Inactive (722)

Segment Number 1
Audio File allina_health/1649ah1a.mp3
Doctors Kresl, Matt
Featured Speaker Matt Kresl, PharmD- pharmacist practitioner
Guest Bio Matt Kresl is a pharmacist practitioner with Allina Health. He started with Allina Health in 2004 and has worked in various patient care and administrative positions. His current practice involves working with primary care providers on improving patient symptoms, better treating chronic diseases, and removing barriers to safety and effectively taking medications.

Learn more about Matt Kresl
Transcription Melanie Cole (Host): According to the Diabetes Research Institute, in the last decade, the cases of people living with diabetes jumped almost 50% to more than 29 million Americans. My guest today is Dr. Matt Kresl. He's a pharmacist practitioner with Allina Health. Welcome to the show, Dr. Kresl. So, people hear the word diabetes and they think Type I or Type II and they don't know the difference. Please explain that for us.

Dr. Matt Kresl (Guest): Yes. So, Type I is also referred to as Juvenile Diabetes, although that can be a bit misleading because there are certainly other individuals who are diagnosed not in childhood with Type I diabetes. But, you know, the causes are a little different. With Type I, there are suspicions of infectious causes. There are other suspicions that it's an autoimmune-driven disorder, meaning that your body kind of attacks itself, or attacks the pancreas. It's kind of like friendly fire a little bit on the body. The takeaway is that with Type I diabetes, your pancreas is kind of rendered ineffective or not useable as it relates to insulin, so you're basically dependent on insulin to treat your disease. With Type II diabetes, it's a little different. It's usually developed over a lifetime. Most patients, it's developed through lifestyle-related things that go on and not all patients with Type II diabetes need insulin. In fact, many of them don't versus Type I patients which are basically managed exclusively with insulin. So, as far as medicines go, kind of the important distinctions. Again, Type I, very much insulin dependent; Type II's, sometimes insulin necessary, but not always.

Melanie: So, let's concentrate for a minute on Type II as this is becoming more and more common and as we're seeing this obesity epidemic. Type II diabetes, Dr. Kresl, used to be called “Adult Onset”, but now it's called Type II because we're even seeing children and teenagers coming up with this type of diabetes, so what are we doing about it? What kind of medications? What is the treatment that we're seeing now for diabetes?

Dr. Kresl: Well, it kind of depends on you know, where a patient is at and so, really just to kind of set the stage, you know. Diabetes is typically diagnosed with a blood test that you would get at your doctor's office. The way it's been diagnosed has evolved over the years, but the most common test that's done is what's called an “A1C” and that's a shorthand for what's kind of longhand called “hemoglobin A1C”. And if your A1C number is above a threshold, 6.5 is the cutoff, so if it's 6.5 or higher, generally you are labeled or diagnosed with Type II diabetes. Any number, again, above that would tell you worsening degrees of Type II diabetes, and at that point, that's where the intensive discussion with your doctor or provider is going to happen. At that point, there are a couple of decisions. One is if whether you need to go on medications or not or whether you want to approach it with just lifestyle intervention and, frankly, it's going to depend on how high your number is above that threshold of 6.5. Really, to give a little more detail about that test, what that test is picking up is a measure of how much sugar that's been floating around in your bloodstream over about a three-month period of time. So, it's a very useful test for doctors to tell long-term what type of sugar control your body has. And then, from there, decisions about medicine or no medicine can come.

Melanie: There are glucose monitors at the pharmacy. Do you advise people to keep track?

Dr. Kresl: Certainly for diabetics, it's kind of an entry-level expectation and, certainly, for patients that are poorly controlled or have longstanding diabetes, you know, checking 2, 3, 4 times a day is a norm. For those patients that are very well controlled, meaning their A1C is close to 6.5, maybe it's dipped even a little below that, meaning that they've kind of reversed course a little bit, you know, checking a couple of times a week is going to be important, but the level of intensity in monitoring is generally driven by how well or poorly controlled you are. More poorly controlled means more monitoring, less poorly controlled means less monitoring. So, one of the things I always tell my patients is, “The better you do, the less you have to monitor; the less you have to poke yourself.” So, it provides an incentive because most patients don't like to have to check their sugars.

Melanie: So, as we made that distinction at the beginning, Type I is insulin-dependent, so that's generally an injection. Now, what kinds of medications are used for Type II? Is it always an injection? Can it be in oral form? What are the medications?

Dr. Kresl: Yes. So, once you're kind of at the point where you're starting medicines, there are luckily a number of medicines in the toolbox. In the last, I'd say 25 years, there's really been a windfall as far as science in the pharmaceutical industry producing medicines. The first one that most patients will be offered is a medicine called Metformin. The trade name is Glucophage, although it's available in the generic form and very affordable for most patients. You can often get it for $4-6 per month out-of-pocket. What that medicine does is a couple of things. One, is it tells your liver to stop producing sugar to the same degree it had before and the other thing it does is it helps your muscles use sugar a little bit better than it would otherwise. It's a nice medicine; it's generally well-tolerated; and it's got a lot of evidence supported kind of life-changing, life-altering, life-prolonging effects. And, because it's cheap, generally well-tolerated, there's a lot of evidence where it's benefit; it's generally kind of the first option providers are going to offer. But there are certainly many others. There's a medication class called the Sulfonylureas. There are medicines called GLP-1 Inhibitors; DPP-4 inhibitors; SGLT-2 inhibitors--these are long acronyms and probably will confuse most, but the takeaway is that there are lots of tools in the toolkit for providers and the right medicine for the patient is going to depend on a discussion with your doctor and then really understanding the effects and the side effects.

Melanie: When people ask you, and we know that with diabetes with Type I it's, as we said it's insulin-dependent, but with Type II, it's insulin-resistance; your body just isn't utilizing, but it still making insulin. What do you tell them when they ask about lifestyle and other things that they can do? Because we have learned that exercise has an insulin-like effect. Do you talk about that with your patients?

Dr. Kresl: Yes, I often do. So, as a pharmacist practitioner, we sit down and sometimes patients are newly diagnosed, depending on the situation, we may be meeting with them in conjunction with a diabetes educator. So, as far as lifestyle goes, we do talk about diet. We oftentimes refer the specifics around diet to the diabetes educators, but, yes, that's certainly the first lifestyle intervention. And, we really spend a lot of time talking about carbohydrates because that's the most kind of prevalent culprit of causing high blood sugar to develop. But, certainly from there, it's lifestyle related to physical activity. You know, once patients become obese, it becomes more difficult to move, so we oftentimes set goals around just modest changes in lifestyle that they can build up to. That might be as simple as going on a walk for 10-15 minutes a day, again something as simple as that. But we do look at other lifestyle things. Smoking certainly is not going to improve exercise tolerance, so we do kind of look at the whole patient, the whole picture, and try to make sure we're addressing whatever it is that ails them. Sleeping is another common challenge. A lot of obese patients have sleep apnea or other medical conditions that makes it harder to feel rested during the day, so we oftentimes think about that or discuss that. Again, holistically thinking about what is going to impact lifestyle in a global sense, not just kind of sending them out with get more exercise and have a nice day.

Melanie: So, wrap it up for us, Dr. Kresl, your best advice, what you tell people every day as a pharmacist practitioner about managing their diabetes and what you really want them to know.

Dr. Kresl: I think, really, the best advice I can give them is where they're at. You know, diabetes can be a very frightening diagnosis. It comes with a whole host of worries from kidney damage to stroke and heart attack increases and many patients you'll deal with have family members who have been diagnosed with Type II diabetes and have seen their family members suffer. So, usually the first piece of advice I give them is, “Help me understand what your concerns are. If you have a cousin who had dialysis or a mother who went blind from diabetes, okay, well, let's talk about that.” And then, once I understand what their worries are, then I can talk about what motivating factors are going to be needed to take your medicines as you should, to check your blood sugars, and to know what the numbers mean. What's a good number, what's a bad number, what risks come with the medicines, meaning low blood sugars or things like that. And then, from there, you know, what type of follow up they're going to see. So, that might mean coming to the doctor's office every three months, it might mean coming to the doctor's office every six months for their A1C re-check, and then just to give them hope that while Type II diabetes isn't necessarily cured, it is oftentimes a disease that I would call reversed, or optimally managed, meaning that you can largely make it disappear and there is hope for medicines to be reduced or stopped if the disease is managed. So, I know that's more than one piece of advice, Melanie, but that is kind of what I try to tell patients when they're dealing with this.

Melanie: Well, it's certainly great advice, Dr. Kresl. Thank you so much for being with us today. You're listening to The WELLCast with Allina Health and for more information, you can go to www.allinahealth.org. That's www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

Targeted Therapies for Cancer: The Latest Advancements

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Segment Number 4
Audio File city_hope/1646ch2d.mp3
Doctors Hajjar, George
Featured Speaker George Hajjar, MD
Guest Bio George Hajjar, MD received his medical degree from Aleppo University in Syria and continued his training at Seton Hall University in New Jersey. Before joining City of Hope, he spent a decade serving the community of Porterville, California at the Sierra View Cancer Treatment Center.

At City of Hope's Santa Clarita and Antelope Valley practices, Dr. Hajjar handles all general medical oncology, with a special interest in gastrointestinal cancer. His research in the field has earned him awards from the American Cancer Society and the Cancer Institute of New Jersey.

