University of Virginia Health System http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva Tue, 12 Sep 2017 23:00:38 +0000 FeedCreator 1.8.3 (obRSS 1.9) http://radiomd.com/images/podcast-uvhs.png University of Virginia Health System http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva Signs of Stroke: FAST (Face, Arm, Speech, Time to call 911) http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=35514-signs-of-stroke-fast-face-arm-speech-time-to-call-911 signs-of-stroke-fast-face-arm-speech-time-to-call-911Stroke can happen at any age, even in infants. In fact, one-third of strokes happen to people under age 65.

Many of the risk factors for stroke can be changed. Smoking, obesity, heavy drinking, high blood pressure — all can play a role, as can conditions such as heart disease.

In this segment, Dr. Nicole Chiota-McCollum discusses why it is important for you to know the signs of a possible stroke, learn your risk factors and identify what you need to do if you suspect you or a loved one is having a stroke.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: Null
  • Audio File: virginia_health/vh179.mp3
  • Location: Null
  • Doctors: Chiota-McCollum, Nicole
  • Featured Speaker: Nicole Chiota-McCollum, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Nicole Chiota-McCollum, MD was born and raised in Ocala, FL. In 2004, she graduated from Furman University located in Greenville, SC. There she double majored in biology and Spanish language and literature. In 2008, she graduated from Georgetown University School of Medicine.

    Learn more about Nicole Chiota-McCollum, MD
  • Transcription: Melanie Cole (Host): Stroke can happen at any age. In fact, one-third of strokes happen to people under the age of 65. Many of the risk factors for stroke can be changed – smoking, obesity, heavy drinking, high blood pressure all can play a role as conditions such as heart disease. It’s important for you to know the signs of a possible stroke, learn your risk factors, and identify what you need to do if you suspect if you or a loved one is having a stroke. My guest today, is Dr. Nicole Chiota. She’s a neurologist at the UVA Health System. Welcome to the show, Dr. Chiota. Tell us about stroke. What exactly is a stroke?

    Dr. Nicole Chiota (Guest): Thanks, Melanie, I’m happy to be here. Stroke is an interruption of the normal blood flow to the brain. That can actually come in two different forms. There's a type of stroke called a bleeding or hemorrhagic stroke, which is really the minority of stroke that we see – it only accounts for 10 to 15% of strokes. The much more common type of stroke that we see is what we call an ischemic stroke where there is a blood clot that interrupts the blood flow to the brain, depriving the brain tissue of the oxygen and sugar that it needs for normal function.

    Melanie: What puts somebody at higher risk for having one of these strokes?

    Dr. Chiota: You mentioned a bunch of the risk factors that we typically think of. The same risk factors that put people at risk of developing heart disease also apply to developing stroke. High blood pressure, smoking, diabetes, obesity, an irregular heart rhythm called atrial fibrillation -- which can also be associated with heart disease in general, is another major risk factor. When someone comes to us with stroke-like symptoms, the first thing that we want to do is identify if in fact there has been a stroke – either a bleeding or an ischemic stroke. Then the next course – or the next phase of care is really identifying what any particular individual’s risk factors are, and then trying to mitigate those risks – implementing prevention strategies to reduce their risk of having another event.

    Melanie: Well, let’s talk about something pretty important because there is a moniker that people should know if they think that they or a loved one are having a stroke. Tell us what that is and why time is brain, and that is so important when a stroke might be occurring.

    Dr. Chiota: You’re absolutely right. We have effective interventions for stroke, but they are only available to people within the first several hours of when symptoms start. Recognizing the signs of stroke, calling 9-1-1 and seeking attention as fast as possible is really the cornerstone of effective stroke care. Recognizing the signs of stroke means being aware, and there’s an acronym, FAST, F-A-S-T, that you can remember to help keep the signs and symptoms of a stroke on top of the mind if you will.

    The F stands for facial droop. The A is for arm weakness. S is for speech difficulty. If you have any of those symptoms, the T stands for time to call 9-1-1. Face, arm, speech, time to call 9-1-1. There’s been a recent analysis of how sensitive those symptoms are to detect stroke, and what they actually found was that it’s very good. About 85% of stroke patients have one of those three symptoms. If you’re already familiar with the acronym FAST and you want to go to the next level of knowledge, you can add BEFAST to your awareness -- B meaning balance and E being eyesight symptoms. If you include those two symptoms, it actually increases your sensitivity to detect stroke up to 95%. Balance, eyesight, face, arm, and speech are symptoms you want to keep in mind, and if you have – if you or any of your loved ones have any problems in those arenas, you want to call 9-1-1 because we would want to evaluate urgently for stroke.

    Melanie: Dr. Chiota, what is the importance of calling 9-1-1 as opposed to driving a loved one to the hospital? Are there certain things the EMS can do on the way to the hospital that make it that much more important?

    Dr. Chiota: That is a great question, and the answer is yes. EMS, in our current system of care, pre-alerts the hospital that they are arriving – triaging the patient too -- so that a team is in place when that patient arrives for an expedited evaluation. Here at UVA, that means that the neurology stroke team is actually awaiting patients in the Emergency Department. We have the CT table cleared so that as soon the patient is deemed stable and safe to go to radiology; we can get that scan done as urgently as possible. We have pharmacy support ready in the event that we need to mix the clot-busting medicine called tPA and administer it as fast as possible.

    In the future, we anticipate that there may be other opportunities for advanced evaluation of patients while they’re still in the field, either using telemedicine or even by phone with the EMS providers to make sure that the patient is being triaged to centers that can provide the right level of care for the presenting symptoms.

    Melanie: Speak about what you do when you’re waiting there for this suspected stroke patient. You mentioned tPA and the clot-busting medication, so let listeners know what they can expect. What does that do?

    Dr. Chiota: tPA, the clot-busting medication, is the only FDA-approved medication that we have to treat acute ischemic stroke – the type of stroke where there is a blood clot. We actually all make tPA. It’s an endogenous substance, so it circulates in our bloodstream, but when we have a patient that we suspect that there is an acute blood clot, we can give a super dose of tPA to help the body break down the clot. What that does is restore blood flow to the area of the brain that has been robbed, if you will, of adequate oxygen and sugar stores. The idea is to restore blood flow to the area at risk around that brain tissue that hasn’t been receiving enough blood flow.

    In cases where we actually see the blood clot on vessel imaging, we can combine tPA with a procedure called thrombectomy. What happens with a thrombectomy is our interventional neuroradiologist or vascular neurosurgeons can actually place a catheter through the groin and snake that catheter up into the blood vessels of the brain and pull the clot out. There have been several studies in the past several years that the combination of tPA with that type of procedure actually dramatically increases the likelihood that someone will have a functional, independent neurologic recovery after a stroke compared with folks who receive only tPA alone or no intervention at all.

    Melanie: What is life like for stroke recovery and rehabilitation, and does this put someone at risk for having a recurrent stroke?

    Dr. Chiota: People who have had one stroke are at high risk for having a second. Even if you have stroke symptoms that resolve, which we would call a TIA or transient ischemic attack, that indicates to us that you are at high risk for having another event that could put you at risk for disability or even death. We take these events very seriously in trying to identify what any individual’s risk is, and therefore, direct our preventative strategies to that individual’s risk. For some, that means screening for that irregular heart rhythm called atrial fibrillation. We put patients who have atrial fibrillation on different medicines than those who do not to try to prevent stroke. Treating blood pressure, screening and treating for diabetes, smoking cessation, are things that we encourage in all of our patients who have had strokes of either the hemorrhagic or the ischemic type.

    In terms of life after a stroke, the fortunate thing is that strokes do get better. It takes time, and it takes rehabilitation. Working with our colleagues in physical therapy, occupational, and speech therapy, and the physicians who oversee all those therapy programs – in physical medicine and rehab – is a key part of stroke care. Our goal in evaluating people acutely is to offer interventions that will decrease the likelihood that patients will experience disability. But as I said before, really knowing the signs of stroke, seeking emergent attention if you were to ever experience them, and then, engaging in healthy lifestyles and having your risk factors treated is really the key to preventing disability from stroke.

    Melanie: Dr. Chiota, tell us about the Stroke Center at UVA Health Systems achieving the target Stroke Elite Plus Honor Roll, which is the higher honor role for stroke centers.

    Dr. Chiota: Yes, thank you, Melanie. We are very proud of this distinction that we’ve recently received. What it basically means is that we provide the highest level of care for patients presenting with complex vascular neurology problems -- whether that be TIA, hemorrhage, subarachnoid hemorrhage, ischemic stroke. We offer a 24 hour, 7 days a week program with coverage from the moment the symptoms are identified in the field, and we’re pre-alerted, and our team is ready to greet people in the Emergency Department, through potentially intensive care and the interventions that we offer, and then all the way out into the outpatient setting where we have our outpatient clinic coordinators to ensure that the stroke care that we offer from stroke onset all the way through the rehabilitative process is as comprehensive as it can be.

    Melanie: Wrap it up for us, with your best advice about stroke awareness, knowing your risk factors, and also knowing what to do if you suspect that you or a loved one is having a stroke.

    Dr. Chiota: Awareness is key. Remember FAST – Face, Arm, Speech, Time to call 9-1-1. If you can remember BEFAST where Balance and Eyesight problems are also signs of stroke. Calling 9-1-1 to seek emergent care as soon as any of those symptoms are recognized in either yourself or a loved one is of paramount importance. And beyond that, knowing your risk factors, working with your primary care physician to make sure that your blood pressure, and your sugar, and your cholesterol are under control, engaging in a healthy lifestyle – all of those things are the way to prevent stroke and ensure a long, healthy, and functional neurologic existence [LAUGHTER].

    Melanie: Thank you, so much, for being with us today, Dr. Chiota. It’s really important information for listeners to hear. If you’d like to assess your risk of stroke, you can go to uvahealth.com/services/stroke-center, that’s uvahealth.com/services/stroke-center. This is UVA Health Systems Radio, and I’m Melanie Cole. Thanks, so much, for listening.
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  • Hosts: Melanie Cole, MS
Tagged under: Stroke]]>
David Cole Mon, 05 Jun 2017 21:56:33 +0000 http://radiomd.com/uvhs/item/35514-signs-of-stroke-fast-face-arm-speech-time-to-call-911
Hematologic Malignancies and Stem Cell Transplantation http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34985-hematologic-malignancies-and-stem-cell-transplantation hematologic-malignancies-and-stem-cell-transplantationUVA Cancer Center has a team of dedicated physicians who specialize in the diagnosis and treatment of non-cancerous (benign) blood disorders, including those that are secondary to hematologic or other cancers. Our hematopathologists are experts in identifying rare and complex diseases of the blood, and our benign hematology physicians and nurses offer superior care for patients in whom blood disorders have been diagnosed.

Dramatic advances have been made in recent years for most hematological cancers because of research. Novel targeted therapies, which complement or replace traditional chemotherapy and radiation treatments, are now routine for many hematological malignancies.

Listen as Karen Ballen, MD discusses Hematologic malignancies and stem cell transplantation at The UVA Cancer Center.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: Null
  • Audio File: virginia_health/vh178.mp3
  • Location: Null
  • Doctors: Ballen, Karen K.
  • Featured Speaker: Karen K. Ballen, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Karen K. Ballen, MD is the Director of Stem Cell Transplantation at UVA Cancer Center and Professor of Medicine at UVA School of Medicine.

    Learn more about Karen K. Ballen, MD

    Learn more about UVA Cancer Center
  • Transcription: Melanie Cole (Host): UVA Cancer Center has a team of dedicated physicians who specialize in the diagnosis and treatment of blood disorders. The hematology physicians and nurses offer superior care for patients in whom blood disorders have been diagnosed. My guest today is Dr. Karen Ballen. She's the Director of Stem Cell Transplantation and Hematologic Malignancies at UVA Cancer Center. Welcome to the show, Dr. Ballen. So, what conditions would be associated with hematologic malignancies? Explain what that is to the listeners.

    Dr. Karen Ballen (Guest): Well, thank you so much for having me on. My mother asked me the same question. So, hematologic malignancies refer to cancers of the blood and most of patients that we see have either leukemia, a type of blood cancer, lymphoma, Hodgkin's Disease, or multiple myeloma. It would also encompass patients who have what we call “myo-proliferative diseases”. Some of those are diseases such as chronic myeloid leukemia or myelofibrosis. So, these are all cancers of the blood.

    Melanie: First of all, who's at risk for blood type cancers?

    Dr. Ballen: Well, unfortunately, we all are at risk, and as we get older, the risk of having a blood cancer goes up. Blood cancers aren't necessarily related to any lifestyle choices such as smoking or alcohol or where you live. We are still really learning about why people get them. So, we actually all are at risk for developing a blood cancer.

    Melanie: Are there any genetic components to them?

    Dr. Ballen: There are genetic components in that there are different genetic mutations that can contribute to blood cancers, but most of these are not passed down in families.

    Melanie: So, what symptoms would somebody experience that would send them to somebody to get checked in the first place?

    Dr. Ballen: Well, you know, often the symptoms are very mild. It might be fatigue or a headache, or sometimes easy bruising, and sometimes it is difficult. Some patients do see several doctors or maybe have gone to the emergency room before the diagnosis is made, but certainly, a fatigue that seems out of proportion to what one usually has, easy bruising, fevers and infections that don't go away would all be signs that people should get blood counts checked and get further care to make sure that there's no problem.

    Melanie: So, if you do the blood counts and you diagnose with lymphoma or Non-Hodgkin's, or one of these things you've mentioned, what is the next step for that person?

    Dr. Ballen: Right. So, these diseases are usually diagnosed either on a bone marrow test or on a biopsy of a lymph node, and then once a diagnosis is made, we'll evaluate the patient here at UVA and often, will work with our colleagues in other specialties such as radiation, or surgery, to give the patient the best care possible. Fortunately, most of these diseases are curable and patients will then start on a treatment plan often involving chemotherapy. The good news is that our chemotherapy these days is a lot easier to take. We have many medicines for nausea to make patients more comfortable. So, in many cases, we will have an excellent outcome.

    Melanie: You mentioned radiation. Can you use radiation therapies for blood cancers when blood is moving and it's not in a specific spot?

    Dr. Ballen: Well, that's a great question. So, for some of the blood cancers like leukemia, we don't usually use radiation, but for others such as lymphoma, or Hodgkin's disease, particularly if the disease is localized in a specific spot, then sometimes radiation can be very successful and sometimes it's given by itself, or maybe in combination or after chemotherapy.

    Melanie: So, Dr. Ballen, speak about stem cell transplantation and how that works. Give the listener a little working definition of what that is and hematopoietic cell transplantation.

    Dr. Ballen: Right. So, we all have stem cells in our bodies. These are the cells that make all of our blood cells. Our red cells that carry oxygen and white cells that fight infection and platelets that help to clot the blood. When someone has a stem cell or bone marrow or hematopoietic cell transplant, we're all talking about the same thing. It's basically taking someone who has a bone marrow disease and replacing their abnormal bone marrow with a normal bone marrow from a donor. That donor could be a brother or sister. Nowadays almost everyone has a donor, either in their family, through the only related registry, or through something through what we call umbilical cord blood. Blood that normally just gets thrown out when a woman has a baby, can also be used to save someone's life in a transplant.

    Melanie: How does that work, then, and then just explain a little bit for the listeners about transplant related morbidity and what they can expect as far as rejection of the marrow or the stem cells? How does that all work?

    Dr. Ballen: Right. Well, for the donor, the donor usually has the easy part. The donation is usually done as an outpatient and usually takes several hours. For the patient, it is a long process. The patient may be hospitalized for several weeks here at UVA. During that time, they're receiving intensive chemotherapy and what we call supportive care--antibiotics and transfusions and medicines to make them feel more comfortable. So, it is an intensive procedure but, fortunately, it's something that we're getting better and better at and making it safer and easier for the patient to get through.

    Melanie: You mentioned that some of these are curable. What does that mean for the patient and how do you know?

    Dr. Ballen: Right. So, when we say curable, it means that the patient has no evidence of their disease and often, you know, to be honest, that means that they're living 15, 20, or 25 years later and maybe getting hit by a bus or some other event happens but unrelated to the cancer. So, for many of these cancers, if the disease has not come back in a five-year interval, it's very unlikely that it would and so that's also an important landmark in many of these diseases.

    Melanie: Are there any current clinical trials at UVA?

    Dr. Ballen: Yes. So, we have many clinical trials at UVA. Some of them relate to choosing the best donor for a patient who is undergoing a stem cell transplant, that's a very large, national study. We're also looking at using different types of chemotherapy and immunotherapy to help fight cancers. That's a new way of treating blood cancers by using the immune system to help fight the cancer. That's the focus of many of our clinical trials at UVA.

    Melanie: Dr. Ballen, if somebody is interested in being a bone marrow or stem cell donor, what should they know? What do you want them to do?

    Dr. Ballen: Well, the best way to find information is through the international registry which is called “Be the Match” and they can find that information online. And to become a donor, all it takes nowadays is just a cheek swab that puts the DNA sample into the registry.

    Melanie: So, tell us about your team at the UVA Stem Cell Transplant program.

    Dr. Ballen: Right. So, we have an excellent team. It certainly does take a village to care for these patients in the best manner possible and we're fortunate to have an excellent team of physicians, nurses, coordinators, physical therapists, dieticians, social workers all really working to help in the care of the patient. It's the people sometimes they don't see who are most important for their care, that includes everyone that keeps the hospital running from an administrative and facilities standpoint; it's the people in pathology reading the slides; people reading their X-rays, that often also have a big impact on a successful outcome.

    Melanie: So, wrap it up for us, if you would, Dr. Ballen, with your best advice for people that are concerned about blood cancers and what you want them to know about the UVA Cancer Center.

    Dr. Ballen: Yes. Well, I think unfortunately cancer affects all of us. We've almost all had a friend or family member that's affected by cancers. I think the good news is that the majority of these patients are curable, while the treatment is not easy, it is often successful and, therefore, patients should be hopeful and we're certainly happy to work with the patient on their journey through this.

    Melanie: Thank you so much for being with us. It's really great information. You're listening to UVA Health Systems Radio and for more information, you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Blood Disorders]]>
David Cole Tue, 14 Mar 2017 23:25:49 +0000 http://radiomd.com/uvhs/item/34985-hematologic-malignancies-and-stem-cell-transplantation
Cancer Center Learning Resource Center http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34839-cancer-center-learning-resource-center cancer-center-learning-resource-centerUVA Cancer Center treats patients for their disease but places equal emphasis on their well-being throughout the process. Learning about your condition is a great way to be an informed patient. 

Listen as Lydia Witman, MLIS discusses the Cancer Center Learning Resource Center at UVA Health System. 

Learn more about the UVA Patient and Family Library

Learn more about The Cancer Center Learning Resource Center

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1649vh3e.mp3
  • Location: Null
  • Doctors: Witman, Lydia
  • Featured Speaker: Lydia Witman, MLIS
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Lydia Witman, MLIS is the manager in the Patient and Family Library at UVA Medical Center.

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

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

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

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

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

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

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

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

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

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

    Melanie: Thank you so much for being with us today, Lydia. You’re listening to UVA Health Systems Radio. And for more information, you can go to www.uvahealth.com. That’s www.uvahealth.com for more information on the Cancer Center Learning Resource Center. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Cancer, Health Care]]>
David Cole Thu, 23 Feb 2017 00:16:27 +0000 http://radiomd.com/uvhs/item/34839-cancer-center-learning-resource-center
A Prescription for Information? The UVA Patient and Family Library Is There to Help http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34838-a-prescription-for-information-the-uva-patient-and-family-library-is-there-to-help a-prescription-for-information-the-uva-patient-and-family-library-is-there-to-helpWhat would you say if your doctor gave you a prescription to gather information on your particular condition? This is when the UVA Patient and Family Library can help. A more informed patient can be a better patient, with better outcomes. 

Listen as Lydia Witman, MLIS discusses information prescriptions as a way for your doctor to guide you to be your own best health advocate. 

Learn more about the UVA Patient and Family Library

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/vh176.mp3
  • Location: Null
  • Doctors: Witman, Lydia
  • Featured Speaker: Lydia Witman, MLIS
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Lydia Witman, MLIS is the manager in the Patient and Family Library at UVA Medical Center.

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

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

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

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

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

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

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

    Lydia: No.

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

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

    Melanie: Well, it certainly is a quiet place to study, read or wait. You can go to the Patient and Family Library and find that information on www.hsl.virginia.edu. You’re listening to UVA Health Systems Radio. And for more information on the Patient and Family Library, you can go to www.uvahealth.com. That’s www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Health Care]]>
David Cole Thu, 23 Feb 2017 00:12:21 +0000 http://radiomd.com/uvhs/item/34838-a-prescription-for-information-the-uva-patient-and-family-library-is-there-to-help
Understanding Health Information and Terminology http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34837-understanding-health-information-and-terminology understanding-health-information-and-terminologyWhat does it mean to be your own best health advocate? It is The knowledge, ability, and confidence to find and evaluate information about your own health.

The Patient & Family Library in the University Hospital lobby near the Information Desk, is a good place to find easy-to-understand health information. 

Listen as Lydia Witman, MLIS discusses ways to help you understand your health information and be an informed patient.

Learn more about the UVA Patient and Family Library

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/vh177.mp3
  • Location: Null
  • Doctors: Witman, Lydia
  • Featured Speaker: Lydia Witman, MLIS
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Lydia Witman, MLIS is the manager in the Patient and Family Library at UVA Medical Center.

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

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

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

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

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

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

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

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

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

    Lydia: Absolutely.

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

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

    Melanie: And that website is www.hsl.virginia.edu/pfl. And you can find out more information about the patient and family library at the UVA Medical Center. Such great information, Lydia. Thank you so much for being with us today. It’s important that people understand to be their own best health advocate and that their providers do appreciate when they are an informed patient. So, thank you so much for the great information. You’re listening to UVA Health Systems Radio. And for more information you can go to www.uvahealth.com. That’s www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Health Care]]>
David Cole Thu, 23 Feb 2017 00:01:13 +0000 http://radiomd.com/uvhs/item/34837-understanding-health-information-and-terminology
Precision Breast IORT http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34518-precision-breast-iort precision-breast-iortPrecision Breast IORT (intraoperative radiation for breast cancer) offers an image guided radiation treatment option for women with early stage breast cancer who apply for and are accepted into the study. With this unique form of IORT, subjects receive concentrated radiation at the time of their lumpectomy combining multiple procedures into a single visit.

Listen as Shayna Showalter, MD discusses Precision Breast IORT, a clinical trial option for women with early-stage breast cancer.

