Inactive (722)

Segment Number 3
Audio File city_hope/1701ch2c.mp3
Doctors Dellinger, Thanh H.
Featured Speaker Thanh H. Dellinger, MD
Guest Bio Thanh H. Dellinger, MD is an assistant professor in Division of Gynecologic Surgery, Department of Surgery as well as a gynecological oncologist. She also is leading a clinical trial in hyperthermic intraperitoneal chemotherapy.

Learn more about Thanh H. Dellinger, MD
Transcription Melanie Cole (Host): Every year, more than 60,000 women in the United states are diagnosed with endometrial and uterine cancer. My guest today is Dr. Thanh Dellinger. She’s an assistant professor in the division of gynecologic surgery in the department of surgery, as well as a gynecological oncologist at City of Hope. Welcome to the show, Dr. Dellinger. What’s going on today with endometrial uterine cancer? Are we seeing more or less?

Dr. Thanh Dellinger (Guest): Thank you, Mel, for having me on the show. I’m very pleased to talk about this. This is actually a very interesting research project of mine. Interestingly, endometrial cancer -- which is synonymous with uterine cancer, by the way – is actually rising in incidence. Compared to other cancers, actually, it’s also – the mortality’s rising. It’s very, very difficult to treat endometrial cancer once it’s recurred, or it’s advanced stage and that is probably the reason why the mortality is increasing.

Melanie: What are some of the risk factors for uterine cancer? What might somebody have that would predispose them to this type of cancer.

Dr. Dellinger: Uterine cancer, unfortunately, has predispositions in those who have more estrogen and -- for example, patients who are obese, or overweight, have an increased risk for developing uterine cancer -- those who take, for example, Tamoxifen, what we call unopposed estrogens. Other patients may have a genetic, or hereditary risk such as Lynch Syndrome, which increases your risk for colon cancer and uterine cancer and those are typically the risk factors for endometrial cancer.

Melanie: Are there any screening tests for uterine cancer? People hear about pap smears, they hear about ovarian cancer being this silent cancer. What are doing in terms of screening?

Dr. Dellinger: Unfortunately there isn’t currently any screening for uterine cancer, so unlike cervical cancer, which is screened with a pap smear – the Pap smear typically does not detect endometrial cancer. Ovarian cancer, on the other hand, like you mentioned, is a silent disease. Fortunately, uterine cancer is not a silent disease. Most women who develop uterine cancer have vaginal bleeding that is abnormal. Either you’ve already undergone menopause and now you’re having bleeding all of a sudden, or you’re premenopausal, meaning you have not undergone menopause, but have more bleeding than usual or irregular bleeding. Those are always warning signs, which would definitely result in you seeing the doctor and then getting worked up for that.

Melanie: And what would be the workup? If somebody was having an abnormal amount of bleeding and they’re in perimenopause, or—are you talking about bleeding when it’s not actually your period, or just a large amount of bleeding during perimenopause, or while you’re entering menopause?

Dr. Dellinger: Actually both. However, it is abnormal, whether it’s irregular, outside of the period, or whether it’s more than usual. That really should prompt what we call an office endometrial biopsy. The patient comes in and says they’re coming for a pap smear, you do a speculum exam, pelvic exam, and part of this, a small endometrial pipelle, or straw is placed inside the uterine cavity through the cervix during the vaginal exam. It takes about five minutes or so. There’s a little bit of cramping involved, but most patients tolerate it very well and it’s a very easy office procedure that can then tell you whether there’s evidence of pre-cancer or endometrial cancer.

Melanie: And would you see this on ultrasound as well?

Dr. Dellinger: The pelvic ultrasound is another way -- part of the workup for this. The ultrasound actually will tell you whether there’s a thickened endometrial lining. The inner lining of the uterus is thickened in women frequently when they have endometrial cancer, but bear in mind that in younger women, in premenopausal females, the lining is thickened because they undergo periods and have the usual menstrual cycle. It’s not as telling in a premenopausal lady, but in the postmenopausal female, generally a thickened lining is a warning sign.

Melanie: If a woman is diagnosed, and hopefully you’ve caught it early enough based on these symptoms, what are some of the treatment options available?

Dr. Dellinger: Fortunately most women with endometrial cancer are diagnosed with stage I disease and those women, most of the time, are cured. They can be cured with a simple hysterectomy and most frequently we are able to do what we call a robotic-assisted, or a laparoscopic surgery, a minimally invasive approach, which in surgery, small skin incisions which reduce postoperative pain and the hospitalization. During this surgery, we remove the entire uterus and cervix, and most of the time both ovaries and tubes. That is part of the staging. Sometimes we also remove some of the local lymph nodes, the lymph nodes that surround the uterus and the ovary and a little bit higher in the abdomen. Those are part of what we call the staging procedure where we want to ensure that the lymph nodes are not affected by malignancy and that would then tell whether the patient would require more therapy, such as chemotherapy or radiation.

Melanie: Does that happen very frequently where they might need chemotherapy and radiation in addition to the minimally invasive surgeries?

Dr. Dellinger: Most of the time they don’t like I said. The vast majority of patients are treated and diagnosed at stage one endometrial cancer and they’re cured with the hysterectomy and the removal of the ovaries and tubes alone. A small percentage of patients have, what we call Stage Three disease where the lymph nodes are involved, or the ovaries are involved. They do, unfortunately, require chemotherapy and radiation.

Melanie: What about hormone therapy, or does someone – you mentioned Tamoxifen earlier – is there anything that women have to do after the treatments, or continue with as an additional adjunct treatment?

Dr. Dellinger: That’s an excellent question because, like I mentioned, endometrial cancer is a frequently estrogen-responsive cancer. I mentioned that hysterectomy Is an often times a curative treatment option, but in women who are still young and desire to have their fertility spared -- or in those women who have, what we call endometrial pre-cancer – there is potentially an option to use progesterone. This is a hormone that people often times take as part of the oral contraceptive pill, but in women with a thickened endometrial lining -- or pre-cancer, or very early stage endometrial cancer – they may be candidates for progesterone treatment. That can either be given as oral tablets, or it can be given as IUD, as an intrauterine device inside the uterus that has progesterone that then gets released from this device. I do need to be very careful on saying it treats endometrial cancer because it really is only for very, very early stage endometrial cancer, women who desire fertility-sparing treatment.

Melanie: Tell us what’s going on exciting at City of Hope in the field of endometrial cancer. What are you doing there?

Dr. Dellinger: For endometrial cancer, we use robotic-assisted laparoscopic surgery, which is now the norm for uterine cancer. We also use sentinel pelvic lymph node biopsies as part of the staging procedure in early stage endometrial cancer and that avoids the full lymph node dissection for the staging procedures so as to avoid any lymphedema. Lymphedema is swelling in the leg that can occur when you remove a lot of the local lymph nodes in the pelvis. Sentinel lymph node biopsies are a nice way of avoiding lymphedema. Some other things that we’re doing at City of Hope are trying to develop a novel therapy for those patients who, unfortunately, have advanced stage disease, such as recurrent disease, or those who have failed chemotherapy. We’re trying to specifically develop personalized target therapies that are immunotherapy -- antibodies that can recognize a specific antibody that is expressed in high-risk endometrial cancers. This particular protein is called L1CAM and we’re trying to develop antibodies that recognize that, but also that are very specialized in such a way that they can also illicit T-Cells, which is part of the immune response, and then allow the body to fight cancer with your own immune cells.

Melanie: Wrap it up for us, Dr. Dellinger, with your best advice for people, for women, about taking charge of their own bodies and being their best health advocate in regards to endometrial cancer and what you want them to really be aware of.

Dr. Dellinger: There really are two things. One is being overweight, and obesity are probably the two biggest risk factors for endometrial cancer. Exercising and losing weight are great ways of preventing endometrial cancer. And the second thing is being aware of any abnormal uterine bleeding, so if your menstrual cycles are abnormal or – especially if you’re overweight -- or if you’re menopausal and you have bleeding again – that’s not something that should wait. That’s something that should be evaluated by a gynecologist.

Melanie: Thank you, so much, for being with us. It’s really 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

Do You Suffer From Back Pain? Relief is Available

Additional Info

Segment Number 4
Audio File texoma/1702tm5d.mp3
Doctors Choi, Kenneth
Featured Speaker Kenneth Choi, MD
Guest Bio Dr. Kenneth Choi is a board certified anesthesiologist and a member of the Medical Staff
at TexomaCare.

Learn more about Dr. Kenneth Choi
Transcription Melanie Cole (Host): Chronic low back pain can result from a wide range of problems and used to be something many patients simply had to learn to live with. In recent years, however, researchers have learned a great deal about pain and it’s led to pain management treatments that can provide relief. My guest today is Dr. Kenneth Choi. He’s a board-certified Anesthesiologist and Fellowship-Trained in Pain Management and a member of the medical staff at Texoma Medical Center. Welcome to the show, Dr. Choi. What about this burgeoning field of pain medicine -- it seems to be a field that’s growing and relatively new -- tell us about the field of pain management.

Dr. Kenneth Choi (Guest): The field of pain management is rapidly changing, even up until the 90’s through the early 2000’s, our concept of pain management was to -- as I mentioned earlier in this podcast – to treat with oral medications, such as Oxycontin, Percocet, and we realized that this may not have been the best approach as these medications aren’t as benign as we thought they were. Now we are facing opioid epidemics and we need to figure out as a country, and as a medical community, how to solve patient’s chronic pain without resorting to using these medications as a first-line treatment. Pain Medicine is really developing to find ways to treat back pain, treat neck pain, treat all these other forms of pain using Precision Medicine, meaning medications or interventions that are tailored to the specific cause of the patient’s pain. We’re also developing different forms of ways to determine what medications are working for this patient and which medications may not, so there’s a lot of exciting things that are happening in our field that’s just evolving every day.

Melanie: Tell us what are some of the most common causes of chronic low back pain?

Dr. Choi: The back is composed of many different structures and the source of back pain can be very complex to find out. The back pain can be coming from the ligaments and muscles. It can also be coming from the joints in the spine. It can also be coming from the nerves that give pain sensation to the back

Melanie: People have tried a myriad of different ways to relieve back pain – it’s one of the bigger problems in this country. Tell us about the new understanding of chronic pain as a Pain Medicine specialist.