Learn more about George Hajjar, MD
Transcription Melanie Cole (Host): Cancer treatments are becoming more powerful, less toxic and increasingly individualized by patient and by tumor. Researchers are enlisting the immune system in the body's fight against cancer's many forms. My guest today is Dr. George Hajjar. He's an oncologist with City of Hope. Welcome to the show, Dr. Hajjar. Tell us what targeted cancer therapies are. What does that mean when people hear the words “targeted therapies”?

Dr. George Hajjar (Guest): Thank you very much for having me on your . . . to talk about this very exciting and probably changing way of we approach our treatment of cancer. So, targeted therapies are substances or medications that work by suppressing the growth and spread of cancer. The main idea centers on the fact that there are specific molecules that can be seen mainly in cancer cells or in the cancer tumor environment and these specific molecules are very essential for the survival, growth, or spread of cancer to other organs. So, by identifying these molecules and then developing medications that specifically target them, we are working on blocking the function of these molecules which, as I said, are essential for the survival and growth of these tumors and by doing that, we are suppressing the tumor cells. So, having said that, this is different than what our traditional chemotherapy is which is basically giving medications that kill the cells that divide rapidly, including the cancer cells, but also there are a lot of normal cells in our body that also divide rapidly and will be affected by the chemotherapy. Here, we are trying to identify these areas where we are targeting mainly the tumor and trying to avoid exposure to the normal cells in the body. So, basically, we are turning the cancer treatment from hit and run treatment which was mainly with the chemotherapy, to more turning this disease into chronic disease that we keep giving these medications to suppress the growth of the disease and keep it under control.

Melanie: And, what types of targeted therapies are available as of now?

Dr. Hajjar: There are different molecules and different ways of playing on this modality of treatment. So, there are the hormonal therapies, which some diseases depend mainly on our normal hormones to grow, like our usually dysplastic or breast cancers and by the fact that we identified these tumors that depend mainly on the hormones and suppressing the hormones, we can control them. There is something called “angiogenesis” which is basically, tumors to grow, they need the blood supply. So, they have the capability of making their own blood supply and if we target that capability, the tumors will have not enough blood and they eventually suffocate and die. There's ways of what we call “apoptosis”, which is in using death sentence into the cells so it does not keep growing forever. There are immunotherapy treatments that will also alternate the way how the immune system is handling the cancer because we all know that tumors do suppress our own immune system from attacking them and by reopening our own immune system to attacking the tumor cells, we also use that to kill the tumors. Finally, there is the idea of using something called “monoclonal antibodies” which, again, they are antibodies against these molecules that are presented on the tumor cells, and there's a lot of studies now that if we are able to tag these antibodies with a toxin substance or with even a radioactive isotope, and then inject this molecule, this combined molecule, if you want, into the patient, then the antibody will carry the radioactive isotope or it will carry the toxins very close to the tumor cell where the antigen is, where the substance for this antibody is, and direct deliver the poison, if you want, right into the tumor cells while minimizing exposure to the surrounding tissues. So, there are a lot of ways that are new and also vaccine therapy where we get the patient's tumor and then we create a vaccine that is specific for this patient's tumor and then re-inject it back into the patient's system and depend on that system to do the same and we have one, at least now, approved for the prostate cancer which also was a breakthrough treatment for these patients.

Melanie: That's absolutely fascinating, Dr. Hajjar. What are some of the limitations, as you see it, for targeted cancer therapy?

Dr. Hajjar: So, the main thing, as we said, is to find these targets. So, there's a lot of research being done to identify these molecules that are specific for each disease type and once we get that, then we get the other researchers working on the other hand to develop treatment that targets that specific target, if you want. So, identifying these targets will be one of the limitations in a way. Then, the side effects profile of these medications is somewhat different than what we used to see with the chemotherapies. So, we don't see much the nausea, the vomiting, the hair loss much, but we see more specific type of side effects and, again, these are new medications so we are learning how to deal with that. Like the hormonal therapy medications can increase the risk of osteoporosis, can give the patient hot flashes. Some of these medications can cause skin rashes, we call it “acne-like skin rash”. I tell my patients I'm going to give you acne rash, but I cannot bring you to be a teenager again. Some of these medications can cause clotting, can affect the wound healing, and the latest class of these medications works more on the immune system, so we have seen that the immune system, after it gets off the suppression from that tumors, it's sometimes affecting some other organs, also, like the thyroid. We see people come in with thyroiditis or sometimes diverticulitis or colitis, which is something, again, we are not used to seeing with the traditional chemotherapy medications.

Melanie: In just the last few minutes, how is it determined whether a patient is a candidate for targeted therapy and then, tell us about your what you're doing that's really exciting at City of Hope.

Dr. Hajjar: Yes. So, these days when we get the patient diagnosed with a cancer, we don't just ask the pathologist to tell us if the patient has cancer or not. We ask for a lot of information. We call it “genetic testing”. Let's say a patient comes with a diagnosis with lung cancer, as an example, so we need to know what kind of cancer, and then we ask for some genetic testing, something called EGFR, something called ALK, and the reason why we ask for that, although it's not very commonly seen, it's probably seen between 5 and 10% of patients, the reason we do that is because if a patient with lung cancer comes with, let's say EGFR mutation or possibility, then they are treated with a pill that they take at home and minimum side effects, the mainly is the acne-like skin rash that I talked about before, and I have patients on this pill for more than a couple of years now, just taking the pill every day with no, with the tumor being under . . . It's suppressed, under control. So, there's a lot of information that are needed to identify the specifics for each patient and we at City of Hope have a lot of research being done in the pre-clinical area where a lot of researchers are working to identify more targets, if you want, on specific tumor types and then once we identify this, as we said mainly expressed on the tumor cells, and we have other researchers who are working on developing targets that go right after these molecules and eventually develop new treatment for this disease. It's a very exciting time to be practicing oncology in this era of targeted therapy.

Melanie: Thank you so much for being with us today, Dr. Hajjar. As I said before, it is absolutely fascinating what you're doing. Thank you so much for all of your hard work and thanks for being with us today. 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

Taking Care of Your Heart

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Segment Number 1
Audio File doctors_laredo/1649dl4a.mp3
Doctors Nimchan, Ralph
Featured Speaker Ralph Nimchan, MD
Guest Bio Ralph Nimchan, MD is a cardiologist and the Medical Director of the Doctors Hospital Cardiac Rehab Program.

Learn more about Ralph Nimchan, MD
Transcription Melanie Cole (Host): According to the American Heart Association you've never too young or too old to take care of your heart. Preventing heart disease and all cardiovascular disease this means making smart choices now that will pay off for the rest of your life. My guest today is Dr. Ralph Nimcham. He's a cardiologist and the medical director of Doctors Hospital Cardiac Rehab program. Welcome to the show, Dr. Nimcham. Tell us about heart disease and what you tell people as the best advice and the first most important thing you say to them every day about taking care of their heart.

Dr. Ralph Nimcham (Guest): I'm a cardiologist and therefore I focus on the heart almost exclusively. What I do, is I see patients ranging from younger individuals in their twenties to people in their eighties and nineties. And perhaps the most important thing that I have to say to them is that so much of heart disease is preventable and so much of what you can prevent depends on your lifestyle choices. We currently have an epidemic of obesity that's plaguing our country, in some states more than others. And where we live here in Texas is particularly high. We almost see every second or third patient in my office comes in with medical conditions that are associated or secondary to their obesity. I see a lot of patients with diabetes, hypertension, hyperlipidemia; let me simplify that… patients who have problems controlling their sugar intake, fat intake in their meals and their salt intake. All three things are dietary problems that one can easily take charge of for him or herself.

Melanie: So no matter what their age, because we may go through these ages just a bit. But what do you want people to know about choosing a healthy eating plan and being physically active, no matter what their age?

Dr. Nimcham: Well, in the first place a lot of this stuff begins in childhood. I believe one of the local pediatricians is an authority on childhood obesity and has written and talked about the success. Because we do have a problem with childhood obesity. And that's the basis, the development of all these other illnesses -- diabetes, high blood pressure, high cholesterol -- that are risk factors for heart disease. So if we start early in life, and focus on our children and ourselves of course as adults, but focus mainly on our children and help our kids with initiating and respecting and continuing with good healthy lifestyle choices. Particularly the things that we give our children. The fast food industry unfortunately is a real problem for our children because a lot of parents tell me that they pick up their kids at school and take them to a fast food restaurant because it's a lot easier for them to take care of the children that way. They go home and then they get to their homework etcetera, but `instead of allowing them to make wise choices, the parents themselves making the choices for the children. And when my kids were younger 8, 9, 10 years old we made a choice that they would have low-fat milk, 1% and 2%. Initially we had some opposition from the children but they accepted it, that's all they had in the refrigerator. And we gave them crackers but they were not salty crackers, they were not crackers that had salt in them. We talked to them about choices in meats and what good proteins choosing chicken or turkey instead of other meats that have high concentrations of fats.

Melanie: So it really is up to the parents to not only be good role models but have this discussion with their children about ways to eat healthy and stay physically active. As a whole family now, what about when they turn 20 and 30 and sometimes people of that age group feel a little bit immortal, so they don't see that healthy eating and physical activity are such a necessity as you do once you hit fifties and sixties, what do you tell people in their twenties and thirties about the importance of keeping a healthy heart?

Dr. Nimchami: Well, these are college graduates for the most part coming to see you; and some of them come in because their blood pressure is borderline, elevated or they got a blood sugar reading from a lab test that says that their blood sugar is borderline, or it's a little bit elevated or that their weight BMI is in the obese range and they need to be reminded that they need to look at that. Because the obesity problem is associated with and is caused by a lot of unwise choices in their meals and because of that they gain weight. A lot of kids that are in college and all their lifestyles are a little bit less choosy and so they eat and drink things that ought not to do and studying up late at night, stuff like this.