Additional Info

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Melanie: Thank you so much for being with us today, Dr. Showalter. You're listening to UVA Health Systems Radio. For more information you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Breast Cancer, Women’s Health]]>
David Cole Sun, 08 Jan 2017 22:59:40 +0000 http://radiomd.com/uvhs/item/34518-precision-breast-iort
International Travel and Vaccines http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34427-international-travel-and-vaccines international-travel-and-vaccinesAt UVA Travelers' Clinic, we provide pre-departure assessments and counseling for any international traveler. We see adults and children who may travel for:

Vacation, including visits to friends and relatives
Business, including health-care related work.

We focus on illness and injury prevention information. We also offer guidance and medication for self-treatable conditions such as traveler's diarrhea, altitude sickness and jet lag.

Listen in as Tania Thomas, MD discusses the UVA Travelers' Clinic where you can find reliable information on vaccines for safe travel.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1649vh3c.mp3
  • Location: Null
  • Doctors: Thomas, Tania
  • Featured Speaker: Tania Thomas, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Tania Thomas is an Assistant Professor in Infectious Diseases and International Health at UVA School of Medicine. She oversees the UVA Traveler's Clinic and provides counseling to foreign and domestic travelers on the vaccines they should be getting for safe travel.

    Learn more about Dr. Tania Thomas

    Learn more about UVA Travelers' Clinic
  • Transcription: Melanie Cole (Host): Travelling abroad requires more than just a passport. Travel to certain foreign countries requires individuals to have certain vaccines as a health precaution. UVA has a traveler's clinic that has all the information and can provide vaccines for safe travel. My guest today is Dr. Tanya Thomas. She's an Assistant Professor in Infectious Diseases and International Health at UVA School of Medicine. Welcome to the show, Dr. Thomas. Tell us about the UVA Travelers' Clinic. What services do you provide?

    Dr. Tanya Thomas (Guest): Yes, thank you, Melanie, for having me on. The UVA Travel Clinic is a medical clinic and it focuses on pre-departure assessments and personalized counseling for international travelers. You know, foreign travel is really becoming so much more common these days and it really takes on many forms. Aside from people traveling for like vacation or business-related work, we routinely see people who are traveling to study and work abroad or people who are embarking on medical missions or research trips, as well as people who are returning to their home countries or visiting friends and relatives. So, as you can gather, you know, each itinerary is just as unique as the purpose of the travel and so, our job is to really to combine our knowledge of the epidemiology and preventable conditions with the traveler's itinerary and their own medical conditions that they bring and other kind of personal risk profiles. So, we use all of this information and we cater advice to prevent injury and illness while traveling.

    Melanie: So, who should seek appointments at the UVA Travelers' Clinic and how are the appointments received?

    Dr. Thomas: Well, actually the Center for Disease Control and Prevention recommends that any international travel should have a travel medicine visit, but we really feel that this is especially important for those who are traveling to a low- or middle-income country and those travelers who have existing medical conditions. At the travel clinic, we really welcome any child or adult who's traveling for any reason and appointments can be made by scheduling this with our front office associate.

    Melanie: So, give us some general travel health advice. What do you tell people every day, Dr. Thomas, that you want them to be aware of and when they come for that medical appointment before travel, what do you tell them about the importance of vaccinations and what they should they be bringing with them, what they should look out for? Just give us some good, general travel health advice.

    Dr. Thomas: You know, I think that travel health advice really does start with just making sure that the routine kind of preventive medical conditions that we face here in America are definitely addressed and already kind of dealt with, right? So, that's just routine vaccinations for living, living here. We recommend that everyone be aware of their vaccination status, and so we do ask people to bring in their immunization records which is sometimes really hard to get, but we really try and work together in order to make sure that everything that has been recommended has already been received for domestic, everyday kind of life, but then we evaluate the individual person and really what their activities are going to include while they're traveling. We use this information to make a judgment call on what the potential risks of exposure may be and what vaccinations would be beneficial for the traveler. In many cases, there are some that are so routinely recommended that it's commonly given based on the country of travel, but for other things, it's very much dependent upon the nature of the trip, what activities the traveler is going to be engaged in, if it's kind of eco-tourism and a lot of time outdoors, if this is the season that has peak mosquito activity, and things like that to really help cater what vaccinations we recommend. In addition, we talk about conditions that every traveler should be aware of to reduce risk from a health perspective and from preventive medical conditions including things like traveler's diarrhea. We give them advice and education on how to stay safe and healthy from a food and water sanitation perspective and we also give medications for self-treatable conditions related to this.

    Melanie: What about health insurance? Should they check if their health insurance works in other countries?

    Dr. Thomas: That's always a very good idea to do. That's one of the three steps for being prepared is actually knowing a lot about your own medical condition and then what is going to be covered and not covered based on what insurance services you have domestically. So, a quick call to your insurance company can be very helpful with this and, in many cases, there are some things that are not covered and in those circumstances, we encourage people to get supplemental insurance, including medical evacuation insurance for emergencies. We also provide information on how to get in touch with the local US Embassies and Consulate services if there are any emergencies that occur while on the trip.

    Melanie: How early do you recommend people examine what vaccines they might need if they're going to a third world country or one of those types of places where you might need a vaccine? How much in advance do you tell them that they need to start looking into this?

    Dr. Thomas: Well, we like to see people in our clinic at least four to six weeks before departure and so, that means that kind of backtracking, that it would be good to really get a handle on your own vaccine records and other medical conditions, other prescriptions, things like that, at least six to eight weeks before departure. This gives us enough time in order to administer the necessary vaccines but it also allows the body sufficient time to create a robust immune response, which is going to be the key to really preventing these medical conditions while abroad.

    Melanie: Dr. Thomas, what do you tell people is important for them to bring with them if they are going abroad? A prophylactic antibiotic, or if they do have a medical condition, obviously, their medications well-marked, but what else do you tell them to bring with them?

    Dr. Thomas: So, a lot of this depends upon where they are going and how long they are going, right? So, every trip is slightly different, but I do recommend that people have an emergency medical kit with them, with some of the basics that one may be able to get at a local pharmacy while here, but on your travels, sometimes it's a little bit harder to access some of the things that are familiar to us. And so, in order to save them one step, we recommend that everyone have their own emergency medical kit with them. In addition, it's important to have your own prescriptions that you may be taking day-to-day here available with you on your travels in well-labeled bottles with the original prescription label on them as to prevent any kind of confusion when traveling. I think it's also really important for people to have an emergency medical card if they have any pre-existing conditions, pre-existing allergies, things like that and so, if there are any troubles, there's a way for someone to quickly identify what the high-risk things may be for that individual. And then, of course, during the travel clinic visit, we talk a lot about some of the basics for preventing any illnesses from mosquitos, right? So, we talk about the proper use of bug spray for your skin as well as for treatment of the clothing. We talk about taking malaria prophylaxis and we give medications for that, prescriptions for that. We also talk a lot about traveler's diarrhea and we provide education on how to prevent traveler's diarrhea. What are good food choices and how to be aware of proper food storage and handling tips. We talk a lot about safe water and then we review different over-the-counter medications that may be helpful to take on your travels as well as provide prescriptions for antibiotics that can treat traveler's diarrhea, if this should occur.

    Melanie: What a great service you're providing. Wrap it up for us, if you would with just your best advice for people that are traveling to a foreign country and what you would really like them to know about the UVA Traveler's Clinic and when they should come see you.

    Dr. Thomas: Well, I think that it's very important to be an informed traveler, to be really prepared and know about the destination that you're going to visit and be very well-versed about your itinerary and what you may come into contact with or what you anticipate or hope to come into contact with on these excursions. I think it's very important to know all about your own health status and be proactive in really being able to mitigate and minimize any illnesses and injuries while on your travels. So, at the UVA Travel Clinic, we really work with individuals to combine all of this information to make sure that these trips are as fun and rewarding, safe and healthy as possible.

    Melanie: Thank you so much for being with us today and for more information on the UVA Travelers' Clinic, you can go to www.uvahealth.com. That's www.uvahealth.com. You're listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Vaccinations]]>
David Cole Wed, 21 Dec 2016 00:59:41 +0000 http://radiomd.com/uvhs/item/34427-international-travel-and-vaccines
Debunking Clinical Trials Myths http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34378-debunking-clinical-trials-myths debunking-clinical-trials-mythsA clinical trial is a scientific study that tests the effectiveness of a treatment, a device or a drug. A trial could test, for example, the effectiveness of blood pressure medication in lowering blood pressure or whether a certain drug could decrease cholesterol.

Clinical Trials are important in finding new cures for diseases, yet many people are skeptical of participating in clinical trial.

Dina Halme, Ph.D  discusses the importance of clinical trials and myths that are associated with them.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1649vh3b.mp3
  • Location: Null
  • Doctors: Halme, Dina
  • Featured Speaker: Dina Halme, Ph.D
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dina Halme, Ph.D is the Associate Director for Research Program Administration for UVA Cancer Center. An immunologist by training, she is focused exclusively on facilitating research done by the member of the Cancer Center. Because of her scientific background, Halme contributes to fostering collaborations and thinking strategically about recruitment efforts.

    Learn more about Dina Halme, Ph.D
  • Transcription: Melanie Cole (Host): Clinical trials can be so important in finding new cures for diseases, yet many people are skeptical of participating in one. My guest today is Dr. Dina Halme. She’s the Director for Research Administration and Strategic Planning for UVA Cancer Center. Welcome to the show, Dr. Halme. What is a clinical trial?

    Dr. Dina Halme (Guest): Good afternoon, Melanie. Thank you for having me on. A clinical trial is really just a research study that involves people. The study will explore whether a medical approach or treatment or device is safe and effective for humans. So, really, a great way to think about is that all of the current treatments for breast cancer such as Herceptin, aromatase inhibitors, tamoxifen, radiation-- all of the things that we do right now to treat breast cancer patients were studied in several clinical trials. I think that you could extend that to say that clinical trials are an essential step in discovering new ways to prevent, detect, diagnose, and treat cancer. Clinical trials are particularly important because they help researchers learn both what does and what does not work in people. Our focus is generally on treatment but it’s also important to note that clinical trials can tell us more than whether a treatment works. They can help answer questions like, does the treatment work better than other treatments; does it have any side effects; if it does have side effects, are those side effects acceptable when weighed against the benefits of the treatment? So, really, clinical trials are essential to our being able to advance medicine.

    Melanie: Do they typically happen, because people have this question, before FDA approval or after?

    Dr. Halme: Ah, so there are two kinds and the majority of them occur before FDA approval. In order to get FDA approval, you have to be able to demonstrate to the FDA that the medication or treatment that you would like to have their approval for is both safe and effective in people and the only way to do that is through a clinical trial. After FDA approval, there’s something called “post approval monitoring”. And there may be trials that would involve, rather than a small number of people, hundreds of thousands of people over a long period of time to see if there are any unexpected side effects or long-term consequences of the drug.

    Melanie: Why do you think that people are skeptical of clinical trials?

    Dr. Halme: I think that people worry that either they’re going to be guinea pigs or that they won’t be getting the best possible treatment and I would really like to reassure people that neither of those things are true. For instance, in a clinical study with cancer patients, a cancer patient cannot be given a placebo or a therapy that’s known to be ineffective. So, a placebo can’t be used if it would mean putting people at risk by denying them effective therapy. So, patient’s participating in cancer treatment clinical trials must be given the standard treatment. Now, sometimes the study might be comparing standard treatment plus a new drug and then the comparison would be standard treatment plus placebo. But, you see, in either case, the patient is always getting what we know to be the best available therapy to date. So, I think that that’s one fear. And, another fear really is related to whether people are approached about clinical trials only if they are out of other options. And, I’d like to hopefully debunk that myth as well. So, basically, clinical trials in some cases are reserved for cancer patients who’ve exhausted all of their other treatment options but most studies are designed to compare the current standard treatment with the one being developed. These would be open to patients with earlier stages of disease or they might be other kinds of trials like trials to study methods for preventing cancer and people with high risk or detecting and diagnosing cancer or even preventing recurrence in patients with cancer is in remission or has hopefully been cured. And then, there’s a whole area of clinical trials which I think is increasingly appealing to patients to participate in, which is improving the quality of life of cancer patients and survivors, particularly because many of the treatment regimens for cancer are so difficult for patients in the process of being treated.

    Melanie: I’m glad that you pointed out that they’re not just for people who have no other options. And, let’s bust up a few more myths. Do health insurance companies cover the cost of a clinical trial?

    Dr. Halme: Great question. So, it depends. Your health insurance may pay for some or all of the treatment. Most of the time, the way it works is the study or the clinical trial will pay for the study therapy and insurance companies will pay for the routine care. So, it is unusual that a patient would participate in a study where it would cost them anything to participate. Usually, the costs are covered either by insurance or by the study itself.

    Melanie: What’s informed consent? And if, once you’ve defined it for us, once you’ve signed that form, do you, are you legally bound to participate in this trial?

    Dr. Halme: Ah, another great question. So, informed consent means that before a patient agrees to participate in a study, they really need to know what they are agreeing to do. So, they’ll be informed of the potential benefits but equally importantly of the potential risks of participating in the study. And, it’ll be explained to them why researchers and physicians think that this is a good idea to test in the clinical trial. So, they need to have all of their questions answered before they can give informed consent. And so patients should really feel free to ask as many questions as they need in order to get all of the information they feel they need in order to make an informed choice or give informed consent. However, once a patient gives informed consent, they are in no way bound to maintain being in the study. So, a patient can quit a clinical study for any reason at any time. So, I want to say that again. Patients can quit a study for any reason at any time; just because they don’t want to anymore is totally sufficient and this will not affect the quality of care that they receive if they decide to withdraw from a study or if they decide not to participate in first place.

    Melanie: I think another fear or another myth that we can break up here: can patients expect to be, to have reviews on what’s going on with them. They feel that they can’t always expect the medical personnel to keep them informed and that they just have to go through blind.

    Dr. Halme: So, I think that is also a myth. I think that the same way any patient who’s receiving medical care of any kind should feel empowered to ask their care providers what’s going on. The same is true for patients participating in clinical trials.

    Melanie: I’m glad you said that because people feel like if they’re given results and information during a clinical trial that it ruins the end result of the trial but that’s not true, yes?

    Dr. Halme: That is not true.

    Melanie: And, you also mentioned the placebo situation. What do you tell patients when they ask you, “Well, is there you know a randomized placebo? Is this. . . How does it work?”

    Dr. Halme: Well, it really depends on the trial and the thing that we make sure to do is to give accurate information to the patients about the particular trial that they’re being asked to consider participating in. So, placebos would really only be given if no standard treatment exists in a study to test drugs that might prevent cancer or, as I said before, in combination with a current therapy. So, placebos are never given when there is a therapy that could be offered.

    Melanie: And, what do you tell somebody who’s on the fence about clinical trials and they say, “Well, I’m just not sure if that’s for me.” What do you tell them about a reason if you think, as their doctor, that they should be involved? What do you tell them if they’re on the fence?

    Dr. Halme: Well, I tell them to keep asking questions, really. What are the risks? What are the potential benefits? What extra work will be required of them? Will it cost them anything? You know, ask as many questions as they have. Then, really think about what is the potential benefit for themselves? How risk averse are they? How afraid are they of untested risks, and then, really to encourage them to think about how they can expand knowledge or treatment. So, if a patient is unsure about whether or not to participate in a trial, I would strongly encourage them to ask lots of questions. But, ultimately, one of the things that help a lot of our patients decide to participate is that even if the study doesn’t help them, it’s expanding our knowledge or developing new treatments that may help others in the future.

    Melanie: Do they have to stop their standard therapy to participate in a clinical trial? If they are already in treatment, maybe chemotherapy or radiation, whatever it is, do they have to stop that standard therapy to participate?

    Dr. Halme: Usually not. Usually whatever the standard treatment is would be incorporated into the study because the study is designed to add on to standard treatment rather than to replace it.

    Melanie: And, what if this treatment, this clinical trial works for somebody and then the trial ends, will they not have access to that experimental medication or treatment when the trial ends, even if it is working for them?

    Dr. Halme: That’s a great question. So, it depends on whether or not the company is willing to continue to provide the drug. And, in most case, they are because there is something called “compassionate use” or “expanded access program”. And so, the drug will continue to be available, not through the trial because the trial may have ended, but through the same physician and from the same company that makes the drug.

    Melanie: And, in just the last few minutes, doctor, please just wrap it up for us about clinical trials; what you want people to know; and why they should look to UVA Health System Cancer Center for their care.

    Dr. Halme: Well, I think the most important thing is for people to remember that many of the wonderful treatments that we have available today are all dependent on the fact that other patients in the past were willing to participate in clinical trials. I would encourage everyone to take the opportunity to participate in a trial if one is offered to them. I think UVA Cancer Center is a great place for that because we offer trials across the entire spectrum: treatment, diagnosis, imaging, detection, prevention. And, in addition, we’re doing a long-term study that we’re approaching all of our cancer patients about called “Partners in Discovery for Total Cancer Care”. And it’s part of a consortium of fifteen centers around the country where we’re collecting data and leftover biological specimens. So, that would be if someone has surgery and we don’t need all of the tissue for clinical purposes. We’re collecting all of these data and specimens and sharing them to be able to have studies over time and resources available for patients to be included in studies in the future. So, UVA really has the whole gamut and I think that if patients were to come here, they’d be given the opportunity of whatever is the cutting edge standard treatment or the potential to participate in a trial where they may have access to something that they can’t get in the community.

    Melanie: That’s absolutely amazing and so glad to have spoken with you 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.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Clinical Trials]]>
David Cole Tue, 13 Dec 2016 02:23:05 +0000 http://radiomd.com/uvhs/item/34378-debunking-clinical-trials-myths
The Latest Research on The Cancer Crisis in Appalachia http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34325-the-latest-research-on-the-cancer-crisis-in-appalachia the-latest-research-on-the-cancer-crisis-in-appalachiaResearch from the School of Medicine shows that rural Appalachia now has the highest cancer death rates in the country. Nengliang (Aaron) Yao, PhD, and other researchers in UVA’s Department of Public Health Sciences examined decades of data obtained from the National Center for Health Statistics. They found that cancer incidence declined in every region of the country between 1969 and 2011 except rural Appalachia, where it increased. 

Listen in as Nengliang (Aaron) Yao, Ph.D discusses the research being conducted to help discover why the cancer rate is increasing in rural Appalachia.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1649vh3a.mp3
  • Location: Null
  • Doctors: Yao, Nengliang (Aaron)
  • Featured Speaker: Nengliang (Aaron) Yao, Ph.D
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Nengliang (Aaron) Yao, Ph.D is an Assistant Professor with the Department of Public Health Sciences.

  • 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.



  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Tue, 06 Dec 2016 01:32:59 +0000 http://radiomd.com/uvhs/item/34325-the-latest-research-on-the-cancer-crisis-in-appalachia
Signs That an Aging Loved One Needs Help http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34239-signs-that-an-aging-loved-one-needs-help signs-that-an-aging-loved-one-needs-helpPhysical and mental health decline often surprises family members, especially if aging relatives seemed fine the last time they were seen.

Hear from Laurie R Archbald-Pannone, MD, a UVA Geriatrician, about signs that indicate something may be wrong, so you and your loved one can properly prepare for the future.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1642vh5e.mp3
  • Location: Null
  • Doctors: Archbald-Pannone, Laurie R
  • Featured Speaker: Laurie R Archbald-Pannone, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • 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.





  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Aging]]>
David Cole Tue, 22 Nov 2016 01:42:46 +0000 http://radiomd.com/uvhs/item/34239-signs-that-an-aging-loved-one-needs-help
New Guidelines to Reduce Sudden Infant Death Syndrome http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34183-new-guidelines-to-reduce-sudden-infant-death-syndrome new-guidelines-to-reduce-sudden-infant-death-syndromeApproximately 3,500 infants die annually in the United States from sleep-related deaths, including SIDS, ill-defined deaths and accidental suffocation and strangulation. The American Academy of Pediatrics recently published new recommendations to reduce the risks, and UVA expert Dr. Moon was the lead author.

Listen in as Dr. Moon discusses these new recommendations and what you can do to keep your baby safe and healthy.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1642vh5d.mp3
  • Location: Null
  • Doctors: Moon, Rachel Y.
  • Featured Speaker: Rachel Y. Moon, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Rachel Moon is an internationally recognized expert in SIDS and postneonatal infant mortality, and serves as Division Head of General Pediatrics at the University of Virginia.

    Learn more about Dr. Rachel Moon

    Learn more about UVA Children’s Hospital
  • Transcription: Melanie Cole (Host):  Approximately 3,500 infants die annually in the United States from sleep related deaths, including SIDS, ill-defined deaths, and accidental suffocation and strangulation. The American Academy of Pediatrics recently published new recommendations to reduce these risks. My guest today is Dr. Rachel Moon. She's an internationally recognized expert in SIDS and post-neonatal infant mortality and serves as the Division Head of Pediatrics at the University of Virginia Health System. Welcome to the show, Dr. Moon. Let's start with these recommendations from the American Academy of Pediatrics. Is this new recommendations? What's changed?

    Dr. Rachel Moon (Guest):  We have updated the data and the research. The basic recommendations have stayed the same. We still want babies on their backs in a crib which is in their parent’s room. We want the crib to be flat and firm and well-fitting without any extra bedding, just the baby in the crib. Those kinds of things are all the same. We still want babies to be breastfed. We don't want them to be around smoke or families who have been drinking or things like that. There are some nuances that have changed. For instance, we now recognize that couches and sofas and cushioned chairs and things like that are very, very dangerous for babies. We don't want babies to be placed on those services to sleep. We also recognize that parents sometimes may accidentally fall asleep while they're feeding their baby, and if you think that's going to happen, then we want you to rather do that in your bed rather than on a couch or sofa or an armchair, and to remove all the bedding from your bed so that if you do accidentally fall asleep, it won't be quite as dangerous for your baby. There are some things like that which we have with increasing and newer data we have updated.

    Melanie:  Parents are always wondering if you put your baby on their back to sleep and for every sleep including naps but some babies start to roll over earlier than others. Do you keep going in and rerolling your baby? What do you do?

    Dr. Moon:  Well you know there's rolling over and there's rolling over. If it's a first time that the baby has rolled over and sometimes the babies will do it and you're not sure that they know how to do it again. A baby like that, I would actually roll them back over. If the baby is really pretty comfortable with rolling back and forth by him or herself, it's fine to leave them as they are. I would put them on their back to start with and then, if they roll over onto their stomach, it's fine to leave them as they are but I would make sure that there is nothing else in the crib, no blankets, no soft pillows, no stuffed animals, no bumper pads because we know that if babies roll into soft bedding, then sometimes they get stuck and they can't get out.

    Melanie:  You mentioned about if you fall asleep feeding your baby and it's in your bed. What do you think, Dr. Moon, about co-sleeping and sleeping with your baby in the bed as opposed to maybe just in your room in their own separate sleeping arrangement?