Dr. Choi: There’s been a lot of advancement in the treatment of low back pain. Initially, people were treated with medication, such as narcotics, and we found that these medications don’t tend to work very well in the long run so we’ve developed more and more interventional procedures to try to target to the source of the back pain. These include procedures such as epidural steroid injections, lumbar medial branch blocks -- which is the lumbar, meaning the low back area – and we can also burn these nerves to give semi-permanent pain relief. There are also forms of, what we call, neuromodulation where we try to change the signals that are going from the back and legs to the brain. This includes therapy such as a spinal cord stimulator.

Melanie: Since pain is pretty subjective and it’s hard to define somebody’s pain from another person’s, what do you tell people when it’s time for them to seek treatment, about those various treatments out there?

Dr. Choi: So my general recommendation is that back pain should not be chronic, meaning greater than three months. If you’re noticing that you’re having back pain that is not getting better after one or two days, you should definitely go see your primary care physician to have that evaluated. At that point, the primary care provider will determine if you would need to see someone that is a specialist in low back pain. If they try certain medications, such as Tylenol, or over-the-counter medications, ice, rest, heat, and these things do not resolve the back pain, at that point it would be a good idea to speak to a specialist regarding the different treatment available.

Melanie: So let’s start with injections – and you mentioned steroid injections, epidurals – is that the first line of defense, Dr. Choi, and what’s involved in that?

Dr. Choi: The steroid injection depends on, again what the cause of the back pain is. A good specialist in pain management will do a thorough history and physical evaluation to determine what is the most likely cause of the low back pain or leg pain. In the situation where the specialist believes that the back pain is secondary to a nerve pinch, such as, what we call spinal stenosis -- sometimes people will refer to this as sciatica, where there is a pain going down the leg secondary to a nerve irritation -- then a steroid injection would be applicable. A steroid injection is typically done under X-ray guidance to make sure that the steroids are deposited in the correct places in the spine.

Melanie: And then how long might something like that last?

Dr. Choi: That depends on patient-to-patient and how severe their disease process is. As the disease process becomes more severe, the steroid injections may not last as long, or may not work at all. I typically tell my patients that these steroid injections last weeks to months. Now, the important aspect of back pain treatment is that the patient should also undergo other forms of treatment, such as physical therapy, so that they’re able to strengthen their core muscles in their stomach as well as improve their back flexibility and posture so that when the pain does come back, the back is supported and the pain may not be as severe.

Melanie: And Dr. Choi, what about spinal cord stimulators and surgically implanted electrotherapy devices, where do those fit into the picture?

Dr. Choi: When patients do not recover or get better with conventional therapy, including medications, physical therapy, interventional procedures, such as those steroid injections that I just mentioned, then they would either be referred to be considered for surgical intervention including a laminectomy and fusion done by a spine surgeon. Despite if they had the spine surgery and continued to have back pain and leg pain, these patients would be a candidate for spinal cord stimulation. The most common indication that we use spinal cord stimulation is for what we call Failed Back Surgery Syndrome or Post-Laminectomy Syndrome where the patient continued to have back pain and leg pain despite having surgery.

Melanie: And what about some of the other minimally-invasive procedures -- maybe ablation procedures -- speak to some of the others that might be available for people suffering from chronic low back pain.

Dr. Choi: You mentioned radiofrequency ablation and that is an excellent therapy for patients that have low back pain that would be secondary to arthritis-related back pain. There are a pair of joints at each of the spine bones called facet joints in our spine. These joints are innervated by nerves called medial branch nerves and we can find the location on X-ray and burn those nerves and this would create pain relief for the patient for up to roughly nine months to twelve months and this can be completed indefinitely.

Melanie: Are there certain people for whom you do not think are candidates for any, even these minimally-invasive procedures, or even an epidural, Dr. Choi – are some people just not a good candidate? Maybe the elderly, or people who just have had recurrent stenosis?

Dr. Choi: There are many patients that wouldn’t qualify for steroid injections or minimally-invasive procedures, such as ablations and even spinal cord stimulation. There are certain patients that aren’t able to tolerate these injections secondary to their medical condition. For people that have blood-thinning medications that they cannot come off of, for patients that perhaps have other components that play into chronic pain, such as psychological or psychiatric disorders, may not respond as well to these injections and neuromodulation techniques. These are some of the things we look out for.

Melanie: So then, please, what would you tell patients that are suffering from this type of pain? And if you’re not somebody who’s ever had back pain, it’s difficult to understand the debilitating effects that it can have on your quality of life. What should people with severe back pain think about when seeking care?

Dr. Choi: Back pain is one of the most common indications for a patient to see their physician, and it’s also a major cause of disability – Osteoarthritis, in general, is a major cause of disability in the United States. I would tell patients that they are not alone and that chronic pain really disturbs a person’s mood, a person’s desire to live. It doesn’t just cause pain, it causes your quality of life – just as you mentioned – to be severely diminished. I would suggest that anybody that’s listening to seek out help because there are ways that back pain can be treated and very effectively. It just needs to be explored and figured out.

Melanie: Why should they come to Texoma Medical Center for their care?

Dr. Choi: Texoma Medical Center has a very multidisciplinary approach to any form of the disease, including pain, including all of the other specialists that treat their various disease processes and pathology. Our team is dedicated, they are kind, and particularly I can speak for my own staff, they are very efficient and they will also reach back to my patient. Any patient that steps in my office, typically are very satisfied with their care and treatment.

Melanie: Thank you, so much, Dr. Choi for being with us today. You’re listening to TMC Health talk with Texoma Medical Center. For more information, you can go to TexomaMedicalCenter.net, that’s TexomaMedicalCenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole, thanks, so much, for listening.
Hosts Melanie Cole, MS

Early Heart Attack Care

Additional Info

Segment Number 3
Audio File texoma/1702tm5c.mp3
Doctors Handlang, Deaun
Featured Speaker Deaun Handlang, RN
Guest Bio Deaun Handlang is a registered nurse and Texoma Medical Center’s Chest Pain Coordinator.
Transcription Melanie Cole (Host): If you believe you’re having a heart attack, call 9-1-1. Tell the operator, “ I think I’m having a heart attack.” Time lost is heart muscle lost. You can delay your treatment if you drive yourself to the hospital and the paramedics can begin treatment as quickly as possible once they reach you. My guest today is Deaun Handlang. She’s a Registered Nurse and Texoma Medical Center’s Chest Pain coordinator. Welcome to the show, Deaun. People experience chest pain for many different reasons --stress, anxiety, gas – when do you concern yourself with chest pain? When do you know it’s something that you need to be concerned about?

Deaun (Guest): You need to be concerned about chest pain whenever it progressively gets worse, it doesn’t get any better, when it’s accompanied with other symptoms, such as a feeling of fullness, or jaw pain, excessive fatigue, nausea, shortness of breath. Also, it’s worse whenever you start walking or with exercise.

Melanie: And what about for women, because we hear that chest pain and even heart attack symptoms can be different from women than men?

Deaun: Women’s symptoms are often atypical symptoms. Men usually have symptoms, such as chest pain, left jaw pain, left arm pain. Women usually will have the more atypical symptoms, such as the excessive fatigue, the nausea, feeling like they have, maybe some reflux, shortness of breath. They often think that they have another illness and not having chest pain.

Melanie: If you truly believe that this is something based on the symptoms you’ve described, that might possibly be a heart attack, what is the first thing that you do?

Deaun: The first thing that you want to do is you want to call 9-1-1. That’s going to activate the EMS and they are going to come out to you and pick you up and take you to the hospital. You will always want to call EMS because you want to survive and you don’t want to drive. It’s very important to call EMS. They can do so much in the field to get things started. They can draw your blood, they can take your vital signs, they can do EKGs, they can get some of the medications started that could improve your survival rate.

Melanie: And what about Aspirin, Deaun? People have heard, “Oh, if you think you’re having a heart attack or a stroke, take an Aspirin right away.” Is that true?

Deaun: Yes, ma’am, the Aspirin can help prevent the occlusion that is in your heart from getting worse and it is a good medication for prevention of heart attack as well.

Melanie: So if you’re with somebody that you love and they think that they are having a heart attack, or you suspect they are – you’ve called 9-1-1, maybe even given them an Aspirin -- if they do start having a heart attack, just speak to us about CPR a little. What’s going on in the world today with CPR?

Deaun: Okay, so if someone you know from teenager to adult, suddenly collapses from cardiac arrest, which would be if you fell and you were unresponsive – and most often that’s caused by a cardiac issue -- you would start hands-only CPR. Hands-only CPR is a type of CPR that does not involve mouth-to-mouth. You want to do 100-120 compressions per minute in the center of the chest, but you always want to make sure that before you start anything that you check for responsiveness and call 9-1-1.

Melanie: That’s very good advice, Deaun. And what can they expect to happen -- you mentioned that EMS can get the medications started and such -- what can somebody expect if they get taken to the Emergency Room with a suspected heart attack?

Deaun: When EMS picks you up, they are going to do your vitals, they’re going to talk to you about what your symptoms are and then they’re going to do an EKG on you that looks at your heart and tells us whether you’re having an acute MI or not. They can often draw blood. They give medications such as Aspirin, Morphine, Oxygen, and Nitro. They place the Oxygen on you and get you to the hospital. The EMS is able to alert the hospital if you are having an acute heart attack and that way the hospital is able to get the people there needed to open the occlusion in your heart.

Melanie: Is a heart attack something that can cause long-term disability?

Deaun: Yes, Ma’am. A lot of times you see people who wait until the damage is already done to their heart and they can have long-term effects, such as congestive heart failure, they have permanent damage to the heart, that heart muscle – anytime that you have a heart attack and it’s an occlusion to the coronary artery, that part of the muscle will die. It does not get reestablished blood flow to it.

Melanie: And why do you think that some patients don’t benefit from optimal medical advances, or that they deny thinking that they are having a heart attack. Have you seen that happen?

