ask you about, Lydia, is children because sometimes especially if a child or the parent is going through a disease process and treatment, it’s very scary for children. Having them look at some of this information can be quite overwhelming. So, what do you do for children, and showing them things that are maybe age appropriate about whatever disease or condition they’re there to research?

Lydia: That’s an excellent question and we do have a children’s hospital here at UVA, so we have many pediatric patients, even though it’s smaller than the number of adult patients we have here. I think the child life department in the children’s hospital really does an excellent job. Their focused 100% on pediatrics. They have all kinds of resources, you know, written specifically--or they also have iPads. You know, the kids--it’s actually based on good research where if you can distract a child maybe during an MRI or another procedure that they’ll have better results because they remain more calm if they’re watching a peaceful video or something on the iPad. They have child specific and family and parent specific resources on our children’s hospital floor here. In the Patient and Family Library, we do maintain a small collection of books for children and some of them are very general like, “What is going to happen when I have my surgery.” Or, “I've just lost a sibling.” Or “My brother died,” or something like that. We see lot of siblings actually with the children in the main area because where we are located is the main area of the lobby in the hospital. I find that sometimes the siblings have these questions. I helped a tiny young lady the other day. Her mom was in surgery, and the grandmother had brought the young girl in while they were waiting, while the mother was in surgery. I was chatting with the little one and then she ended up going towards this book about “what’s going to happen when I have surgery”. And I realized that when I was reading through it with her that, even though the book was written as if the child were having surgery, she probably was having questions answered about what’s happening to mommy right now. So, we try to support not only pediatric patients but siblings and children of patients and families.

Melanie: I think that that is just lovely and so important became when families are involved, and the studies are showing more and more, that when families are involved as that support system for the disease, the person, the loved one that’s going through that, that better outcomes can result.

Lydia: Absolutely.

Melanie: So, I think education and information is important. So, Lydia, wrap it up for us with your best advice about being your own best health advocate, understanding your disease process, the treatments available and out there, and then give us the hours and your location.

Lydia: I think it really starts with a conversation with your doctor or whoever is taking care of you medically. Health information is a supplement to the actual medical care that you are receiving and that’s a relationship that really needs to be a good one for your to get what you truly need to get better or to prevent illness. So, I'm always reminding people, you know, “Have you asked your doctor about this, or you know, maybe it’s a conversation you want to have next time you go to the doctor.” And I have sheets that can help people jot down their questions. So, they sometimes think of questions while they’re in the library that they need to take back to their care team because we can't answer clinical questions. We can't give medical advice in the library but we want to encourage that conversation and help patients and families come to that conversation prepared with good information. If they can say to their doctor, “I was on the National Library’s medicine site or I was in the library, and the librarian helped me see the blah, blah, blah”, they can say, “Is this treatment an option for me?” or, “Is this what’s going to happen?” The doctors and other care team members will respond positively when you say you were in the library or you were at the library website. So, we are trying to help empower you to have a good conversation and get the care that you need. We see twice as my family members as patients themselves and I think this is really to your point about when there’s a team involved, not only the clinical team but your personal family and friends to support you, the more the merrier. The more informed, the more information, the better it is for you. You might not be feeling well enough to educate yourself on something, but then you may have a spouse who is going to be on top of that for you. I know that from my own experience as well. All of us are patients and families of patients so we definitely take that into consideration when we’re helping people in their time of need here. People are onsite at UVA, and we are located right in the main lobby of the hospital which is also attached to many of the primary care center clinics. We serve, not just hospitalized patients but also outpatients, clinics, and day surgeries and things like that. We’re open Monday through Friday, 10 am to 4 pm. People can also access our resources online. We have a collection of excellent health information resources online at our website. Of course they can call us and email us as well.