Melanie: It certainly is! And as they enter into their fifties and sixties do you want them to know the warning signs of heart attack and stroke? Is that when we start to think about those things? And what about Dr. Nimcham, aspirin regimen, are you still as cardiologists recommending that people take an aspirin a day to help this?

Dr. Nimcham: Absolutely. Particularly if you're overweight, particularly if you have a family history of diabetes or if you have a tendency towards developing diabetes, if your blood sugar fluctuates a little bit and we check your hemoglobin A1c and the blood studies and these are borderline or slightly elevated we try to get to you right away. Talking about heart disease in the younger individuals, I've even had patients as young as 25 and 26 years old who've had heart attacks and one of them was related to tobacco use which is a major risk factor and course something that you can deal with. You can certainly choose not to smoke, but to be addicted to cigarette smoking and not being able to control it is a bad risk factor. You have the risk of cancer, heart disease, cancer anywhere in the body, heart disease is really the worst manifestation of heart disease when one smokes as a single risk factor that is even more important than the diabetes, controlling diabetes, controlling your diet, controlling your weight and having regular exercise. As children we don't have a choice because if you're in school you've got the recreation periods, when you have to go out and do physical activity. So the majority of children get some form of exercise, but do they continue this at home? We as parents and as adults take the kids before 6 o'clock, 7 o'clock in the evening it's quiet, it's not as hot and it's easier to get everybody together to go for a walk in the park. And the more time we spend or doing this with their children is very important that we the parents set the example for our children. These are examples that they would follow hopefully through life and it's very important that they keep these practices, these healthy practices.

Melanie: So wrap it up for us in the last few minutes in what you want people to do to protect their heart through any age.

Dr. Nimcham: There are several things and this is lifestyle prevention and you can get information on this from your local physician, pharmacies sometimes, from other health entities, at clinics. You need to have the approach of prevention and the approach of personal responsibility for your lifestyle choices and once you've made these good choices; you ought to be able to stick with these choices throughout life, because if you stop most times when you backslide as it were it becomes worse to control these risk factors and to control these habits and it is more difficult to do so. So getting into an established healthy lifestyle with regards to your diet, physical activity, exercise, and watching your weight, controlling your weight. These are very important things. And not only things for ourselves as adults, but things that we can explain and exemplify to our kids and our grand kids. It is very difficult to explain to an individual who is in his seventies, that he now must make secondary choices. He had ability to make primary choices on his own and stick with this throughout life. but because they did not make these choices now see have to go to the individual at age 70 who has had a heart attack and try to rehabilitate him again utilizing these main principles. We try to get them into, if you've had a heart attack or you've had bypass surgery or you've had a procedure like stent placement done to treat coronary artery disease, which incidentally is one of the major killers in the country, coronary artery disease and fortunately for some organizations like the American Heart Association that has made in rows into the community with their programs. Educational programs are encouraging people to modify their lifestyles and seek treatment earlier, listen to their physician's recommendations. These are things that we can do by ourselves. It's very difficult when you've had an established problem with your lifestyle and cigarette smoking or eating excessively and not counting your calories, or not exercising or very sedentary. It's very easy to stay with those habits and once they become established in your life, then there are risks for you developing all these other complicated medical illnesses that become real problems for you like diabetes and high blood pressure. Each one of these things are associated with heart attacks and each one of them contributes in a major way to heart attacks.

Melanie: So, the secret is really, starting very early and learning these healthy habits and continuing them through life and Dr. Nimcham, why should they come to Doctors' Hospital of Laredo for their care?

Dr. Nimcham: Let's start at the very beginning. We have a very active heart program at Doctors hospital, in which the emphasis is education, making sure our patients are educated. When they come in here for their treatment for their heart problem it's an all-out effort in order to educate our patients and have them make major lifestyle changes. Cardiac rehabilitation for instance in which I'm deeply involved will look at the patients who have established heart disease but who has had difficulty in maintaining their weight or maintaining an exercise program or even initiating an exercise program. Because these individuals for the most part are often very scared after they are told that they have a heart condition. And so it's very important for us to let them know they can get into a program at the hospital and can provide very important information and treatment for their medical problems and particularly the heart problems. There are so many patients who've had a heart attack or who've had heart surgery or heart procedure that unfortunately is still confused as to what changes they ought to make and getting into a program like a cardiac rehabilitation program for instance its different approaches, but all are aimed at making the patient responsible for their health care in helping the patient make wise choices. Once you get started in the exercise program so many people don't know how much exercise to do, where to go for exercise and whether to do it on their own without the monitor. And it's so important that if you're in a program that's being monitored, you know your heart rate is being monitored, your heart rhythm is being monitored, you have the nurse checking your blood pressures after each stage of your exercise rehabilitation program. We make sure that we give reports to the family doctors so that they know what your status is, whether you're improving. We have a graduation program where we take each patient who is on the program and say look you've made great advances, you've done a lot, you've lost weight, you've been on an exercise program, you're taking your medications as advised and now it's in your hands whether you want to have another heart attack or whether you want to prevent another heart attack or whether you want to improve the overall quality of your heart care. So it's important that people are aware of this. Let me summarize it, so much of heart disease is preventable so much of it is dependent on a person's personal decisions and personal responsibility. So much can be prevented as well as treated when you have the right approach, the right attitude, to making wise choices and protecting your heart.

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

The Latest Research on The Cancer Crisis in Appalachia

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Segment Number 1
Audio File virginia_health/1649vh3a.mp3
Doctors Yao, Nengliang (Aaron)
Featured Speaker Nengliang (Aaron) Yao, Ph.D
Guest Bio Nengliang (Aaron) Yao, Ph.D is an Assistant Professor with the Department of Public Health Sciences.

Learn more about Nengliang (Aaron) Yao, Ph.D
Transcription Melanie Cole (Host): Rural Appalachia is home to an underserved population with limited access to medical care, and cancer deaths in this region have gone from being the lowest in the US to the highest. My guest today is Dr. Aron Yao. He's an assistant professor in public health science at the University of Virginia, School of Medicine. Welcome to the show, Dr. Yao, what does your research tell us about the prevalence of cancer death in Appalachia?

Dr. Aron Yao (Guest): Just like the introduction, it was the lowest death rates in the country and now it is the highest. Cancer deaths really started to decline in early ‘90s all over the country but much lower in Appalachia, unfortunately. It's not just about the mortality rates, when we look at incidence, we look at stage of diagnosis, and we look at their survivorship care. We just saw distracting and very disturbing results that they actually have disparities across the continuum of cancer care from the incidence, early diagnosis to survivorship, all the way to mortality.

Melanie: Before we talk about the disparities and some of your theories on the reasons for those, what types of cancer have the highest death rate in the area? What are we talking about?

Dr. Yao: We include all cancer sites but for rural Appalachia, you can imagine, lung cancer death rates are really high and colorectal cancer.

Melanie: Then, the disparities, why, in your opinion and your research, based on your research, why do you think this is happening? Do they have limited access to medical care? Are there not areas around them or within driving distance? Explain some of these disparities.

Dr. Yao: Sure, I think it's multi-faceted. First off, a lot of incidence disparity is actually due to lifestyle factors. I think the high obesity rates in rural Appalachia and high smoking rates, not much exercise, these kind of things going on. There might be also some environmental risk factors, too, because coal mining has been going on for many-many decades. Some of the water and soil are polluted. So, that's for the incidence part. When we talk about health care access that treatment, then, of course, they are really far away from lot of comprehensive cancer centers. So, they don't get as much screening as other people do, and when they get cancer they don't get same quality of cancer treatments or new treatments.

Melanie: Do you think they have an inadequate awareness of the screening or just not the ability to get to a screening?

Dr. Yao: I think it depends on which cancer we are talking about. I think for breast cancer a lot of patients out of that group have done a lot of great work. So, I think people are pretty aware of breast cancer risks and benefits of screening. But, for colorectal cancer screening or lung cancer screening, that's more complicated than breast cancer screening. So, for like lung cancer screening it just gets going so we probably need to do more health education to raise awareness in people of lung cancer screening. But, I want to say that also the access issues in the mountains and in the rural Appalachia is that there's just not many screening facilities there. At UVA, we actually have a bus, so they actually drive into rural Appalachia to help people get a screening, but lung cancer screening, it’s more complicated than just a mammography. When I look at the data of Virginia, I actually found out that the region with the highest smoking rates and, at the same time they don't have any lung cancer screening facilities. They don't have any--literally.

Melanie: That is really amazing information. What about preventative services and education? Do you see a disparity there in maybe what the schools are teaching about the dangers of smoking or about any of these awareness initiatives that are going on?

Dr. Yao: Yes, that gets to a different area, it's very much about public health, and how we can work together with local government to do the tobacco controls. It's a lots of historical reasons, I guess, in the rural Appalachia they used to grow their tobacco. Tobacco and coal mining were their major industry for many decades. Now, the tobacco control was pretty successful in other places of the country but not really in the historical region where they grow their own tobacco. There are also not many smoking cessation programs in that area. The best they can get is just a 800-number. You can call, a quit line, but there's no sophisticated intervention programs to help people to quit. At UVA, we have a team and are trying to do a pilot project in Southwest Virginia to help people quit smoking. For the school education, I don't know because I haven't done much research about that. I don't know if they haven't done enough at elementary or middle school. I just don't have the information.