Deaun: Yes, Ma’am, there are so many times that people think that they have the flu, or they have pneumonia. The symptoms, such as feeling a fullness, anxiety, nausea, back pain, shortness of breath, these are things that are often associated with so many other illnesses. Many people will hold off on going to the emergency room because they think that they just have the flu or they think that, “I may have some reflux because I just ate some spicy food,” or “this is just an illness, I’ll get better.” They just put it off and really it’s a life-threatening condition.

Melanie: So how would they know, Deaun, if they’re going to have a heart attack, would anybody know, or does it happen as a surprise? In many instances, is there something that would predispose people, let them know that they might be at risk for heart attack?

Deaun: A lot of times it does come as a surprise because people just do not pay attention to the warning signs, but most often there are risk factors. If you have a family history of cardiovascular disease, high blood pressure, being overweight or obese, having a sedentary lifestyle -- just not moving around a lot, doing exercises -- uses tobacco products, metabolic diseases such as diabetes and other illnesses. For women, it puts them at a higher risk if they use birth control pills or they had a history of pre-eclampsia.

Melanie: So as far as prevention, do you have some advice that you’d like to give listeners about possibly preventing a heart attack in the first place?

Deaun: Yes, you need to quit smoking, if you smoke, or using any kind of tobacco products. You need to try to quit. There are several ways of learning to stop smoking out there today. You need to decrease your stress, whether it’s at work or in the home, find ways to do stress management. A family history is hard because there’s not way to change your family history, but you need to realize that if you have a family history and you’re overweight, try to exercise and get to a normal weight. If you have high blood pressure, you need to go to your family physician and try to get your blood pressure under control and just know the warning signs and know the signs and symptoms so that if you have them you can get immediate care.

Melanie: In just the last few minutes, Deaun, what should people who might be at risk for a heart attack think about as very important information? Wrap it up for us with what you said somebody should do if they think your loved one might be having a heart attack.

Deaun: Most of the damage to the heart occurs within the first two hours of a heart attack, so knowing the early signs and symptoms and being aware that that could potentially be a heart attack and not waiting to call 9-1-1 is the most important thing that I could say because it really is going to save someone’s life.

Melanie: And why should they come to Texoma Medical Center for their care?

Deaun: Texoma Medical Center is an accredited facility with the Society of Cardiovascular Patient Care. This is just a accredited body that comes in and surveys the hospital to make sure that we are meeting all of the standards to best take care of the heart attack patient.

Melanie: Thank you, so much, for being with us today. You’re listening to “TMC Health Talk” with Texoma Medical Center. For more information, you can go to TexomaMedicalCenter.net, that’s TexomaMedicalCenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole, thanks, so much, for listening.
Hosts Melanie Cole, MS

Gluten Awareness & Food Sensitivity

Additional Info

Segment Number 1
Audio File florida/fl017.mp3
Doctors Nasr, Issam
Featured Speaker Issam Nasr, MD
Guest Bio Dr. Issam Nasr is a board certified Gastroenterologist. He attended and graduated with honors from medical school in 2002. He completed his Internal Medicine residency and Gastroenterology fellowship at University of Iowa. In addition, Dr. Nasr completed advanced endoscopy training in 2011. He has extensive training and experience in a wide range of complex digestive diseases. In our area, he is one of the very few GI doctors who are fellowship trained in Endoscopic Ultrasound (EUS) which is a minimally invasive procedure to assess gastrointestinal disease.

Learn more about Dr. Issam Nasr
Transcription Melanie Cole (Host): It may seem more and more common for people to have food sensitivities. You might notice a reaction to a certain food, but in many cases, it may be an intolerance rather than a true allergy. We're also hearing more about gluten issues as a culprit for many diseases and conditions. My guest today is Dr. Isam Nasr. He's a board certified gastroenterologist with Florida Hospital. Welcome to the show, Dr. Nasr. What is considered food sensitivity and how is it different from an allergy?

Dr. Isam Nasr (Guest): Okay. Thank you, Melanie, for having me on in your talk. So, there is a very big difference between food allergy and food sensitivity. With allergy, you have the immune system involved. So, the body recognized a part of the food as dangerous, so the immune system becomes very activated and now that immune system is attacking and when that process, secretes a significant amount of hormones such as histamine. Now, this can cause significant symptoms including, ranging from like hives or rash to a significant degree of other symptoms including anaphylaxis, which can be deadly.

Melanie: So, what is gluten?

Dr.Nasr: So, gluten is protein and now it's present mostly in wheat, barley, and rye. So, most of the gluten, most that we eat, is actually composed of carbohydrates. Only 10% is protein, and this is what we "gluten".

So, with gluten, gluten can be both. Can be allergy and it can be sensitivity. And, when we say "sensitivity", it's a difference here because you have sometimes what we call "intolerance" as well. So, when we have insensitivity, the immune system is not involved, and when that is happening . . . excuse me here, when that is happening, it's a different story, because this can be dose dependent, meaning that you can tolerate some food or some substance but not a lot of it. It's very different than allergy.

Melanie: Now, why are so many people becoming sensitive to gluten? We hear more and more in the media about gluten-free. What does that even mean and why are we seeing so many more people becoming sensitive to this?

Dr.Nasr: Yes, so gluten is the protein that goes inside our intestines. Unfortunately, a lot of us cannot digest this protein and break it down further. So, for some people, and this is estimated to be about 1% of the population, 1-2%, this causes an allergy and here the immune system is also involved and then the immune system attacks the cells that get in touch with this gluten protein and then people can get of a lot significant symptoms that can be only intestinal or can manifest into the whole body like fatigue, neuro symptoms, weight loss, calcium deficiencies, and osteoporosis and others.

Now, for other people, they have only sensitivity, meaning that the immune system is not involved, but when they get exposed, and this is about 4-6% of the population, they might get some symptoms and these symptoms can also vary significantly. Now we're becoming more aware of this because of two things. First, doctors are becoming much more aware of it because we know for sure that gluten sensitivity, or Celiac disease, can mimic any GI illness, or intestinal illness.

So, we think of about it very often. Now, the second important thing is awareness of the population but also gluten has got significant bad press over the past several years, so now more and more people are aware of it.

Melanie: So, how might somebody know that there's gluten in food? Is this on the labels? Are there certain label things we should be looking for that might signal food sensitivity items that people are becoming more sensitive to?

Dr.Nasr: Yes. So, yes, of course. First, whenever you're ingesting any material that has wheat, barley, or rye, most of the time, or most likely, unless it is labeled as "gluten-free", you should know that you're ingesting gluten. Most of the labels, now, again, actually I encourage people to read more the labels more and more because not only is it the gluten that we should really be aware of, there are a lot of other substances inside the food that we should be aware of.

For example, if you look at our processed food, you really find significant amounts of preservatives, sulfides, carcinogens, artificial colors, additives, dyes, antibiotics, and if you think about it briefly, this food is manufactured by the food industry, they want to sell more, so they want it to stay on the shelf longer, so they add preservatives to preserve it so it doesn't get bad. These preservatives are chemicals that kill bacteria and fungi so the food doesn't go bad, but these preservatives can affect our intestinal bacteria and cause significant other symptoms. You know, they also add flavoring materials so we can go buy the food again. They improve the texture by thickeners and all of these are chemicals that go into inside our intestinal tract and cause significant symptoms. It can be only intestinal, but it can also cause significant issues. For example, if you digest some of these materials, our body can't absorb them, so they go to the colon. The bacteria will interact with these substances and might produce significant amounts of gases, amino acids, and other fatty acids that can cause us, for example, headaches, depression, and so many other ailments that might not be intestinal only. But, again, it's very, very important to pay attention to our diet and read the labels.

Melanie: You mentioned Celiac Disease earlier in the segment, Doctor. What is Celiac?

Dr.Nasr: So, Celiac Disease is like an allergic reaction. It's an immune-mediated allergy to gluten. So 1% or about 1-2% of the population in the US has Celiac Disease. The immune system here recognizes the gluten protein as allergen or dangerous, so the immune system attacks the cells that deal with this protein. It causes flattening of the intestinal lining and what happens with that is we don't absorb as well, so now we can end up with osteoporosis because we don't absorb the calcium. We can end up with iron deficiency because we don't absorb iron. We can end up with significant weight loss, fatigue, tiredness.

So, if we're having symptoms when we're ingest gluten, we really have to check with a doctor because we need to be tested and we need to find out if we have Celiac Disease or sensitivity or not at all. Because if you have Celiac Disease, it's a very dangerous disease and can lead to lymphomas of the intestine, it can lead to many other cancers.

So, we truly have to be completely gluten-free and strictly. Even some of the medications have gluten in it, so you have to look at everything around you and everything you're ingesting and you have to be completely, completely gluten free. This is not the same case for sensitivity. With sensitivity, you can tolerate some. So, if you go to a restaurant, and you might think you have a sensitivity to gluten.

Now, if you're Celiac, you really have to speak to the waiter in a lot of detail and ask for strictly gluten-free diet. If you are sensitive only, you might be able to tolerate the gluten that night if you want to enjoy it or you say, "I might have some symptoms, and these symptoms probably severe or not", but you're not allergic, so you can tolerate some. Now, you have also to remember that a lot of people feel better when they follow gluten-free diet, but it might not be actually the gluten itself. So, gluten is present in wheat, barley, and rye, and these substances also contain large amounts of carbohydrates and fibers.

So, some of the carbohydrates present in the wheat are something we cannot absorb and digest and it might give us bloating, gas, abdominal pain, diarrhea. If we avoid these substances, we feel better, but it does not mean it's the gluten and some of the cases, gluten-free diet might not be very healthy. So, before you become lifelong gluten-free person, I think you really need to check with your doctor, ensure that what you're avoiding is the right thing. You might be able to eat some gluten in a different form, or if you're Celiac patient, you definitely have to be completely gluten free.

Melanie: So, wrap it up for us, Dr. Nasr, about food sensitivity and what you're seeing as a gastroenterologist because a lot of that people go gluten-free, as you mentioned, maybe don't need to be completely gluten-free. So, tell us what you really want the listeners to know about food sensitivities today and gluten?