Melanie: And that website is www.hsl.virginia.edu/pfl. And you can find out more information about the patient and family library at the UVA Medical Center. Such great information, Lydia. Thank you so much for being with us today. It’s important that people understand to be their own best health advocate and that their providers do appreciate when they are an informed patient. So, thank you so much for the great information. You’re listening to UVA Health Systems Radio. And for more information you can go to www.uvahealth.com. That’s www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Stress Management: Discovering Your Inner Healing Resources

Additional Info

Segment Number 3
Audio File allina_health/1705ah1c.mp3
Doctors Crowell, Nancy
Featured Speaker Nancy Crowell, RN
Guest Bio Nancy Crowell is a certified vascular nurse with over 20 years of experience working with Peripheral Artery Disease. Her career has been enhanced by Integrative Healthcare education and certification with the American Holistic Nurses Association.
Transcription Melanie Cole (Host): When you’re under extreme stress, your body reacts, and your fight-or-flight system kicks in, however as our bodies are actively trying to protect us we can experience real physiologic effects from our psychological stressors. Our ability to heal ourselves depends in large part on our ability to manage those stressors. My guest today is Nancy Crowell. She’s a Certified Vascular Nurse at United Vascular Clinic, part of Allina Health. Welcome to the show, Nancy. So what happens to our body when we are under extreme stress?

Nancy Crowell (Guest): First of all, thank you, so much for allowing me to be here. I’m super excited to share this topic. Overall, my approach to this is more of a holistic approach. Our body, when we’re undergoing stress, there’s a lot of chemical reaction. There’s a lot of physical, emotional, and spiritual effects of stress in our lives. We take it to the level of – we’ve got a fabulous prevention clinic that addresses the medical and interventions that we can do as far as surgeries and angiograms and such, but then encouraging our patients to recognize that just with a simple breath, you can also help manage those stressors that play a key role in developing disease states, such as atherosclerosis and plaques that build up in our arteries.

Melanie: Well, Nancy, we’ve heard over the years -- and as Eastern Medicine makes its way really more into the mainstream -- we’ve heard that our bodies have this amazing ability to help us heal whether it’s from stressors or even cancer, heart disease, all of these things if we treat it right, use our spiritual side, and as you say the holistic and complementary side – so speak about some of those kinds of things that we can do – you mentioned breathing – what do we do? How do we use things like breathing and aromatherapy and massage to help us help our bodies?

Nancy: Sure, the first key to understanding all of this is we have to understand that we are always capable of healing. We may not always be able to cure, but we can always heal. They have different definitions. Getting rid of a diseased state or condition, that’s curing. We’re geared towards healing and that we can always accomplish. Let’s take breathing, for example, encouraging our patients to visualize the breath going in – I always say, “How about trying lights? Your whole body just illuminates, and when you exhale, smoke is released, anything that doesn’t belong to you is now released and feel the change that happens with that simple breath.” We use aromatherapy – it complements it beautifully in that they smell great, but they have an actual impact on what’s happening inside of our body. When we’re inhaling that, it goes up into our limbic system, it sends a message to our body, so I find breathing exercises coupled with maybe some lavender – I have a diffusor going -- or some soft music, people, truly notice a difference just within minutes of a calm, mindful breath. When I say mindful breath, it’s that visualization that you’re seeing that transformation take place in your body.
The other key piece of that is energy. We have energy flowing in our body just like we do arteries and veins. If you have a blockage in your energy system, it manifests itself just as you would if you had a blocked artery. That’s a problem, and it needs to be fixed. In your visualization, envision your body as a beautiful flow of energy, you’re creating open channels, you’re opening yourself up to healing, you’re opening yourself up to this bright light of wisdom that guides you down the path of what you need to do to take care of yourself. Like Einstein says, “We can’t create or destroy energy, but you can transform it.” If you have stress let’s change that, let’s try to transform that and then visualize the stress just going away and instead, you have courage and hope. Instead of fear let’s transform that to wisdom. Instead of anger, let’s have peace. It’s this transformation that I encourage people to see that we’re working with energy because emotions and feelings are energy, so let’s transform that energy to allow our bodies to have that energetic flow that’s natural to our own – that’s our innate ability – and we tend to put blockages there by our stresses. Let’s open up those channels and get back to the healing state that’s natural to us.

Melanie: And what about the importance of touch because even – some studies have proved that a good, long hug can reduce your cortisol levels, increase your serotonin levels and really calm your heart rate down, things like touch and even some types of therapy, music therapy, imagery, speak about those kinds of things.