Melanie: Do you think that there is... and, again, in your opinion an interesting effect of education versus income in these awareness of the dangers of these various things and cancer awareness and screenings, and then, after that what do you think can be done? What would you like to see done about these health disparities in the area?

Dr. Yao: That's a very good question. I've been asked this question very often. I think the economy should be the first thing we need to address there. A lot of the health disparities you see or social disparities you find there, I think, are rooted in their economy. Like I just talked, they were very dependent on coal mining and tobacco growing, and this kind of economic pattern is just not sustainable in the globalized world. We're moving from coal as an energy source and also we're doing a lot of tobacco control in the world. So, for that area, we really need to improve their economy. When you think about the social issues or health care issues, you think about their poverty and the employment rates. You will find 'why' because it's just a lot of people don't find a job, and the economy is really bad, and you cannot support a lot of social functions or health care resources. I think the policymakers, the local government should do something to improve their local economy. I think, in the globalized world, we should look for maybe some international investment too, not just from local manufacturing jobs but maybe there are some foreign companies that are willing to do some factory manufacturing jobs in rural Appalachia if they are aiming for US as a market. It's a huge market. I think in a globalized world we should take advantage of a lot of opportunities coming from other countries. I would like to add that in order to solve all these problems, the health care disparities or social issues, I think the local residents or other US citizens who care about the rural Appalachia and low income people in the mountains should take their phone and try to call their elected officials to do something to improve the economy so we can improve other things. That's I think is my best suggestion.

Melanie: It's a great call to action. Thank you so much, Dr. Yao, for being with us today. 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

Atrial Fibrillation (AFIB): What You Need To Know

Additional Info

Segment Number 2
Audio File florida/1647fl2b.mp3
Doctors Fisher, Christian
Featured Speaker Christian Fisher, RN, BSN, MBA
Guest Bio Christian Fisher RN, BSN, MBA is the Director of Cardiovascular Services at Florida Hospital Memorial Medical Center and Florida Hospital Flagler.
Transcription Melanie Cole (Host): As many as 6 million people in the United States have atrial fibrillation and with the aging of the US population, this number is expected to increase. My guest today is Christian Fisher. He's the director of cardiovascular services at Florida Hospital Memorial Medical Center in Florida Hospital Flagler. Welcome to the show, Christian. Tell us what is atrial fibrillation?

Christian Fisher (Guest): Atrial fibrillation is essentially a condition where the top two chambers of the heart, the atria, which pump blood into the bottom two chambers of the heart, the ventricles, those atria quiver. Instead of actually pumping blood into the ventricles, they basically shake, vibrate, or quiver. As a result, blood does not flow very effectively from the atrium down to the ventricles, you have reduced blood flow, and it tends to cause patients to have a number of symptoms as a result.

Melanie: Who would be at risk for AFib?

Christian: There are a number of people at risk. Those who are of advanced age, high blood pressure; those who have some kind of previous heart disease or valve problem; those who drink alcohol--significant alcohol consumption; those with a family history of AFib also tend to get it themselves; sleep apnea is another one where we're finding a lot of patients with it. Oddly enough, athletes. Some athletes are prone to it, particularly those who have had some sort of rapid heart rate condition when they have exercised, and, you know, just some other chronic conditions that patients may have, such as thyroid problems, diabetes, asthma, a few of those, as well.

Melanie: So, would someone know they have atrial fibrillation? Would they feel that flutter you described? What are some symptoms?

Christian: They may or may not. Some people feel it more severely than others. They could feel this fluttering. The other symptoms really are weakness, shortness of breath, particularly in areas where they were walking, doing whatever, just a week or two before, and now, all of a sudden, they have this problem where they don't have the energy, they're short of breath, what have you. A lot of times, you’ll find those patients are actually in an episode of AFib and it's just night and day difference from normal rhythm of the heart to AFib and how it affects people in even their activities of daily living, not to mention exercise or something more strenuous.

Melanie: And, are there some complications to it not being treated or diagnosed?

Christian: Absolutely. The biggest complication, really, is stroke. One of the problems when the atrium is quivering or vibrating like that, as you can imagine, blood is not flowing effectively, as we said before. One of the problems is outcropping off the left atrium, called the left atrial appendage. And, in that outcropping, because blood is not flowing effectively, blood kind of pools there or stagnates, much like it would in a pond or a stream where it's not flowing well and where blood pools and collects, it's going to develop a high risk for clot formation. And then, those clots, unfortunately, find their way down into the ventricles and get ejected into the body and as those clots travel around through various arteries in a patient, they can get lodged, unfortunately, particularly in the brain, and cause stroke.

Melanie: So, then, if somebody is diagnosed--first how do they get diagnosed?

Christian: There's a number of ways. Oftentimes, the patients will complain of symptoms as we described before and then they'll go see their doctor and their doctor will check their pulse, just even on a routine check and we can find that irregular heartbeat. And so, because the atrium are quivering, the ventricles don't know that they're not in normal rhythm, and the ventricles, the lower two chambers, don't know how to pump effectively, so it gets off-rhythm. So, you'll feel this erratic sort of pulse when you feel your pulse. It will be you know, anywhere from 60 beats to 120 beats and it's all over the place. And so, that's one. They'll diagnose it by EKG, putting those leads on your chest and watching the tracing, as well. So, they can feel it, and they can also see it through EKG.

Melanie: Once it is diagnosed, then what's the first line of defense, Christian?

Christian: Well, initially, it's seeing if we can do some sort of rate control. Oftentimes, patients have a much higher heart rate than is typical for them, so they're going to be above 100, particularly if they're in an AFIB episode. So, we want to control that rate. So, medication is one way that we treat it. The other is past that to see how long has a patient been in AFib and would they be a candidate for a process called cardio-version, where we use a small amount of electrical energy; people are put into a twilight sleep. They use a small amount of electrical energy to basically reset the heart into its normal rhythm. And so those are the two initial treatments; medication and that, and of course, if a patient remains in AFib, we need to look at blood thinners for them to prevent that risk of stroke.

Melanie: If they do start with blood thinners, or blood clot prevention medications, is this something now that they're going to have to be on for their life?

Christian: This is a life-long thing while they remain in AFib, yes. And so, whether they're on the standard, which is Coumadin, which is a daily medication, or one of the newer drugs, where you take it once a day, but you don't have to be tested. That's the big problem with Coumadin. There has to be regular testing because of the fluctuations and the variety of thinness of the blood, but with the other medications that are out there, and some we've seen on TV, they're called novel anti-coagulants, and those are only taken once a day and we don't test for those. The patient is just anti-coagulated and protected from stroke while they're on those.

Melanie: And, if you use one of those procedures for rhythm control, does it solve the problem? Can it come back afterwards if they have a catheter ablation or one of these procedures?

Christian: Yes, it can come back. Catheter ablation is a significant treatment, usually after cardio-version does not work and the patient does not remain in rhythm. So, first it's cardio-version, then it's ablation, but there's still always a risk of it coming back and it's always important that people are managing the lifestyle changes that are necessary in order to help prevent that from coming back.

Melanie: And, does someone with AFIB sometimes need a pacemaker?

Christian: Sometimes they do because the medications, or the heart itself, that we use to keep rate under control, sometimes the heart is just too slow. The ventricles are pumping too slow and so a pacemaker is needed. We see that sometimes more as patients age, more likely as advanced age comes into it, a patient will need a pacemaker.

Melanie: So, Christian, are there any lifestyle modifications that can help with these treatments, go as an adjunct to them, or possibly prevent AFib?

Christian: Certainly, and they're a lot of things that go hand-in-hand with just good heart care. One is a good diet that's free of excess salt and we all know the bad stuff: the fats; the cholesterol, and all of that. We want to avoid that whenever possible. The excess salt as well, really as much salt as we can get rid of, the better. And then, the next thing is alcohol. Patients who are prone to this, even one or two drinks can be serious to bring on an AFib episode; it's been shown in the literature. But, typically, it's more significant alcohol consumption, so you want to get rid of that, altogether. And then, significant rest at night and just in general. A good pattern of getting regular rest every day--a good 6-8 hours of sleep at night--all of that really does make for a difference in treating AFib. And then, finally, diet also plays a part if you're on Coumadin because there is a particular nutrient called Vitamin K that is present in green, leafy vegetables and in other areas. We're not saying you shouldn't eat green, leafy vegetables, or broccoli, or what have you, but if you're going to eat it, you stay consistent with it so that the Vitamin K level is consistent in your body and then we can give you enough Coumadin to make your blood thin enough. Vitamin K acts as sort of a block to the Coumadin. So, you don't want to fluctuate on your diet. You want to stay on a consistent diet if you're going to be on a blood thinner.

Melanie: Christian, it's such great information. Please wrap it up for us in the last few minutes. Give your best advice for someone to live a long, healthy life, even if they do have atrial fibrillation, and why they should come to Florida Hospital Memorial Medical Center for their care.

Christian: Well, that is a very important part of dealing AFib--learning how to live with it, and so those things I outlined before: good diet, a little exercise--as much as you get into--and watching your alcohol consumption, but in particular, the most important reason to come to Florida Hospital Memorial Medical Center. We have the staff, the expertise, and the ability to help change a person's life in this regard in order to manage this disease and, hopefully, actually cure it and eliminate it from affecting the person's life.