Dr.Nasr: So, we are, as humans, as human beings, we are not supposed to be eating a very large amount of chemicals that is added to our food. We also can be allergic to certain types or substances inside our food itself. It is very important for all of us to look at our diets very, very closely because this is something that affects our whole body. It's not only about the constipation or diarrhea or the gas.

You need to read the labels. I would really encourage my patients and also all the listeners, to try to eat more fruits and vegetables, try to cook the food if you're able. I know it's hard and it requires a lot of work, but try to cook and know what exactly you put in your foods and also if you think you are gluten sensitive or you might have allergy, please check with your doctor. I mean, if you're going to try a gluten-free diet, try it for six weeks. It's okay to try it but when you restrict your diet for the rest of your life, I really think you need to be evaluated before you follow such a strict diet because that can also cause you some harm.

Remember, we have a significant amount of additives, we have a significant amount of antibiotics, and other chemicals inside our diet, so please, please, read all the labels before you ingest any processed food. You might be trying to eat healthy, you might eat a very large salad, but the dressing you're putting on is packaged and could have a lot of chemicals, so it does not sometimes, make sense to buy and pay a large amount of money for organic vegetables and fruits, and you add the chemicals on them when you add the dressing.

Melanie: Thank you so much, Dr. Nasr, for being with us today. It's great information. You're listening to Health Chat by Florida Hospital and for more information on Dr. Nasr's services, you can go to www.hcpphysicians.org. That's www.hcpphysicians.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Your Brain 101: The Chemistry of Love

Additional Info

Segment Number 3
Audio File allina_health/1649ah1c.mp3
Doctors Corry, Jesse
Featured Speaker Jesse Corry, MD, neurologist, St. Paul Nasseff Neoroscience
Guest Bio Jesse Corry, MD interest is in the stroke continuum of care, from primary prevention to acute management and through secondary prevention. In his practice he will see patients in the hospital and clinic. His practice philosophy is based on providing the best possible care for the patient commensurate with their wishes and values.

Learn more about Jesse Corry, MD
Transcription Melanie Cole (Host): When do you know if you really like someone? What does love do to your brain chemicals and is falling in love just nature's way to keep our species alive? My guest today is Dr. Jesse Corry. He's a neurologist with Allina Health's United Hospital in St. Paul. Welcome to the show, Dr. Corry. Are we talking about how falling in love affects the brain or is it the other way around? Does the brain affect whether we fall or stay in love?

Dr. Jesse Corry (Guest): This is a great example of both. It's an example of biology affecting culture and then culture reciprocating to biology. If you think about it, what's the body want us to do? It wants us to make little ones but also give those little ones the chance to have little ones of their own so you need to find some sort of process whereby the beings are going to reproduce but that reproduction, that offspring, is going to be able to survive itself.

Melanie: So, when we're talking about brains, what goes on in our brain when we find ourselves attracted to someone and, Dr. Corry, I would like you to also mention, because the teenage brain is the subject of so much study, it's incredible. But, teenagers, you know, can fall in and out of lust in a matter of minutes. So, what goes on with the brain when we are attracted to somebody.

Dr. Corry: Well, you know, it's interesting. There seems to be about three phases that the brain goes through. There's this lust phase, kind of the sex drive, and while that shares a lot of similarities with our more regular notions of romantic love and long-term attached love, they're sort of independent pathways. Then, you go into the more classic pathways of romantic love, and then how that evolves over time into attachment. You know, being with somebody for 30, 40 years. What I think is fascinating is when they look at societies around the world, they see it's almost ubiquitous--that almost every society has a positive view of romantic love. Actually, I think there was this one survey they looked at 166 different cultures and 147 of them had a positive view of romantic love and the rest of the them--nobody had a bad idea of it and 19, they asked the question wrong. So, it's pretty much the same thing and all of them across the board really shared similar stages. You know, this lust, then it's actually courtship, and then attachment. And so, what we're seeing is when we first have that first, like you're saying, the teenagers and that lust stage. That's actually driven by this kind of biologic need to be part of a group; to be sociable. We're social animals. So, what's going on is actually the first, most important thing to kind of initiate the process, is stress. It’s just basically not being with that special someone. So, you have these really high levels of cortisol in the body that makes us more nervous. It starts to really affect our motivations. We wind up kind of looking for people to be with us. We want to impress other people and the biological of this stage is really to, for lack of a better term, reproduce with as many people as possible. And then, during this stage of kind of indiscriminately going out there and trying to meet people and whatnot, that's what then triggers, once you find somebody meets kind of your pair bonding, your mate preference, that's when you start then transitioning into those other stages of the romantic love and attachment.

Melanie: So, it really is a chemical reaction involving cortisol, the stress hormone, and then our happy hormones--adrenaline, dopamine, serotonin; all of these things kind of swirling around to get us to the point where we feel that sense of love. Do you think that that is our body's way of keeping the human species alive?

Dr. Corry: You know, I think it is. I mean, you look at across the cultures, we have similar models. Something had to evolve in that way and it makes sense. When you look at these three stages: that early stage, the cortisol gets high, as you transition to the second stage, things start to become more rewarding so you start making dopamine; and then, that dopamine, as we start going from that second to that third stage, starts releasing other hormones. Oxytocin and vasopressin, these are what helps. The oxytocin is that kind of cuddling, that "feel good" hormone and the vasopressin is what kind of really reinforces that pair bond that says, "I want to be with this special someone," and long-term, that high stress stage, when you're trying to date someone, meet somebody, becomes a low-stress state. So, when you're in the attached phase, in that ideal phase, you still have the dopamine you had when you were first meeting that person when they were still new, but you don't have that social apprehension, you don't have that nervousness you had before.

Melanie: So, what about--and you mentioned people that have been together for 50 years--what changes? If we've had that attached phase with oxytocin and the vasopressin, what happens in the longer phase and what happens if we start to fall out of love?

Dr. Corry: Okay. So, what happens is, when you start in that attachment phase first, when you start to have kind of that "Oh, I like this person," and you've gone and you've showed them that "Oh, you're special to me and here's why," there's a part of the brain called the “ventral tegmental” area and this a part of the brain kind of lower in the brain, by the brain stem, and this is kind of what starts really pumping up that dopamine. And then, this goes to a part of the brain called the nucleus accumbens. And what this area starts to do, it starts to kind of really reinforce that motivation that says "Hey, I want to keep on doing these things that make me feel good." The parts of the brain that were kind of being triggered to make you a little more nervous, a little more fearful, the amygdala being one of those structures, it suppresses that a little bit, it calms it down. But then, there's another part of the brain called the ventral pallidum and what the nucleus accumbens starts to do, it starts to really reinforce this pathway and as we get older and as we have more experiences that release the oxytocin, the vasopressin, that pathway to the ventral pallidum really becomes amped up. And so, when you look at successfully married or pair bonded couples, you know, 10, 20, 30 years down the road, this seems to be kind of the new love center. If the ventral tegmental area is the love center when we're younger, this area becomes the love center when we're older. And so, and as a result of what's happened before, you're less stressed out. Now, you asked what happens when we fall out of love, here, and what I think is fascinating when we look at the brain of people who are in love versus people who have fallen out of love or who are single, there are actually structural brain changes in the part of the brain called the “striatum”, which it's kind of the risk manager. It looks at risk/reward benefits of different activity. When a person's in love, that part of the brain tends to become a little less dense, meaning that the nerves actually have more connection to other nerves and people are able to kind of put a different spin on things, they view the world differently. And then, when they fall out of love or they're single, that area shows less of these synaptic connections, here. So, these chemicals are actually changing the ways our nerves are connected. When you fall out of love, you lose that chemical feedback to make those connections so the brain will structurally start to change and a part of the brain that becomes really active is the part that questions conflict called the “dorsal anterior cingulate gyrus”. And this area then starts kind of questioning , "What did I do wrong?" "Why are we not together?" and so you now have a loss of chemicals, almost a withdrawal phase and part of the brain that questions conflict all really amped up, and so that's when you start having these, the "love hurts”--you know, that really painful part of [CROSS-TALK] . . .

Melanie: And it actually does. It actually does hurt.

Dr. Corry: Yeah, that's why it's happening.

Melanie: Tell us, does science have any advice because the listeners want to know how couples can return to the more blissful stage of love and get those brain chemicals involved? In just the last few minutes, give us your best advice, really, on how couples can return to that feeling.

Dr. Corry: I think the trick is, you know, when they look at successful couples, the trick is newness, newness, newness. So, if you've recently fallen out of love, right, you need to try something different. So, go on a trip. Go and pick up a new hobby. I think for men, in particular, being able to communicate some of what went wrong or what their feelings are is important and there's been some evidence with women that communicate, but don't bring up the past constantly. Now, if you're in a relationship and you want to maintain that, again, newness is important, because that newness is going to trigger that dopamine release and that's going to trigger all the other things. So, what they've found is couples that share things. I'll give you an example. Friends of mine, been married 15 years, his wife started taking up shooting. He shot for years as a hobby. She's taking it up right, so now it's something new that they're sharing and she's enjoying this, you know? So, taking up hobbies of the other person, or starting new hobbies together.

Melanie: Showing the interest in their interests.

Dr. Corry: Exactly. Exactly. And probably, one of the most important things is just sex. Sex releases that oxytocin, that helps form that pair bond. It releases that vasopressin that reinforces that you are monogamous to this person. So, newness, enjoying each other--these are all very important to having a successful, long-term relationship.

Melanie: Wow. What an interesting topic and we could really talk about this for a long time, Dr. Corry, but thank you so much for being with us today. You're listening to the WellCast . . .

Dr. Corry: Thanks, Melanie. It was great.

Melanie: It was lots of fun. 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

Facial Rejuvenation-Surgical and Non-Surgical Options

Additional Info

Segment Number 2
Audio File texoma/1702tm5b.mp3
Doctors Yeung, Terry
Featured Speaker Terry Yeung, DO
Guest Bio Dr. Terry Yeung is with TexomaCare-ENT and Cosmetic Surgery. He is fellowship trained in Full-Body Cosmetic Surgery and is Board Certified in Otolaryngology (ENT) and Head and Neck Surgery.