Nancy: Yeah, that is very powerful too, and classes that I’ve taken and patients to them working with you, they describe that you feel that. If somebody even comes and puts their hands behind you and even touches your shoulder for example, that immediately – and everyone’s different, some people don’t want that, but those who are open to it -- most people can’t deny the calming sense of just having somebody place their hands on your back, or what I like to teach patients to do is do a self-applied massage. Even your own touch, if you put a little essential oil – and it’s diluted of course – rub that on your feet before you go to bed, rub it on your hands, again we’re using mindfulness because what we’re doing is we’re sending messages to our body. Thank your feet for taking you through life, and your hands and the touch of what you experience throughout the day. Touching another person like we say, “in hug,” that just completely sends this calming response and in the middle of treatment when I’m working with somebody when we do a massage, they instantly verbalize that they feel so much better. It’s a great coupling with music oils and massage, too.

Melanie: These are all great ways to do that. Especially women, Nancy, we negatively self-talk ourselves so much that we sometimes put that block on our ability to use some of these things – energy work or, massage, or breathing exercises, because we’re so hard on ourselves. What do you tell women that constantly berate themselves and use all this negative self-talk against ourselves?

Nancy: Well with the integrative therapies that’s one of the things I love is that there are so many out there to choose from. Each person’s palate of their modalities that work for them is going to be a little bit different, but one thing I think is important for everybody – especially women who are hard on themselves – is journaling. If you can just jot down each day, start with something simple. What are you grateful for today -- something good that happened today. Or telling them to go back and look at themselves and what did you accomplish today, or what made you feel good today. Even one or two things each day – if you have a journal and then you can refer to it each day, that’s very powerful in healing as well. The other piece that I say is that I keep going back to the transformation of energy. These feelings that we put on ourselves with stress and the demand that we’re trying to raise kids, and work, and clean. Give yourself some love time too. A foot massage is so simple, and it doesn’t take time because that’s the cycle we get in, we say we don’t have time to do this because we’re busy and then that compounds the stress so doing a simple foot massage before you go to bed takes five minutes. Breathing throughout the day, people will see the difference when you associate a meaning to it rather than just running to the office, how about when you’re approaching the door, you take two slow, deep breaths before you enter. See yourself just light up and exhale what doesn’t belong to you and move on to your day. You will notice a difference in how you feel. You can transform this energy.

Melanie: And one thing that didn’t use to be so prominent and now is, is fueling that healing with nutrition. What do you say to people when they say, “What are some sort of toxic things I should try and stay away form or some things that can contribute to this negative energy?”

Nancy: I’m pretty careful about when I try to get too specialized – I’m not a nutritionist, so the great thing about the prevention program where I work is we’ve got specialists who are very good at informing patients about what things are good about promoting good health and how you feel. I focus more on – what I would say to somebody, in that case, is you have to use some common-sense things, but what foods – how do you feel after certain foods because some foods just make you feel rotten, period. Avoid those things. Those are common-sensical [sic] things that I would recommend and of course getting a good nights’ sleep, but I don’t get too much into the nutrition piece because we have such fabulous experts who address that in a good, comprehensive package.

Melanie: So wrap it up for us then with your best advice about the ways that we can manage some of the stress, to discover inner healing resources that we all possess already.

Nancy: I would summarize it by saying this is a really fun journey. When you discover – just think about the fact that everything is energy. If you’ve got stress, think of it as energy and transform it. We know that you can transform energy. Play with different ways of accomplishing that, whether it’s breathing, dancing, music, acupuncture, play with it. So many of those resources are free; there’s no copay, they belong to, discover them, tap into them, enjoy the journey, it’s fun. I often say if you have a present under the threat, you won't leave it there. Open it up and discover it and you’re going to heal. It’s just a guarantee that you will heal when you apply these concepts of transforming negative things that don’t belong to you into the positive flowing energy that does belong to you.

Melanie: Wow, thank you, so much, Nancy, for being with us. What great information and for further information on stress management and discovering your inner healing resources, or to make an appointment, you can call 651-241-2970. You’re listening to Well Cast with Allina Health, and for more information, you can go to AllinaHealth.org, that’s AllinaHealth.org. This is Melanie Cole. Thanks, so much, for listening.
Hosts Melanie Cole, MS

The Use of Robotic Surgery in the Management of Gynecologic Cancers

Additional Info

Segment Number 2
Audio File city_hope/099.mp3
Doctors Kebria, Mehdi M.
Featured Speaker Mehdi M. Kebria, MD
Guest Bio Mehdi M. Kebria, MD, is an assistant clinical professor in the Division of Surgical Oncology, Department of Gynecologic Oncology and and a gynecologic oncologist at City of Hope.