Melanie: Thank you so much for being with us, and if you'd like to take a quiz to assess your risk of heart disease, please go to www.fhheart.com. That's www.fhheart.com. You're listening to Health Chats by Florida Hospital. This is Melanie Cole. Thanks so much for listening.
Hosts Melanie Cole, MS

How Social Media Can Enhance Outcomes In Cancer

Additional Info

Segment Number 3
Audio File city_hope/1646ch2c.mp3
Doctors Sedrak, Mina S.
Featured Speaker Mina S. Sedrak, MD
Guest Bio Mina S. Sedrak, MD., MS., is an assistant professor specializing in breast oncology in the Department of Medical Oncology & Therapeutics Research at City of Hope.

Learn more about Mina S. Sedrak, MD
Transcription Melanie Cole (Host): According to the American Society of Clinical Oncology, more and more new communication technology is being used to provide cancer care. Web-based tools, wearable technology, and smart phones let lots of cancer patients engage with each other and share information and medical institutions and individual health care professionals are also developing ways to use this technology to improve the quality of the medical care they provide. My guest today is Dr. Mina Sedrak. He's an assistant professor specializing in breast oncology in the Department of Medical Oncology and Therapeutics Research at City of Hope. Welcome to the show, Dr. Sedrak. So, tell us a little bit about some of these technologies we're seeing today in cancer care, and, as an oncologist, how are you seeing the future of using these kinds of technology to aid in cancer care?

Dr. Mina Sedrak (Guest): Well, Melanie, thank you for having me. As you can tell, there is a rapidly new communication landscape that is changing among how we communicate. There's a shift from traditional to participative communication; a type of communication that enables users to interact, create, write, and exchange information with each other. Social networking has shot up in the past decade. Sixty-five percent of adults now use social networking sites. That's a nearly ten-fold jump in the past decade and this new communication landscape where social media provides this tapestry of information. It captures our daily interactions and exposures and, not only does it capture them, but we have now these communication information being measured, recorded, and memorialized. I believe there's an opportunity for researchers to systematically witness public communication about health and, specifically, about cancer care.

Melanie: So, how do you foresee doctors and patients using these social media and technologies to engage with each other?

Dr. Sedrak: So, I think that we first need to understand the existing cancer communication on social media sites in order to understand how it's going to work. What are the uses and limits of these new modes of communication as they apply to cancer research? So, one of my areas of interest is cancer clinical trials. Cancer clinical trials are essential to translate scientific discoveries into new treatments, but only three to four percent of adult cancer patients participate annually in therapeutic clinical trials. And, we know that when we educate the public on the condition being studied, that has been linked with improvement in patient recruitment to clinical trials. As numerous organizations and campaigns are starting to use social media, such as Twitter, for example, as a platform for health promotion and education, despite this apparent increase in use, we don't know how these types of communication share information about a subject as complex as cancer clinical trials. So, in my mind, the first steps are to understand the existing cancer communications on social media sites, such as Twitter, in order to better utilize these sites to deliver cancer information.

Melanie: So, Dr. Sedrak, how can they also--they might present some potential risks to patients regarding maybe the distribution of poor quality information. I mean, we see a lot of these forums for cancer patients, maybe a doctor could have damage to his professional image--what do you see--even breaches in patient privacy--where do you see some of the challenges associated with using this new technology in oncology?

Dr. Sedrak: Yes. I think these are very important issues that are potential challenges in this area. I think that there are issues around professionalism for physician behavior; there are ethical issues in the kind of medical or clinical information that is shared online, and I think that what we have to do is understand a little bit about the current cancer ecosystem to understand how these issues play out and then instead of being afraid of these issues, I think we need to address them head on because the reality is that more and more people are using social media to communicate with each other. It's going to become a part of how our world, if it hasn't already, become a part of how we are you know, interacting with our world. I know that a lot of people my age and younger, the millennials, use social media to gather information about current events. They learn about the news from their blogs and their Twitter feeds and their Facebook pages. So, there is a lot of that that currently exists out there. And yes, there are challenges in understanding how these data can be linked to medical or clinical information in terms of both ethical and potentially legal challenges. I think that, like I said before, the first step is to understand the ecosystem to see is there even signal in the noise and then to figure out what are those challenges and how can we best address them in order to think about what is the benefit of this type of communication in patient care.

Melanie: Dr. Sedrak, people are talking about wearables. They were just on the top of the list of the American College of Sports Medicine's fitness trends, so tell us a little bit about how you think wearables might improve cancer care for the patients. How can they be using some of this technology that's not necessarily social media, but technology to help improve just our general overall health?

Dr. Sedrak: Yes. I think wearables have a potential role of adding a sort of a third dimension to the kind of understanding of patient illness that could inform physicians and scientists about what happens outside of that 20-minute visit that I have with my patient. When I see a patient in the clinic, I see the woman and I talk to her and I try to gather as much information from her about how she's dealing with her cancer and I gather labs and imaging to understand how the cancer is reacting to the treatment that we are providing her. But, those are only very few, limited data and time points. Imagine if I can gather the number of steps that she walks to understand her functional performance status, or her heart rate and blood pressure, and her sugars, outside of those 20 minutes, how much more of that information could be valuable in understanding her disease, her response to treatment, and her overall care as I provide it? How much more improved can I provide that care for her with that kind of information? I think, again, this is an area that's been untapped and this is where I think there is some potential opportunity to do research in understanding how this type of technology can, in fact, if it will, aid that provider’s understanding of a patient's disease experience beyond the limited time points that we have with our patients in the clinic?

Melanie: Well, I agree with you, and I think these can offer even more avenues of patient support and engagement with their own medical care, and that seems to be a great route to self-health advocacy. So, just in the last few minutes here, Dr. Sedrak, give us your best advice about where you see the future going for the use of new technology in cancer care and what are doing at City of Hope?

Dr. Sedrak: I think that the future of technology is definitely expanding. I think that, you know, the way we are learning about technology and, you know, social media communication as it relates to cancer care, is really is in its infancy. Its value and direct application remain to be seen, and I think that this warrants further exploration and that's what our work here at City of Hope is trying to do--to understand how the current technology as exists, can be better utilized to deliver cancer care, both from the individual and the population level. We hope that these insights, in turn, would allow us to design targeted interventions that use technology, digital health, mobile health, social media to promote better cancer care for our patients, both at City of Hope, and across the country.

Melanie: Thank you so much. It's really great and such interesting information, Dr. Sedrak. Thank you for being with us today. 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

Palliative Care and Symptom Management for Cancer Patients

Additional Info

Segment Number 2
Audio File city_hope/1646ch2b.mp3
Doctors Mooney, Stefanie N.
Featured Speaker Stefanie N. Mooney, MD
Guest Bio Stefanie N. Mooney, MD is an assistant clinical professor in the Department of Supportive Care Medicine. Board certified in family medicine, Dr. Mooney holds active memberships with the American Academy of Hospice and Palliative Medicine and the American and California Academy of Family Practitioners. Her research focuses on the ways in which palliative medicine can improve both outpatient and inpatient care. She is also no stranger to volunteer work, having travelled on a monthly basis to Mexico to provide free health care for the community of Valle Redondo from 2008-2010.

Learn more about Stefanie N. Mooney, MD
Transcription Melanie Cole (Host): Many people mistakenly think that palliative care is the same as hospice care, but it isn’t. Palliative care is meant to help patients get relief from their symptoms, pain and stress-- whatever their diagnosis. My guest today is Dr. Stephanie Mooney. She’s an assistant clinical professor in the department of supportive care medicine at City of Hope. Welcome to the show, Dr. Mooney. So, tell us the difference between palliative care and hospice care.

Dr. Stephanie Mooney (Guest): Hi, good morning. Thank you for having me on your show. Very commonly, we get patients and families who are a little bit intimidated by us as palliative physicians because they mistakenly confuse us as being the same as hospice. However, there are some very important differences. While both palliative care and hospice care focus on symptom management--things like pain, shortness of breath, nausea, as well as the emotional impact of a serious illness--hospice is a program that really focuses on end-of-life care in the last six months or so of a patient’s life. On the contrary, palliative care is really designed for any patient at any stage of their illness that is suffering from symptoms.

Melanie: So, when you speak about the fact that this can be with any illness and it’s the symptom management, what’s involved in palliative care?

Dr. Mooney: So, there’s several things that we focus on. Here at City of Hope, the majority of our patients, of course, are suffering from very advanced cancers, and this may result in things like pain, either related to the cancer itself or as an effect of their treatments for cancer. So, we will often do a very thorough assessment of whatever symptoms they may be dealing with which commonly involve pain. At times, it may involve nausea, constipation, and we do our best to help manage these symptoms whether it’s through the use of medications or whether it’s through the use of advice about different things that they can eat, about different exercises that may be helpful--really trying to focus on how we can best manage their symptoms that they can go through the treatment that they’re experiencing.

Melanie: Can someone have palliative care while they’re going through treatment? It doesn’t mean that if you’re doing palliative care that you have to stop other treatments or curative treatments.

Dr. Mooney: Absolutely. And it’s, again, a common misconception that you can have only palliative care once curative options for a disease such as cancer have gone away. However, as I previously said, many of our patients are receiving treatments for their cancer that come with side effects. The treatments in and of themselves are extremely important in order to prolong a patient’s life and, in time, may help their symptoms as well. And so, one of the things that we do as palliative physicians, is we help to manage those symptoms so that they are able to in fact complete their treatments.

Melanie: Is palliative care, Dr. Mooney, only medicational type intervention or are there other aspects to it, maybe spiritual care, psychological counseling--because if you are suffering from a disease, cancer or otherwise, there could be depression, stress, anxiety, all of these other issues can come into play.