Learn more about Dr. Terry Yeung
Transcription Melanie Cole (Host): Our face is one of the most distinguishing features on our entire body, however as we grow older, fine lines, wrinkles, age spots, and other signs of aging appear. Facial rejuvenation can mean different things to different people. My guest today is Dr. Terry Yeung. He’s board certified in Otolaryngology and Head and Neck Surgery and he’s a member of the medical staff at Texoma Medical Center. Welcome to the show, Dr. Yeung. I’d like to start by asking you what happens to facial bones and skin as we age?

Dr. Terry Yeung (Guest): Hi Melanie, thanks for having me. Well, as we age, the skin becomes thinner and with the effects of gravity, it descends. There are certain fat pads on the face, such as below your eyelids, and also in your cheek region, which sit nice and high in younger patients. However, with time they begin to sag as well, so what we’re seeing with age is a volume loss, a skin laxity and a descent of facial tissue.

Melanie: Then let’s start with some nonsurgical options for facial rejuvenation. What are some of the things that can be done? We all see those little wrinkles -- laugh lines, worry lines, whatever you’d like to call them -- what’s the first, best line of defense?

Dr. Yeung: Yeah, absolutely. There’s multiple areas where wrinkles tend to occur on the face, most commonly on the forehead, which are the horizontal lines. We also get the frowny lines right between your eyebrows, which are either horizontal or the vertical elevens. And the ones like you were alluding to -- the laughing lines, which are the crows feet -- which are to the side of the eyes when people smile or laugh. And then lines along the nose and the lips as well. What can be done? Well, Botulinum toxin, commonly known as BOTOX, is a neurotoxin that temporarily deactivates the facial muscles responsible for facial expression. Over time, as we age, overuse of these muscles to animate our faces leads to these wrinkles. Injecting BOTOX into specifically targeted muscles of the forehead, frown lines, around the eyes, kind of like I was discussing, will temporarily weaken those muscles and ultimately remove the wrinkles.

Melanie: How long does something like that generally last?

Dr. Yeung: Effects are typically three to four months. However, there are patients that will have longer lasting effects. It very much has to do with ones’ metabolism and can change from individual to individual.

Melanie: So, BOTOX would be something that people can start with. What else can be done to add volume to that aging face?

Dr. Yeung: The most commonly used dermal filler is composed of Hyaluronic Acid. Many different companies produce this. It’s actually a naturally occurring substance in the skin. It naturally produces nutrients, helps the skin retain moisture and softness, and ultimately, for our purposes restores volume. Injections are performed in the cheek area or the nasolabial folds area to help restore age-related volume loss. It can also correct the deeper moderate to severe facial wrinkles and injection around the lips, or the perioral area can also augment the lips or correct perioral lines.

Melanie: Dr. Yeung, as people are looking at this minimally invasive or nonsurgical options for facial rejuvenation, what about some surgical options? What are some signs that facial aging that might require a surgical intervention?

Dr. Yeung: That’s a good question. Excessive bulging, or laxity of the upper eyelid, can cause a very noticeable hooding of the upper eyelid, or actually can be severe enough to cause a loss of peripheral vision. That would be an indication for a surgical procedure to be done because there’s nothing in terms of a BOTOX or a filler that I could do to help that. In terms of other things, prominent nasolabial folds, which are the folds that run from your nose to the corner of your lip -- the sagging of your jaw or a droopy jaw line -- those are things that can be corrected mainly by surgery as well.

Melanie: And Dr. Yeung, what is a facelift? People hear about it. They see stars and people in the media having had them. What is an actual face-lift?

Dr. Yeung: A face-lift is a surgery performed on patients who have the complaint of a prominent nasolabial fold or sagging of the lower neck -- or sorry, the lower face or the upper neck or chin area. It is performed with an incision, which hides along the front and back of the ear on both sides and while excess skin is excised, the muscle layer beneath the skin is also tightened. This ultimately creates a smooth, youthful facial contour, which helps the overall facial complexion.

Melanie: Are there some circumstances when you would tell somebody, “No, I don’t think you should have a face-lift?”

Dr. Yeung: Certainly patients who are young, patients who have a significant amount of fine wrinkles, those are things that could be addressed by noninvasive procedures, but the prominent nasolabial fold and the sagging jaw line, those you’re not going to be able to fix with injectible fillers.

Melanie: And what about the chin and neck? People get worried as they get older, the wrinkles, or turkey neck or they get a double chin. Are there any surgical or nonsurgical procedures that can correct areas of the chin and neck?

Dr. Yeung: Absolutely. There’s actually a fairly new product on the market, which is composed of deoxycholic acid, which is actually a naturally occurring molecule in the body. This aids in the breakdown and absorption of dietary fat. This is a new FDA-Approved injection treatment that destroys fat cells under the chin to improve one’s profile. The result is a fairly noticeable reduction in chin fullness and ultimately it improves the profile of the chin.

Melanie: In just the last few minutes, Dr. Yeung, what should people that are considering facial rejuvenation think about when seeking care? What is the most important bits of information you like them to have before they consider these types of procedures?

Dr. Yeung: Well, I think one of the most important things is, to be honest with yourself, have realistic expectations. We all look at ourselves in the mirror every day and a lot of times our impression of ourselves may not be how we actually appear. Really isolating the areas that patients require treatment is good because that communicates with the physician the areas that should be a targeted. Also, for patients that spend a lot of time outdoors, I can’t stress this enough, sunscreen, sunscreen, sunscreen should be worn at all times and, once again a realistic expectation and a positive outlook is probably the most important advice I can give.

Melanie: And why should they come to Texoma Medical Center for their care?

Dr. Yeung: Well, we have a great staff. We have an excellent operating room facility, state-of-the-art, very advanced, very new, and we have a great staff. Everybody seems to have a great time and we work very well as a team so I would certainly give it a shot if I was a patient.

Melanie: Thank you, so much for being with us today. It’s really great information. You’re listening to “TMC Health Talk” with Texoma Medical Center. For more information, you can go to TexomaMedicalCenter.net, that’s TexomaMedicalCenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Talk with your Doctor about these risks to find out if cosmetic surgery is right for you. This is Melanie Cole, thanks, so much for listening.
Hosts Melanie Cole, MS

Learn The Signs of Stroke Using The Acronym F.A.S.T.

Additional Info

Segment Number 1
Audio File texoma/1702tm5a.mp3
Doctors Reeves, Jenny
Featured Speaker Jenny Reeves, RN
Guest Bio Jenny Reeves is a registered nurse and Texoma Medical Center’s Stroke Services Coordinator.
Transcription Melanie Cole (Host): According to the CDC, stroke is the leading cause of death in the United States, killing nearly 130,000 Americans each year. That's one of every 20 deaths. My guest today is Jenny Reeves. She's a registered nurse and Texoma Medical Center Stroke Services Coordinator. Welcome to the show, Jenny. What is stroke?

Jenny Reeves (Guest): There are actually two types of strokes. There's an ischemic stroke and there's a hemorrhagic stroke. With an ischemic stroke, it's an area within the brain that does not receive blood or oxygen, and so there is brain death around that area. So, the hemorrhagic stroke is a situation where a blood vessel bursts inside the head also resulting in a loss of blood to the tissue causing an area of brain death as well.

Melanie: So, would people know if they're suffering a stroke? Are there certain risk factors that contribute to this?

Jenny: Absolutely. High blood pressure, not knowing what your lipids are, or your LDL, not eating healthy, not exercising, obesity, diabetes. If you have AFib or an irregular heart rate, you are five times more likely to have a stroke. Of course, if you smoke, that also increases your risks for a stroke, but many people are not aware that these are actually stroke risk factors until they come in with stroke symptoms.

Melanie: Now, can you survive a stroke? Is this a possibility? People hear stroke, they think of severe debilitation, but that's not the case, is it?

Jenny: It's not always the case. It is the first leading cause of disability in our country, so it is a very great possibility, but there is treatment now available that can reverse a stroke while it is occurring, if someone comes into the emergency room fast enough and they are a candidate.

Melanie: So, they say that time is brain and that's why it's so important to recognize the symptoms of a stroke. So, Jenny, describe the symptoms that you might notice either in yourself, or in a loved one that are so important and that you get emergency help as quickly as possible.

Jenny: Well, you are correct. For every one minute stroke goes untreated, 1.9 million brain cells die and the most important thing is to know the symptoms of a stroke. The easiest way to remember the signs of a stroke is with the acronym FAST. F-A-S-T. This captures 89% of stroke symptoms. The "F" stands for face. You would ask the person to smile. Does one side of their face droop? "A" is for arms. You ask the person to hold up both arms in front of them. Does one arm drift downward? "S" is for speech. You ask the person to repeat a phrase. Are their words slurred? And "T" is for time because time is really important. It's immediately time to call 9-1-1.

Melanie: Now why is it so important, Jenny, to call 9-1-1 instead of trying to drive your loved one to the hospital?

Jenny: The fact is, patients that came in by EMS received treatment earlier. Because every one minute is 1.9 million brain cells, time is of the essence. I actually did a survey, collected information on all of our stroke patients over a period of 12 months, and I ask them, "Why did you not call 9-1-1?" And the first reason was, "I didn't know I was having a stroke," but the second reason was "I thought it would be faster if I drove myself." That is a huge problem and the reason why is because it helps me recognize the public does not understand the role of EMS. They are not just transport. Actually, EMS begins treatment in the field. They start IVs, they call us with a pre-arrival so we can open up our CT scanner, they do a neuro assessment, they call us and tell us the patient appears to be stroke positive. So, when the patient comes to the emergency room, we're waiting at the ambulance bay, ready to go, everyone is prepared to receive the patient, so it saves time, and that saves brain.

Melanie: And, Jenny, sometimes people might have that speech difficulty and start those beginning symptoms that you described, and they're not that recognizable for stroke. You think maybe they've had a drink, or maybe they're just making a joke, so sometimes, there's a little bit of confusion. What do you tell people about recognizing these signs for what they are?