His specialty is Robotic Surgery and Cytoreductive Surgery with HIPEC.

He grew up in a family of physicians and is proud to carry on that tradition. He is board-certified in obstetrics and gynecology and specializes in ovarian, cervical, vulvar and uterine cancers.

Learn more about Mehdi M. Kebria, MD
Transcription Melanie Cole (Host): Every year, more than 60,000 women in the United States are diagnosed with endometrial or uterine cancers. My guest today is Dr. Mehdi Kebria. He’s an Assistant Clinical Professor in the Division of Surgical Oncology in the Department of Gynecologic Oncology at City of Hope. Welcome to the show, Dr. Kebria. When we’re talking about gynecologic cancers, what are we really talking about? What type of cancers?

Dr. Mehdi Kebria (Guest): When we talk about gynecologic cancers there are several cancers of female organs that are basically included in gynecologic cancer. The most common cancer that we deal with as gynecologic oncologists are uterine cancers, followed by ovarian cancers, and then cervical cancers and then vulvar cancers, vaginal cancers, and gestational trophoblastic disease. These are the majority of the diseases that we deal with as gynecologic oncologists.

Melanie: So when we’re talking about treatments that are involved and if surgical intervention is involved, what does that usually entail and tell us about how robotic surgery is involved in this.

Dr. Kebria: As gynecologic oncologists, we perform a great deal of robotic surgery. The majority of our surgeries are minimally invasive surgery, and basically one of the advantages of robotic surgery is the fact that we can perform the surgery that previously has been done in an open fashion or invasive fashion. Currently, we do these procedures as a minimally invasive fashion. We use smaller incisions and more sophisticated instruments and tools to perform these surgeries. Robotic surgery gives us the advantage of using a dual camera. It gives us clearer images – high definition images and a 3D view of the surgical field. It gives us depth perception and improves the visualization of the surgical field. Also, it gives us instruments that are articulating. They have precise articulating instruments, and it allows us to perform complex procedures in a minimally invasive fashion.

Melanie: What are the benefits for the patient for this type of robotic surgery?

Dr. Kebria: The main advantage for the patients are that the incisions are smaller, about eight millimeters in size, each incision and there’s minimal tissue trauma to the patient. There is faster recovery for the patients, and usually, they experience less pain. There are several studies that have compared the outcome of patients with minimally invasive surgeries, or robotic surgeries to traditional open surgeries. Most of those studies, the majority of them are showing that you can perform these surgeries in a minimally invasive fashion while you have similar cancer outcomes, but less risk of complications, less risk of pain, and the patients end up recovering faster.

Melanie: Are there some people that might not be a candidate for this type of robotic surgery for gynecologic cancers?

Dr. Kebria: There are some groups of patients that are not candidates for minimally invasive surgery, and those are patients with advanced cancer. Women who have cancers of the ovary that are advanced, they need an open procedure because the extent of disease is in a way that minimally invasive surgery is not going to be able to remove all of the disease basically. We reserve minimally invasive surgeries for mostly patients with endometrial cancers, cervical cancers and early stage ovarian cancer.

Melanie: So what would you tell a patient to look for when choosing a surgeon to perform this type of robotic surgery?

Dr. Kebria: I think experience is important. I think, like many procedures, you would want to be operated on by a surgeon that has good experience in this field. They have to perform the majority of their surgeries in this way, in a minimally invasive fashion, or robotic surgery, in order to be able to safely perform those surgeries for the patients. Basically, the FDA approved this robotic platform for gynecologic surgery back in 2005, and since then we’ve come a long way, and I can tell you that the majority of the procedures in this field are currently done robotic. There was recently a new development in the field of robotic surgery that includes a single site operation basically. We perform the robotic surgery through one, single incision that’s usually at the level of the umbilicus and that gives a better cosmetic result to the patient. There’s a lot of new developments and studies going on in this area.

Melanie: And how do you see robotic surgery changing in the next several years? What’s exciting at City of Hope? What are you doing?