    Dr. Moon:  We don't recommend that because the data has shown that it is a more dangerous situation than having the baby in a crib next to the parents' bed. So, what we recommend is that a crib or a bassinette or a portable crib be placed right next to the parents' bed and then, that way you can have the baby close to you, and you can hear the baby, and you can monitor the baby, you can bring the baby into the bed to feed them, but that's going to be the safest place for the baby.

    Melanie:  The guidelines are indicating that babies should receive as much breast milk as possible for as long as possible. Does this help reduce those sleep related deaths?

    Dr. Moon:  Yes, it does. We don't exactly know why. There are a lot of different possibilities but we do know that babies who receive breast milk are at lower risk for SIDS.

    Melanie:  What else would you like parents to know? Things that should be avoided, you've mentioned things in the crib. What about the ambient air or noises or any of these kinds of things? Do they play a role in a child safe sleep?

    Dr. Moon:  There has been one study that showed that a fan in the room reduces the risk. Nobody else has been able to reproduce those results, so that's not a consistent finding that we've seen in multiple studies. I would take that with a grain of salt. There really aren't any data that I know of in terms of noise level. So, I can't really make any recommendations about that.

    Melanie:  What about pacifiers at naptime and bedtime? Are there any studies or research involving the use of pacifiers?

    Dr. Moon:  Yes, and actually almost every single study that has looked at pacifiers has shown that the pacifiers reduced the risk of SIDS, and it's interesting because the risk reduction comes if you fall asleep with a pacifier in your mouth, even if the pacifier, which we know always happens, even if it falls out as soon as the baby falls asleep. Just the fact that it was in the baby’s mouth as the baby was falling asleep has a protective effect.

    Melanie:  What about products that claim to reduce the risk of SIDS? People look at positioners, wedges, and special mattresses. What do you say about that?

    Dr. Moon:  What I would say would be none of them have been shown to reduce the risk of SIDS. If they claim that they do, be wary. That's number one. Number two, if they tell you that you can do something that Safe Sleep recommendations tell you not to do—so, if they say that you can sleep on your stomach, or you can stand upside down, or do something like that, again, be wary. If it's a product that meets the safety standards and you use Safe Sleep recommendations ,then that's fine.

    Melanie:  What about tummy time? Does that interfere with Safe Sleep recommendations? Should we still be giving our baby's tummy time?

    Dr. Moon:  We should definitely be giving our babies tummy time when they're awake and they're being supervised by an adult, they should get tummy time starting early. Do it early; do it often because we know that helps with upper body motor strength.

    Melanie:  Then, wrap it up a bit for us, Dr. Moon, and what you want parents to know and what you tell them every day about the new guidelines from the American Academy of Pediatrics about children sleeping and safe sleeping. Tell them what you want them to know.

    Dr. Moon:  I want them to know that the baby should be on their back, in a crib in the parents' room, ideally close to the parents' bed. There should be nothing in the crib except for a tight fitting mattress with a tight fitting sheet on it and the baby.

    Melanie:  Is there a time when parents can stop worrying about SIDS?

    Dr. Moon:  The definition of SIDS is up to a year. Technically, it goes up to a year, but ninety percent of SIDS occurs by the time that the baby is six months of age, and the peak period of time is between one and four months. Once the baby gets to be four, five, six months of age, I think you don't have to worry quite as much. The first few months are definitely when the baby is most vulnerable. Then, as the baby becomes a little bit older our concern drops a little bit, but you're not out of the woods yet until the baby is one.

    Melanie:  When is it safe for the child to be in their own room? Parents have video monitors these days, and, of course, monitors have been around a long time. When is it safe to put them in a crib in their own room?

    Dr. Moon:  I would say definitely not until at least the first few months of life and what we've said in this iteration is that at least for six months and ideally for a year. I know that's difficult for some families but the first six months are actually pretty critical because, again, this is when the vast majority of the SIDS occurs. We know that sleep location is very critical at this period of time and there's something protective about the baby and the parent being in the room together. We think that it actually changes a little bit how the baby sleeps because every time they hear the parent move, they'll wake up a little bit, maybe not fully awake but they'll arouse a little bit and what we believe is going on with SIDS is that it's a failure of arousal, so the babies can't wake up. This is actually why babies who are on their stomachs are more likely to die of SIDS because babies who are on their stomachs, they sleep more deeply and they sleep longer which is why parents and everybody likes their babies to be on their stomachs but that actually is what is probably dangerous about sleeping on the stomach. The same thing is true for the babies who sleep in the parents' room--they sleep differently, and they have these little awakenings and that, we think, is protective.

    Melanie:  Thank you so much for being with us today. It's such great information for parents. You're listening to UVA Health Systems Radio and for more information you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.





  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Sun, 13 Nov 2016 23:58:47 +0000 http://radiomd.com/uvhs/item/34183-new-guidelines-to-reduce-sudden-infant-death-syndrome
How to Prevent, Identify and Treat Infections in Young Children http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34141-how-to-prevent-identify-and-treat-infections-in-young-children how-to-prevent-identify-and-treat-infections-in-young-childrenMinor infections are a normal part of childhood, but they can be puzzling and concerning for parents. If your child is in day care, the infections compound and can seem like an every day thing. 

What infection symptoms should parents watch for in young children?

Dr. Leigh Grossman, a UVA Health System expert, provides tips for parents to navigate dealing with infections in young children.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1642vh5c.mp3
  • Location: Null
  • Doctors: Grossman, Leigh B.
  • Featured Speaker: Leigh B. Grossman, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Leigh Grossman is the medical alumni endowed professor of pediatric infectious disease, and the associate dean for international programs at the UVA School of Medicine. She has edited and authored five books; her newest book, The Parent’s Survival Guide to Daycare Infections, was released in October 2016.

    Learn more about Dr. Leigh Grossman

    Learn more about UVA Health System
  • Transcription: Melanie Cole (Host): Minor infections are a normal part of childhood but they can be puzzling and concerning for parents. My guest today is Dr. Leigh Grossman. She's the Medical Alumni-endowed Professor of Pediatric Infectious Disease and Associate Dean for International Programs at the UVA School of Medicine. She's also edited and authored five books including her newest book, The Parent's Survival Guide to Daycare Infections. Welcome to the show, Dr. Grossman. So, a question that parents always seem to have is, “Does getting sick in daycare or school help kids build up those immunities”?

    Dr. Leigh Grossman (Guest): That’s a great first question, Melanie, and I appreciate it because I think many people who send their children off to daycare, preschool, kindergarten, are very concerned that the health, not only of their child, but what they bring home, just ratchets up immediately. And it does, in fact, because they're exposed to germs of all varieties from all the other kids they are in close contact with. Having said that, each one of those infections endows them with immunity, or an ability to prevent future infections with that germ. So, this is an absolutely normal part of childhood, and whether you do this at two or you do it at four, whenever you enter the larger pool of germs, you're going to get sick, and you're going to get sick with organisms that you need to see in order to develop normal immunity.

    Melanie: So, what are some of the most common infections that you see, that children in daycare have?

    Dr. Grossman: Well, the classic colds, coughs, runny noses, ear infections, are the usual and customary that plague parents most of the way through the winter. And, if you accept that the normal, healthy child, with the normal robust immune system is going to have five to seven of these infections per year--that's an average; many have more, some have less--but the average is five to seven a year and most of those are clustered in the winter months when these kids are in close quarters. And so, that's every month, every other month? So, it is constant, and if you have two or three kids in the house that are bringing these bugs home, everybody is sick for prolonged periods of time during the winter months.

    Melanie: Isn't that the truth?

    Dr. Grossman: Yes. So, the other common infections are, obviously, is the stomach flus, the vomiting, diarrheal illnesses, and, additionally, common viral rashes. None of these infections are life-threatening in and of themselves, so they are just a huge toll on the family. Sleepless nights; can I take my child to daycare the next day? Can I go to work? Am I going to be sick with this germ? All of the above questions continue on a regular basis.

    Melanie: So, then let's continue with that question, Dr. Grossman. When do you keep them home? What do you tell parents about the symptoms that they might see? Whether it's a stuffy nose or cough or watery eyes; when do you keep a child home and when do you say "Okay, they're all right to go to daycare" ?

    Dr. Grossman: Great question. The real truth for me is whether that child can carry on normally. So, if they're well enough to continue with normal activities, whether they have a runny nose, or a mild rash, they acquired this infection at the daycare or the preschool and so to think that keeping them home is going to shelter the rest of the children from that infection--there's no way. They are all spreading around these germs in a normal fashion. However, at the point where a child has a fever, is too fatigued to participate in normal activities, has diarrhea that cannot be contained, is vomiting, has symptoms that do not allow them normal participation in the school activities, then they need to stay home. Above and beyond that is a child who has a fever above 101.

    Melanie: So, what should you look for in a daycare center for your child in terms of infection prevention best practices? Are there certain things when you're walking around, looking at a daycare center, that you should be looking for?

    Dr. Grossman: At the point where you're looking for a new daycare or a daycare for your child, it's a dicey time, and you can go in and you can look at colors on the wall and great school materials and pleasant environment and wonderful, nurturing people, but from an infection control standpoint, decreasing the risk of serious infectious disease, not the things we've been talking about previously, I am very interested in what they're doing for their infants, because that's a high-risk group, and so, I want to make sure that there are less than three or four per each caretaker in the infant spaces. Are there separate rooms and caregivers for diapered and non-diapered children? They should be different caregivers; they should not be all grouped together. Are food preparation and feeding areas separated from where you change diapers? Do you have proper hand washing facilities and procedures? There should be policies on bedding and toy and play equipment cleaning. They should have policies on when children must stay home and they must have policies on how parents are notified if they're children become ill at daycare. I want to know if they have a sick room for children who have minor illnesses or become sick at school until their parents can pick them up. I also want attendee policies. So, I want policies for children entering that daycare center that include a healthy child or documentation of what the child has that the daycare center needs to worry about, and what are the vaccine policies for each daycare center? In addition, the personnel or staffing policies are extremely important to know that the staff is healthy and does not have a communicable disease, and staff vaccines so that the staff are also immunized against the usual childhood illnesses so they're not further spreading around illnesses. And, lastly, you want pet policies, because some daycare centers encourage having animals and pets in the daycare center and you want policies to insure that they're not spreading a disease that can be prevented.

    Melanie: So, how can one prevent infection in their children, if at all possible, and what do you think of the use of sanitizers all over the place? Do you want us teaching our children, of course, to wash our hands, Dr. Grossman, and to teach them proper hand washing, but what about using sanitizers after playing with communal toys or any of those kinds of tips? What do you think?

    Dr. Grossman: Well, as we started, I have accepted that I am not going to prevent the usual and customary viral illnesses in this age group and I don't really want to, because I do want to boost their immunity with these illnesses, as unpleasant and difficult as they are to manage for the parents for this age child. Having said that, the organisms that I would like to decrease the spread of are things like strep throat, which we can treat with antibiotics, but if we could decrease the amount of that and that requires sanitizing the common use tables and using hand sanitizers after or before eating. You cannot stop a child from touching their eyes, their nose, their face in the way you might be able to educate adults. And so, I think the hand sanitizers in this setting would be before eating, and before and after using the bathroom.

    Melanie: In just the last few minutes, tell us about your book, The Parent's Survival Guide to Daycare Infections.

    Dr. Grossman: So, this is a book that was born out of a previous book that was written for pediatricians and public health care providers and nurse practitioners and daycare providers, and that book is in its eighth edition. And this current, new book was written because the professional guide was being picked up by parents and utilized, so we changed that book; I've edited this book with thirty-nine infectious disease authorities from around the country, on what to do with specific infections, how to choose a daycare center, what vaccinations are recommended, what policies are recommended for, let's say, a higher-risk child, such as an infant or a child with cardiac with disease or a child with cerebral palsy, so there might be other things that you would do for those children that we would recommend. So, it is a reference guide, hopefully user-friendly It's just out and so we don't have too much feedback, yet, but I'm looking forward to seeing parents' response to this new book.

    Melanie: And, where can they find it?

    Dr. Grossman: On the web, and it's The Parent's Survival Guide to Daycare Infections; Amazon has it on-line.

    Melanie: Thank you so much for being with us today, Dr. Grossman. It's such great advice for parents and the book is called The Parent's Survival Guide to Daycare Infections, by Dr. Leigh Grossman. You're listening to UVA Health Systems Radio and for more information, you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Mon, 07 Nov 2016 02:54:41 +0000 http://radiomd.com/uvhs/item/34141-how-to-prevent-identify-and-treat-infections-in-young-children
Lung Cancer: Screening Can Save Your Life http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34085-lung-cancer-screening-can-save-your-life lung-cancer-screening-can-save-your-lifeLung cancer accounts for about 27 percent of all cancer deaths and is the leading cause of cancer death among both men and women. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined.

Listen in to learn more about preventing and treating this disease from Dr. Michael Hanley, a UVA expert.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1642vh5b.mp3
  • Location: Null
  • Doctors: Hanley, Michael
  • Featured Speaker: Michael Hanley, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Michael Hanley serves as the medical director of UVA's comprehensive lung cancer screening program.

    Learn more about Dr. Michael Hanley

    Learn more about UVA Health System
  • Transcription: Melanie Cole (Host): Lung cancer counts for about 27% of all cancer deaths and is the leading cause of cancer death among both men and women. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. My guest today is Dr. Michael Hanley. He’s the medical director of UVA’s Comprehensive Lung Cancer Screening Program. Welcome to the show, Dr. Hanley. How common is lung cancer? Are you seeing a rise in it these days?

    Dr. Michael Hanley (Guest): Thanks for having me. Yes, as you mentioned, lung cancer is the leading cause of cancer related death. We have seen an increase in the patients that we see for lung cancer, both partly because of our growth but also because of the region that we’re in. The rates have been coming down for men but they’ve actually been increasing for women, which is concerning.

    Melanie: So, then, tell us a little bit about lung cancer and the risk factors that you look for.

    Dr. Michael Hanley: Sure. Smoking is attributable to about 90% of lung cancer. There are other environmental risk factors: radon exposure, occupational exposure, things you may have been exposed to in the environment but, again, 90% are about smoking. The reason that the risks for men are coming down is because of very aggressive anti-smoking campaigns but the risks for women are increasing because we see a little bit of a lag from in the late 70’s and early 80’s when there was a lot of targeted advertising to women.

    Melanie: So when you’re speaking about the lung cancer risk factors, is there a genetic component to lung cancer?

    Dr. Michael Hanley: There certainly is. It’s not one of the cancers that we know an exact gene and we can’t test for it, much like we can test for the breast cancer gene. We know that it does run in families so while we don’t know the gene exactly, we do assume there is some genetic component.

    Melanie: Is there a screening tool available for lung cancer?

    Dr. Michael Hanley: People have been looking at how to catch lung cancer early for years. One of the major problems with lung cancer is that about 80% of patients diagnosed with lung cancer get diagnosed in later stages where surgery is not curative. There have been people that have looked at a variety of different things. They started out looking at annual chest x-rays. So, if you just come in for your annual exam to see your doc you would get a chest x-ray. They looked at that very carefully and they found that actually wasn’t very helpful. They’ve looked at things where you would spit in a cup and they would look at that under a microscope and see if they could detect cancer early. That didn’t really pan out. There are blood tests in development and a few other things that are kind of in development, but what really came out of the last couple years is should we use CT scans to detect early cancers? We know that CT scans do an excellent job of taking up early nodules. We see nodules on quite a high percentage of studies that we look at for other reasons, but what we are trying to look at is should we use that tool to look at very high risk patients? That’s what the lung cancer screening trials have shown us in the last couple years--that annual low radiation dose CT scans are helpful in detecting early lung cancers.

    Melanie: Who is a candidate for this type of screening?

    Dr. Michael Hanley: Generally, looking at heavy smokers between 55 and 77 years old and heavy smokers are really defined as a 30 pack year history. So, if you take someone who smoked one pack a day for 30 years that would equal 30 pack years, or two packs a day for 15 years, or some equivalent thereof. We also want people to be free from symptoms of other cancers. If patients are having severe symptoms where they and their doctor think that they’re worried about something and they need a CT scan, they may need a CT scan but probably don’t want to be part of our screening process.

    Melanie: So, then, the screening takes place how often?

    Dr. Michael Hanley: It’s an every year low radiation dose CT scan. It takes just a few minutes to have it done but here at UVA we also couple that visit with a visit with our nurse practitioner. What our nurse practitioner will do is talk about smoking cessation for patients that are still smoking. They could prescribe cessation medications, if needed, and really be a great resource for patients going through what could be one of the hardest things they’ve ever gone through. As many smokers know, it is very, very hard to quit.

    Melanie: Dr. Hanley, do insurance companies recognize this particular type of screening?

    Dr. Michael Hanley: They do. It’s all insured. Because of the Affordable Care Act, all insurers must provide this coverage without co-pay.

    Melanie: Now, if somebody is worried about lung cancer, are there some symptoms – people think of coughing, they think of sputum, any of these kinds of things – are there any symptoms to watch out for?

    Dr. Michael Hanley: There are. One of the things that is kind of tricky with lung cancer is that many smokers have a chronic cough. So, you don’t want to say, “Well, if you cough then it must be cancer,” because there’s a lot of other reasons to have a cough. But, if that cough gets worse or doesn’t go away and is worse than the normal smoker’s cough, that is something that could be worrisome and you should see your physician about. Other things like coughing up blood or chest pain and shortness of breath are other things that we would ask about. Weight loss is also something that’s concerning for cancer and a lot of different cancers share those symptoms.

    Melanie: So, if you do diagnose somebody, that can be the most scary diagnosis to hear. What do you tell them to give them some hope and what are some treatment options available?

    Dr. Michael Hanley: Sure. Again, the reason that we want to catch cancer early is because that’s when there are curative cancer treatments. Say, for example, a patient comes and they have a cancer that’s the size of a dime that we detect on a CT scan, they would be able to undergo resection of that. They could see a surgeon, have that cut out, and they would effectively be cured, and that’s really what we’re going for. We want to avoid what is the current state most of the time – again, 80% of the time – when we diagnosis people with lung cancer, it’s done at a state where it’s already spread to other areas, which then just leaves chemotherapy as effective treatment options.

    Melanie: So then if people go through this, and what do you tell them about obviously life style modifications, is there anything else besides quitting smoking that you like them to do after treatment?

    Dr. Michael Hanley: Actually, quitting smoking-- they’ve actually been looking at quitting smoking even after someone’s been diagnosed because there’s a lot of sentiment of our patients that they say, “Well, it’s a stressful time when they get diagnosed and they’ve already been diagnosed with cancer so why should I quit now?” And they’ve actually done a lot of research looking at patients who quit smoking at the time of their diagnosis and patients that don’t quit, that continue to smoke during their treatment, and patients who quit smoking after they get diagnosed do much, much better through their treatment. Really, that’s something that we definitely focus on. Again, it’s a very, very hard thing to quit so we want to make sure that we give the patients all the support that we can to not only to physically get through and emotionally get through a diagnosis of cancer, but also the smoking component.

    Melanie: Dr. Hanley, tell us about UVA’s Comprehensive Lung Cancer Screening Program and tell us about your team.

    Dr. Michael Hanley: Sure, we’re very lucky to have a team that-- what our real goal is, is to try to provide a full service for patients that are undergoing this exam. The CT scan is really just a part of it. We’ve partnered with the cancer center to hire a nurse practitioner. She’s really the focus of our program where she sees the patients; she develops lasting relationships with our patients; she can help them quit smoking, as I mentioned; and then, also, when patients are due for their annual study, we work on making sure that we get in touch with those patients. We don’t want anybody falling through the cracks, so having someone that can help coordinate the program is really essential. We also have a great team including thoracic surgeons, thoracic oncologists, and all of our other treatment specialists who, when patients are identified, we can make sure that they’re seen quickly and with great specialists.

    Melanie: Thank you so much, Dr. Hanley. It’s great information. For more information on UVA’s Comprehensive Lung Cancer Screening Program, you can go to www.uvahealth.com. That’s www.uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Lung Cancer, Cancer]]>
David Cole Sun, 30 Oct 2016 17:13:22 +0000 http://radiomd.com/uvhs/item/34085-lung-cancer-screening-can-save-your-life
Breast Cancer: The Latest Information From UVA http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=34014-breast-cancer-the-latest-information-from-uva breast-cancer-the-latest-information-from-uvaThe UVA Breast Care Program offers advanced diagnostic and screening options for women and men, and personalized care and support for patients who need breast cancer treatment.

Learn more from Dr. David Brenin, a UVA surgeon, about the second most common form of cancer diagnosed in women in the United States.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1642vh5a.mp3
  • Location: Null
  • Doctors: Brenin, David
  • Featured Speaker: David Brenin, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. David Brenin is chief of breast surgery at UVA Health System, and co-director of both the UVA Breast Care Program and the High-Risk Breast and Ovarian Cancer Clinic. His clinical practice specializes in the treatment of breast cancer, and benign diseases of the breast.

    Learn more about Dr. David Brenin

    Learn more about UVA Cancer Center
  • Transcription: Melanie Cole (Host):  In the United States, breast cancer is the second most common cancer in women after skin cancer. My guest today is Dr. David Brenin. He is the Chief of Breast Surgery at UVA Health System and Co-Director of both the UVA Breast Care Program and High Risk Breast and Ovarian Cancer Clinic. Welcome to the show, Dr. Brenin. So, are you seeing a rise in breast cancer today?

    Dr. David Brenin (Guest):  Well, there is a trend towards an increased number of patients being diagnosed with breast cancer today. That is true.

    Melanie:  Are you seeing that more women are coming in for screenings and do we think that that's why we are seeing more breast cancer because there is more awareness for screening?

    Dr. Brenin:  That's certainly part of it, but sadly, enough women probably aren’t being screened today. It depends on where you live in the country, the proportion of women who do undergo screening. In Virginia, sadly, it ranks kind of in the middle of the field when we look across the United States for women who have reported undergoing a mammogram. So, we really need to do more to educate women about breast cancer screening and its benefits.

    Melanie:  So, then, let's talk about breast cancer screening. When do you advise women to start their first mammogram?

    Dr. Brenin:  Well, that's a very complicated subject right now and there are several points of view. At UVA, what we recommend is that when women approach the age of 40, that they sit down with their primary care doctor and evaluate their risk of developing breast cancer and also sit down and think about what their goals are in terms of risk reduction and how they feel that breast cancer screening would fit into their lives.

    Melanie:  So, what do you tell women every day about getting their first mammogram--that baseline to see where they stand--and then also self-exams. Do you think women should be doing this on a regular basis as well?