Dr. Mooney: You’re absolutely right. Often we find that a symptom on the physical side doesn’t exist without a symptom on the emotional side as well. Each side really impacts the other. A person who is dealing with depression may have much more difficulty managing their physical symptoms. And so, I agree that it’s important for us to assess for these other emotional impacts as well, not only for the patient themselves but as well as for the family units. Another big focus of palliative care is recognizing that a patient does not exist on their own, that they are often a part of a family unit, and the disease process can impact the way that they view themselves, the way that they view their family members and their role in life. And so, frequently, we work very closely with other members of the department of supportive care including our psychiatrists, our psychologists and social workers who are all very, very skilled at managing some of these emotional issues that come up. Additionally, in palliative care, we’re trained to really try to seek out the values that a patient and their family has. Oftentimes, we get caught up in just what’s the next step in a patient’s care, but we tend to take a step back and really look at the big picture, what matters in a person’s life, and how can we best recommend a path in their care that is most aligned with their values.

Melanie: And, who is a palliative care physician? Does that person work with your physician or is your oncologist or physician that’s helping you with your disease, the person that would deal with the palliative care?

Dr. Mooney: Palliative care can be done in a number of ways. Here at City of Hope, one of the aims that we have is to help teach our colleagues in the process of primary palliative care, meaning that if we are able to help provide education to other physicians in other departments, we can reach so many more people. In addition, as secondary palliative care, when there’s a patient that is dealing with symptoms whether they be physical or psychological that are maybe a little bit more challenging, we are sometimes called in as specialty palliative physicians to come in and help assess the situation and determine how we might be able to best provide additional support.

Melanie: How long can someone receive palliative care?

Dr. Mooney: Really, as long as they’re having symptoms, that’s as long as they can receive palliative care. I've had some patients that I meet at the end of life; I've had other patients that I've known for years. So, it really is just dependent on the person, and if they have a serious illness and they have symptoms that need managing, we can be there.

Melanie: So, they don’t have to give up their own doctor, and who else besides the patient can benefit from palliative care? Does it involve any other members of the family?

Dr. Mooney: Absolutely. As I had mentioned, much of what a patient goes through is really impacted by the involvement of their family. Many cultures don’t make decisions for medical care on their own, they make it as the family unit. And so, it’s important that we involve the main family members whenever we’re having discussion about goals of care or really even when we’re discussing what are some ways that we can help a family to best understand what a patient is going through. Just the other day, I had a patient and his wife come in, and he’s been suffering from some difficulty with appetite which is, unfortunately, an expected part of his disease process. And so, what he’s been struggling with is working along with his wife, and they’ve always made a really good team. But, at this certain point in time, there’s been some frustration around his wife providing him food that he feels uncomfortable eating, and her feeling like he’s not trying, and he feeling like she’s pushing him. So, we attempted to really just reassess the situation and try to acknowledge that some of these symptoms are quite common, and that if we work to try to understand the different perspectives of the illness, both from the patient’s side as well as from the caregiver’s side, then we can hopefully work together better as a team.

Melanie: Can people get palliative care even if they’re at home during their treatments?

Dr. Mooney: They can. City of Hope does not have a home palliative program here. However, we do see patients on a outpatient basis in our clinic. Patients that are still ambulatory or can get around in a wheelchair come to see us in our clinic just as we see patients in the hospital when they are hospitalized. When there are patients whose disease progress is significantly advanced and their decisions have shifted away from curative treatment to more comfort oriented measures, that’s a point in time, when we, as palliative physicians, may work together with the primary oncologist and the rest of the team to determine whether a home program may be in a patient’s best interest based on their value such as something as a hospice program or a home palliative program.

Melanie: Does insurance recognize palliative care?

Dr. Mooney: It’s definitely been a challenge in our field. It’s something that I think has improved over time, but it is a specialty that City of Hope finds a lot of value in, and, hopefully, our patients find a lot of value in as well. So in spite of the fact that it is somewhat challenging to get fully reimbursed for our time and our services, we believe that it’s something that is so important that we find a way to make it happen.

Melanie: In just the last few minutes, Dr. Mooney, and what great information and so important for people that have a disease to hear from you, give your best advice about palliative care, really what they can expect from it for symptom management and why they should come to City of Hope for their care.

Dr. Mooney: Well, I would say, first of all to keep an open mind. We work together as a team with the oncologists, and our oncologists are really wonderful here, and they’re going to seek out the best treatments possible to help the disease process. In the meantime, keep an open mind and if you are suffering from any symptoms whether it be pain, whether it be depression or anxiety, reaching out to us or the primary oncology team reaching out to us, we can help guide the patients throughout their process from diagnosis through their treatment and hopefully through recovery and survivorship as well.

Melanie: Thank you so much for being with us today, Dr. Mooney. 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

Blood Pressure Medications 101

Additional Info

Segment Number 5
Audio File allina_health/1642ah4e.mp3
Doctors Kresl, Matt
Featured Speaker Matt Kresl, PharmD- pharmacist practitioner
Guest Bio Matt Kresl is a pharmacist practitioner with Allina Health. He started with Allina Health in 2004 and has worked in various patient care and administrative positions. His current practice involves working with primary care providers on improving patient symptoms, better treating chronic diseases, and removing barriers to safety and effectively taking medications.

Learn more about Matt Kresl
Transcription Melanie Cole (Host): According to the CDC, about seventy million American adults have high blood pressure. That’s one in every three. Only about half of the people with high blood pressure are actually managing their condition. If your doctor has told you that you have high blood pressure, they may recommend blood pressure medication to help control that hypertension. The array of medications available can be quite confusing. My guest today is Dr. Matt Kresl. He’s a pharmacist practitioner with Allina Health. Welcome to the show, Dr. Kresl. First, give us just a little working definition of blood pressure. What is hypertension?

Dr. Matt Kresl (Guest): So, hypertension is kind of defined as, for most patients, greater than 140/90. And so those two numbers can be confusing. So, really, what the high number represents is what’s called “systolic blood pressure”. And so that’s basically telling us what the heart is doing when the heart is actually contracting. And, so, that’s the squeeze that the heart is doing pumping that blood out. And then the low number or the ninety number or less than ninety is considered the diastolic blood pressure. And that’s really what the heart is doing when it’s relaxing. And so, it’s the combination of those two numbers that healthcare givers are looking at to help us find what is high blood pressure and what is low blood pressure.

Melanie: So, if somebody is told that they have high blood pressure, what do you see every day as the most common medications used and what are these medications intended to do, Dr. Kresl?

Dr. Kresl: Yes. So, most patients, when a doctor sees an otherwise healthy patient with high blood pressure, we’ll generally start with a low-risk medicine called a “diuretic” which is kind of a fancy way of saying water pill. What that water pill does is it removes water off of your body and, for reasons that even scientists don’t quite understand, that has a blood pressure lowering effect. Because it’s generally so safe and well tolerated, for many patients, that’s the starting point. But, after that, depending on the medical condition you have, there are certainly other medicines that can be used. But that’s kind of the first start for many patients.

Melanie: So, then, speak about a few of the other medications, maybe ACE inhibitors or angiotensin-receptor blockers? What are those meant to do to the heart?

Dr. Kresl: Yes. So, depending on what medical conditions you have, different blood pressure medicines are used. So, for example, if you have a heart condition, say you’ve had a heart attack in the past or you have a family history of heart disease where family members have died at a very young age from a heart attack or something like that, they’ll use medicine called a “beta blocker”. What a beta blocker does is it slows the work that the heart has to do and that lowers your blood pressure. So, if the heart is working less hard, that’s a good thing for your heart; less work equals less strain. So, those medicines are often used for people with heart conditions. Where patients with diabetes, for example, may use a medicine called, like you mentioned, an angiotensin-receptor blocker or an ACE inhibitor. Again, these are just fancy terms for groups of medicines that have benefit for patients with diabetes. And, the specific benefit for those medicines is really on the kidney. So, people with diabetes are at high risk for kidney disease. In fact, it’s the leading cause of kidney disease in the United States. Those medicines have not only the blood pressure lowering effect but also the kidney protecting effect. So, it’s kind of like getting more bang for your buck when you take a medicine like those for those types of specific conditions.

Melanie: Do people sometimes have to take a combo of the medications?

Dr. Kresl: Yes. So, it’s not uncommon for people to be on two, three. I’ve had patients on up to five different blood pressure medicines. For reasons that aren’t completely understood, some people are more genetically at risk for hypertension, either through family history or sometimes we look at things like lifestyle, sodium intake, and other things. But, yes, there are a wide spectrum of challenges with blood pressure. Again, some people can manage on just one very low dose and others need to be on multiple ones.

Melanie: Do you advise people to keep track of their own blood pressure on a regular basis? How often if that’s the case?

Dr. Kresl: It’s a good question. I would say, for most patients, it’s a good idea to track your blood pressure at home. The American Heart Association actually has recommendations with monitoring and they advocate for a blood pressure monitor that you wrap around your arm similar to what you would use in a doctor’s office. And, there are a lot of blood pressure monitors out there, some of them you wear around your wrists, which I don’t mind for patients. They just aren’t endorsed, I guess, by the American Heart Association and the issue with them is that they can give readings that are inconsistent. But, I would say, as a general rule of thumb, I like when patients monitor their blood pressure at home for a few reasons. One, I know patients experience this what’s called “white coat syndrome” where you go to the doctor’s office and you get super nervous and your nervousness then raises your blood pressure. I think it increases your health literacy and what I mean by that is if you know what number you’re getting on your cuff, then you’re more likely to know what the goal is and how to advocate for yourself in terms of getting to a lower number and I think that it just empowers people to take control of their health. So, I always encourage my patients to buy a blood pressure monitor, especially for those who have a difficult time controlling it.