Dr. Kebria: City of Hope basically has adopted this robotic technology very early on, and they’ve been doing these procedures here at City of Hope for several years now. The majority of our procedures for endometrial cancer is currently done in a robotic manner. We have done some research in this field. There is a lot of new developments, including what I mentioned earlier about the development of a single site robotic surgery at City of Hope. We are hoping that in the future we can use robotic surgery also for some other procedures such as hyperthermic intraperitoneal chemotherapy for patients with ovarian cancer also.

Melanie: So then wrap it up for us Dr. Kebria, if you would, with your best advice for women that are considering all of their options if they’ve been diagnosed with a gynecologic cancer.

Dr. Kebria: Most importantly I would suggest that they should seek medical care from a specialist in this field. Unfortunately, there’s still a lot of women who are diagnosed with gynecologic cancer who are currently in the community or seen by physicians who are not specialized in gynecologic oncology. There are several papers and studies that have shown patients’ outcomes are better if they are treated by a specialized surgeon, so I do advise them to seek care from a gynecologic oncologist basically.

Melanie: Thank you, so much, for being with us today, Doctor. It’s great information. You’re listening to City of Hope Radio, and for more information, you can go to CityofHope.org, that’s CityofHope.org. This is Melanie Cole. Thanks, so much, for listening.
Hosts Melanie Cole, MS

Personalized Treatment for Breast Cancer

Additional Info

Segment Number 1
Audio File city_hope/098.mp3
Doctors Chu, Dortha
Featured Speaker Dortha Chu, MD., Ph.D
Guest Bio Dortha Chu, M.D., Ph.D., specializes in breast cancer surgery and strongly advocates early and regular screenings for all women. She received her medical and doctoral degrees from Washington University School of Medicine in St. Louis, and completed her general surgery training at University of California San Diego.

Learn more about Dortha Chu, M.D., Ph.D
Transcription Melanie Cole (Host): An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. At City of Hope, your care team will utilize the most state of the art breast imaging technologies and laboratory techniques to guide your personalized treatment. My guest today is Dr. Dortha Chu. She’s an assistant clinical professor in the division of surgical oncology in the department of surgery at City of Hope. Welcome to the show, Dr. Chu. What is meant, people are hearing more and more the term personalized medicine?

Dr. Dortha Chu (Guest): Well, it means that these days with the advances in knowledge as well as technology we’re able to actually determine in many cases the specific treatments that have been shown to be beneficial depending on your specific tumor type and other markers. And so, we can offer you therapy that would give you the maximum benefit and hopefully with the least side effect. We also take into account other factors such as social factors that may impact your overall healing and survival. And the quality of life afterward. So, that allows us to really be able to make the whole process much more personal, and much more effective for the individual patient.

Melanie:    So, when it comes to breast cancer, and somebody, a woman is diagnosed and there’s all these different terms in sight too and this, how do you determine what that tumor type is, so that you can give that personalize treatment. What does that mean for women with breast cancer?

Dr. Chu: Well, one of the major advancements that we’ve been able to establish in recent years is with the various types of genetic markers that we can identify and allow us to distinguish different types of breast cancer and in many cases even predict their potential behavior. And now, again, even further in some cases we’re able to predict their possible response to various types of therapy. So, it does become difficult in the beginning, to make sense of all the alphabets that come along with cancer and cancer treatment. But, if we take the time and sort through that, then it really makes sense in the end to allow us to personalize that treatment, and take the most effective treatment for the patient.

Melanie:    So how do you do that, do you do that in conjunction with the patient. Or do you as the doctor say, I think this is going to be the best course of treatment for you. Because if the person wants to be their own best health advocate. Then they need to be doing maybe their research, they need to look and see what it is that’s going on. So, how do you approach it with the patient, Dr. Chu?

Dr. Chu: Oh, I believe absolutely that the patient should have full partnership, as a full partner, in determining the best treatment. Because some of the factors that go into effectiveness isn’t just scientific. It also involves how the patient will feel about their overall treatment. So, I very much believe in having a full discussion with the patient before any decision about treatment is made. The challenges in the beginning, the helping the patient to really understand all the complexity of their diagnosis. Because as I mentioned the advances are wonderful for treatment, but they can become very confusing especially if you don’t have a scientific background. And the internet is wonderful, it’s full of information. But it can be very challenging to piece apart what’s really relevant to the individual patient versus just information in general. So, I look at my job as in that initial process is to help the patient understand what their test results demonstrate and how to put that together into a context to understand their particular disease. Once we’re able to do that, then we’ll talk about how the treatments work and which treatments would work best for them. And that is in conjunction with their input as to how they are able to handle the treatment process as well as the side effects and all those other issues that come along with treatment.