    Dr. Brenin:  Let's first talk about breast imaging and mammography. So, when a woman should start mammography, probably should grow out of that discussion that I mentioned earlier with their primary care doctor. For women who are high risk--in other words, women who have many family members with breast cancer or perhaps have received radiation therapy as a child or who have had previous breast problems-- it makes sense, clearly, to start routine screening and mammography at age 40 and to undergo that test once a year. Certainly, if not starting at 40, they should start at age 45. For young women, for women between the ages of 40 and 55, if they are going to have mammography, it makes sense to do it every year. I think that once women reach the age of 55, the types of tumors that are most common in the post-menopausal patient are more slow growing tumors. So, it is reasonable to consider cutting down the frequency of mammography to every other year, but beginning at age 45; whereas, tumors that occur in women between the ages of 40 and 55, tends to be a little bit faster growing. So, it makes sense to catch those tumors when they are smaller with breast imaging and in order to do that, they really need to have the mammogram once a year.

    Melanie:  We hear about other types of imaging. There is advanced ultrasound and 3D tomosynthesis. What do you tell women when they ask you if they have dense breasts, which one should they go for? Does insurance cover it? How do they decide which one to get?

    Dr. Brenin:  Well, 3D tomosynthesis is a relatively new technique that is available to many patients around the country. The real benefit of the 3D imaging is that it decreases what are called “call backs”, in other words, what we know as false positives, wherein a patient has a mammogram, a routine screening mammogram, and she gets a phone call that says you need to come back for more imaging. That's a very stressful situation and it would be ideal to avoid that and 3D mammography or tomosynthesis decreases the risk of that substantially. In terms of ultrasound, this is something that may be useful for patients who have high breast density or extreme mammographic breast density. This would be in addition to a mammogram or tomosynthesis.

    Melanie:  So, then, as women hate that waiting for that call back, as you say. That's just a terrifying feeling for most women, then what? If you see something suspicious, then what goes on diagnostically as the next step?

    Dr. Brenin:  Well, typically, there'd be more imaging and if, on the additional imaging, the area that looked suspicious continues to look suspicious, the next step is usually an Image Directed Biopsy, where, most commonly, under ultrasound guidance or under x-ray guidance, a small needle is placed through the skin and into the abnormal area and some tissue is removed for analysis by a pathologist.

    Melanie:  So, Dr. Brennin, before we get into some of the advances in treatment for breast cancer, people hear on the media are all over about the BRCA Genes and they don’t understand that these are genes we already have. It's the mutation of the genes that you all are looking for. What do you tell women who ask you, should they get tested for this mutation?

    Dr. Brenin:  So, there are very clearly articulated indications from the various cancer societies about which patients should undergo genetic testing for BRCA 1 and 2 mutations. Typically, what we are looking for is women who have multiple breast cancers within the family, usually over several generations. Most often, these cancers occur in relatively young women, in other words, pre-menopausal. We also look for any patient family history of ovarian cancer and, to a less extent, pancreatic cancer and melanoma. So, we have to look at the entire family history for these types of malignancies and, if we see a preponderance of these malignancies within the family, we will usually recommend genetic testing. Often the genetic test includes, today, more than just BRCA mutation testing, but panel mutation testing. So, we look at some other areas that we know that genetic polymorphisms may impact on breast cancer and other malignancy risks.

    Melanie:  And, I know that it depends on the patient and it's certainly individual, but as far as surgical interventions or first line of defense if a woman is diagnosed with breast cancer, what are you seeing most often, Dr. Brennin?

    Dr. Brenin:  Well, still today, breast preservation or lumpectomy is definitely the most common treatment that women select to treat their breast cancer as long as they are candidates for breast preservation. Mastectomy is the other option and it is true that we are seeing a little bit of an uptick in women who are eligible to save the breast, who choose to have a mastectomy. But, right now, still the preponderance of women do undergo a lumpectomy or breast conserving therapy.

    Melanie:  And, then, for after the fact, are they going on to Tamoxifen or are there different medications out there today? What about after a lumpectomy or a mastectomy?

    Dr. Brenin:  Well, after a lumpectomy, we are going to do several things. The first thing after a lumpectomy is the patient's going to receive radiation therapy to the breast as an adjuvant treatment. But, in terms of systemic treatment like pills or chemotherapy, I think that perhaps that really is your question and Tamoxifen is used a little bit less frequently today. We have newer agents called “aromatase inhibitors” that are a little bit more effective than Tamoxifen and also have a little bit of a different but more preferable range of side effects. Chemotherapy is also something that is very commonly given to patients who have breast cancer, although fewer and fewer people today are having chemotherapy after surgery for breast cancer because we have very good techniques to try to identify which women will benefit the most from chemotherapy, based on certain molecular characteristics of their tumor. We can now do a test on the patient's tumor, which will help us determine what that individual patient's risk is for the tumor coming back elsewhere in the body and what the impact on chemotherapy would be to lower that risk.

    Melanie:  And, as far as advancements in what women can look for in the future, are you doing immunotherapy, targeted cell therapy for breast cancer? Tell us about some of the latest advances.

    Dr. Brenin:  So, it's the hope of the community that immune therapy is really going to be the next step in our treatment of all types of cancers. To date, there has been some evidence in certain selected groups of women who have breast cancer that immune therapy may be effective. But, at this point in time, it really is the very beginning of the evaluation of immune therapeutic techniques to treat breast cancer. Most of the immune therapy that has been shown to be very effective has been against cancers that are, in themselves, more immunogenic; in other words, that the immune system can detect them. One of the problems with breast cancer is that it has the ability often to fly under the radar of the patient's immune system. So, that is not very immunogenic as compared to something like melanoma, which is one of the most immunogenic cancers that we see. Breast cancer is often undetected from the body. The hope of using immune therapy to treat patients with breast cancer is to wake up the patient's immune system so that they can detect that cancer that is sitting there; that, prior to giving an immunotherapeutic drug like a checkpoint inhibitor, that the tumor was not seen by the patient's immune system. Some of the breast cancers that we are seeing today, it is effective in, but the vast majority to date, that has not been the case.

    Melanie:  It's absolutely fascinating what's really going on and so, in just the last few minutes, Dr. Brenin, tell us about your team at the UVA Breast Care Program.

    Dr. Brenin:  The UVA Breast Program is a true multidisciplinary team that takes care of all of our patients who are seen with breast cancer at UVA. When you come see us at the UVA, you are not only seeing a surgeon, but your case is evaluated at our weekly tumor board where all the breast surgeons will be there; all of the medical oncologists--the doctor's that give chemotherapy; all of the radiologists--the doctors that look at your mammograms; the pathologists--those are the doctors that look at the slides from the biopsies; as well as radiation oncologists; and the entire care team of care coordinators, social workers, as well as all of our trainees. Each Friday at UVA, every breast cancer that's treated here is reviewed by a group of at least 30 individuals and the patients really do benefit from that shared experience.

    Melanie:  Thank you so much for being with us today, Dr. Brenin. You are listening to UVA Health Systems Radio and for more information you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Women’s Health, Cancer]]>
David Cole Thu, 20 Oct 2016 00:42:32 +0000 http://radiomd.com/uvhs/item/34014-breast-cancer-the-latest-information-from-uva
Healthy Holiday Eating http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33991-healthy-holiday-eating healthy-holiday-eatingThe holiday season is full of family, friends, fun and food. That means it's easy to over do it at the buffet table or at a festive party.

Hear from Katherine Basbaum, a clinical dietitian with UVA Health Systems, about the healthy way to approach holiday meals and parties.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1639vh2e.mp3
  • Location: Null
  • Doctors: Basbaum, Katherine
  • Featured Speaker: Katherine Basbaum
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Katherine Basbaum is a clinical dietitian. She provides nutrition counseling and creates clinical treatment plans for patients with heart disease, heart failure and other chronic conditions such as obesity and type 2 diabetes.

    Learn more about UVA Heart & Vascular Center
  • Transcription: Melanie Cole (Host): The upcoming holiday season is full of family, friends, fun, and food, with an emphasis on the food. Can you make healthy choices during the holidays? My guest today is Catherine Basbaum. She's a clinical dietitian with UVA Health Systems. Welcome to the show, Catherine. So, let's start with the holidays. People hear about the weight gain that goes on, we're going to all of these parties. What are some of the triggers that people you know, kind of submit to make those poor food choices that they make?

    Catherine Basbaum (Guest): Well, a couple of things. First of all, the food itself, right? So, during the holidays, we see foods that are richer and more delicious and it's our favorites, and they're family recipes. As far as I'm concerned, that's one of the big triggers is that the actual holiday food tends to be really, really special and that makes it harder to resist. Another thing is that in the holidays we identify with a lot of socializing and celebrating and I would venture to say that the holidays for many people, that means a lot of extra socializing and celebrating and being with family. Food and family are connected in a great way. Some might even say that the fact that the in the holidays, there's a little bit more alcohol flowing. Cocktails and champagne and things like that and when we're drinking, sometimes it's easier to go off our diets a little bit and forget about making good choices.

    Melanie: Well, certainly, it does reduce your inhibitions. So, what are some foods that people commonly see that masquerade as being healthy? Because people will say, "Okay, I'm putting out the hummus," or "I'm putting out something," but then it ends up to be something that's really full of fat or really has no redeeming value?

    Catherine: Well, yes, it's interesting, Melanie, that you brought up the hummus because hummus, which is actually going to be a good choice for you, the base being good heart-healthy olive oil and chickpeas or garbanzo beans. In the same kind of category as an appetizer, spinach dip. You know, people think, “There's spinach in it and it's a dip, and I just put a carrot in it or a chip or a piece of bread,” but compared to a hummus, or like some other light dip, spinach dip or artichoke dip is going to be one of the really, really rich, indulgent, lots of calories, lots of fat, lots of salt in that. Another category is just vegetables in general. You know, we think about fruits and vegetables as being generally healthy. So, if you see sweet potatoes, "Oh, I hear sweet potatoes are good for me," or you know green bean casseroles or just any of these kind of vegetable dishes, but around the holidays especially, there's going to be a lot of cream and butter and sugar added to these things that are going to kind of wipe out the health benefits. And then, the other one I was going to mention was when you're picking your proteins, right? You might have the option of some ham or a red meat option or a poultry and some of us may think "Well, I'll just go for the poultry, that's going to be the really light and nutritious one," but if you're getting a turkey leg, dark meat with all the skin, you might be actually making a worse choice than one of the others.

    Melanie: So, I think we can consider that if stuff has a lot of butter, sour cream, or mayonnaise, it's probably off the healthy choice list. How do you avoid those things? As you mentioned, alcohol, you know, that makes it a little more fun, you're socializing, you're talking, what are some tips you give as a clinical dietician to people every day about not giving into those cravings and saying, "Oh, that spinach dip looks so great," and just eating too much of it? Are we allowed to have just a little? Can we stop at just a little?

    Catherine: Some people can stop at just a little bit and some people can't and that's one of the things that as individuals, we need to be able to recognize, "Can I have just one chip and dip?" or, “If I have one, then, I'm not going to be able to stop.” One of the things that I talk to my patients a lot about, and this is an oldie, but a goodie, is do not show up hungry at a dinner or at a cocktail party or at the office celebration, or whatever, because, if you don't eat much at all several hours before, thinking you're going to be eating a bunch later or you want to save your calories, if you think about a scale of 1 to 10, 10 being ravenous, you go to that party or that event at a 10, your willpower is out the door. But, if you have a snack a couple hours or an hour before; a slice of whole wheat bread with peanut butter, or a couple of slices of cheese and an apple, whatever, then you'll be at closer to a 6 or a 7 on that hunger scale and you'll actually be able to make some good choices. So, that's one. Another thing is what I do a lot of work with patients is what we call the plate method. So, if you are having dinner at a holiday party or you're making yourself a little appetizer plate, then fill up half your plate. Load it up with fresh fruits and vegetables, whatever they have. Just load it up. You can eat that to your heart's content. Give yourself a little bit of something indulgent in the starch department, a little something indulgent in the protein department, and call it a day.

    Melanie: If you're somebody that journals to really keep your eye on your weight, is it possible to keep that up during the holidays?

    Catherine: Sure! I mean, it's not that fun, but, I mean, if it's something that . . .

    Melanie: Trying to keep track at a party of every chip you put in your mouth or every glass of wine that you have, I mean, it can be quite daunting, so if somebody is doing that, and they're trying to keep track, do you advise they use maybe some of the apps that are out there that they can, and I'm not talking appetizers, but some of the apps that are out there to help keep track of what it is they're eating, and then when they get home, they can kind of go through it and see what they did?

    Catherine: Well, yes. I mean I don't recommend the apps for everybody, because I've got plenty of patients that are not tech savvy or they prefer pen and paper; they're old school. But, for those that like the smartphone, whether it's writing it down or tapping it into their phone as they're consuming it, so that they don't forget later, or maybe they want to take a quick snapshot photo of everything. I mean, their friends might think they're a little kooky, but who cares? They're the ones that are not going to be feeling heavier.

    Melanie: But that's a good idea, though, because you can look at it afterwards. Now, what about the alcohol, Catherine, because it add up? Those calories, wine, beer, margaritas, drinks with cream in them. So, what do you tell people about the calorie content and the weight gain involved with so much alcohol over the holidays?

    Catherine: Well, what I say is as much as possible, stay away from the mixed drinks. The ones that are made with, as you said, the fruity juices and the creams, and like the egg nogs, the margaritas, whatever, those ones are going to be the calorie bombs. They're going to just put you over the limit. I would rather my patients, and I would rather myself, I would rather eat my calories. So, have a small glass of wine, have a small glass of champagne, or, if you like liquor, do it with club soda and lime instead of tonic water, or juices, and things like that. And, try to one for one with a tall glass of water instead of just going glass of booze after booze, just pace yourself a bit and you'll still enjoy yourself and save a bunch of calories.

    Melanie: And do people "But resveratrol is supposed to be good for me." So, I want to have the wine!

    Catherine: Yes, I hear it every day, but what I tell them in return is I say, "Look, if you want potential heart-healthy benefits from red wine because of the resveratrol, then, yes, if you decide to have an alcoholic beverage, you might want to go with a glass of red wine." But, if you are not a drinker, there is not enough evidence to say, “You should start drinking and especially red wine.” That we can’t advocate. We can't support that yet. But, yes, there might be some benefits--not in excess.

    Melanie: And, so, then there's the next day. You go to a party and people always want to know, “Can I then starve myself the next day to make up for what I did last night?” What do you tell them to do the next day?

    Catherine: Well, the next day. No, you can't starve yourself the next day or the day before to kind of balance everything out. Number one, it's painful to do that, and number two, I don't really think it's necessary. Ideally, what I like to see with my patients is that they're eating cleaning, real fresh, real wholesome foods about 80% of the week, and then the other 20%, then they're having some indulgence. They're having some fun. The same thing applies during the holidays. If they're going to go to a couple of events one day, then the next day that's part of their 20%. Then, they just go back to regular eating. No fasting or skipping. A nice balanced breakfast, lunch, and dinner. That's how I feel.

    Melanie: So, wrap it up for us, Catherine, because it's great advice for people to listen to as these holidays start to come upon us with everything from Halloween candy all around to Thanksgiving and then onward. So, give your best advice for people as it starts into this season what you tell them every day about watching what they eat and trying to make those healthy choices.

    Catherine: I'd say, bottom line is don't deprive yourself of your favorites. If you have a favorite candy from your kids or your Halloween bag, then give yourself one a day for a week, or whatever. If your mom or your sister's apple pie or the green bean casserole or whatever it is, you have to give yourself those things and you should because it gives you great pleasure, but don't overdo it. Don't take a bunch of every one of the indulgent items that are being offered. Be like, “This is the one that is my favorite and I'm going to have a piece of it and I'm going to love it and enjoy it and the rest of my plate is going to be a bit more sensible.” And the same thing applies for appetizer time or for desserts. Ideally, you're going to just take a little bit of the indulgent and then fill up with the fruit and the vegetables to fill up your belly and once the New Year comes and goes and you're back to normal, then, hopefully, the plate method idea sticks and the idea of the alcohol and the lower-calorie drink sticks. And the not showing up to just a regular dinner with your friends starving or ravenous. Hopefully, that sticks as well.

    Melanie: That's great advice and something people really should take to heart. Thank you so much 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.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Healthy Eating, Healthy Living]]>
David Cole Sun, 16 Oct 2016 18:44:10 +0000 http://radiomd.com/uvhs/item/33991-healthy-holiday-eating
Celebrating 50 Years of Organ Transplantation at UVA http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33952-celebrating-50-years-of-organ-transplantation-at-uva celebrating-50-years-of-organ-transplantation-at-uvaIn June 1967, the UVA Transplant Center transplanted its first solid organ, a kidney. Since then, we have completed over 1,500 kidney transplants, 1,200 liver transplants, and our lung and liver programs have achieved the highest survival rates in the country.

As the only Comprehensive Transplant Center in Virginia, UVA has more than 45 years of experience.

We provide comprehensive treatment for patients needing heart, lung, pancreas, kidney, liver and islet cell transplants.

Hear from Dr. Alden Doyle, the medical director of UVA’s kidney transplant program, about the evolution of transplantation, and UVA’s commitment to patient centered care.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1639vh2d.mp3
  • Location: Null
  • Doctors: Doyle, Alden
  • Featured Speaker: Alden Doyle, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Alden Doyle is a transplant nephrologist and the medical director of the kidney transplant program at UVA’s Charles O. Strickler Transplant Center.

    Learn more about UVA Health System
  • Transcription: Melanie Cole (Host): In June 1967, the UVA Transplant Center transplanted its first solid organ, a kidney. My guest today is Dr. Alden Doyle. He’s a transplant nephrologist and the Medical Director of the kidney transplant program at UVA’s Charles O. Strickler Transplant Center. Welcome to the show, Dr. Doyle. Tell us a little bit about the transplant center at UVA and the 50th anniversary coming up in 2017. Give us a little background on the evolution of kidney transplantation over the years.

    Dr. Alden Doyle (Guest): Sure. So, the program is a well-established one that does most of all the solid organs. So, they have a robust program in heart transplant, kidney transplant, pancreas transplant and lung transplant, and a separate one in bone marrow. So, almost all of the normal organs that are transplanted. They have been innovators in the field for years with tissue typing and different organ transplant techniques, and there’s a lot of nice overlap. So, they’ve been in the business for a long time, and recently, with a new dean who is a lung transplant specialist himself, have really put a lot of resources to make all the transplant programs go under one transplant institute, and continue to grow and be innovators in the field. In terms of history of transplant, we’ve come a long way. As you know, in the mid-50’s, the original transplant was basically reserved for very healthy folks who had living donors, and so the immunosuppression was very modest and the understanding of how the immune works to keep one healthy and to reject organs was only very rudimentary. So, it was really only available for a few folks under special circumstances. And now, with lots of medicines and a lot of greater understanding, it’s available to, not all but many, people with different kinds of organ disease and different backgrounds.

    Melanie: So, there’s are many organs that you transplant now, and UVA is the only comprehensive transplant center in Virginia with more than 45 years of experience. Dr. Doyle, speak about some of the other organs that are transplanted, what people should look for when looking for a transplant center?

    Dr. Doyle: So, I think there are a couple of things you can look at. There’s publicly available data. So, there’s an organization that the government funds and supervises which is called “United Network for Organ Sharing” or “UNOS”. So, they have the responsibility of maintaining oversight for transplant programs across the country and publish on the website the outcomes. So, I think one question a potential transplant recipient would ask is, “How do they do? And if I get a transplanted at the center, would I expect to survive, and how would the function of the organ work?” So, they publish one- and three-year patient and graft survival as a first test. On top of that, I think you’d want a comprehensive center that can offer the broad range of services, including overlap of disease. So often we see that patients have not just kidney disease but also liver disease, and so it’s nice to have one center that can manage the thing from soup to nuts, and even up to the unusual circumstance of requiring two organs at once.

    Melanie: What do you anticipate the future holds for kidney transplantation?

    Dr. Doyle: Well, our hope is a couple of things. One is, one of the biggest problems we have and we’re victims of our own success in a way. We have the one-year graft survival and patient survival that has gone steadily up and, as I mentioned before, there are a lot more folks who are potential candidates. And so, with organ donation rates being reasonably flat—they’ve grown a little bit--then there’s a bigger disparity between need for organs and availability of suitable organs. So, we hope that there’s going to be continued public advocacy for donation, different ways to do this, but to increase the supply because there’s a growing number of people who die waiting for organs even though they know that if they got transplanted, they’d be successful, but there just isn’t enough to go around. So, that’s a piece of it. Part of it is public policy so there are some things we hope Congress will do to make living donation and organ transportation even easier. They’ve been supportive but there are some important steps to make right now. There’s also a lot of science in immunology and related fields like genomics and proteomics that we hope will translate into better outcomes for transplants so we have more of an individualized medicine. We know that different people respond to medications and have different risks of rejection, but why that is in all circumstances is less clear. So, going forward, if we can make an individual plan so that this combination of medications and these organs will be the best for an individual patient, that would be a real step forward in keeping with the way--the direction--of modern medicine.

    Melanie: So, can you tell us about any breakthroughs in post-transplant care?

    Dr. Doyle: There’s been some. It’s been incremental. I wouldn’t call it absolute breakthrough. There have been some new medications that change the paradigm of immunosuppression. For example, there are some medications that people can get once a month by IV, that’s never been possible before. There’s been some work to try to promote tolerance where, under certain circumstances, patients would not require immunosuppression--although it’s the exception. But, it’s exciting stuff.

    Melanie: Dr. Doyle, what factors are considered in organ matching and allocation? How does that matching process work?

    Dr. Doyle: A number of things. It’s complicated and simple. In kidneys, unlike other organs, the primary driver for allocation of a kidneys, in other words, who gets which kidney, is based on time on the waitlist. So, recently that’s undergone a big change. So, now time counts back to when either you get listed or when you started dialysis, whichever is first, because some people used to wait years before they came in to get evaluated. So, the time is the number one thing. There are some immunologic factors and a degree of matching for the human leukocyte system, the HLA system. So, you get points for certain types of matching where, if the kidney’s a better match, you would get the equivalent of more time. And then, there are some special circumstances where your body may have immune barriers to block kidney transplants. So, it makes it harder, and so you’re given a special dispensation. So, that’s the normal thing. And then, kids get transplanted earlier because they know that kidney failure doesn’t allow them to grow normally. So, there’s couple of special circumstances, but mostly it’s driven by time.

    Melanie: How does somebody get on the waiting list?

    Dr. Doyle: You come into a center and you have to either be on dialysis or it should be importantly noted that you can have 20% kidney function or less. So, the best circumstance is, as soon as you hit 20% function, before you go on dialysis, which usually occurs at around 10% function, you get into a transplant center and get listed quickly because that pushes the time clock going earlier. The evaluation process always involves a multidisciplinary approach: that’s a dietician; that’s a social worker; that’s a transplant coordinator, which is a nurse or a nurse practitioner; the nephrologist like me; and a surgeon. So, we all work together in concert to try to make a decision about who’s a candidate or, more importantly, what things we need to do to get people ready so they’re the best candidate they can be.

