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With a relentless focus on excellence in healthcare, Pullman Regional Hospital presents the Health Podcast.

Bill Klaproth: So what is genetic testing? What types of conditions does it help identify and what is genetic counseling and how can it benefit you? Let's find out with Ian Wallace, a genetic counselor at Pullman Regional Hospital. Ian, thank you so much for your time. So first off, what is genetic counseling?

Ian Wallace: Yeah, Bill, that's a question I actually get all the time, even from people in my own family who should know better, but they don't. Honestly, so many people have asked because they've never needed to know about their genetics before until they happen to get referred. And so that's the first time they've had to really think about what a genetic counselor might bring. So our main job is just to provide diagnostic testing options and support for families who may be at risk for an inherited condition. We are investigating the health problems that are present in the family, but I try to take puzzle pieces and assembled them to determine what's going on because it can be kind of a mystery sometimes. And you have to do some of that research and then actually maybe ordering the test, interpreting the test, which actually is a really important thing that we do that, you know, not everyone can necessarily interpret the genetic testing results on that end product, and then reviewing just all the different options available for them. Not really there to sell them on the idea of doing testing, really just them with options that are best for them and their families. And then we also support other medical professionals, just because a lot of physicians and nurses just don't have that background in genetics. So making sure everyone's on the same page for that patient care to give them the best care that they need in their situation.

Host: Well, that is really interesting. I like how you said your kind of assembling the different puzzle pieces. So then overall, what are the benefits of genetic testing?

Ian: Genetic testing can be really helpful for people who I just want to gain a better understanding of why they're experiencing whatever they are experiencing and what medical problems they're having. If we can diagnose that disorder, we can hopefully provide more personalized care and management, and staying ahead of the curve instead of waiting for things to happen by being a little bit more proactive on the surveillance that we're giving them. But then alternatively, even if we rule out disorders, that's just less things for people to worry about and they can go on their way, maybe researching to see maybe something else medically is going on, or maybe that is the end of their diagnostic journey. We've ruled those things out so they don't have to worry about them more. So that's really helpful for kind of both ways that it can go.

Host: So then I'm curious, what types of conditions does genetic testing help identify?

Ian: Yeah, there's thousands, probably more than 5,000, almost 6,000 now, a known genetic and chromosomal syndrome that have been identified. And so some of them are really rare, some of them are a little bit more common. And so since genetics can play such a major role in almost all aspects of our health, it's kind of an overwhelming question pill, to be honest, but we have, if we can break it down into different subsets, it can really help kind of define that better. So the main areas of genetic counseling that we think of are cancer, which is like someone having a personal or family history of cancer, prenatal, so usually seeing either people who are, you know, there's a pregnancy that's ongoing, or maybe in advance of pregnancy that got preconception state to screen for different disorders, or maybe a couple had multiple miscarriages and trying to find out the underlying cause, pediatric cases link which includes an assessment of children who have autism or developmental delays, or maybe some birth defects and trying to find out the underlying cause for those cases. And then finally the adult cases which don't fit neatly in those other ones. And some of the more common adult types of syndromes are connective tissue disorders or cardiac syndromes and trying to find that underlying cause for them. So those are the kinds of the main categories and looking for any number of thousands of different disorders.

Host: Wow, that's really interesting. So what about neurological conditions? Is that covered in genetic testing as well?

Ian: Absolutely. Yeah, so if it's in the, mostly, it's going to be in those pediatric or adult realms, depending on you know, the age of the person sitting there, but there are many, many different neurological disorders out there. Some of them are common disorders that we've almost all of us have heard of before, just as an example, like Huntington disease. But then there's very rare syndromes out there as well where maybe seizures or other, Neuro, MRI anomalies have been identified, that we can hopefully find an underlying cause for.

Host: So then who is a candidate for genetic counseling?

Ian: Since there just are so many disorders out there, that's a really broad question. So it's going to really based on what that patient has been experiencing or what their family has been experiencing. So one of the best kinds of just blanket statements you can say is that if someone's just concerned about these, you know, maybe they should talk to, maybe their primary care provider to see if they should be referred to a genetic counselor. And then hopefully as part of this interview, you know, my contact information hopefully is put out there as well. I'm always happy to answer any questions by phone or email. If someone just has, you know, those questions to see if they would be a good candidate to talk about these options.

Host: So you just mentioned a physician referring someone to a genetic counselor. So is genetic counseling typically covered by health insurance?

Ian: Yeah Bill, this is one of the most common questions I'm asked all the time and it's especially the case I think because I think we all heard that, you know, back in the olden days of genetics and the early two-thousands, genetic testing costs thousands and thousands of dollars. And as a result, obviously, insurance companies weren't too happy about even covering that. But some of the nice progress that we talked about earlier that's happened in our field as we've, you know, technology has allowed this testing cost to come way down. And as a result, insurance companies now generally cover the testing and the visit. There might be some co-pays or deductibles associated with either the visit or the testing. But generally speaking, we can say that most of these testing options we've been discussing are covered.

Host: Yeah, that is really, really good news. So is there anything else you want people to know about genetic counseling?

Ian: Well, not so much about broadly the field of genetic counseling, but specifically kind of what we're doing here at Pullman Regional Hospital, which is, I think a really nice construct that helps a lot of people. So, I'm in a relatively rural area. There's not a lot of genetic specialists anywhere around, but that's also the case for a lot of the United States. There's just not enough of us around, unfortunately. So one of the nice things that we're doing is not only seeing patients in person, but we also do telehealth by a webcam visit. And that's something we've been doing even before the kind of recent healthcare developments where a lot of people have been having to be at home to do their appointments, but we always have been doing that. So it's been really nice because even not just in rural areas, but even in major urban areas where you actually have maybe lots of genetic specialists available to you, there can be very long waitlists. Maybe six months, a year to actually be seen. And so no matter where someone is globally or in the United States, Pullman Regional Hospital allows us to see them and give them some great patient care without them even leaving home. So I think that's a really nice service that we're offering that's exciting and hopefully can help a lot of people.

Host: And then the last question, Ian, when someone comes in for a genetic test, how do you get the information you need? Is it a simple blood test?

Ian: So that's a good question. So usually if they're being seen, you know, right here in person, it's going to be a blood draw and that can be done, arranged remotely as well. But saliva test options, a little bit more in-depth than like the cheek swab that a lot of people have been familiar with, this is actually saliva or blood, are usually going to be the ways that we do this kind of testing. And so then what we've essentially done is assembled the panel of genes or the chromosomes that we're actually looking for that are the candidates for those underlying disorders. And then trying to rule out, you know, hopefully, lots of disorders at once. So that's kind of the strategy we like to use.

Host: Just so fascinating. And as you can see very beneficial for people to understand this information. Ian, this has really been great. Thank you so much for your time. We appreciate it.

Ian: Yeah, absolutely. Thank you very much for having me on

Host: That's Ian Wallace. And to learn more about genetic counseling providers and services at Pullman Regional Hospital, please visit Pullmanregional.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Health Podcast from Pullman Regional I'm Bill Klaproth thanks for listening.