Melanie:    So, because there are so many tools in your toolbox now. Between surgery and radiation and chemotherapy targeted imunal therapy, you have so many different tools now and even in radiation you’ve got IORT and all of these different types. How do you determine what the patient, based on their cancer and their lifestyle, give us an example, you know for an example, of what you would say to somebody about tissue sparing or nipple sparing mastectomies? Give us an example of something of personalize medicine.

Dr. Chu: Sure. So, I think, if I may, I think the best way to put it would be if I had a hypothetical patient that came to me in my clinic. At our first visit, presumably she’s known about her diagnosis, we would go over all the tests that have been done. I should say there’s a lot of testing that goes along with getting that initial diagnosis, from imaging to biopsy etc. So, I feel that it is important that we start first by establishing a good understanding of what exactly her cancer entails. This includes things like the receptor status and what does it again, predict about the particular behavior of her cancer. Once we’ve established that. I explain to the patient that these days, breast cancer is treated, I should say, with multiple modalities, as you mentioned surgery, radiation and medicine and that just about every patient unless it’s a widely metastatic, then we’re kind of limited in our options, but if it’s early enough, then they have all those options all available to them. It’s just how do we package it in a way that’s specifically targeted to them. Then I break it down and we start talking about initially how surgery works, because typically the first step of early breast cancer is surgery. And at that point is when I would talk about the differences between a lumpectomy or partial mastectomy or breast conservation, they all mean sort of the same thing. Maintaining some portion of the breast versus a full mastectomy. And the medical advantages and disadvantages if you will, of the two options. Then I would break it down in terms of how that would apply to this particular patient in terms of her tumor size, how big are her breasts. Is it going to be cosmetically advantageous to maintain the breast, given those parameters? Or would she be better off with something like a mastectomy that would be give her both treatment as well as better cosmesis. If mastectomy is an option she seems to be interested in, or something that she wants pursue then we’ll talk about the different types of mastectomy’s that are available. Nipple sparing, skin sparing being some of the more recent developments that we’ve been able to offer patients. Then again, how does that apply to her with her specific cancer size, size of her breasts all of those physical factors that would play into those over all cosmetic approach and effectiveness of that treatment. And once we establish that, and the patient’s understanding of the surgical options to her. Then I would talk about how radiation comes in, in terms of what option she chooses. Generally speaking, for most patients, mastectomies don’t require radiation, accept under some specific cases. But with a partial breast resection, for example, a lumpectomy, typically radiation is included as part of the package to really get the full effectiveness, so, I encourage them to think of it that way. And then once we finish that part, then we talk about how medical therapy would impact on their ultimate adjuvant response as well as potentially prevention of the recurrence and decreased risk of recurrence and or future new cancer. So, that’s sort of more or less the steps that I would go through with a patient. You know, stopping at each step of course, making sure they understand how it all fits together. And then once we sort of have that global view, then we break it down to a little bit even further as to how, again specifically how each of those parts would be relevant to that particular patient. And at that point I usually will give the patient some time to think about it, to process. And then we come back to any additional tests that might be indicated at this point for staging or other purposes, and then we meet again and that’s when we really tease the part, now that she’s had time to think about it, what does she want, in terms of cosmesis, in terms of future risk reduction and so that’s when we sort of formally put it all together and come up with an actual plan for her.

Melanie:    So, Dr. Chu in just the last few minutes, where do you see this field of personalized medicine in specifically for breast cancer going? What are you doing exciting at City of Hope that you want listeners to know about?