    Melanie: That is exciting. Tell us about the transplant center. Tell us about your approach to patient-centered care. What can a patient expect, because that’s a very scary thought but yet very hopeful and exciting?

    Dr. Doyle: Yes. So, we try to take the broad view and that is, once upon time transplant centers were largely happy to have their success of transplant. So, the focus was always on the numbers and getting people through the operation and getting them up to a year or three years. I think as they got better, we still want--those are really obviously very important metrics but there’s more to that. So, I’m trying to push for a patient-centered approach which means yes, we want the numbers to look good but we also really want to take a person through a journey from a point of end-stage organ disease--kidney in this case--all the way through to health because kidney transplant and other organs, too, is a special case where people can really know what it’s like to be sick, sometimes deathly ill, on dialysis, and they see some people--some make it and some don’t, and you can give them the second chance. And, unlike things where people have a revelation at the end of their lives or their final days of their life and that may or may not be true for a short time, people can have--we’ve had kidney transplant patients who’ve lasted 40 years. So, you can have somebody who gets very close to being very, very sick and have the knowledge that that brings, the wisdom that that brings sometimes, and then get a second chance and be able to live that second chance for potentially decades. So, as we go forward, I’d like to continue to manage the nuts and bolts of transplant but also to increasingly focus on the human aspect which is this is really a wonderful celebration of life and a second chance.

    Melanie: Wow. Such great information. Thank you for all the great work that you’re doing, Dr. Doyle. You’re listening to UVA Health Systems Radio. And for more information, you can go to www.uvahealth.com. That’s www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Health Care]]>
David Cole Mon, 10 Oct 2016 01:10:44 +0000 http://radiomd.com/uvhs/item/33952-celebrating-50-years-of-organ-transplantation-at-uva
Digging into Dementia http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33934-digging-into-dementia digging-into-dementiaWhen someone hears the word ‘dementia’, they automatically think Alzheimer’s disease. But there are dozens of conditions that can cause dementia, and it doesn’t just affect the elderly.

Hear more about dementia from Dr. Erin Foff, an expert at UVA’s Memory and Aging Care Clinic.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1639vh2b.mp3
  • Location: Null
  • Doctors: Foff, Erin
  • Featured Speaker: Erin Foff, MD, PhD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Erin Foff is an Assistant Professor of Neurology. She received her Ph.D. in Molecular and Human Genetics from Baylor College of Medicine (Houston, TX) and her medical degree from the Jefferson Medical College in Philadelphia, PA. Following neurology residency at the University of Virginia, she completed a research fellowship in nucleotide repeat disorder biology at the University of Virginia. She has a basic science laboratory where her team conducts research on several nucleotide repeat disorders, including frontotemporal dementia/ALS and myotonic muscular dystrophy. Dr. Foff sees patients with neurodegenerative diseases causing cognitive complaints, and she specializes clinically in early onset dementias, frontotemporal dementia and the primary progressive aphasias. She lives in Charlottesville with her husband and two children.

    Learn more about Erin Foff, MD, PhD

    Learn more about UVA Health System
  • Transcription: Melanie Cole (Host): When someone hears the word dementia, they automatically think Alzheimer’s disease but there are dozens of conditions that can cause dementia, and it doesn’t just affect the elderly. My guest today is Dr. Erin Foff. She’s a neurologist and a memory disorder specialist at UVA Health Systems. Welcome to the show, Dr. Foff. As I said in the intro, when someone hears that word, they automatically think Alzheimer’s but tell us about some of the other conditions that can cause dementia.

    Dr. Erin Foff (Guest): Absolutely. You know, that’s one of the most common misconceptions that patients and their families come into our clinic harboring. So, dementia is actually just a description of the severity of a cognitive problem. And many, in fact dozens, of disorders can cause dementia. Alzheimer’s is really only one of them. Other disorders--other neurodegenerative disorders that can cause dementia include such diseases as dementia with Lewy bodies which many of the listeners may be familiar with because it is the disorder that Robin Williams recently passed away from, as well as frontotemporal dementia which we’ll discuss a little bit today; vascular dementia which is even more of a problem in our society with many vascular risk factors that our patients suffer with; and then, other non-neurodegenerative diseases like autoimmune diseases that lead to cognitive complaints, and also mood disturbances.

    Melanie: So, people also usually think that dementia only happens to older people but some of these conditions, as you mentioned Robin Williams, happen to younger people. So that’s true, correct? And what are some of the conditions that might happen to a younger person?

    Dr. Foff: That’s exactly right. So, oftentimes in our clinic, we are stratifying people in terms of their risk of a certain type of dementia based on their age. So, Alzheimer’s dementia tends to strike mostly folks who are above age 65, most commonly in 70s and 80s, and, in fact, by the time people reach their mid-80s, they’re approaching about 50% risk of developing Alzheimer’s disease. But, some of the disorders that can strike young folks in their 40s, 50s and 60s, include diseases like the frontotemporal dementias which is a class of diseases that tends to strike young. There is a form of Alzheimer’s called “early onset Alzheimer’s disease” that strikes, again, before age 65. And, many of the non-neurodegenerative dementias, those associated with severe depression or autoimmune disease, can also strike folks that are much younger than you would typically expect for a dementing illness.

    Melanie: Dr. Foff, what are some of the red flags that people--they hear about leaving their keys somewhere or not knowing where they’re going, but what are some of the ones for loved ones that they might notice in somebody that would signal the onset of one of these dementias?

    Dr. Foff: That’s a really great question. So, typically, it’s actually not the patient that recognizes there may be a problem, but oftentimes their family or another one of their healthcare providers like their primary care physician. So, it’s true that we do lose some mental flexibility as we age but when family members start to indicate that somebody is repeating their sentences or questions over numerous times, if there are severe or unusual personality or mood changes, if there is any evidence of weakness or changes in the sensory system of the body, those can all be red flags--headaches, etc. So, we typically encourage people, if anybody has expressed concern that perhaps their slight memory problems seem out of proportion that they should at least have a quick screening exam with their primary care doctor, and if it looks like there may be more severe problems, having a referral to a neurologist.

    Melanie: Is there a screening? I’m glad that you mentioned that because, is there a way to diagnose it for sure? Is it based just on history or would something like a CAT scan or an MRI show you anything that would tell you that that person is in cognitive decline?

    Dr. Foff: So that’s great question, and that really is dependent on the reason for the cognitive decline. So, certainly, a primary care physician or a general neurologist can do the initial workup that can include some screening measures that are usually validated mostly for older patients. But, if there is a concern, we can do more in-depth cognitive testing. This is something called “neuropsychological testing” which is looking at all of the cognitive domains for evidence of abnormalities. And, in addition to standard tests like structural imaging or MRIs, looking for shrinkage of the brain or lesions in the brain, we can also do some very advanced testing, actually looking specifically for the presence of the Alzheimer’s protein or other patterns that indicate the brain is not functioning normally, and that can help a lot with diagnosis. There are now also more sophisticated biomarker tests which is where we analyze spinal fluid on patients to look for evidence that there is breakdown of brain cells and, in a particular pattern, consistent with certain diseases. So, we are much more accurate in our diagnosis now than we ever were before.

    Melanie: You’re among a select group of researchers worldwide trying to find the genetic defects behind frontotemporal dementia. Tell us about the work that you’re doing in the lab, and how it might one day benefit these families.

    Dr. Foff: That’s right. So, I work on a particular form of frontotemporal dementia that is associated with one underlying genetic defect, and it’s the most common cause of inherited frontotemporal dementia. It is also linked and causes many cases of familial or inherited ALS which many people know by the other name, Lou Gehrig’s disease. And so, typically in the past, people have studied mouse models or animal models in an effort to understand how these diseases progress and to develop therapies targeting those processes. We take a different approach in our lab using stem cells created directly from patients, where we are able to take patients skin cells from an adult living patient, turn them into a stem cell which is a cell that can become anything in the body, and then further make that stem cell into brain cells in a dish, and we have created very complex models of the brain in three dimensions from those patient cells so that we can study them and understand what’s going wrong, and hopefully develop drugs that can target that process.

    Melanie: That’s absolutely fascinating and so well spoken. You explained that just perfectly for the listeners, Dr. Foff. Now, tell us what you tell families when they do get diagnosed--someone that they love. What do you tell them about available treatments or lack thereof or lifestyle things that they can do to at least help this person while they’re going through this?

    Dr. Foff: That’s such a critical part of the process. So, many people are aware of the fact that we just don’t have a cure for any of these neurodegenerative diseases although we really hope, as a community, that we’re headed there soon. But, that doesn’t mean that our process stops at the diagnosis. So, we are very interested in pursuing what we call a “multidisciplinary approach” for every single patient. So we try to provide support along every line of the patient’s process and journey, and this includes symptom management--since many of these diseases come with lots of symptoms in terms of mood or physical symptoms--as well as providing support for the family, and access to community resources, palliative services when necessary, and then, importantly, clinical trials when patients are interested in pursuing that. For many of these disorders, we have national clinical trial networks and after we identify patients that are interested in participating in those trials, we can help direct them to the appropriate trial, which oftentimes is testing a new drug therapy that we hope will be that future wonderful drug that can slow or prevent these diseases from getting worse.

    Melanie: So, tell families that are facing dementia what they should think about if they want to consider a clinical trial.

    Dr. Foff: That’s right. So, the first thing is to be referred to a center that does clinical trials. That’s very, very important. And then, once there, the neurologist or the care team can help decide the appropriate diagnosis because that determines the clinical trial, and then can lead the patient and the family through their available options. Clinical trials are labor intensive for both the providers and the patients and their families and understanding fully exactly what being in a trial entails is really important. We also make a big push to make sure that patients and their families know that, in addition to the clinical trials, there are things that the patient should be doing at home to slow decline and that includes regular, vigorous exercise, a healthy diet, social engagement and good sleep. All of these things have been proven to slow decline and should be done in concert with a clinical trial as well.

    Melanie: And now, to wrap up, what do you tell families, Dr. Foff, because this is, as we said, such a difficult time, not only for the person going through it, but for their loved ones, about that support for them as a caregiver, and how difficult it can be to watch somebody in cognitive decline.

    Dr. Foff: That is such a crucial piece of the puzzle. So many of these caregivers take on just an incredible burden in terms of emotional output, time away from work--all of those things that. So, what I tell families is this is a marathon and not a sprint. And that keeping them healthy, well-supported emotionally and from community resources, etc, and from the clinic resources, is really critical to keeping them healthy through the entire process. And making sure that every step of the way, they understand that there’s a team that can help answer their questions, making sure they get rested when it’s needed—all of those are just so crucial to making sure that the entire family unit is supported, not just the patient alone.

    Melanie: Great information. Thank you so much, Dr. Foff, for being with us today. You’re listening to UVA Health Systems Radio. And for more information, you can go to www.uvahealth.com. That’s www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Alzheimers Disease, Aging, Mental Health]]>
David Cole Tue, 04 Oct 2016 23:49:43 +0000 http://radiomd.com/uvhs/item/33934-digging-into-dementia
Diabetes Prevention and Management at UVA Health System http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33923-diabetes-prevention-and-management-at-uva-health-system diabetes-prevention-and-management-at-uva-health-systemThe Diabetes Education and Management Program at UVA Health System offers a complete approach to diabetes care that addresses your whole body, with special clinics focusing on how diabetes can affect your heart and weight.

Our Certified Diabetes Educators (CDE) are registered nurses and dietitians that provide education and support on how to manage and prevent the complications of diabetes.

Our approach makes it easy for us to evaluate and treat your diabetes and help you understand how to reduce your risk of complications.

Learn more about preventing and managing this condition from Dr. Jennifer Kirby, a UVA Division of Endocrinology and Metabolism physician.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1639vh2c.mp3
  • Location: Null
  • Doctors: Kirby, Jennifer
  • Featured Speaker: Jennifer Kirby, MD
  • Guest Name: Null
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  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Jennifer Kirby is a physician board-certified in both general internal medicine and endocrinology, diabetes and metabolism at UVA.

    Learn more about Dr. Jennifer Kirby

    Learn more about UVA Health System
  • Transcription: Melanie Cole (Host): The Diabetes Education and Management program at UVA Health System offers a complete approach to diabetes care that addresses your whole body with special clinics focusing on how diabetes can affect your heart and weight. My guest today is Dr. Jennifer Kirby. She’s a board certified in other general internal medicine and endocrinology. Welcome to the show, Dr. Kirby. So, tell us about the two different types of diabetes.

    Dr. Jennifer Kirby (Guest): Primarily, we think about diabetes as Type 1 or Type 2. Type 1 diabetes also known as juvenile diabetes--although I will share with you that more than 30% of the patients diagnosed with type 1 diabetes are adults--are patients who have an autoimmune disorder that causes a loss of insulin production from the pancreas. So, these patients are considered insulin dependent. The more predominant or prevalent diabetes is Type 2 diabetes. This is the one that we think about as being adult onset, and related to weight is Type 2 diabetes which is more insulin resistant. The insulin that we are making isn’t doing a good job at keeping our blood sugars normal.

    Melanie: So, just for the listeners, insulin resistant--so the pancreas is making insulin but the cells of our muscles and such are just resistant to the actions of that. They just won't let them in the door, right?

    Dr. Kirby: Absolutely, and the way I think about it is a key and a lock. So, if you have Type 2 diabetes, you’ve got the key, but there’s gum stuck in the lock so it’s difficult for that insulin to do its job and get the glucose to go into the cell.

    Melanie: So, we used to call Type 2 diabetes “adult onset” but now we’re even seeing children coming up with this type of diabetes as a result of the obesity epidemic. Tell us about some of the risk factors that might affect children and/or adults that would predispose them to diabetes.

    Dr. Kirby: That’s a great question. So, right now, we know that there are about 86 million Americans who are in the pre-diabetes category, meaning they are at risk for developing diabetes. That’s a lot of people, about 9 out of the 10 people who have pre-diabetes don’t know about it. So, risks include higher weight. So, those patients who have excess weight, patients who are sedentary, patients who have a family member--a brother, a sister, a mother, a father--who has Type 2 diabetes are at increased risk. So, those are all clues that patients may need to be clued into that they may be at risk for diabetes.

    Melanie: And, you mentioned the term pre-diabetes. How would somebody know? Is this something that’s going to show up on their annual physical or would they feel something, would they notice anything that would really send them to the doctor in the first place?

    Dr. Kirby: So, with pre-diabetes, they may not actually have any signs or symptoms and so it is something that we probably, as healthcare providers, need to be screening patients for, or for patients who feel that they’re a high risk, to ask about it. It could show up in blood work, so if they have an abnormal fasting blood sugar meaning that if they haven’t eaten anything but their blood sugar is slightly high, that can be a sign. There’s also other tests. Things like a hemoglobin A1C, which is a test of how your average blood sugar is over a three month period. We use that test for our patients with diabetes but it can also help diagnose pre-diabetes.

    Melanie: And, because it’s not necessarily insulin dependent, when you’re talking about Type 2, what is the first thing you tell patients that are told that they either have pre-diabetes or full blown diabetes that they have to do that’s so important that they start doing to manage this condition or possibly eliminate it altogether?

    Dr. Kirby: So, one of the best pieces of news that I can give patients is that diabetes and pre-diabetes are extraordinarily responsive to weight, meaning that for patients who lose even a small amount of weight, 3% to 5% of their weight, that that can make a big difference on their risk of developing diabetes or on their absolute diabetes control. There was a study called the “Diabetes Prevention Trial” that showed that a 7% weight loss prevented about 50% of patients from going from pre-diabetes to diabetes in five years. And, that’s a doable amount of weight loss for a lot of people.

    Melanie: And, what about other lifestyle modifications that they can make, even if they’re small ones, that could make a big difference in this diabetes diagnosis?

    Dr. Kirby: Absolutely. Part of the weight loss is being driven by changing how you eat and being more active. So, just increasing your activity level can help and getting help on eating healthy. There’s a lot of confusing information out there about what we’re supposed to be eating. What I usually tell people is, you can never go wrong with lots of vegetables, lean healthy proteins, and making sure that you’re getting up and you’re moving every single day. The American Diabetes Association recommends 150 minutes of cardiovascular exercise every week. That means that you’re doing about five days of 30 minutes where you heart rate is up and you’re feeling like you’re working hard. The good news is that doesn’t have to be all at one time, you can break it up. So, three 10 minute walks during the day can be just as powerful.

    Melanie: And, when does it require some kind of medicational intervention?

    Dr. Kirby: So, we usually start with our lifestyle intervention first, encouraging patients to change what they’re eating, to be more active, to try to lose weight, but Type 2 diabetes is a progressive disease and if those interventions are not successful, then we would start thinking about medications. Our first line medication for many patients is a drug that’s been around for a long time called Metformin, and it’s a very good drug because it works well, and it prevents the problems of diabetes such as the kidney and eye disease and it’s inexpensive at this point because it’s been around for such a long time.

    Melanie: So then, back to foods for just a second, Dr, Kirby, because people say, “Oh well, now I can't eat that, it’s got too much sugar,” and maybe they’re talking about carrots or tomatoes or another type or vegetable or they’re worried about grains, legumes, because they’ve been told they’re pre-diabetic. Clear up that myth for us about those healthy foods that people sometimes get confused for bad carbs.

    Dr. Kirby: Absolutely. There’s been a myth out there that carbohydrates are bad and the problem is that not all carbohydrates are alike. There are carbohydrates that are probably ones that people should avoid--all people should avoid--whether you have pre-diabetes or diabetes. These are your simple sugars, so the refined sugars. So, the extra sugars that get put into foods, and I will say that there’s going to be new labeling out there in the world that has--these added sugars that are going to be added to the label so it’s going to make it easier for consumers to get healthier options. But, there are complex carbohydrates, so our whole grains, our whole wheat breads and our very difficult to digest carbohydrates are more healthy and they’re less likely to make blood sugars go high if you have diabetes. And, those are important sources of nutrition that we all need to be eating. So, we talk about these low carb or no carb diets, I think, that has given carbohydrates a bad name when really we should just be getting rid of the extra sugars that are in our diet.

    Melanie: Do you advocate or ask your patients to check their blood sugar on a regular basis?

    Dr. Kirby: I do. It depends on their situation. So, it depends on the level of treatment they’re getting. If they’re using insulin multiple times per day--because sometimes patients with Type 2 diabetes will need insulin at some point--those patients often need to be checking their blood sugars more often. If there are patients who are on oral medications like Metformin, they may not need to be checking their blood sugars quite as often but I think for patients who check at different times, they can start to see the impact of things like the piece of cake that they had after dinner or the exercise that they did after dinner, and they can start to see the impacts of those choices on their blood sugars. So, there can be real value in that as well.

    Melanie: So, wrap it up for us, Dr. Kirby, and your best advice that you tell patients every single day about lifestyle modification, controlling their diabetes or possibly preventing it altogether.

    Dr. Kirby: I think every single time a patient walks into my clinic, and my patients will vouch for this, I'm talking to them about how they’re eating, how much they’re eating, what they’re eating, are they getting enough activity. Even for my patients who are not sedentary, meaning they have an active job, I still encourage them to be exercising on top of that. And, the other important piece is sleep. I think it’s the third pillar of our healthy lifestyle that we don’t focus on but patients also need to be getting sleep. So, I think those three components of your life, if you can be working on those, and we all need to be at all times, that’s the best device for all of us.

    Melanie: Thank you so much, Dr. Kirby. It’s really great information. For more information on diabetes and the UVA Health System and the programs that they offer, you can go to www.uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole, and thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Diabetes]]>
David Cole Sun, 02 Oct 2016 22:59:30 +0000 http://radiomd.com/uvhs/item/33923-diabetes-prevention-and-management-at-uva-health-system
Stamping Out a Smoking Addiction http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33872-stamping-out-a-smoking-addiction
Hear from Connie Clark, a tobacco treatment specialist, about common approaches, how to take the first step toward quitting, and available smoking cessation resources at UVA Health System.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1639vh2a.mp3
  • Location: Null
  • Doctors: Clark, Connie
  • Featured Speaker: Connie Clark
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Connie Clark is a tobacco treatment specialist at the UVA Cancer Center.

    Learn more about UVA Cancer Center
  • Transcription: Melanie Cole (Host): The UVA Cancer Center offers free assistance to tobacco users wanting to address their addiction to tobacco. My guest today is Connie Clark. She's a tobacco treatment specialist at the UVA Cancer Center. Welcome to the show, Connie. So, what are some of the most common approaches you hear or see every day for smoking cessation?

    Connie Clark (Guest): Well, I have to tell you, Melanie, it's a very individual thing. Basically, when I have someone that comes to see me, we meet for an hour in person at first because in a perfect world, it would be a one size fits all, but it's not. So, I kind of meet with them to try to figure out what their motivation is, how inspired they are to quit, and then we talk about options: medication, behavioral changes and oftentimes it's a combination of both and also coming back to see me, really up to a year. I try to check in with them to make sure that they've quit and stayed quit.

    Melanie: So, how do you help individuals determine which approach is best for them? There are so many ways to quit and medications on the market. How do you help someone decide?

    Connie: I do motivational interviewing and spend time with them figuring out is it--oftentimes it's habitual behavior that comes with the nicotine addiction--and figuring out what combination will work for them. If someone suffers from mental health issues, then obviously Chantix is not going to be for them. Wellbutrin is an option but oftentimes it does have its own side effects as well. So, it's kind of figuring out what will work for them. I worked with somebody this morning who is going to try acupuncture, kind of figuring out where their mindset is and what they feel comfortable with.

    Melanie: What a hard thing to do--quitting smoking. So, what is the first thing you recommend for those people that want to quit? What do you tell them to do day one?

    Connie: Day one: set a quit date. Because when you set a quit date, even if it's two months from now, I think that that is a commitment that they make and helps them formulate a plan. It's helping us work towards a goal and I think that that's always helpful.

    Melanie: So, tell us about some resources in the Charlottesville community for those who are trying to quit smoking.

    Connie: So, in the Charlottesville community, we are very fortunate that we have quite a few resources. The Health Department offers free acupuncture every Tuesday from 5.30pm - 6.30pm. We also have Quit Smoking Charlottesville, which is a support group offered also by the Health Department. They meet in the fall and then again in the spring, and offer a support group service in addition to some other strategies that people might try. There's Quit Now Virginia, which is a helpline that they can call and offers free counselling to people who want to quit and they will follow up with them as well. So, those are a few of the resources that we have.

    Melanie: Connie, how long does it take for somebody to get over that nicotine dependence?