Melanie: If they don’t work or if you notice your blood pressure fluctuating a lot, do they sometimes have to change dosages of the medications that they are on?

Dr. Kresl: Yes, so blood pressure, you know, it seems like an exact science in the sense that you look at the number. If it’s above 140/90, then we need to take more medicine but sometimes providers will look at one number in isolation and say, “You know what? Let’s just see how this goes.” And that’s why monitoring at home is such a good thing. The nice thing about the medicines we have today is there’s a spectrum of doses we can use and so we generally start at the lowest dose and then we work our way up on the dose until we achieve the benefit that we want. I do want to offer one caveat though which is that often times lifestyle measures, meaning diet and exercise, have been shown in studies to actually have a similar or even sometimes better blood pressure lowering benefit than the medicine. So, you know, it doesn’t kind of preclude you from doing the lifestyle stuff. And, in fact, the lifestyle stuff can be better and it’s obviously safer than taking medicine.

Melanie: Dr. Kresl, what’s the deal with salt? Is that really a bad thing for people that have high blood pressure?

Dr. Kresl: For certain types of people with high blood pressure, yes. And for patients with heart conditions, I would say, that’s where it becomes more of a challenge. The science on salt is not conclusive for patients who don’t have a heart condition, meaning your body’s ability to get rid of salt is generally pretty good, especially if you’re younger. But, I think anybody who’s eaten too much salt and felt their fingers swell up, they’ll tell you that it does have some effects on blood pressure. Really, where it becomes more imperative is when patients have heart failure and they’re salt restricted, in part because their blood pressure can change quite dramatically very quickly if not watched closely.

Melanie: Are blood pressure medications expensive?

Dr. Kresl: These days, actually not. You would think with all the medicines that are out there, many of them are very, very expensive but most patients can be maintained on a blood pressure regimen that’s pretty inexpensive. And, what I mean by inexpensive is that they’re generally generic and there are often times extensive programs through pharmacies where you can get them for $5 or sometimes even less a month. So, the number fluctuates but I can get many patients under control with their blood pressure on one to two medicines for often times $10 or less a month.

Melanie: If they take the pills and adhere to their medication management, does that mean they’re not going to have a heart attack or stroke?

Dr. Kresl: Not necessarily, no. I mean the data on the benefits for a population is conclusive in the sense that better blood pressure control reduces heart attacks and strokes. So, when you’re thinking about taking your blood pressure medicine every day, that’s the gain you stand to get from taking those medicines. But just kind of know that it doesn’t preclude you from getting one but it definitely improves your odds. And as I mentioned before, if you’ve got a preexisting condition like you’ve had a heart attack already or a stroke already or you have diabetes, those blood pressure medicines not only lower your blood pressure, which you get a gain from, but also help protect your heart or kidney from further damage, which is another benefit.

Melanie: So, in the last few minutes, are these typically lifelong medications or can you reverse in, as you said before about lifestyle modifications, can those actually fix your blood pressure or possibly reverse the situation?

Dr. Kresl: Yes. So, the good news is that for a number of patients that I work with who certainly have a goal of reducing the number of medicines they take, you know, if they undergo the lifestyle changes, we, as caregivers, can often times eliminate the blood pressure medicine entirely. And it’s generally kind of negotiated between the patient and the caregiver. Meaning patient comes in and says, “You know, I’ve really made some lifestyle changes. I’ve lost this amount of weight. My blood pressure’s been under control for the last, say, year and a half or two years.” And the doctor or provider says, “Yes, okay, let’s see how you do on a drug holiday, meaning you don’t take the medicine for some time, and we’ll check your blood pressure and that can be one less pill you have to take through nothing other than lifestyle intervention.”

Melanie: So, give your best advice here to people who are suffering from hypertension, who’ve been told that they do have blood pressure and what you as a pharmacist practitioner want them to know about medication management.

Dr. Kresl: I would say that, in general, blood pressure is hard because it’s not something you generally feel but it is known as the silent killer for a reason. The medicines are generally well tolerated. We generally start at the lowest dose. They have been proven to be effective and they’re one of those medicines that you can get into and take for a relatively modest price. So, it’s a medicine with low potential cost and high potential gain. So, it’s something that’s I think important for everybody to be aware of, the potential benefits of managing it with medicines.

Melanie: Thank you so much for being with us today, Dr. Kresl. It’s such important information. You're listening to The WellCAST with Allina Health. 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

Signs That an Aging Loved One Needs Help

Additional Info

Segment Number 5
Audio File virginia_health/1642vh5e.mp3
Doctors Archbald-Pannone, Laurie R
Featured Speaker Laurie R Archbald-Pannone, MD
Guest Bio Dr. Laurie Archbald-Pannone is a UVA Health System geriatrician.

Learn more about Dr. Laurie Archbald-Pannone

Learn more about UVA Health System
Transcription Melanie Cole (Host): Physical and mental health decline often surprise family members, especially if aging relatives seemed fine the last time they were seen but what are some signs that indicate something may be wrong so you and your loved one can properly prepare for the future? My guest today is Dr. Lori Archbald-Pannone. She's a geriatrician with UVA Health Systems. Welcome to the show, Dr. Lori. I think that we want to start with some common signs. If you've been with a family member two three weeks ago or a month ago and then you see them, what things should you look for that might be different that would signal a few red flags?

Dr. Lori Archbald-Pannone (Guest): Thank you. Things to look for when you're visiting with your family member who you may or may not see very frequently are to ask them how they're doing, and not just assume things are going well all the time, but to really sit down, take the time and ask what's new or different? What we do in the clinic is, we often ask and recommend family members to ask about falls. Have you had any fall? Have you had any almost falls, where you feel unsteady? Sometimes, we can have big falls that we don't know about and that's important to know but, more importantly, those little missteps, those almost falls that we have are important to know about before we have a big fall so, hopefully, we can intervene. Falls are important to know about, also keeping up with day to day activity, what we would call our activities of daily living. Things like dressing, feeding ourselves, being able to go to the bathroom and take a shower. How are those going for someone? Are you able to do that? Also, keeping up with medicine. Sometime our family members can be on so many medicines that it's a lot to keep up with for anybody, especially if we're starting to get a little bit of functional or cognitive decline. So, ask them about how the medicines are going. Looking at the pill bottles, looking at the system that we have in place to remember when to take which medicines, and seeing if we're up to date. If we're getting our medication refill, if we're going through the bottle at a rate that's appropriate, and then checking in with physicians, too, to see how they're doing.

Melanie:   If we're at the person's house, is it acceptable for us to be looking around to see if it's disorganized, if there's expired groceries that don't get thrown out, or if there are any of those kinds of things around the house that we notice? Do those signal something?

Dr. Lori: Well, they certainly can, and it's important to pay attention to the day to day, and to see how someone is able to take care of themself, to see how they're able to take care of their house. Again, all of us are very proud people and we want to continue to do what it is that we've done but sometimes we need a little more help, and it's hard sometimes to be able to initiate that, to either ask about it, or ask for help. So, being aware of signs around the house can be very helpful, again, in terms of those day to day activities. Kind of beyond just our activities of daily living, there are the ideal, the instrumental activities of daily living, which represent our ability to care for ourselves in the community. Those are things like shopping. So, exactly right, are the things in the refrigerator fresh and new? Are they expired? Have they been there for a while? Is the trash getting taken out? Things that are important in terms of taking care of a home or local environment on a day to day basis. To make sure that we're eating well, and we're in a healthy environment are important as well.

Melanie:   So, then, if we do notice those things, then comes the difficult part of having that conversation, as you said, doctor, we are proud people, and if you have an aging relative and you say, “I'm starting to notice some changes,” or “I'm noticing you haven't been taking your medication,” sometimes those conversations are very difficult to start because people get very offended. What do you recommend to your patients and their loved ones starting that conversation?

Dr. Lori: I think the most important is to really approach all of these difficult conversations with respect and love. The reason we're having these conversations are because we love and care for someone and we want to make sure that they're safe and well taken care of. That's the most important thing often that needs to be said, so that nobody thinks that we're trying to be sneaky or find out some sort of weakness, or some other ulterior motive. Just be up front, that this is because we love you, we respect you and we want to make sure that you're safe and well taken care of, and we're doing everything we can to participate in that. That is generally a way to start a conversation that can be better received than certainly any sort of accusation. If somebody feels that you've been kind of sneaking up on them and have some secret information, then people can get defensive if that happens. But, really, just try to be open, try to say that this is really coming from a place of love and caring, which is where it's coming from. And, then, to hopefully move together forward in terms of finding a plan that works for everybody. Not dictating a plan that “This is what it's going to have to be and this is how it's going to have to be,” but really to come up with a plan as a team together.

Melanie:   What are some options people have because some people say it's better to stay in the home, and have a caregiver come to the home; some people say that assisted living are different nowadays. What things should you consider when you're trying to decide how your loved one is going to get the help that they need?