Dr. Chu: Well, I think the most exciting part is all the genetic advances that we’ve been able to make in identifying markers in cancers and specific tumors. That allows us to provide targeted therapy, especially in the form of various types of medications, various categories of medications that can be used to really target specific tumors and also decrease the potential side effects of the more traditional chemo therapy agents that we’ve used effectively in the past. And City of Hope has been on the forefront of helping to develop those kinds of treatments and establish the safety and ethicacy of those treatments. I see that in some not too distant future, we would actually be able to specifically offer the sort of the recipe, if you will, of what medical therapy, radiation therapy, etc. Would be the most effective in the patient based on these kinds of genetic and DNA markers that we are constantly discovering. I think it’s just going to become even more personal and more individual as time goes on and the goal being maximum benefit with the least amount of side effects. And I think that’s where treatment for breast cancer is going and I think that’s exciting for patients.

Melanie: It is exciting. And thank you so much for being with us today. It is such interesting information and exciting for the listeners to here. And thanks for being with us Dr. Chu. You’re listening to City of Hope Radio and for more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole, thanks so much for listening.
Hosts Melanie Cole, MS

The Benefits of HBOT (Hyperbaric Oxygen Therapy)

Additional Info

Segment Number 1
Audio File doctors_laredo/dl007.mp3
Doctors Gonzalez, Manuel
Featured Speaker Manuel Gonzalez, MD
Guest Bio Manuel Gonzalez, MD is a vascular surgeon and a member of the medical staff at Doctors Hospital of Laredo.
Transcription Melanie Cole (Host): Hyperbaric Oxygen Therapy, H-B-O-T, is a medical treatment which enhances the body’s natural healing process. It’s used for a wide variety of treatments and may be part of an overall medical care plan. My guest today is Dr. Manuel Gonzalez. He’s a Vascular Surgeon and the Medical Director of Doctor’s Hospital Wound Healing Center. Welcome to the show, Dr. Gonzalez. Tell us a little bit about hyperbaric oxygen therapy and the evolution of it. When did this come about?

Dr. Manuel Gonzalez (Guest): Well, I can’t tell you exactly when it came about, but it’s been around for several decades now. When it first started, it was thought that it would increase the blood supply to the red cells and they would do it by segments of the body. In other words, they would go ahead and put a part of the limb that was ischemic, and/or a non-healing ulcer into a small canister and they would put a high concentration of oxygen into the canister. With time they found out that this was not the right way to go, so therefore, with multiple research they found that it’s submerging the body to two atmospheres of pressure, or two-and-a-half atmospheres of pressure, they could increase the oxygenation to the plasma and not to the red blood cells. What happens is that the plasma is going with the red cells, they reach areas of hypoxia, or areas of low oxygen tension where the oxygen is really needed to help the healing process and/or, as well to augment the reach of antibiotic therapy.

Melanie: So this increased oxygen enhances the ability of, not only what you’re discussing, but the white blood cells to kill bacteria, reduce swelling, so what are some of the benefits? Who is a candidate for HBOT?

Dr. Gonzalez: Well, as time goes on the government has limited us quite a bit in who is a candidate for hyperoxygenation. Some of the people that really benefit from them are, of course, some burn patients, people that have infections of the bone, diabetics, people with ulcerations secondary to peripheral vascular disease that are not healing, people that have had post-radiation therapy – in other words, post-cancer therapy – that have a problem with wound healing secondary to radiation.

Another thing is that they’re also being used a lot for mandibular ischemia and/or necrosis of the mandibular bone at the joint area and also for post-radiation proctitis, which is quite common in this new era where we’re doing advanced surgery down all the way to the anal region for carcinoma of the colon. Many people get radiation at the rectal area and get resected for a cancer cure, but end up with what they call radiation proctitis, which is a very bad situation for patients to have and they benefit greatly with hyperbaric oxygenation.

Melanie: What’s it like? What’s this procedure like for a patient?

Dr. Gonzalez: Well, first of all, what we do is that we make sure that it’s an appropriate candidate. Once we have an appropriate candidate, we make sure that the patients can tolerate hyper-pressure. In other words, we make sure his heart is functioning well, he’s not in any heart failure. We make sure that he has good swallowing mechanisms, that his ear drums and ears are appropriately seen and treated by an ENT specialist prior to diving. Once we have all of these preparations, the patients are brought to the center, he’s given a tour, and an explanation of the entire system or protocol is gone with the patient. After the patient has gone through this, the patient is taken into the hyperbaric room. He is shown the chambers and what to expect and what not to expect and also to alleviate their fear of claustrophobic. Our tanks are made out of clear plastic – acrylic, which maintains the pressure – you can see out. We also have televisions, which is usually standard for most hyperbaric chambers so the patient can lay there and watch a television program to alleviate not only their tension but to pass the time.