    Connie: The nicotine dependence and withdrawal symptoms usually last about 3 weeks. So, if they can get through those 3 weeks of crankiness, lack of sleep, headaches--that kind of thing--it's really good. I also tell them when I meet with them that the craving for nicotine when you're trying to quit, if you can push through that 5-7 minutes and get through that craving, then you're good to go for a while. Will the craving come back? Absolutely! But, if you tell yourself, “5-7 minutes. I can do anything for 5-7 minutes”, then you're good to go for a while longer.

    Melanie: So, then, there's the behavioral aspect. That's really one of the more difficult as well because people have their routines, they either go outside or they need something to do with their hands. What do you tell them about that behavioral aspect?

    Connie: Well, that's another challenge that I have to personalize for each of the patients that I work with. And, that's part of that hour I spend with them trying to figure out, is it the coffee in the morning that's a trigger for you? Is it stress? Is it after every meal you're used to having something in your hands? For a female patient I work with, it is that kind of inhaling motion with her mouth and so she was able to replace that with lemon drops. I have another person that, actually, it's the reaching in his overall pocket and grabbing something and keeping it in his hands that he was missing so he replaced that with pretzel sticks and salt-free pretzel sticks, actually, because he had some teeth issues that he was coping with as well, so that he has something in his mouth and can grab something out of his pocket. Pringle sticks works for some people. I have some people with the coffee in the morning that are using the Pepperidge Farm Pirouettes. It's something in their hand and something to replace that "I have to have something with my coffee" feeling. Sometimes it can be as simple as changing the behavior. If you smoke inside, go outside. If you're an outside smoker and that's where you have your cigarette and coffee, then do it inside. Changing the habit and creating a new one.

    Melanie: So, if they've planned how to deal with those urges to smoke and those behavioral issues then, how long does it take somebody? You said 3 weeks for those cravings. Is that true for behavior as well? Is it generally like a 3-week kind of time that they have to put up with?

    Connie: It can be longer and I should have said from the get go, oftentimes people will try to quit 4-5 times before it sticks. When you think of nicotine, people think of it as being so acceptable socially, but the two most addictive drugs are heroin and crack. Nicotine is number 2. So, it's very difficult to quit. And I tell people I work with all the time, is it going to be in 3 weeks that you're going to feel great and not want it? Probably not. It takes a long time to change the behavior, to change habits. I was speaking with a patient this morning. I learned recently about something called a “mini-quit” that he's going to try which is try to dwindle down the 10 cigarettes he smokes but also implementing those behavioral things now so that when he gets to his quit date, those are already in place and when he gets stressed out he knows what's going to work and what to go to. So, it's kind of a process for each person and I wish there was a 'in 21 days you're going to feel great', but it's very individual.

    Melanie: What about the weight gain that people associate with quitting smoking? What do you tell people that are concerned about that?

    Connie: Typically, science says that on average, you might gain up to 10 lbs. And, some people don't gain any. I think it's kind of a matter of putting in place, if that's something that they are concerned about, making sure that they don't go to food and, if they do, it's something that won't cause weight gain. It's also kind of putting it into perspective in saying, “If you put on 5 or 6 lbs. while you're trying to quit, the perspective of what health concerns that is versus smoking or using tobacco on a daily basis which affects every part of your body and is the most preventable cause of cancers that we deal with.” So, kind of putting it in perspective and helping them come up with some strategies that they can use to kind of combat that.

    Melanie: And, what if they have a slip? What do you tell them about those guilt feelings?

    Connie: I tell them don't feel guilty. As long as you have a desire, you are never a failure. And, I remind them that it is the second most addictive drug and that it is hard to stop and people oftentimes will try 4 or 5 times before they are completely successful. But, if you have a desire, you are never a failure.

    Melanie: And are there some systems like e-cigarettes or any of those kinds of things that you like or approve of? Do you like the patch? You mentioned Chantix and Wellbutrin. So, just for a minute here, speak about some of the ways to quit and the ones that you like and the ones that you don't.

    Connie: So, e-cigarettes, I just will say this: I know that when they came out a few years ago, they were marketed as a method to help people quit. What we know is that e-cigarettes actually have more nicotine in them than regular cigarettes and the FDA is just getting involved, as you know, in August. There is kind of that 2-year span where people who are selling e-cigarettes have the opportunity to show them what's in them before they kind of make a final decision. But, I absolutely do not support that as a way to quit because they actually have more nicotine and they weren't regulated. So, it was really a big problem. As far as some of the other things, there's the patch, the gum, lozenges, the nasal spray, inhalers and, again, I would say it's very individual. I have people that the gum won't work for because they have dental issues that have been caused by either dipping or smoking. So, that isn't a possibility for them. Patches work. I'm a huge proponent of patches if they're used correctly. The idea isn't to put on two patches and still continue to smoke a pack of cigarettes, though. As with everything, they have to be used the way that they were designed. The inhaler and the nasal spray, they can work for some people if they're open to that idea. It's really about figuring out what each person is going to be okay with. Some people come to me very adamant about “I don't want any medication. I want to be able to do this on my own.” Okay. I respect that. And then, there are other people who are very open to that. So, it's really about doing that motivational interviewing and figuring out where they're at and what they would be okay with.

    Melanie: And, how is UVA Health System helping patients quit smoking?

    Connie: Well, here at the Cancer Center, they have me now as a full time person who works with all cancer patients who are dealing with cancer and also have tobacco issues. They can be referred to me. I can meet with them as many times as they want either in person or by phone, follow up with them for as long as they are open to me following up with them. They also have the early detection low dose CT scans that they do here on programs that Melissa Stanley, who is a nurse practitioner here, is helping to work with people who smoke to do some early detection so that it doesn't get to the point where it has caused any kind of cancer. I know “Hoo’s Well” has a program for employees who have a desire to quit that they have implemented here. So, I think it's something that they feel very strongly about and are really becoming very active and proactive in dealing with.

    Melanie: Thank you so much for being with us today, Connie. It's great information and so important for people to hear. You're listening to UVA Health Systems Radio and for more information you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Smoking, Heart Disease, Heart Health]]>
David Cole Sun, 25 Sep 2016 01:25:29 +0000 http://radiomd.com/uvhs/item/33872-stamping-out-a-smoking-addiction
Halloween Safety Tips http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33864-halloween-safety-tips halloween-safety-tipsEach year, poison centers manage numerous exposure cases involving Halloween-related substances, like candy, glow sticks, and special cosmetics.

Hear from Dr. Christopher Holstege, director of the Division of Medical Toxicology at UVA, and the co-medical director of the Blue Ridge Poison Center, about simple precautions to take in order to prevent accidental poisoning this Halloween.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1635vh4e.mp3
  • Location: Null
  • Doctors: Holstege, Christopher
  • Featured Speaker: Christopher Holstege, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Christopher Holstege is director of the Division of Medical Toxicology at UVA, and the co-medical director of the Blue Ridge Poison Center.

    Learn more about Dr. Christopher Holstege

    Learn more about UVA Health System
  • Transcription: Melanie Cole (Host): Each year poison centers manage numerous exposure cases during Halloween and Halloween related substances like candy glow sticks and special cosmetics. My guest today is Dr. Christopher Holstege. He's the Director in the Division of Medical Toxicology at UVA and the Co-Medical director of the Blue Ridge Poison Center. Welcome to the show, Dr. Holstege. So, what risks exist to kids and adults celebrating Halloween in terms of toxicology and your specialty?

    Dr. Christopher Holstege (Guest): Having been a parent of 6 children and having gone through this many times personally as well as many years of working with the Poison Center, very rare to have problems from a toxicology standpoint.

    Melanie: So, those days when we used to hear that people put things in the candy, it doesn't happen quite as much as people might realize.

    Dr. Holstege: No, it does not. It's very rare that those occur and I think most people are very safe in regards to what they're putting in their mouths.

    Melanie: That's great to hear for parents, certainly, but there are some other hazards from the emergency medical standpoint that happen at Halloween that as parents we have to worry about. Now, the first one I think about when our kids get a little older and they can go out on their own, Dr. Holstege, the cars and traffic and running across streets to get to the next house.

    Dr. Holstege: Correct, and I agree with you on that. It's dark out, kids are going from house to house, there are impediments that may be out in the yards, for example, that they don't see. In fact, I remember one time when I was walking with a group of kids as a parent, he walked right into a black mailbox and never saw it. So, making sure that they are paying attention to where they're walking and not looking at their cellphones, which certainly will blind them as they're walking. Wearing reflective items. We always hand out, for example, glow sticks to kids so that they would have those, so then hopefully cars would see them.

    Melanie: So, back to the toxicology for a second with glow sticks. If those things leak, which they do quite often, and they get on you, is that stuff dangerous?

    Dr. Holstege: No, in fact if you look at the majority of the times, the glow sticks that you buy in the United States are kids safe and they are not going to cause a problem from a toxicology standpoint. You can always look in the package to make sure that's indeed true.

    Melanie: Okay, so we're not going to be as worried about the candy but cars and traffic certainly making sure our children are seen, that the cars can see them and that they know really where they are going and what's in front of them. And, what about some of the things that they use to get into costume? There are cosmetics and contact lenses that have different colors. Do you have a feeling about any of those?

    Dr. Holstege: Yes, I think you need to be careful of the mask, for example, things that are causing visual impediments so that they can't see well which will also put them at risk for running into things or not having good peripheral vision when they're crossing streets. Contact lenses, you have to be careful. Some are meant more for adults versus kids. I would talk to the store you're buying it from to make sure it's kid appropriate. Other things on costumes, even things that cause costumes to light up, they need to be careful with and, certainly, very young kids. Some have those small batteries. If they come out, they can put them in their mouth and can swallow them. That can be a big deal.

    Melanie: And, what about carving pumpkins? Now they've got these new kind of knives. But, in the day, would you see kids getting hurt from doing this or do the parents mostly do it? What about that?

    Dr. Holstege: Yes, absolutely. We did see kids, and we still do see kids, getting hurt from that--using knives. I think most parents are very careful but the kids want to carve their own pumpkins. They have these great carving knives that you can get now that are serrated and blunt that are much lower risk than say, a steak knife that you may take out of your kitchen. But, the kids just aren't used to using those knives and they may still slip through and cut them and we certainly have seen plenty of injuries from that in the past.

    Melanie: And, while we're just talking about Halloween and Halloween safety, let's just delve a little bit into the nutrition factor. You're a doctor. What do you tell your kids and your friends' kids about maybe eating before they go out or eating candy while they're walking? Just the whole general idea of Halloween.

    Dr. Holstege: Well, it's a fun time for kids. They get a large array of candies and many full of sugar. Absolutely. They should eat a full meal before they go out so that they will be at least somewhat satiated; they won't gorge on the candy. And, be reasonable about how much of that candy they eat. Again, having six kids, it's hard to control that as they're walking with a bag full of very sweet items that taste good to them and in an interesting array and they are going to be at risk for getting sick if they eat too much of that.

    Melanie: As a father and a doctor, how do you decide as a parent when your child is able to go out with their friends without a parent?

    Dr. Holstege: It's a difficult question. And, the reason I say that is it probably depends on your neighborhood you're in. I was always very cautious with my kids and there are different ages that parents will want their children out. It depends on the group they're with, too. It's certainly the younger ages, I think by age 12, my kids were starting to ask to go out on their own. My youngest now is just turning 14 this year and this will probably be the first year that I will let her go out with a large group of friends, very well understanding the route they are taking, not going down dark alleys, following a very clear picture and the next thing is now, with some of the phone capabilities, you can actually have devices that follow those kids where you can actually follow and see exactly where they are in the neighborhoods.

    Melanie: Rock on with that! I like that idea. So, that parents can see. You can even maybe Skype your kids while they are doing it so that you can see exactly where they are. What about as parents giving out candy? Do you want to be the parent on the street that gives out raisins or pencils or what do you do?

    Dr. Holstege: No, we give out the typical variety of candy that you'll buy in the store. But, again, I think everything in moderation. Certainly, there are parents who will give out healthy items, I think. But the most important thing that comes across in today's environment, unless you really know the house you're getting them from is people are getting pre-packaged things that are sealed to assure that indeed those items are safe as well as you can, as opposed to things that may be unwrapped or homemade.

    Melanie: So, wrap it up for us with this great advice, Dr. Holstege. For Halloween safety all around, for parents and their kids.

    Dr. Holstege: Stay in a group, make sure that their vision is not impeded by what they are wearing, keep them with materials, either things that glow on their clothes or glow sticks, flashlights so they are well lit up as they're moving around the neighborhood, assure that your older kids have a planned route so you know where to find them and eat healthy before they leave the home as, hopefully, kids will be eating candy in moderation while they're having a fun night. Finally, the Poison Centers are always available 24/7. Their phone number is 1-800-222-1222 for any questions on candy, cosmetics. Please feel free to give them a call. They'd love to talk to you about that for safety reasons.

    Melanie: Thank you so much for being with us. What a great topic. You're listening to UVA Health Systems Radio and, for more information, you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Sat, 24 Sep 2016 19:51:57 +0000 http://radiomd.com/uvhs/item/33864-halloween-safety-tips
SPEED Clinic Helps Athletes Prevent Injury, Improve Performance http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33838-speed-clinic-helps-athletes-prevent-injury-improve-performance speed-clinic-helps-athletes-prevent-injury-improve-performanceThe UVA SPEED (Speed, Power, Endurance, Education and Development) Clinic is a world-class program for runners and golfers that combines modern technology with practical experience in sports to optimize athletic performance and heal and prevent injury.

The SPEED Clinic offers advanced technology for biomechanical analysis for athletes of all levels, from weekend warriors and 5K enthusiasts to Olympic competitors.

Learn more about the services offered from Max Prokopy, a UVA exercise physiologist.

Learn more about the UVA SPEED Clinic 

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1635vh4d.mp3
  • Location: Null
  • Doctors: Prokopy, Max
  • Featured Speaker: Max Prokopy
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Max Prokopy is an exercise physiologist and director of the SPEED Clinic at UVA.
  • Transcription: Melanie Cole (Host): The UVA SPEED Clinic is a world class program for runners and golfers that combines modern technology with practical experience in sports to optimize athletic performance, heal and prevent injury. My guest today is Max Prokopy. He's an exercise physiologist and the Director of the SPEED Clinic at UVA Health System. Welcome to the show, Max. Tell us what is the SPEED Clinic and what does it stand for?

    Max Prokopy (Guest): Hi, Melanie. Thanks for having me on and I appreciate you getting my last name correct. It's a tough one to pronounce. The SPEED Clinic here at University of Virginia is an acronym. It stands for strength, power, endurance, education, and development.

    Melanie: And, what does it do? What do you do at the SPEED clinic?

    Max: Over the years we've done many things. We started out as a research laboratory. We had one of the first, what's called a “force instrumented” to treadmill which basically allows people to see exactly what's happening in walking and running in terms of the forces that are occurring throughout the body. That allowed us to do a lot of research on let's say, for example, footwear, like do high heels really change how you walk? Or, even sports performance such as, if you go out for a bike ride, does that change how you run right after you take a bike ride? So, those would be a couple of examples. We're now going to transition our services and it's something that's a little more custom, individual oriented. In other words, an individual athlete comes to try and optimize their performance or, more than likely, to try to figure out why they might be getting hurt.

    Melanie: So, what type of patients do you see there?

    Max: We see a tremendous variety. We've seen people anywhere from 11-84 years old, primarily runners and golfers, and we see some occasional speed walkers, baseball players and we're developing some stuff from lacrosse and tennis as well.

    Melanie: So, how do assessments, Max, at the SPEED Clinic differ from seeing like a physician or physical therapist?

    Max: I think number one, you get a lot of time with us. So, a typical assessment lasts about two and a half to three hours, which, in the modern Western healthcare industry, is pretty hard to get time with a medical professional for that amount of time. So, what that means in that amount of time, we're not just having somebody sit around and check their emails for the entire time. We're digging through every little possible facet of what may be going on, and that's all relative to their individual goals. Some people come to us with the goal of qualifying for the Boston Marathon or breaking 80 in golf. Other people want to find out why their right knee hurts that's been hurting them for years and they can't get to the bottom of what to do about it. And then, finally, we can actually work with therapists or physicians in other parts of the country or region to kind of help them; help guide their therapeutic processes. In other words, using our data and our technology to help them understand what the next steps are for the athlete. In the end, what we end up seeing are actually a lot of frustrated athletes. And then, occasionally, we see some really smart ones that say, “I don't have any particular issues. I just want to get a little faster, a little better, “ or, “I run my first marathon and can you help me make sure that I'm doing this kind of thing correctly?” So, those are the people we really like to see. They're thinking ahead.

    Melanie: You touched on it a little bit but what type of equipment and technology does the clinic use to help identify, analyze and correct issues that impact these patients?

    Max: We have 12 infrared cameras. They can shoot anywhere up to 2000 frames a second and with that, what we do is, essentially, we create a 3-D animation of what's happening in an athlete. And then, more importantly, we can see what happens at every joint in their body that we care to measure. So, if there’s something going on during a motion--walking, running, biking, golfing--we're going to be able to figure out what that motion is and then we can also figure out through some pretty fancy tricks of engineering, we can figure out what kind of forces are happening at their joints.

    Melanie: So, what are some of the most common problems for runners and golfers? As you're studying these biomechanics of these athletes, what are you seeing most commonly for runners and golfers?

    Max: Well, the most common symptoms in runners, would be knee pain, plantar fasciitis, IT Band syndrome, and then a lot of times what would go sort of unnoticed by them, but I sort of prod and get through it. In runners, we see actually a lot of back pain. They just don't really think that they have it or they don't think it's running related. In golfers the most common complaints injury wise would be back pain, wrist pain and elbow pain.

    Melanie: That certainly is so common among golfers. So, when you're working with them, Max, what are some adjustments that you can make to improve their athletic performance with golfers? Are you teaching them better swing techniques, not hitting the ground? What are you teaching them?

    Max: First w kind of show them, again, based on their individual goals, how are they moving their bodies, and what's contributing to some of their either complaints or what's holding them back from their goals. And then, coming up with a series of strategies, it could be exercises; it could be drills. It could be just simple technique ideas that will help them kind of break through those barriers. So, the number one thing that we'll look at, especially with runners is their posture. That's probably the most underrated aspect of what a runner needs to be able to do is maintain their posture for a significant period of time. That helps them control the forces better across joints. So, if you think about it, let's take a runner's knee pain, for example, or runner's knee. That's simply a case of overuse. The knee is either taking on too much stress or it's moving too much in a direction that the joint and the joint tissues don't like. So, our job, then, is to help them distribute those forces better across other joints so the knee takes less of a load.

    Melanie: So then, let's talk about some other things that you do for them if they have pain relief, if they do have injuries. Do you help them work through that? And, also mental coaching because so much of athletics, especially running and golfing, really takes a large amount of mental concentration. So how do you help them there?

    Max: That's a great question. So, I do delve a little bit into pain research. I don't do the research myself. I just read about it. But, pain is clearly a central nervous system, meaning the brain and spinal cord complication, and people can absolutely get trapped in a cycle of pain. In other words, they can either engage in avoidance behaviors or they can get themselves in sort of a defeated cycle. Even your most motivated and seemingly positive people can get themselves trapped in a cycle where they don't think their knee is never going to hurt again. Breaking through that is really important. That's where the data really help. We can just clearly show them that, “This is why your knee is bothering you. It's not like some other crazy thing. You didn't drop out of the airplane,” or some other this kind of stuff. This is exactly what's going on and why, and here's what we're going to do about it. So, we have to show them a path forward that doesn't involve pain or discouragement.

    Melanie: And, what about the mental coaching?

    Max: Well, the first thing is to help somebody understand that they can make an effective change through fairly simple habits, right? So, if we go back to posture, which I said was really key to running healthy. Posture is simply the accumulation of our daily habits. So, if we sit in a certain kind of chair all day or we repeat a motion at a factory all day, our posture is going to be reflected in that. So, effecting change in those areas will, then, lead to some of the things that we're looking for there. So that's, for a lot of people, a big wake up call. I very rarely have to say much more than that to sort of help them mentally, so to speak.

    Melanie: Is there any nutrition advice going on as athletes are trying to increase their athletic performance and optimize it?

    Max: We do some consultation there in that sense. Many people come to us with their complaints, their issues or their goals that are so much more immediate that in a session, we will rarely get all the way down to some nutritional fine tuning. But, certainly we do talk, primarily in the case of the people we would see in pain, we certainly do talk about anti-inflammatory strategies through diet.

    Melanie: So, wrap it up for us, Max, about the UVA SPEED Clinic--speed, power, endurance, education and development--at UVA and why you want listeners to come there to optimize their athletic performance.

    Max: We don't rely on a range of other people’s opinions or this person did x, y and z and so, you should do x, y and z. We rely on taking a lot of time and a fine tooth comb to figuring out exactly what works for you and we have a technology to back that up and, frankly, have the experience and testimonials to back that up. In other words, somebody is coming for their own interests and we do a remarkable job of figuring out exactly what they need specific to their own anatomical needs. So, I'll give you an example. We had a runner come just the other day who ran with the toes pointed together, kind of pigeon-toed and he had 4-5 coaches that were trying to get him out of that type of positioning. After a few tests, we came to the conclusion that that's actually the best way for that person to run. That person never had injuries, they came to us, they were like they want to get faster. All the coaches want them to not run pigeon-toed and I said, “Bud, you should run a little bit pigeon-toed. I'm sorry but that's going to be the fastest way for you to run.” So, this is the kind of story that we can produce in the sense that we are going to take a look at the individual standing in front of us and not worry about, necessarily, generalities.

    Melanie: Thank you so much for being with us today, Max. For more information on the UVA SPEED Clinic, you can go to www.uvahealth.com. That's www.uvahealth.com. You're listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedics, Sports Medicine]]>
David Cole Mon, 19 Sep 2016 22:40:31 +0000 http://radiomd.com/uvhs/item/33838-speed-clinic-helps-athletes-prevent-injury-improve-performance
Nail Insertion to Address Limb Length Discrepancy http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33822-nail-insertion-to-address-limb-length-discrepancy nail-insertion-to-address-limb-length-discrepancyAt UVA Children’s Hospital, orthopedic surgeons encounter a variety of congenital conditions that affect a child’s mobility, and stay abreast of the latest technologies and procedures to provide patients with greater options.

Learn from Dr. Mark Romness about one innovative procedure to treat patients who have one limb that is significantly shorter than the other.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1635vh4c.mp3
  • Location: Null
  • Doctors: Romness, Mark
  • Featured Speaker: Mark J Romness, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Mark Romness is an orthopedic surgeon who focuses on the treatment of children with musculoskeletal problems and the effectiveness of those treatments.