Jenny: I think if we see someone having a little bit of slurred speech, or maybe our arm feels different, maybe we assume we slept on it wrong. I think that's when we should stop and implement that entire FAST assessment. Have them smile, hold both arms up, are there speech changes? If you do that and you can actually observe the patient is having more than just a little humor or a little weakness, I think that would support calling 9-1-1, and if there's any doubt, call 9-1-1. It's better to come in and be assessed and look for treatment, because we only have 60 minutes to treat the person for stroke.

Melanie: Are there some other symptoms that might go along with this that would help us really say "Okay, this is what's happening,"?

Jenny: Absolutely. There's actually quite a few symptoms. Increased confusion. Sometimes, the patient may be confused as to where they are. One that I see a lot of the time, especially if there is a stroke in the back of the brain, is an ataxia. That means a loss of balance. This is not dizziness. This is when the person gets up and they can't walk straight. That is really common, ataxia is. But we assume that it's not a stroke. It doesn't sound like a stroke to a lot of people. Also, some sensory deficits, meaning your left arm feels different than your right. It almost feels duller when someone touches it. That is also a common sign of a stroke. And, also to remember, the number one complaint with those patients that come in with an inter-cranial hemorrhage, which is also a stroke, is the worst headache of my life. They say "I've never had a headache this bad," and, frequently, that can be symptom of a head bleed.

Melanie: So, Jenny, what happens? What can people expect? So, you've mentioned that EMS really is the way to get your treatment started as quickly as possible and they alert you to what is going on and that this is possible stroke. What can people expect at the emergency room?

Jenny: Well, if they're having an ischemic stroke, or hemorrhagic stroke, as soon as they come to the door and we already know they're stoke positive, they don't even go to a room first. They go directly to a CT scanner. Because the first thing that we want to do is see what's going on in the head. The only thing the CT will tell us is if they're having a head bleed or not. If they don't have a bleed within their head, we automatically know we're probably looking at an ischemic stroke, which is a blood clot or plaque that has traveled up. So, we do a full neuro-assessment. We look at the patient's clinical situation, we do a series of blood work, and if we feel like the patient meets the criteria for a clot buster, we quickly administer a clot buster.

Melanie: Then, wrap it up for us. What great information you've given today. Wrap it up with some really good tips for people on prevention of stroke and why recognizing the symptoms is so important.

Jenny: Know your risk factors, visit with your doctor, go for your physicals, and know “Is my blood pressure high? Are my lipids elevated? Do I have early diabetes? Do my family members have a history of stroke? Do I have AFib?” Be aware of your risk factors and adjust your lifestyle to decrease those risk factors. There are some risk factors we can't help. We can't help the fact if we're African-American. We can't help the fact if maybe we have a valve issue in our heart, but know your risk factors. Be aware of the signs and symptoms. Be familiar FAST to quickly assess for stroke, and above all, call 9-1-1 before you bring your loved one into the hospital. Those patients get treatment faster. Every one minute counts.

Melanie: And, why should they come to Texoma Medical Center for their care?

Jenny: Here, at TMC, our stroke treatment is three times the national average and we have a designated stroke team that responds immediately. We quickly assess the patient. Everyone comes in together. We are a primary stroke center, accredited by the Joint Commission and the state has recognized us also a stroke center. So, here at TMC, we offer all stroke services to give our patients the best possible stroke care.

Melanie: Thank you so much for being with us today. You're listening to TMC Health Talk with Texoma Medical Center. For more information, you can go to www.texomamedicalcenter.net. That's www.texomamedicalcenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The Hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Radiotherapy for Lung Cancer

Additional Info

Segment Number 2
Audio File city_hope/1701ch2b.mp3
Doctors Chen, Helen
Featured Speaker Helen Chen, MD
Guest Bio Dr. Helen Chen is an assistant clinical professor in the Department of Radiation Oncology.

Learn more about Dr. Helen Chen
Transcription Melanie Cole (Host): Radiotherapy can play a pivotal role in the treatment of lung cancer of all stages and can result in long-term curative outcome for patients with early stage disease. My guest today is Dr. Helen Chen. She’s a board-certified Radiation Oncologist at City of Hope. Welcome to the show. Dr. Chen, what is radiotherapy?

Dr. Helen Chen (Guest): Radiotherapy -- or what we just simply call radiation -- our field is called Radiation Oncology. First, I want to just preface this with something real basic that I think cancer patients don’t always understand when they’re first diagnosed with cancer. When someone is diagnosed with cancer there’s basically three modalities of treatment that can cure their cancer, or prolong their life, or alleviate symptoms from that cancer. There’s surgery, cutting out tumors. There’s chemotherapy, or drugs, to treat the cancer everywhere in the body. And then there’s radiation which is what I do, which is more actually similar to surgery. It focuses on just a certain part of the body to treat the tumor or where the tumor was. So the patient would see for surgery, a surgical oncologist, for chemotherapy, it’s a medical oncologist, and for radiation, they would see a radiation oncologist. We each specialize in our own treatment modality. I’m a radiation oncologist and radiation is -- you can think of it as high-energy x-rays -- we’ve had x-rays, but it’s a high-energy beam that can penetrate the deeper tissues and with current technology, we’re able to specifically localize where the radiation is delivered. We can treat a volume of tissue anywhere in the body and know exactly what dose is given to any particular location in the body, even within millimeters. And the key thing for radiation is to treat the tumor or the area of the cancer, but avoid giving radiation to nearby healthy tissue. That’s where the technology, the expertise, experience all come into play. And something even more fundamental is that radiation kills cancer cells, so that’s actually why it works. The radiation damages the DNA of the cancer cells preferentially, compared to normal cells, and that’s the biologic basis of how radiation kills cancer.

Melanie: So what does that actually mean when someone hears radiotherapy? Now, we’re talking specifically in this case about lung cancer Dr. Chen, and that it can be used -- as you stated so beautifully -- that it can aim to control the cancer, or the symptoms, to be used to ease the symptoms, or even to possibly cure the cancer. So as it’s killing those cancer cells in there and you say that it doesn’t – we hope that it doesn’t affect the other cells around – how is it that precise? How does that work?

Dr. Chen: Oh okay. Radiation is precise in that anytime—it’s all in the preparation actually -- when somebody is going to get radiation, say they have a lung cancer – everybody has a different shape of tumor, different location, different size – and say we want to treat that tumor, we always do a planning scan prior to treatment. It’s actually a CT scan, but it’s a dedicated CT scanner in our radiation department. With that scan, we have the patient in the treatment position, the position that they’re going to be in for radiation, for example, with their arms up. We actually do a scan, but we’re actually able to perform what we call a four-dimensional CT scan where -- we already know there are three dimensions -- but there’s a fourth dimension of motion that when a patient is breathing, a lung tumor, as you can imagine, can move. Usually, it moves up and down with breathing so we can actually take that into account in our planning, the amount of motion from the tumor from the breathing.
So again, the first thing is the scan, to localize the tumor, account for the breathing and then it’s all behind the scenes work. We have a team of physicists, dosimetrists, myself, radiation oncologists. I localize, I actually outline on the CT scan the area that I want treated and with the physicist and the – what we call dosimetrist—we create a treatment plan where radiation beams come from multiple angles to basically treat a volume of tissue to treat the volume that we want treated, yet avoid areas of healthy tissue that we do not want treated. We are aided by sophisticated computer programs, planning software, obviously, a very state-of-the-art treatment machine, where we can actually angle the beam very precisely and block areas where we don't want to treat.

Melanie: People get nervous when they hear radiation, to begin with, Dr. Chen. Does radiotherapy, radiosurgery, or stereotactic body radiation therapy – do any of these -- which basically you said are all the same thing – do they affect long-term radiation? Do we get radiation from them?

Dr. Chen: Oh, okay, yes. Any kind of radiation treatment, you’re giving a very high dose of radiation to the tumor and I think the thing that people fear, and they should, is number 1, what is the radiation going to cause during treatment? What kind of side effects am I going to have? Number two, what long-term complications can occur from the radiation? I’ll address all of those during radiation if there are radiation doses to normal healthy tissues nearby the tumor, for example, the esophagus or certain areas, you can get side effects from radiation. The key is to minimize, again, radiation doses to normal tissues so you don’t get those side effects, but also if it’s impossible, like the tumor’s right next to the esophagus, and the esophagus gets a dose a person might feel, for example, heartburn when they’re swallowing during the latter course of radiation. So there’s ways to mitigate that, there’s medications to relieve discomfort temporarily until the radiation is finished and then those side effects go away. We can always also put a break in the radiation, but we prefer not to do that because radiation is more effective when it’s given continuously. Now, long-term side effects of radiation are, again, based on how much radiation dose is given to normal tissue, so that’s actually going back to the treatment planning stage. We know exactly how much radiation dose any part of the body can handle, so we limit that dose. There’s very strict guidelines on how much radiation dose can be delivered particularly to – for example, the spinal cord, the esophagus, heart, even how much lung can be treated safely. So those guidelines need to be followed. And then another fear people have is of developing cancer from radiation. Any kind of radiation – the radon from an airplane, or even a chest x-ray there’s some radiation dose. There's a finite chance of developing cancer from radiation, but it’s basically a statistical issue, a math issue. If the chance of developing cancer is very remote, very minuscule, whereas the chance of curing cancer is much higher, so when we weigh the risk versus benefits, so if you have a very high chance of curing cancer versus a very tiny risk of causing cancer, you’re going to give the radiation to cure the cancer. This leads into your question about side effects. One of the revolutionary advents in radiation for lung cancer is the advent of SBRT, stereotactic body radiation, or you can call it radiosurgery, there’s different names for it. So let me give you some background on that. Traditionally, for decades, even since I’ve trained 30 years ago, radiation for lung cancer has been given over six to seven weeks. The patient comes every day, Monday through Friday, for six to seven weeks and we give a small dose of radiation to the lung tumor and then that has potential to cure the lung cancer. But over the last 15 years there's been a new treatment course called SBRT, where instead of treatment over six or seven weeks, treatment for lung cancer can be performed in less than a week, typically, you know, three to five treatments only. So that’s very different. The patient can basically come for the planning scan, then a week later starts treatment and just come in once a day for say four days. The radiation requirement is less than an hour a day, just lay on a table, breathe normally, watch TV, meditate, relax, and during each treatment, a much higher dose of radiation is delivered to this tumor and the total radiation dose, even though it’s five treatments, is actually far greater biologically compared to the six-week treatment. And what we’ve found is that treatment with SBRT is comparable to surgery. The local control rate, meaning the chance of eradicating the tumor with SBRT is in the range of 97%.
What this means is the patients with this early stage lung cancer -- if they are not a candidate for surgery, or don’t want to undergo surgery, or maybe they’re elderly and can’t handle surgery -- can have this SBRT treatment and in less than a week just laying on the radiation table, have a comparable chance of curing their cancer. Let me explain though that SBRT is only for early stage lung cancer. If there’s an early stage lung cancer, instead of surgery, or six weeks of radiation, often times the patient can have SBRT treatment within a week. I’ve been amazed at this. I’ve treated many patients with the SBRT and I actually haven't seen side effects.