Melanie: What does it feel like?

Dr. Gonzalez: I really can’t tell you. I had only been there about ten years ago, and it’s like SCUBA diving. You go down, and you start feeling pressure on your body, and the main thing you have to do is equilibrate your ears. Basically, you don’t feel much except in the tympanic membrane and your earlobes, and you start feeling – like you do on a plane, sometimes your ears pop. The main feeling is mostly in the ENT – Ear, nose, and throat aspect of the body. Otherwise, you don’t feel much.

Melanie: And Dr. Gonzalez, does insurance recognize HBOT?

Dr. Gonzalez: Well, some insurance – most of the private insurance, once you give the proper documentation, they will accept it. Our problem is mostly getting through the government and all the beauroughcratic lingo that we have to go through with Medicare and non-Medicare patients – Medicaid patients. A lot of these do not qualify because they don’t fall into the realm of the protocols of the Medicare/Medicaid system. Basically, there’s -- like I tell you, it’s very limited who can go into the chambers and who can afford it if they have private pay.

Melanie: So how many times would somebody need it if they’ve got a non-healing wound, or if you’re using it for another purpose, then how many times do they have to do this?

Dr. Gonzalez: Well, it depends on the wound, of course, but we usually settle for about 30. We usually go from 20 to 30, to 45. It all depends on the wound, and it all depends on – what we do is at least once a week we assess them for their circulatory status because things change really fast. If their circulatory status changes, the whole protocol changes. But somebody that stays even-keeled, we go about 30 times in the chamber, mostly at 2 atmospheres or 2.5 atmospheres of pressure.

Melanie: And how long would it take somebody to see a result -- if they’ve got a non-healing wound and they’ve done some of these treatments, when would they start to notice a difference?

Dr. Gonzalez: We usually see a difference within a week – two weeks.

Melanie: Wow.

Dr. Gonzalez: Because we do a lot of debridement, so what happens is we look at the wounds quite frequently so we can tell within a week, two weeks if we’re in the right direction. If we’re not, we usually change the debridement protocol and not the hyperbaric protocol.

Melanie: So what would you like to tell patients in the last few minutes, Dr. Gonzalez, about the benefits of hyperbaric oxygen therapy and how to prepare for this treatment?

Dr. Gonzalez: Well, for hyperbaric oxygenation, it’s an adjuvant to good wound care. It’s not the main treatment, but it’s an adjuvant, it helps us. It’s the last 10 yards of a 90-yard run, but the 90-yard run is very important, so that means proper assessment, proper perfusion, proper nutrition, diabetic control, and in the last 10 yards to help us – or the last five yards – is hyperbaric oxygenation. And how to prepare for it? They have to go through the rigamarole of being here and going through the adjustment phase to teach them what it is, so they know what to expect. The most important thing is knowing that the patient knows what to expect when they go into the chamber -- ear cleaning, ear cleaning, swallowing – be sure they feel that they’re not claustrophobic in a closed box, that they can see and watch television. You’ve got to prepare them mentally as well as physically.

Melanie: That’s so important to point out. And why should they come to Doctor’s Hospital of Laredo for their care?

Dr. Gonzalez: Well, I think we’re the only ones in Laredo that offer a surgeon full-time in the wound care center. Second, they have a vascular surgeon full-time at the wound care center, which no one else has. The nursing staff here is superb.

Melanie: Thank you, so much, for being with us today, Dr. Gonzalez. You’re listening to Doctor’s Hospital Health News with Doctor’s Hospital of Laredo, and for more information, you can go to IChooseDoctorsHospital.com, that’s IChooseDoctorsHospital.com. Physicians are independent practitioners who are not employees or agents of Doctor’s Hospital of Laredo. The hospital shall not be liable for actions or treatments provided by physicians. Doctor’s Hosptial of Laredo is directly or indirectly owned by a partnership that includes physician owners including certain members of the hospital medical staff. This is Melanie Cole. Thanks, so much, for listening.
Hosts Melanie Cole, MS

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