    Learn more about Dr. Mark Romness

    Learn more about UVA Children’s Hospital
  • Transcription: Melanie Cole (Host): At UVA Children's Hospital, orthopedic surgeons encounter a variety of congenital conditions that affect a child's mobility and they stay abreast of the latest technologies and procedures to provide patients with greater options. My guest today is Dr. Mark Romness. He's an orthopedic surgeon who focuses on the treatment of children with musculoskeletal problems at UVA Health System. Welcome to the show, Dr. Romness. What is leg or limb length discrepancy?

    Dr. Mark Romness (Guest): Limb length discrepancy is really a fancy medical term for unequal leg length or someone that just has one leg that's longer or shorter than the other one. That can be from multiple causes. Sometimes, there are even some birth conditions where one leg doesn't grow as rapidly as the other. The other area we usually see it is from previous trauma or injury to the child's growth plate in the bone leading to growth abnormalities in the bone and that ends up in one leg being either longer or shorter than the other leg.

    Melanie: Is this something that's very obvious or would the child start to experience some pain in walking, or can you just really see it?

    Dr. Romness: It's usually not painful and it can often start out as something very subtle, which is maybe a quarter or a half inch difference in their length but as the child grows, that discrepancy or difference in leg length can get worse and so it's fairly related to the age of the child. So, the younger the child it's more hidden, but it's also a higher risk in chance that it might cause more problems down the road.

    Melanie: If someone comes to you and their child has this discrepancy, do you start with things like you know, lifts for their leg or for their other foot or do you go right to some interventions?

    Dr. Romness: Generally, a lift is not absolutely required. Everybody thinks that having a little bit of difference in leg length is going to affect your legs, your hips, your spine, cause back pain, but there's really no data to support that. And, the other thing is, just small differences don't make that big of an effect, mainly because we're rarely standing on both legs at the same time. But, it's really the more dramatic differences--once you get up to closer to an inch or more--that you'll actually start to see a significant limp. It can also even affect your energy efficiency walking once you get up to about one or two inch difference.

    Melanie: Are there some complications from not addressing this issue?

    Dr. Romness: I mean, again, shorter or smaller length differences can be compensated just by the body or with a simple lift in the shoe, but once you get up over an inch or once you get into the two to three inch range, then it really throws off the dynamics of the body and you're better off addressing it with more equalization procedures.

    Melanie: So, tell us about some of those equalization procedures--the PRECICE® nail insertion.

    Dr. Romness: Sure. When you're dealing with two legs that are unequal, I often simplify it and say that you can either shorten the long leg or lengthen the short leg. In a growing child, sometimes we can have the leg stop growing early so that the other leg can catch up, but the other way to do it is to lengthen the short leg. The way we do that is make a cut in the bone and gradually separate the bone at about a millimeter a day. Traditionally, that's been done with sort of external fixation, or ring devices on the outside of the leg but, more recently, there's been a new technology where you can actually lengthen with a rod that goes down the inside of the bone and that way nothing is outside.

    Melanie: So, tell us about that procedure. So, this is a surgical procedure for a child. Is it something that stays in permanently? Is it temporary? Tell us about it.

    Dr. Romness: The rod itself goes down the middle of the bone. It's usually only for sort of the older kids that are close to done growing, but it's an excellent internal device that you can control the lengthening carefully with. Once the bone is out to length and healed, we usually do recommend that the rod come out, just because if it stays in there too long, it can be very difficult to get out.

    Melanie: So, you can actually control this rod from outside the body as this child grows? I don't mean to be simplistic, but something like braces in a child's mouth that changes their jaw structure. Is that what this is like?

    Dr. Romness: It's similar. Again, it's a rod that's distracted using magnets. So, you have an external drive device that the patient positions on his or her leg and they can control how much the rod distracts. We usually do three distractions a day at a third of a millimeter a day, so you're actually lengthening the bone at one millimeter per day.

    Melanie: Is this painful for the child?

    Dr. Romness: In general, no. You know, with a simple straightforward distraction, it's relatively pain-free after you're over the initial surgical procedure. It's partly because the distractions are so small. You're looking at one-third of a millimeter per distraction, so the stretch on the leg is usually not that painful.

    Melanie: Do they have a problem going through security in airports? What is it made of?

    Dr. Romness: I don't know the exact metal, but because it's deep and implanted, it rarely sets off metal detectors.

    Melanie: Wow. That's fascinating. How long do you leave it in?

    Dr. Romness: It's usually about a year or two until it's taken out. The lengthening process takes, again, as I mentioned, you're actually lengthening it one millimeter per day, but then you also have to wait for that bone to heal, which takes a little bit longer. On average, a true healing is about one month per centimeter of lengthening. So, if you're looking at an inch of length, that's about two-and-a-half to three months until the bone is well-formed and strong.

    Melanie: So, when the child is done using this device, then the ossification of their bones, is that affected? When you take this out, what goes on inside their bones? Are they still able to grow?

    Dr. Romness: Yes, because during the lengthening procedure, you're lengthening toward the middle of the bone, whereas most of the growth comes from the ends of the bone.

    Melanie: That's absolutely fascinating. Are there any drawback to it?

    Dr. Romness: I mean, with the lengthening procedure, you are concerned about developing contractures in the joints above and below the bone, so that does need to be monitored carefully during the lengthening process. You also have to be careful with your lengthening rate, that if you lengthen too quickly, you'll stretch all the surrounding soft tissues, including the nerves and blood vessels whereas if you lengthen too slow, the bone will form too quickly and then it will actually heal too quickly and you won't be able to keep lengthening.

    Melanie: The surrounding soft tissue was going to be my next question, Dr. Romness, so you answered that. Tell us about some stories and the effectiveness of these treatments--the patients that you've helped that would benefit from this approach. Are they older? Teenagers? Tell us about and give us some of your examples.

    Dr. Romness: For this procedure, they need to be close to done growing, so it's usually a teenager where the bone is nearly done growing for the rod, but you can still do lengthening procedures with the external device on the younger kids. The case I think of most is a kid who has been through two lengthenings. He went through one lengthening with the external rings and then, more recently, he went through a lengthening with the internal rod and both the patient and his mother were just ecstatic about how much easier it was the second time.

    Melanie: And, what is the child's life like with this device inserted? Are they banned from athletics? Do they have trouble walking? What goes on there?

    Dr. Romness: Well, during the initial healing phase, the first week or two, they are on limited activity. It's kind of like when you break your bone, they have to take it easy on it. During the distraction phase they have to be somewhat careful, so we keep them out of sports, but they're able to go to school. And then once the bone is fully healed, it's back to all activities.

    Melanie: So, wrap it up for us, Dr. Romness. What an interesting topic this is--about the PRECICE® nail insertion to address limb length discrepancy. Tell people listening what you really want them to know and why they should come to UVA Health System for their care.

    Dr. Romness: Well, I think it's an excellent opportunity for state-of-the-art technology and I think UVA has been good at keeping ahead of pace with this type of activity and keeping what's best for the patient in mind.

    Melanie: Thank you so much for being with us today, Dr. Romness. We'd love to have you on the show again. You're listening to UVA Health Systems Radio. For information, you can go to www.UVAhealth.com. That's www.UVAhealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedics]]>
David Cole Thu, 15 Sep 2016 23:30:06 +0000 http://radiomd.com/uvhs/item/33822-nail-insertion-to-address-limb-length-discrepancy
Keeping Kids Safe in the Car http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33782-keeping-kids-safe-in-the-car keeping-kids-safe-in-the-carSelecting a child's car seat can be overwhelming for families. However, A car seat is one of the most important purchases you'll make for your child.

Learn current recommendations and tips from KK West, a UVA Children’s Hospital safety program coordinator.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1635vh4b.mp3
  • Location: Null
  • Doctors: West, KK
  • Featured Speaker: KK West
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: KK West is a safety program coordinator at UVA Health Systems. 

    Learn more about UVA Children’s Hospital
  • Transcription: Melanie Cole (Host): Selecting a child’s car seat can be overwhelming for families. My guest today is K.K. West. She’s a safety program coordinator for UVA Children’s Hospital. Welcome to the show, K.K. What are some of the different types of car seats and what ages and sizes should they be used?

    K.K. West (Guest): Okay. There are several different car seats on the market today. We have the rear- facing infant car seat which sort of looks like or is familiarly known as the “bucket car seat” which is used really just for infants. The height and weight limits for the car seat set the tone for the car seat. So, when the child has reached the height and weight limit for that infant car seat, at that point, they would want to either move to a convertible car seat which also can be rear-facing or forward-facing. The infant car seat has a five point harness in it. The convertible car seat is rear-facing and once the child reaches about age two or has outgrown the rear-facing guidelines set by the car seat manufacturer, at that point, that seat would turn around and become forward-facing. Then, forward-facing only car seat would be a car seat that is designed just to be forward-facing. Those car seats can have the five point harness and some for them do convert into a booster seat which has the lap and shoulder belt. Then, there are the booster seats which is the car seat that is designed just for a lap and shoulder belt. Typically, that is for children ages four through eight as long as they meet the height and weight requirements for the seat.

    Melanie: So, that’s where parents need to look--at the height and weight--because some children, mine included, are tiny or don’t fit that height and weight requirement. So then, do we keep them in longer?

    KK: Yes. The American Academy of Pediatrics is recommending that all children stay rear-facing for at least age two, and longer if they still fit the height and weight requirements of that rear-facing car seat. The idea behind that is that children’s head and neck muscles are not as developed as adults or an older child, so keeping them rear facing would keep them safer longer. Then, once the child is large enough to be forward-facing and is in that five point harness, then you would continue to monitor your child’s height and weight based on what the seat manufacturer has established for the seat.

    Melanie: So, what should families look for and keep in mind when they go out shopping for those car seats? There are so many on the market?

    KK: It’s overwhelming what’s on the market. So, there really isn’t a set, “Oh, this is the best car seat.” When you go out shopping for a car seat, you have to keep lots of things in mind. One, which car seat best fits your family’s need? If you have three children, you may need a more narrow car seat to fit the three car seats across the back of your car. If your child is a larger built child, you may need more of a convertible car seat versus the infant car seat. So, the rule of thumb is, you want to look at your child’s specific need, which car seat actually fits in your car and how many car seats you will need. So, if you drive a sports car, for example, a large, huge convertible car seat may not fit as easily as a different convertible car seat. So, it’s really about what works best for your family, your car.

    Melanie: And, you really have to look at the size of your car, the size of the seat and the thought of your back--putting a child in there.

    KK: Correct, absolutely. All car seats are crash tested to the same guidelines. So, when you’re looking at car seats, it really does matter which car seat best fits the child, best fits the car, and best fits your lifestyle.

    Melanie: Now, tell us about the risks of using used or expired car seats. People tend to say, “Oh, I've got one you can use. Don’t bother going out to buy one.”

    KK: Well, the car seats spend a great deal of time in a car. Cars get really hot, cars get really cold. So, when they set guidelines for expired seats, they’re doing it because the integrity of that plastic and the seat material, after so many years of being out in the heat, the sun, the cold, can start to break down. If you think about a plastic chair that sits on your deck and after years of sitting out there, eventually the plastic gets old and brittle. The same thing is true for car seats. You want to make sure that your car seat is safe. So, many car seats have a five year lifespan on them. Others have a little bit longer and it should say on any of the car seat, the “best used by” date on the sticker on the side of the car seat.

    Melanie: What is the LATCH system?

    KK: The LATCH system stands for “lower anchors and tethers for children” and all cars and car seats that came out after 2002 have this new system. What it is, is in the cars, there are little metal rings that are built into the base of the seat, and then there’s a LATCH system that’s hooked in. Sometimes it’s on the back of the seat. It’s a way for families to be able to get a child seat securely in the car without using a seatbelt system. It’s supposedly easier to install than just a secured seatbelt system although those work. The things about LATCH systems is that each vehicle has its own weight limit for the LATCH system and so it’s important that you check with your vehicle manufacturer and make sure that you monitor your child’s weight. Once your child reaches the max weight for that LATCH system, they would then need to use the seatbelt as the means to anchor their car seat.

    Melanie: And, when is a child ready to ride in the vehicle using just a seatbelt? Is that based on height, weight, one or of each of them? What if they don’t match up?

    KK: All of the above. So, the recommendation now is that eight and above is a general age timeframe but, really, it’s about the size of the child because some eight-year-olds are teeny tiny and some eight-year-olds are big. So, the way that you can assess that is if the child’s bottom fits up against the back of the seat with their back against the back of the seat and their knees are bent easily over the edge of the seat with the feet touching the floor, flat on the floor. The shoulder belt needs to fit across the shoulder and not at the neck and the face and the lap belt needs to fit not across the belly or stomach area but across the thigh area.

    Melanie: So, if it’s coming up over by their neck, they are too small to be sitting in that seatbelt.

    KK: Absolutely. Yes. So, many of the booster seats now have increased their height and weight for them. So, some of the booster seats actually go up to 100 pounds.

    Melanie: So, what if your kid fights you on that?

    KK: Then, you work on more of a behavioral and a car seat plan. My son absolutely did not like riding in his booster seat but he wasn’t quite tall enough to come out of the booster seat yet. So, we remind them of the safety and how important it is, and we encourage them that the car didn’t go until everybody had their seatbelts on and he was in his seat. And then, we routinely checked his size to make sure that when he reached that point that he could come out of his car seat.

    Melanie: So, wrap it up for us, K.K.. It’s really great information. It’s so important for parents to hear from an expert such as yourself about why this is so vital to follow these instructions. So, wrap it up with your best advice on car seat safety.

    KK: Okay. I am going to say that all children under the age of 13 should ride in the back seat of the car. I’m going to add that little plug. So, if you are 12 or younger, you really should ride in the back seat of the car. All passengers in a vehicle should be restrained. There was an old rule of thought that once you were in the backseat, you didn’t necessarily have to have your seatbelt on and that’s not true. Set the best example. As a parent or as a guardian, when you get in the car, put your seatbelt on and that’s going to help remind the children that it’s important for them to wear their seatbelts, too. So, modeling that good behavior. The other thing that I would say is car seats should be replaced after a moderate to major crash to ensure that that child is safe. A crashed seat may not be able to provide the safest environment for that child.

    Melanie: Thank you so much 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.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Thu, 08 Sep 2016 20:03:03 +0000 http://radiomd.com/uvhs/item/33782-keeping-kids-safe-in-the-car
Race Recovery: Important Tips http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33732-race-recovery-important-tips race-recovery-important-tipsKnowing how to recover from an endurance event is just as important as knowing how to compete. 

A UVA physician, Dr. David Hryvniak – who is a running enthusiast – shares tips about how to safely get back on your feet after a big race.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1635vh4a.mp3
  • Location: Null
  • Doctors: Hryvniak, David J.
  • Featured Speaker: David J. Hryvniak, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. David Hryvniak is a physician in the Department of Physical Medicine and Rehabilitation (PMR), and an avid distance runner.

    Learn more about Dr. David Hryvniak
  • Transcription: Melanie Cole (Host): Knowing how to recover from an endurance event is just as important as knowing how to compete. My guest today is Dr. David Hryvniak. He’s a physician in the department of physical medicine and rehabilitation at UVA Health Systems and at the UVA Runners Clinic. He’s also team physician for UVA athletics. Welcome to the show, Dr. Hryvniak. Let’s talk about first race day. Before we talk about recovery, I’d like to talk about event day. To plan for a good event, what would like them to do the day of, when they wake up in the morning before a long race or any event?

    Dr. David Hryvniak (Guest): I really think it begins during your training. Really, preparing for a race is you have to practice everything. You’re not only practicing the running in that aspect, but you want to practice your eating. You want to practice the things you will be eating during the race as well as pre-race, so that way you don’t get any GI disturbances during a race. You also want to practice hydrating as well. And you want to have a routine down prior to the race. I always tell people, “You don’t want to try anything new on race day, whether that be shoes, what you’re eating or what you’re drinking.”

    Melanie: Are there some things you like people to eat and/or drink on race day that will help them get to the end of the event and recover faster?

    Dr. Hryvniak: It certainly depends on the event that you’re going to be doing. The typical carbo-loading that many people did before racing doesn’t have a whole lot of literature to back it up, but a lot of people find that the pasta and carbohydrates are easier on the stomach, so most people can tolerate that. I always say, “Find something that works well for you the night before as well as the morning of.” And, if it’s going to be a hot race you really need to make sure you’re hydrating before the race. We want you using both sports drink as well as water and making sure that you’re topped off before you begin the race.

    Melanie: You said sports drinks as well as water. Is there a time when one is preferable over the other?

    Dr. Hryvniak: I find that if it’s going to be really hot, I prefer sports drinks, because you’re getting some electrolytes in that mixture. There is a risk of people overhydrating, especially if they’re just drinking water, and there’s such a thing that we worry about in the marathon medical finish tent at some of the marathons we cover, it’s called “hypernatremia.” That’s where people basically dilute out their salt because they drink too much water during the race and before the race. So, I always find a mix of both sports drink and water, and mixing those up, is the best to prevent that.

    Melanie: Is there anything people can do to limit the soreness during an event that’s going to occur after recovery. Is that only based on their training?

    Dr. Hryvniak: Some of it has to do with training. Some of it has to do with making sure that you’re properly fueled beforehand. And then, as we’ll talk about a little bit later, with recovery, there are certain things that we can do to help limit delayed onset muscle soreness immediately after the race as well as that evening and in the following days and weeks as you recover from the race.

    Melanie: What are some of those? Let’s get to the recovery part of it and what can you do? Let’s just start with soreness and musculoskeletal issues that might happen if you’re feeling knee pain, if you’re feeling a little swollen, maybe you’ve built up a little water retention, or you know you’re going to feel sore. What do you want people to do? Do you want them to stretch? Do you want them to sit right down? What do you want them to do?

    Dr. Hryvniak: I usually break it down into immediately post-race and then that evening and the following day. So, immediately post-race is as soon as you cross the line, the thought is everyone wants to stop. You’ve finished your marathon, you want to stop, but the best thing to do is continue to walk around for 10-15 minutes because that’s going to help get rid of some of the waste products including lactic acid that’s in your legs and allow your body to use those muscles that you have to pump that out of your muscles. If it’s a shorter race, some people like to do a cool down jog, so a 10-15 minute real slow jog. Along the same lines, we’re trying to get all the waste products out of their legs. I find immediately post-race, that’s the best thing to do for the first 15-20 minutes after you finish.

    Melanie: If you’re feeling knees and ankles and such, do you like them to ice once they’ve done their walking around for a while?

    Dr. Hryvniak: Either using ice directly to the joint or an ice bath is very helpful for people. So, usually we recommend that after an event or after you’re done cooling down, doing it for about 10-15 minutes at a time, you don’t want to do it much longer than that. You can either create an ice bath at home and put some ice in your bathtub and sit in there for 10-15 minutes and really ice down all your legs, or you can specifically put an icepack on that joint. But, ice is very helpful. I do caution people to not use anti-inflammatories like Advil or Aleve immediately post-race because that can sometimes have its effects on your kidneys. So, I ask people to avoid using that immediately after the race, even if they’re having some joint aches or pains.

    Melanie: Dr. Hryvniak, you are an avid distance runner. Have you ever taken an ice bath? How uncomfortable are those?

    Dr. Hryvniak: We used to do them after every workout. I ran at the College of William and Mary, and three times a week we would take ice baths. Some of my teammates would do it more often. It is an uncomfortable feeling until you get used to it. But, if you’re not an avid person who likes to sit in the cold, it’s definitely difficult in terms of handling that cold. But, I would usually read a magazine or a book or watch TV and that seems to help take your mind off of it.

    Melanie: Tell us about your long distance runs.

    Dr. Hryvniak: I ran in high school and college and then through med school, I continued to race at the marathon and the half marathon distance. I run four our local post-collegian Olympic training team, it’s called the Ragged Mountain Racing Team here in Charlottesville. We have had several people qualify for the Olympic trials this year. I’m still trying to continue to run well at the marathon and on the road.

    Melanie: That’s fantastic. What about food and beverages after a race? Now we’re hearing more and more about chocolate milk and you mentioned energy drinks. So, what do you want people to do just after as far as nutrition?

    Dr. Hryvniak: There’s really an ideal window. I usually tell people 20-40 minutes after you finish activity is the ideal window when your body is going to absorb the most nutrients and allow you to recover the best. So, I always tell people, “Let’s get some kind of carb, protein and fat in during that period of time.” I usually say do a 3:1 ratio in terms of carb to protein, so something like chocolate milk that has some carbs in it, sugars, as well as it has some protein and fat, is really an ideal post-race drink. Several companies make other kinds of recovery drinks that have similar types of ratios in terms of the carbs, protein and fat. But, even just some sports drinks will get you at least the carbs in if you can’t tolerate the chocolate milk. It’s really important to rehydrate after a race. Especially hot races, we need to replenish our weight loss. It’s not uncommon to lose a couple to a few pounds after a hot race. So, we really want to replenish that weight loss because that is all water loss in terms of that weight, and replenish our electrolytes. So, using some water as well as an electrolyte type drink, like a Gatorade or PowerAde is useful for that.

    Melanie: What about the protein drinks, Muscle Milk and such? People think if you drink these really high protein drinks, 30 grams, 40-50 grams, that it goes right to your muscles and helps them replenish.

    Dr. Hryvniak: You want some protein, but what I find is that can upset people’s stomach, especially post-race, and it’s very difficult to absorb that much protein in a short span of time. So, really, you only end up absorbing some of that and the rest of it is wasted. So, I think finding that perfect ratio, and the literature shows us that 3:1 ratio. You really want to be replenishing your carbs because that’s what your body is predominantly burning, that and glycogen when you’re racing. The protein will help with muscle building and recovery in terms of that. Then, we actually use some fat when we do endurance racing as well, so we want to replenish some of that as well.

    Melanie: In the last few minutes, tell us about the emotional impact of finishing a major race, Dr. Hryvniak. People want to feel that high. They want to feel that satisfaction in knowing that they did something. What does it feel like?

    Dr. Hryvniak: It’s exciting when you finish your first marathon or your first race and you cross the finish line. And then, there’s a little bit of a letdown, because you’ve trained for this event for months and months and now it’s done, and a lot of people are like, “What do I do next?” I’ve found in the past, at least finishing, I think I’ve finished at least 15 marathons, that the first hour or so after the marathon, you hate the event, and then about an hour later you’re looking for the next one. So, there’s definitely a certain amount of motivation to look for your next race after you’re finished but you have to be careful and give yourself a break. I always recommend people make sure they get good sleep that night, take advantage of those free post-race massages that they have at a lot of races. If they don’t have that, do some foam rolling after. And then, for the next several days, especially after a marathon, really make sure you’re resting, retouch with your family, do some things that you weren’t able to do during your training cycle to refresh your mind. And then, you can begin training for your next event.

    Melanie: Just tell us about the UVA Runners Clinic at UVA Health Systems.