Dr. Lori: There are a lot of different factors to consider and really sitting down with somebody who's familiar with your local resources can be the most helpful. Here at UVA, we have our geriatric outpatient clinic, the University of Physicians at geriatric clinic where we can sit down with our patients and their families to say, “Well, what are your medical conditions that may need assistance? What's your functional level? What's your cognitive level? What are your needs and where are those best suited?” We can explore with our social workers, our colleagues over at JAVA, and other services locally as well to say, “Could these be provided in a home? Is there a structure of support when those services can't be there overnight?” For example, it can be difficult to find overnight care. So, will somebody be safe in their home alone at night? That's something that's very important to consider and so knowing your local resources is really important. There are other resources such as assisted living, in and around the Charlottesville area, we have a multitude of different assisted living facilities. Assisted living facilities are all very unique places. They serve different unique needs. So, it's not a simple conversation to say, “Does mom need to be in assisted living?” Well, what assisted living are we talking about and what services can be provided because each facility can provide different services, and even within a facility, there are different levels of services available. So, again, becoming familiar with that and really sitting down as it's a lot of information to go through and to process. So, really, to sit down with a physician or social worker or somebody in the community, where these resources can be helpful to really go through what are your personal needs; and then, what other resources and how can we match those together best?

Melanie:   If dementia enters the picture, which it doesn't always, but if it does enter the picture, does that change the narrative for the loved one in how they pick an assisted living, or how they have that discussion, or what care and needs that person has?

Dr. Lori: Well, any medical condition is going to have specific needs associated with that particular one. But, the basic discussion I think is still the same. It's still that this decision of coming from a place of love and with full respect for the person as an individual; coming together as a team to find the best place so they can be well taken care of in all of the dimensions; and, ensuring, if you are talking about a facility, that the facility is well-equipped to deal with the progression that we can often see with dementia as well.

Melanie:   Wrap it up for us, if you would, Dr. Lori. Just give us your best advice when you're dealing with families and they come to you and they say, “We've decided that now my loved one needs a little bit more help.” What do you tell them are the most important things to start to consider? Our advanced directives, our wills, planning their affairs. What do you tell them really that they need to do while they can have these conversations?

Dr. Lori: While having these conversations, I think that some of the most important things to focus on are making sure we're physically safe so that we're not having falls and that environment around us is safe; and that we're getting taken care of medically in the best possible way--on the right medication and not on excess of medication, on the right dose and that medically we're stable. In addition to that, looking forward, thinking about how we are going to manage our finances? How are we going to make those medical decisions if we're unable to? And, so, having the discussions about advanced directives and code status while we're doing well is really the ideal time to have those discussions. That way, if something were to happen when we're unable to make our own decision, our family or friends or whoever we appoint to make those decision for us, will know what we would have wanted if we were able to make that decision at the time.

Melanie:   Thank you, Dr. Lori. It's really great information and so important to start that conversation with your loved one, hopefully, before you need to have that conversation. 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

Defeat Dust Mites

Additional Info

Segment Number 4
Audio File allina_health/1642ah4d.mp3
Doctors Johns, Kenneth
Featured Speaker Kenneth Johns, MD, allergy and immunology
Guest Bio Dr. Kenneth Johns specializes in allergy and immunology and practices at Allina Health clinics in Cambridge, Coon Rapids and Maple Grove. His professional interests include child and adult asthma, seasonal allergies, hives and skin rashes.

Learn more about Kenneth Johns, MD
Transcription Melanie Cole (Host): In most homes, dust mites are everywhere, often found in linens, bedding, carpeting, and other fabric materials. Dust mites are a big problem for people who have indoor winter allergies. My guest today is Dr. Kenneth Johns. He’s an allergy and immunology physician for Allina Health Clinics. Welcome to the show, Dr. Johns. What are dust mites?

Dr. Kenneth Johns (Guest): Well, dust mites are these microscopic little creatures probably most closely related to spiders. You’ve seen pictures of them on TV. They’re really too small to be seen. They look horrifying up close. They look like a humpback spider, basically. They live in everyone’s home, especially in the bedroom, and their pieces, their bodies, their detritus is extremely allergenic. They’re thought to be the most important indoor allergen and probably the most common year-round allergy.

Melanie: So, why are people allergic to dust mites? And, really, they sound like scary little things.

Dr. Johns: Well, again, they look scary but they’re too small to do you any harm other than being an important allergen. It’s really not clear why some substances, they’re usually proteins, become allergens and some don’t. There are many people that are studying the structure of the protein that we’re allergic to in dust mites and in pet dander and in pollen to find some sort of common thread. I’m just going to say there are some proteins that we become allergic to.

Melanie: So, the, how would you even know if you have a dust mite allergy as opposed to. . . If everybody or many people have these dust mites, first question, Dr. Jones, is how do you know if you have them in your house? Is there a way to detect them?

Dr. Johns: Well, there is. We can test someone to see if they’re allergic to dust mite or not. You’re exactly right. Dust mites are in everyone’s home but only 10 to 20 percent of us are allergic to them. And, that really is important because much to what we talk about to reduce dust mite exposure or to avoid dust mites is very expensive and very time extensive. So, I really only want to recommend that to people that I know are allergic to dust mites, otherwise it doesn’t make sense. Certainly, the treatments in terms of medication as in allergy shots, I really only want to use those when they’re appropriate, if the person is allergic or not.

Melanie: Well, how would we know if we are allergic. I mean because certain allergies, fall season allergies, come and go, you kind of get those red flags and triggers, but something that’s in your home could be a little bit more subversive in the way that it conducts your allergy.

Dr. Johns: I like subversive. So, dust mite is usually year-round allergy symptoms. It may peak a bit in the fall when our heating/cooling systems stirring up the heavier particles but, ultimately, it comes down to we need to test you to see if you’re allergic to dust mite and we have different ways to do allergy testing to see if you have that specific allergy. And, again, it’s important to have a yes or no on that because so much of what we do for dust mite allergy is expensive and time intensive and somewhat disruptive.

Melanie: So, then, what are those tests?

Dr. Johns: Well, we do a skin test and then we have a similar test that’s done through a blood test. So, allergy skin tests are done by a variety of methods. It’s a very safe test and very small amounts of dust mite extract, and you don’t want to know how they make dust mite extract, but very small amounts are introduced underneath the skin and cause a reaction similar to a mosquito bite that tells us the person is allergic. The blood test is basically a blood draw and it does a similar thing. It measures specific IgE antibodies against dust mite. And, again, they’re equally accurate. People seem to have strong feelings about which type of test they would prefer but they’re equally accurate.

Melanie: So, then, if you have detected that somebody does have this allergy to dust mites, what can they do about it at their home level? What is the first line of defense that you would like them to do? Do they change their bedding? Do they prefer dry environments or humid? What should they do?

Dr. Johns: So, there certainly has been a lot of revisionism in the last 20 years or so about what you can do to affect dust mite. The focus has been on a couple of things which are easy for me to talk about but very difficult and expensive and disruptive to do. So, unfortunately, things like air cleaners and air filters and doing a lot of cleaning and what have you really hasn’t been shown to be very effective. It certainly doesn’t seem to make patients feel better. So, the focus has been on flooring in the bedroom. So, any kind of carpeting on the flooring is ideal for dust mites to grow in. So, we’re always better off without carpeting on the bedroom floor. Secondly, concrete floors like a basement bedroom or a concrete floor in a split level, again, is ideal for dust mites to grow on. They need that humidity. They like those damp conditions as you alluded to. Dust mites don’t grow very well on low humidity, so high humidity like a constantly damp floor is ideal to grow dust mites. The allergist’s nightmare of course is carpeting on a concrete floor. So, the most important thing that someone can do is to not have those carpeting and not have concrete floors in the bedroom. A third issue that’s frequently talked about is encasements. So, dust mites actively grow within mattresses and pillows and it’s difficult to remove them. But, in encasement where the entire pillow or entire mattress is encased in a dust mite proof cover can be very helpful to provide that barrier. You know, pillows can be washed or dry cleaned or replaced from time to time, but with a mattress, really, it boils down to that encasement.

Melanie: Then, what about medication intervention, antihistamines or nasal corticosteroids? Are there certain things that you recommend for people that do have an allergy to dust mites if they can’t go about, as you say, the expensive process of totally getting rid of these things?

Dr. Johns: Well, we can help somewhat with medication. It is one of the allergies that can sort of overwhelm a good medication. So, we focus on, these days, on topical steroids. The nose sprays work beautifully for perennial year-round allergens like dust mite. They are safe. They are very effective. We really coach patients to be patient with the topical steroid nose sprays because they do take a while to work. It’s more like weeks or months rather than the American way which is immediate turn overnight. But, they work very nicely. If there’s a lot of itching involved, we might add some antihistamine. But, I would say our topical steroid nose sprays are really our most effective medication here.

Melanie: And so, could you give us some cleaning advice? Is there any cleaning advice as far as you mentioned the carpets and the concrete floors? Do vacuum cleaners or the vacuum cleaners with filters, do any of these things make a difference?

Dr. Johns: No, I think there’s some wishful thinking there but we think that if you do a lot of cleaning and a lot of vacuuming, you’d basically stir up these heavy particles and might even cause things to be worse. So, it isn’t a matter or more cleaning or more dusting or more vacuuming.

Melanie: I don’t know if that’s great news, Dr. Jones, but in the last few minutes, can you please just wrap this up for us and tell the listeners what you want them to know about these difficult to control or manage little dust mites and why people with allergies really need to be concerned about them. What do you want them to know?

Dr. Johns: Well, again, I would emphasize that it’s a very common and a very important year-round allergen. We’re all exposed to them. Again, we do have effective medication treatment. We do have some avoidance or abatement measures that can be very helpful but some might be difficult to accomplish. We do have allergy shots or immunotherapy that’s very effective for dust mite as well, sort of as a last resort. So, we do have good treatment but, again, I’m going to emphasize, I really want to know whether a person is allergic to dust mite or not so here’s an area where the testing is really important.

Melanie: Thank you so much for being with us. It’s really great information. You're listening to The WellCAST with Allina Health. 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

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