Melanie: Isn’t that amazing? What a fascinating advancement in technology. Dr. Chen, in the last few minutes, tell us what’s on the horizon, what’s exciting at City of Hope?

Dr. Chen: City of Hope in general, there are I’d say -- if we’re talking about lung cancer -- for advanced lung cancers, say lung cancers that have spread, or patients who have had chemotherapy, there are numerous clinical trials for new drugs. I think that’s where maybe patients will come to City of Hope having undergone standard chemotherapy and it’s not working any longer, in search of other drugs that may prolong their life so that’s a perfect scenario for them to enter a clinical trial. I’ve definitely seen them work. I’ve seen people -- I mean I just saw a patient in the hospital -- he was actually a friend of a friend – he looked like he wasn’t even going to live more than a few weeks and then they started a new clinical trial drug and just a couple months later he came to my office and gave me a Christmas present and looked perfectly normal. I think that’s where City of Hope is really making strides in not only treating these patients but actually creating these drugs that go from the lab to the clinical trial to the patient. Bench to patient is what’s very unique about City of Hope. In the radiation department, what I really am proud of is that we collaborate, so we have several, maybe half a dozen radiation oncologists like myself in the community. I’m in South Pasadena where we can basically offer City of Hope care closer to the patient. Right in their own community patients can drive just ten minutes and there should be parking and just walk the steps and be right in my clinic so it’s like a miniature City of Hope, so to speak, very convenient. Convenience, I think that’s key when you're talking about someone with cancer. You don’t want somebody spending all their time in the hospital or a clinic. You want to give them their treatment and then they’re out of here, living their life.

Melanie: That is absolutely great information, Dr. Chen. Thank you so much for being with us today. 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

Precision Breast IORT

Additional Info

Segment Number 4
Audio File virginia_health/1649vh3d.mp3
Doctors Showalter, Shayna
Featured Speaker Shayna Showalter, MD
Guest Bio Shayna Showalter, MD is a Virginia native. She grew up in northern Virginia and attended college and medical school at the University of Virginia. She then moved to Philadelphia where she completed her general surgery residency at Thomas Jefferson University and her Breast Surgical Oncology fellowship at the University of Pennsylvania. During her time at the University of Pennsylvania, Dr. Showalter also completed coursework for a certificate in clinical research in the Center for Clinical Epidemiology and Biostatistics.

Following her surgical training Dr. Showalter returned to the University of Virginia as an Assistant Professor of Surgery in the Division of Surgical Oncology. Dr. Showalter now specializes in treating breast cancer and diseases of the breast. She lives in Charlottesville with her husband and three children.

Learn more about Shayna Showalter, MD
Transcription Melanie Cole (Host): Precision breast IORT intra-operative radiation for breast cancer offers an image guided radiation treatment for options for women with early stage breast cancer who apply for and are accepted into the study. My guest today is Dr. Shana Showalter. She's an Assistant Professor of Surgery in the Division of Surgical Oncology at UVA Cancer Center. Welcome to the show, Dr. Showalter. How does Precision Breast IORT work? What is it?

Dr. Shana Showalter (Guest): Great. Thank you for having me. Precision Breast IORT is a treatment option for women with early stage breast cancer and what IORT stands for is “intra operative radiation therapy”. To understand how it works, I think it's easier to take a step back. Traditionally, when women choose to have a lumpectomy for the treatment of their breast cancer, it's followed by about six weeks of daily radiation treatment. IORT is a way to decrease those six weeks into one radiation dose that's given at the time of the patient's breast surgery. So, it's getting six weeks down to one day all in the same time of the surgery. Other facilities have forms of IORT but at the University of Virginia, we developed a precision breast IORT which is completely unique. It combines CT Scan imaging’s that are done while the patient's asleep and high dose rate brachytherapy so that we're able to give the patients a very individualized and high dose of radiation all at the time of their breast surgery.

Melanie: Who would consider this as an option? Who would be somebody that would look into this?

Dr. Showalter: In terms of it, this treatment option is part of a clinical trial here at UVA, mainly because we want to have the ability to follow these women long-term to see in the long term how efficacious this treatment option is compared to whole breast radiation. In the short term, we have found that it is safe and feasible and without any major side effects. So, who we consider it is women who have early stage breast cancer, meaning their cancers are 3 cm in size or less, and they don't have any disease in their lymph nodes, so that the cancer has not yet spread to the lymph nodes and that are all age 45 and older. It really does fit a large cohort of our population in terms of women with early stage breast cancer.

Melanie: Speak a little bit about some of the potential benefits and you mentioned that it's all done at one time, so is this too much radiation for people? What are the side effects like and what are the benefits of it?

Dr. Showalter: Yes. That's a great question. One of the main benefits is patient convenience. For a lot of our patients, they physically aren't able because of where they live, or jobs, or children, or child care to come to the hospital every day for traditional radiation, so this is done all at one time. So, one of the main benefits is patient convenience. One of the others is that we are able, with our CAT scan machine and working with the radiation oncologist and the physicists who plan the radiation treatments, to really give a patient an individualized treatment. Whereas, traditional radiation, the most simple way to think of it is it's coming from the outside in, so the patients that have traditional whole breast radiation oftentimes will have a very significant skin burn and will have radiation to parts of the body that we don't necessarily intend to treat, meaning the skin, normal breast tissue, the heart and the lungs. With Precision Breast IORT, we are able to completely sculpt to the dose away from the skin, the heart, the ribs, and the lungs so that patients get the area of the breast treated that needs to be treated but have essentially no radiation to those normal tissue structures. Then, to answer your second question, “Is it too much radiation at one time,” and the answer to that is "No". Prior to doing this current study that we have opened, we did what we call a Phase One study. In that study, we treated 28 patients and none of those patients had any significant side effects to the amount in dose of radiation that we give.

Melanie: How do you know you're hitting the mark? Speak about that ability to be more precise with this type of treatment?

Dr. Showalter: When we do our treatment, we're working in the brachytherapy suite which is a very unique room in the basement of the Emily Couric Cancer Center which looks very much like an operating room but it has a CT scan that's on rails. The CT scanner can literally move. The procedure starts with myself or one of my colleagues performing a breast lumpectomy and then placing a radiation catheter into the area where we removed the cancer. We then get a CAT scan image and what that image does is it verifies that we're in the correct place in terms of putting the balloon where the cancer had previously been and then it also allows the radiation oncologist to use that CAT scan imaging and really sculpt the dose to the area of the breast tissue that needs to be treated while sculpting it away from the areas that don't need to be treated, which primarily is healthy breast tissue, skin, lungs and the heart.

Melanie: Absolutely fascinating and does this kill the tumor cells immediately or does it take some time?

Dr. Showalter: We think about radiation as killing any microscopic disease immediately that was left behind that might not have been cleared during surgery.

Melanie: What about recovery for the patient? What's that like?

Dr. Showalter: The recovery is pretty phenomenal actually. The biggest complaint the patients have is just feeling tired because it is an operative procedure where they're under general anesthesia but there's very minimal pain involved. It's an outpatient procedure, so patients come in and all in the same day they have their breast cancer removed and their radiation treatment completed with very minimal pain. I often have patients tell me that they don't even fill the prescription from the pain medication that we give them. In terms of follow up, the follow up the same as with any of our patients with breast cancer. We, as the surgeons, see them at routine intervals as do the medical and radiation oncologists, and patients will still get yearly imaging to make sure that we catch any potential breast cancer recurrences.

Melanie: What about the rest of the body? If this radiation is delivered through a catheter directly into the former tumor site, then the rest of the body is out of the picture as it were?

Dr. Showalter: Completely out of the picture, yes. And, that's one of the best benefits of this. We have shown that the radiation dose to any other parts of the body other than the area where the cancer was removed and the 1 cm breast tissue nearby that needs to be treated, the radiation dose to other parts of the body is essentially zero.

Melanie: This is in clinical trial phase as of now, Dr. Showalter. What do you see happening in your opinion with this in the future?

Dr. Showalter: We are right now doing a Phase Two clinical trial to look at the long-term efficacy of this treatment option. We are basically a little under half way through this trial. We actually recently, I think just last week, treated our 100 and 101st patient which was exciting on that day. So, we're going to keep plugging away and treating as many patients as we can. We're hopeful that once we have more long-term data that we could potentially spread this to other institutions because while it's exciting to be doing something where we are the one and only, at some point I want this to be a treatment option that's available for patients, not only in Virginia or Northern Virginia where our patients are coming from.

Melanie: How would patients get involved? Is it too late to get involved in this trial or can they still get involved?

Dr. Showalter: No, not at all. The patients that would come to see us would get involved because we would inform the patients of this as a treatment option but we are also more than happy to see patients that have a recent breast care diagnosis that are being seen at other facilities and all they need to do is contact our offices and we can very quickly make appointments and get everything that we need. We know that when patients get diagnosed with breast cancer, it's a very anxiety rich time in their lives, and so we have a really nice system and we are able to work pretty efficiently to get patients into our clinics. When I started the program, I was able to hire a clinical nurse coordinator specifically to help make the treatment process as efficient as possible for these patients. We have a wonderful nurse that sees and follows and really gets to know all of the patients and help make that transition very easy.

Melanie: To see if you qualify and to apply you can contact Debbie Romano?

Dr. Showalter: Yes, that's exactly right.

Melanie: She's the dedicated IORT care coordinator at 434-924-9725. Dr. Showalter, in just the last few minutes here wrap it up for us, and what you want people to know about this Precision Breast IORT and the importance of this clinical trial for women with breast cancer.

Dr. Showalter: This is a novel and completely unique treatment option for patients with Stage One breast cancer that we think is a very exciting treatment option that allows patients with early stage breast cancer to complete their surgical and radiation therapy treatments all in one day and it's unique in the sense that it involves both high dose radiation and image guidance so that patients have an individualized, customized radiation treatment.

Melanie: Thank you so much for being with us today, Dr. Showalter. You're listening to UVA Health Systems Radio. 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

Latest Advances in Breast Cancer Screening

Additional Info

Segment Number 1
Audio File city_hope/1701ch2a.mp3
Doctors White-Dominguez, Monique
Featured Speaker Monique White-Dominguez, D.O
Guest Bio Monique White-Dominguez, D.O., is an Assistant Clinical Professor in the Department of Medical Specialists, division of Hospital Medicine. She joins City of Hope from Providence Little Company of Mary in Torrance where she served as a hospitalist.

Dr. White-Dominguez earned her undergraduate degree in biology at the University of California, San Diego (UCSD), then went on to receive her doctorate in osteopathy from the Western University of Health Sciences in Pomona, graduating Sigma Sigma Phi. She continued her postgraduate training with an internship and residency in internal medicine at the University of Southern California.

Board-certified in internal medicine, Dr. White-Dominguez is the recipient of several scholarships and honors, including the Louise Kramer Scholarship Award and the American Osteopathic Association Touch Award. Her peer-reviewed publications have focused on health perceptions in African-American women, and she has previously completed research on obstructive sleep apnea in chronic kidney disease.
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. Monique White-Dominguez. She's an assistant clinical professor in the Department of Medical Specialists Division of Hospital Medicine at City of Hope. Welcome to the show, Dr. White-Dominguez. First of all, what is the current screening guidelines for breast cancer? People hear in the media different things coming out from ACOG and different organizations and they don't know what to believe.

Dr. Monique White-Dominguez (Guest): Okay. So, when we talk about women with average risk, which is a large part of the population, risk being like usually less than 15%, generally, we start screening at age 40. So, we decide to start screening average risk women at the age of 40 and it's usually from age 40-49, screening every one to two years and it's again, based on the woman's average risk of breast cancer. So, again, when you have a strong family history or genetic predisposition for breast cancer, screening actually starts earlier than 40 and it's on a per patient basis.

Melanie: So, if somebody has a family history of breast cancer, then they might start earlier, but for the average risk woman, starting at 40 and every one to two years, they get a mammogram. What is involved in the mammogram and also speak about self-exams. What do you want women to know about doing a self-breast exam to maybe find it earlier even than a mammogram?

Dr. White-Dominguez: Exactly. So, what the current recommendations are is when you're between the ages of 30 and 39, you do your clinical breast exam. Well, clinical breast exam is actually every year with your pap smear, but because they've changed the pap smear guidelines, women are not necessarily getting their pap smear annually any more, and so they're not getting their clinical breast exam annually any more. It's usually between one to three years but the clinical breast exams by a licensed professional is supposed to be annually and your self-breast exams are supposed to be done monthly right after the period.

Melanie: So, how do we do the self-breast exam? If a woman asks you for advice on what it is we're supposed…because we all have lumps and bumps, doctor, and sometimes you're not really quite sure what you're supposed to be feeling.

Dr. White-Dominguez: Yes. So, you definitely need to know what your breasts feel like and so it's easier to go in . . . because what I've done, as I'm a doctor and a patient and a woman, right? So, what I've done, when I was in med school, was really worked with my instructor on what normal breast feels like and what an abnormal breast feels like because there's models. Now, not a lot of women are going to be able to know what an abnormal breast feels like, but if they start with lifting their arm up and start in circular motions feeling their breast, there's a pattern in which to do so. So, if you look in Google Self Breast Exams, you'll be able to see--and there's, of course, everything's on YouTube--so, you'd be able to see how one does a self-breast exam. So, that's one start on how to actually do the breast exam, but it's really feeling your breasts completely. It's all the quadrants. Going from the nipple all the way out to the axilla, or the armpit. So, it's definitely a technique, it's very easy to do, but it's getting yourself comfortable with feeling your breast to be able to see if you have a lump of if there is anything abnormal.

Melanie: So, then, let's speak about some of the other forms of testing. We've all heard about the standard 2D mammogram and going in and that it's not nearly as painful or laborious as women sometimes make it out to be and, of course, none of us like that waiting to making sure the pictures came out or that letter that may come that they found something, but there are so many other ways now--ultrasound, MRI, 3D tomosynthesis--speak about some of those as tools to help you guys screen us.

Dr. White-Dominguez: So, basically, the mammogram is the number one, it's the mainstay for the screening of breast cancer. That's going to start an average-risk woman at 40. So, that's still the mainstay of breast cancer screening. Again, when you're a woman with high-risk, you know, high-risk for breast cancer, have a lot of breast cancer in your family, have maternal/paternal relatives diagnosed at a young age with breast cancer, then, typically, before the age of 40, we recommend ultrasound. So, ultrasounds, we may have to do a breast MRI, but the mainstay of screening is number one is going to be your mammogram; ultrasound is used as an adjunct, and it's also used in women younger than 40, and then there's also the breast MRI, which is being used, but, again, it's a more expensive test and there are limitations in terms of insurance and coverage.

Melanie: People hear about the 3D mammogram. What is that?

Dr. White-Dominguez: So, the 3D mammogram is just using basically 3D technology with the mammogram, to see if there's any type of area that wouldn't necessarily have been picked up with the regular mammogram, if there's any area of concern. So, it's just a way in which to provide more sensitivity to the mammogram.

Melanie: Is it easier to read or does it take a different type of specialist to read it?

Dr. White-Dominguez: I don't believe it takes an additional specialist to read, but I do believe there's training with radiologists in terms of reading the 3D part and a lot of insurances in this area won't necessarily cover the 3D portion. You'll have a co-pay of what insurance will not pay and if you do want the 3D mammogram, you would have to pay part of your co-pay that is not covered by insurance to be able to undergo the 3D part of the mammogram.

Melanie: So, what do you tell women all the time, doctor, about some women avoid this because they say that they hear about radiation and that that could increase their risk for breast cancer, and what do you tell them when they question some of this because they hear some of it in the media?

Dr. White-Dominguez: Exactly. I would say that the purpose of screening is to find abnormalities when we can diagnose them early and we can address them properly. And, when we fail to do the recommended screenings, we're at risk to find cancer at later stages, at a terminal stage, when we could have found it sooner. Coming from a family in which several, about 10 of my relatives, maternal/paternal, have some form of cancer, it's not really recommended in my case to not adhere to the current screening guidelines. So, even if you are scared about screening and starting at 40 and do I have to do this every year? My doctor says I need to do it every year. I want to do it every two years--you know, that's when you start asking your doctor, your primary care physician, or if you already have an oncologist, you need to sit down with your doctor and see what's right for you. So, when you usually have that discussion with your physician, hopefully, a physician which you've known for some time, it's easier to make those choices of when and how I should do my screening. What is going to be my screening modality? When should I start and how do I continue you know, to screen in the ways in which it would benefit me the most?

Melanie: Where does genetic testing fit in? You mentioned that you have family members with cancer. Women are hearing more and more about prophylactic mastectomies and the BRCA gene and genetic testing and what do you tell women when they ask you about this new, confusing technology and what it means for them?

Dr. White-Dominguez: So, since I've had first-hand knowledge, for the average-risk woman that has no family history, no factors to make her at high-risk, then you would proceed with the regular current screening guidelines. You would start your mammogram at age 40. In terms of the high-risk individual, like myself, you know, I did already did undergo genetic testing. I went to my OB/GYN who I've known for years, who delivered my children, and we know of my risk, so it's a simple blood test. It isn't always covered by insurance. I had to call and make sure that this genetic test that my OB/GYN recommended was covered, and what I was responsible for in terms of that genetic testing. It's a blood test and you get the results in 7-10 business days.

Melanie: Wow. That is such interesting information and so well spoken. So, just wrap it up for us, what you want women to know about the importance of screening and self-exams to prevent and possibly catch early breast cancer.

Dr. White-Dominguez: So, yes. I would say your self-breast exam every month is critical, learning how your breasts feel is going to be important in distinguishing if you have a breast lump or if something feels abnormal to you, or if your skin starts to change around your breast that you haven't noticed. So, you know, the patient--the woman--is going to be the number one proponent for their health. So, doing that is helpful, talking with your physician, doing your clinical breast exams yearly, is also an important aspect of screening, and then if you don't have any family history, if you don't have any of those factors, you know, recommended starting screening for breast cancer at 40 is appropriate. If you want to sit down and have a discussion with your family physician on your OB/GYN on what's best for you, that's very helpful. All you do is when you go to schedule your appointment is say, "Hey, I want to talk about my doctor about my screening, my risk for breast cancer, and what's best for me," and the doctor is usually always grateful to hear that there needs to be an additional discussion and they can tailor the discussion towards your needs. So, I definitely with all my family history of cancer and having to see breast cancer terminal diagnosis at a young age for my family members, I'm passionate about screening. I believe screening is helpful for everyone, low-risk, average-risk, and high-risk, and I urge women to have this discussion with their physician, their licensed health care provider, and have this discussion on what's going to be best for them.

Melanie: Wow, thank you so much for being with us and sharing your story, Dr. White-Dominguez. Great information. You're listening to City of Hope Radio and for more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

More...

International Travel and Vaccines

Get the Facts on Colorectal Cancer

Do You or a Loved One Suffer From Post-Traumatic Stress Disorder

Debunking Clinical Trials Myths

Start
Prev
2
3
4
5
6
7
8
9
10
11
Next
End

Page 7 of 52