    Dr. Hryvniak: We are the only clinic in the area that is for runners and we are staffed by runners. So, all our physicians are experienced runners and we’re all board certified in sports medicine. Our goal here is we don’t like to tell people that they have to stop running, so we like to get people back out on the roads and will use different tools to help diagnose injuries and get people back on their feet. So, we use gait analysis and customized rehab programs. We’ll make a return to run programs for people coming off an injury or a long break off running. Our enjoyment comes from getting people back out there and able to compete. We also cover a lot of the local races, high school, college and a lot of the local road races, including the men’s 4-miler or women’s 4-miler, the Charlottesville 10-miler and the marathon, which are all major events here locally.

    Melanie: Thank you so much. What great information, Dr. Hryvniak. Thank you so much 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 for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Sports Medicine]]>
David Cole Wed, 31 Aug 2016 01:06:58 +0000 http://radiomd.com/uvhs/item/33732-race-recovery-important-tips
Breast Cancer Screening for Women with Dense Breasts http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33660-breast-cancer-screening-for-women-with-dense-breasts breast-cancer-screening-for-women-with-dense-breastsIf a recent mammogram showed you have dense breast tissue, you may wonder what this means for your breast cancer risk. Doctors know dense breast tissue makes breast cancer screening more difficult and it may increase the risk of breast cancer.

In the United States, there are laws that require doctors in some states to inform women when mammograms show they have dense breasts. But just what women should do in response isn't clear.

Women who have dense breasts are more likely to develop breast cancer than women with low breast density. Researchers are still trying to figure out why.

Dense breasts can make it more difficult to find breast cancer on a mammogram, and since both cancer and dense breast tissue look white or light gray on a mammogram, dense tissue may hide a tumor from view.


Learn about screening challenges and options for women with dense breasts from Jennifer A Harvey, MD, a UVA expert physician.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1629vh3e.mp3
  • Location: Null
  • Doctors: Harvey, Jennifer A
  • Featured Speaker: Jennifer A Harvey, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Jennifer Harvey trained in Arizona, receiving her BS degree in zoology and chemistry at Northern Arizona University and her Doctorate of Medicine degree at the University of Arizona. She also completed her residency training in diagnostic radiology at the University of Arizona, where she served as chief resident. She was certified by the American Board of Radiology in 1993. Dr. Harvey has been the head of the Division of Breast Imaging at UVA since 1994, and director or co-director of the UVA Breast Program since 2000. She is a fellow of the Society of Breast Imaging and the American College of Radiology. Her primary research interest is mammographic breast density and the association with breast cancer risk. From mammography and tomosynthesis (3D mammography), to ultrasound and breast MRI, Dr. Harvey is involved in all aspects of breast imaging. She also performs image-guided breast biopsies including stereotactic, ultrasound, MRI guided biopsies and radioactive seed localization procedures.

    Learn more about Dr. Harvey

    Learn more about UVA Cancer Center
  • Transcription: Melanie Cole (Host): If a recent mammogram showed you have dense breast tissue, you may wonder what this means for your breast cancer risk. My guest today is Dr. Jennifer Harvey. She's the head of the division of breast imaging at UVA Cancer Center. Welcome to the show, Dr. Harvey. So, doctors know that dense breast tissue makes breast cancer screening a little more difficult. What does that phrase "dense breasts" mean?

    Dr. Jennifer Harvey (Guest): So, women with dense breast tissue, that means that there's a lot of white on the mammogram and that white tissue is composed of breast tissue, you know, the part of the breast that makes milk, as well as fibrous tissue, which is just a sort of dense fibrous tissue.

    Melanie: So, how does a woman know if she has dense breasts?

    Dr. Harvey: So, in Virginia, we have a law that requires us to tell you in your letter if you have dense tissue. If you do not have dense tissue, there won't be anything about breast density in your letter of your mammogram results.

    Melanie: So, this is a law in some states and the woman gets it, and then, what does she do with that information?

    Dr. Harvey: Well, that's the big question and it is somewhat under debate with breast imagers. I think the most important thing to know about dense breast tissue is that mammography is less sensitive and so, you know, you hear back and forth "Oh, maybe I should wait more years between screenings," and things. If you have dense tissue, you need to come every year. So, don't skip a year and you should also consider sort of optimizing your screening. And that could be either with tomosynthesis, which is 3D mammography or getting an ultrasound of your breasts. Either of those will give us a better opportunity to see breast cancer at an earlier stage.

    Melanie: So, how does dense breast tissue differ when you're looking at the screening--and you mentioned 3D tomosynthesis--how does it differ for what you see?

    Dr. Harvey: Yes, so, cancers are white, typically, on mammography. So, we're trying to find a white cancer in a background of white tissue. So, you can see why it's harder for us to find them on regular mammograms. The 3D, those are pictures that are taken sort of in an arc over the breast and then, those get reformatted in slices, kind of like a CT scan, and so, basically, that allows cancers to be sort of uncovered, if you will. They can be obscured by clumps of dense tissue, so we can sort of see behind the clumps. So, that helps us see more cancers. But, for women with very, very dense tissue, where it's completely white, the extremely dense category, which is about 10% of women, the tomosynthesis may not be enough, so ultrasound gives us a different way to look at the tissue. On ultrasound, cancers are dark and the breast tissue's white. So, then we're looking for dark masses in a sea of white tissue. So, it's a different way to look at the tissue.

    Melanie: When do we have to go to an ultrasound?

    Dr. Harvey: So, in many states, all women with heterogeneous, or very dense breast tissue, are offered screening ultrasound and I think it's a good idea for most women to at least consider it. Insurance may or may not cover it, but I think it's a really good idea, again, because it's a different way for us to look for cancer. For women with that very dense tissue, that's probably the best option to have a screening ultrasound in addition to the mammogram. Now, the downside of screening ultrasound is that we find a lot of things that we think are going to be cancer, that are benign. So, I think it's really very individual what you decide. If you're somebody who is a minimalist, you know, I definitely don't want to have any extra biopsies or follow ups, then I would recommend the 3D mammography. If you're somebody that wants to do everything and have every opportunity to find cancer earlier, even if it means having more biopsies, then I would do a mammogram and an ultrasound.

    Melanie: Do dense breasts put us at a higher risk for breast cancer?

    Dr. Harvey: Yes, they do and it kind of makes sense. So, women who have denser tissue that likely indicates that the breast tissue is more active, and the more active the tissue is, sort of the more cell turnover it has, and every cell turnover, there's an opportunity to sort of have our DNA make a mistake, if you will, and increase the risk of cancer. So, women who are very dense are about twice as likely as the average woman to develop breast cancer. It doesn't put anybody at high risk on its own, but it definitely does increase the risk.

    Melanie: Will it change our ability to do a self-exam if we're somebody who has dense breast tissue?

    Dr. Harvey: You know, that is a great question and it often does because women with dense tissue often have a very firm breast, but it's not always that way. In my 20 years of practice, I've been surprised sometimes that women with dense tissue can very have soft breasts and can feel lumps easier, but, in general, women with denser tissue, it is going to be harder to feel lumps and they often have lumpy breasts to begin with. So, just doing self-exam alone is not going to be enough to supplement your mammogram. But, if you do feel something, please come and see us.

    Melanie: And if you have dense breasts, are there some lifestyle choices that you can make to help keep your risk a little bit lower?

    Dr. Harvey: Yes, there are. So, you've probably heard that women in developed countries have a higher risk of breast cancer. So, some of the things that increase our risk are things that we can't control as well, like having children at a later age and things like that, but hormone therapy increases the risk, not hugely, but it does increase risk after menopause. Weight gain after menopause increases the risk as well, and alcohol increases risk as well. So, try to minimize your alcohol use. Exercise and breastfeeding are both protective against breast cancer. So, if you can do those, that does make a difference.

    Melanie: In just the last few minutes, give us your best advice. What do you want women to know about the laws regarding dense breast tissue and even where they don't have these laws, what's your best advice for women about getting screened and really taking charge of their own health?

    Dr. Harvey: I think if you have dense breast tissue, you need to know that mammography is imperfect for you. That it is going to be harder for us to find things. So, make the most of your opportunities. Show up every year for your mammogram, don't skip a year, get the 3D, and definitely at least consider ultrasound. You know, if you end up having to have a little needle biopsy or something like that, that may be a small price for us to be able to find cancers early. I would definitely consider that.

    Melanie: Tell us about your team at the Breast Imaging of UVA Cancer Center.

    Dr. Harvey: Oh, we have a great team. So, everybody who works here, we do just breast care. So, for example, all of the radiologists, we do breast care. We don't look at gallbladders and things like that. We are dedicated to what we do, and very passionate about what we do.

    Melanie: Thank you so much for being with us. What great and such important information for women. You're listening to UVA Health Systems Radio and for more information, you can go to uvahealth.com. That's uvahealth.com for more information on breast imaging at the UVA Cancer Center. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer, Women’s Health]]>
David Cole Sun, 21 Aug 2016 00:55:34 +0000 http://radiomd.com/uvhs/item/33660-breast-cancer-screening-for-women-with-dense-breasts
How to Maintain a Heart-Healthy Diet: It's Easier Than You Think! http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33658-how-to-maintain-a-heart-healthy-diet-it-s-easier-than-you-think how-to-maintain-a-heart-healthy-diet-it-s-easier-than-you-thinkEating right: We know how complex it can be. What you eat can have emotional and health impacts and can affect your  family and lifestyle. 

The American Heart Association offers seven simple steps to help avoid cardiovascular disease.

Some common questions about heart healthy eating are how much of an impact does sugar have on the cardiovascular system? What are the key foods to incorporate into a heart-healthy diet?

Listen in to hear answers to these questions and to learn about key components of a heart-healthy diet from Mary Lou Perry, MS, RD, a UVA registered dietitian.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1629vh3d.mp3
  • Location: Null
  • Doctors: Perry, Mary Lou
  • Featured Speaker: Mary Lou Perry, MS, RD, CDE
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Mary Lou Perry, MS, RD is a registered dietitian and a certified diabetes educator.

    Learn more about Mary Lou Perry, MS, RD
  • Transcription: Melanie Cole (Host): Do you know what the key components of a heart healthy diet really are? My guest today is Mary Lou Perry. She’s a Registered Dietician Nutritionist and a Certified Diabetes Educator at UVA Health System. Welcome to the show, Mary Lou. What are the seven simple steps outlined by the American Heart Association to avoid cardiovascular disease?

    Mary Lou Perry (Guest): Well, thanks, Melanie. I appreciate being on. The Life’s Simple 7, actually, Seven Small Steps to Big Changes, is the American Heart Association’s call to action for the population to decrease cardiovascular risk and there are seven small steps that people are encouraged to do. One is to manage blood pressure; secondly, to keep blood cholesterol at or near normal; manage blood glucose, not smoking, and if you do to quit smoking; increasing your physical activity to at least 150 minutes a week; losing weight if you are overweight or obese; and then, finally, the one that’s near and dear to my heart, eating well. So, those are all those things that can go into a heart-healthy lifestyle and reducing the risk of cardiovascular disease or cardiovascular death.

    Melanie: What’s involved in eating healthy? People see so much Mary Lou in the media and all around and it can be a bit confusing when they’re hearing about carbohydrates are not good for you or fats are not good. You should eat more protein, less protein, clear some of this heart-healthy eating up for us.

    Mary Lou: There’s no doubt about it, there are lots of mixed messages out there and depending on someone’s ability to communicate, you might hear one louder than the other. But, here’s what we do know. People do not eat in nutrients. People don’t think about, “Well, I’m going to have two carbohydrates today and one fat today.” People think in terms of food and so we have to start talking to people about eating healthy, not with nutrients but eating healthy with real food. So, what does that actually look like? The big players here for heart healthy eating are always going to be fruit and vegetables. Across the board, no matter what study that you read, no matter what study population or what kind of conditions, what seems to really get filtered through one time and time again is the benefit of consuming lots of fruit and lots of vegetables. So, I would just say to somebody I’m working with, if they’re only eating, and most of us or very few of us are getting the recommended amount of fruits and vegetables. So, first, just start with that, by adding more fruits and vegetables to the way that you eat. Now, what that will mean is that you’re actually increasing healthy carbohydrates and, in doing so, you’re decreasing saturated fat, cholesterol, and total fat. But, the patient hears it or the person hears it as something that they can do--an actionable step that’s relatively simple. I can eat more fruit and vegetables. So, I get why there’s a lot of confusion but we can clear that up by just some basic, simple steps. I already talked about the benefits of fruit and vegetables and we also know that fish and regular consumption of fish is associated with decreasing cardiovascular risk and having real benefit. What’s now recommended for the population is at least two fish meals a week and, if that fish could be some kind of Omega-3 rich or rich in Omega-3 fatty acid, all the better. So, something like salmon, mackerel, or tuna, but even if it isn’t, the fact that you’re consuming seafood or fish means that you’re getting significantly less fat and significantly less saturated fat. So, we know fruits and vegetables are good; we know that consuming more fish, especially about two servings per week; we also know that there are certain kinds of fat, not so much the how much but it’s really about the what kind when it comes to fat. And, this is also where a lot of the confusion comes from. Many people have probably heard the Mediterranean diet or heard of the Mediterranean style of eating. That is what we think about when we think about a heart-healthy diets because one of the things that they do really well in the Mediterranean is eat well because they eat locally and they don’t eat processed foods. They also use lots and lots of olive oil for flavoring and for cooking. So, that’s a real important component of eating healthy and decreasing the amount of saturated fat and increasing the amount of healthy fat. That would be in the form of using olive oil when you can. Additionally, it is important to decrease saturated fat as well as cholesterol. Now, what does that look like? What’s the real food recommendation? That would be increase the amount of chicken, turkey, and lean cuts of beef that you’re eating. Decrease the amount that you’re eating and then, finally, keep the style of cooking bake, broiled or grilled so that you’re decreasing total fat, not only in the cooking but total fat in the type of meat, as well as the amount of meat. Generally, what we tell patients as a good rule of thumb is to use a deck of cards. A deck of cards is the perfect portion for a serving size of meat. So, far you’ve got eating more fruits and vegetables, consuming healthy fats such as olive oil, eating more fish, and using leaner cuts of meat or types of meat. And then, what we also know is that decreasing fried foods becomes important. That will decrease the total fat and the amount of saturated fat, and finally the calories. One of the things that we also know is that two thirds of our population is struggling with weight issues and that means that the majority of the people that we come across probably could lose some weight. To lose some weight, you want to do that slowly and you want to cut back on calories. The way to do that is to decrease high calorie foods like fried foods and snack foods. Another thing that has come about, Melanie, quite interestingly or more recently in the last couple of years, is the whole area of sugar. It used to be that sugar wasn’t recommended because of the extra calories or the impact it has on dental cavities, but now we know that sugar is probably a bigger culprit in cardiovascular disease, diabetes, and other kinds of metabolic type syndromes. If we look at population studies, we know that Americans across the board are consuming too much sugar. In fact, the average sugar consumption in a teaspoon a day, now this just isn’t added sugar but what’s contained in food, average sugar consumption for most Americans is 22 teaspoons of sugar. What the American Heart Association is saying, as well as the US Dietary Guidelines says, “Let’s cut that in half.” Cut that down to about ten teaspoons a day or approximately 100 calories coming from simple sugars or added sugars. So, that’s a very interesting thesis, something people can start thinking about. I think that the way that that would work in a meal plan is look at the beverages that you’re consuming and are you consuming regular soda pop? Are you consuming sugar-containing beverages? Cut back on those and even cut back on fruit drinks that aren’t always 100% fruit but they do contain added sugar. So, watch the beverage intake and try to limit your beverage intake to mostly water, coffee, and tea that’s unsweetened. But, again, I think we can sometimes make it more complicated than it needs to be by focusing on a micronutrient or a macronutrient. By picking on B12 or B6 or picking on carbohydrate, protein, and fat, but it really makes sense to take a couple steps back and look at it in terms of, how to I make sense of this and what do I put on my plate and how do I do this day after day? So, using those general guidelines will help people navigate a confusing world around food and nutrition when it comes to cardiovascular health. Melanie, does that answer your question?

    Melanie: It certainly does Mary Lou. What an amazing guest you are. I have one last question for you, what do you want people to do? Give us your best advice when they dine out to follow these bits of information that you’ve given us today, and they were such great bits of information, but when they dine out, they look at that menu and they don’t know whether one thing is healthy or not. They see avocados. They think that’s going to be healthy but some people say that’s very high calorie, high fat food. What do you want them to know about dining out?

    Mary Lou: Great question and I do want to just, as a side bar, when it comes to avocados, avocados are very healthy foods and so very high in these monounsaturated fats. Avocados, though, high in calories, they also pack a punch. So, I would say avocados on the whole are healthy because of their healthy fats. But, let me get to the real question was, what do we do when we go out to eat? How do we know how to maneuver these dietary guidelines or these dietary recommendations when we eat out? I think first and foremost, just remember, when you eat out, most serving sizes are much too large or way too big for most people. So, ask for a doggy bag, even before you order just say I want to get a doggy bag or simply split the entrée with a friend. That way you’re cutting back on literally half the calories and half the fat. Additionally, with that you want to watch out for fancified types of foods, if you will. Those are things with heavy sauces and gravies and stick with plain things. So, like a plain steak, not a sixteen ounce rib eye, but maybe a four ounce sirloin which is not covered in bleu cheese or not covered in some kind of special sauce. So, the things you want to look for words like “plain” or not fried. And then, another thing is just ask questions. Many times in a restaurant you can make wonderful substitutions that aren’t always listed or clear in the menu. So, if you’re looking at decreasing total calories or decreasing total fat, and on the menu French fries are served, ask your server if you can substitute a steamed vegetable in place of those French fries. You’re going to get healthy carbohydrate, you’re going to get a lot less calories, and you’re going to get a lot more fiber, all of which are heart-healthy. So, I would say just kind of go armed with a healthy curiosity, ask questions of your server and some restaurants are now partnering with the American Heart Association for heart-healthy entrees. So, sometimes you can even look for that as a shortcut to making healthier choices. The one piece of advice that I would give people when they’re getting fast food is to think small. So, when I say that, think like a kid. Get the kid’s meal. Most times, you can ask the fast food restaurant for the kid’s meal. That way, you’re getting much smaller portions of what’s being offered. So, I think, as a rule of thumb, when you go for fast food, think small and also ask the same questions about making some of those healthy substitutions.

    Melanie: Thank you so much for being with us today, Mary Lou. It’s really great information. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Sat, 20 Aug 2016 22:52:44 +0000 http://radiomd.com/uvhs/item/33658-how-to-maintain-a-heart-healthy-diet-it-s-easier-than-you-think
Prostate Health, Cancer Risk Factors and Screening http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=33654-prostate-health-cancer-risk-factors-and-screening prostate-health-cancer-risk-factors-and-screeningProstate cancer is the most common form of cancer among men (after skin cancer). Screening has helped doctors to find and treat this cancer in its early stages.

Listen in as Dr. Robert Dreicer, the Deputy Director of UVA Cancer Center, shares information about prostate health and examinations to detect prostate cancer.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1629vh3c.mp3
  • Location: Null
  • Doctors: Dreicer, Robert
  • Featured Speaker: Robert Dreicer, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Robert Dreicer is deputy director of UVA Cancer Center, serves as the director of solid tumor oncology within the division of hematology/oncology and is a professor of medicine and urology.

    Learn more about Dr. Robert Dreicer

    Learn more about UVA Cancer Center
  • Transcription: Melanie Cole (Host): Prostate cancer is the most common form of cancer among men after skin cancer. My guest today is Dr. Robert Dreicer. He's the Deputy Director of the UVA Cancer Center. Welcome to the show, Dr. Dreicer. A little physiology lesson, what is the prostate? What does it do?

    Dr. Robert Dreicer (Guest): Well, the prostate is a small gland that is sort of encompassed by the bladder and it's important in terms of fertility, sperm formation, and it serves a number of other functions, as well.

    Melanie: So, what happens to the prostate for men as they age?

    Dr. Dreicer: So, something called “benign prostatic hyperplasia,” the number of prostate cells increase over time, the gland enlarges, and because the urethra--the tube that runs from the bladder to the outside world--lives in that area, so it begins to get squeezed. So, as the prostate gets bigger, we start having problems with the ability to urinate or having to urinate more frequently.

    Melanie: So, then, is there anything men can do to stop this progression or is it pretty much common and most men will get BPH?

    Dr. Dreicer: I think it's a pretty common thing. We don't yet have a way to prevent it. There are certainly medications that can help, but, unfortunately, we haven't yet figured out how to stop it.

    Melanie: So, then what would you like men to know about coming in for annual screenings and, Dr. Dreicer, mostly men don't want to do these kinds of things and women have to push their men in to see a urologist or somebody to get that annual screening. Tell us about the screening.

    Dr. Dreicer: So, prostate cancer screening is very controversial and, over the last couple of years, there have been actually sort of a change in some of the recommendations that come from the major societies. So, for example, the American Urologic Association basically recommends that PSA testing before the age of 40, or after age 70, is probably not appropriate and, even for most men between 40 and 54, it may not be appropriate, but there are clearly men who are at increased risk and those are men who have a first-degree relative--meaning a brother or a father--who had prostate cancer. Certainly, African-American men are at increased risk, so that men between 55 and 69, who at high risk because of these features, should have conversations with their physicians about screening.

    Melanie: What's involved, then, in the screening? Blood test? Urinalysis? Digital? Explain some of the screening procedures.

    Dr. Dreicer: So, typically, a prostate cancer screening would involve a digital rectal exam, meaning the physician examines the prostate through the rectum using just a finger as well as a blood test--Prostate Specific Antigen. That would be what we would think of as prostate cancer screening.

    Melanie: Tell us about the PSA. What is that Prostate Specific Antigen and what numbers are what you want to look for?

    Dr. Dreicer: So, that's a really great question. So, PSA, or Prostate Specific Antigen is a protein made by all prostate cells, so this isn't just a cancer marker and that's why it's a difficult marker to use with regards to a number. Unfortunately, what we've learned over the last decade or so is that there is actually no normal PSA range--meaning in a very large study that was done testing screening, what we found is that there are men who have PSAs below 1 who have prostate cancer. So, unfortunately, there's no normal range where we can say "If your PSA is below a certain value, you're home free." So, it's a complicated issue, that's why there really has to be a good conversation with your physician with regards to risks, benefits, and what's involved.

    Melanie: When you do a digital exam, something most men are terrified of, what are you looking for?

    Dr. Dreicer: You can feel the prostate, especially when it's enlarged, by a digital rectal exam, because the wall of the rectum where the finger goes, the prostate is right up against the wall. So, if the prostate is enlarged, typically a physician can feel some abnormality in the contour and the shape of a prostate gland.

    Melanie: So, when a man comes to see you, he's taken his PSA, you've done this digital exam, what do you tell them about how often they should get this done and what they should do lifestyle-wise? Is there anything that they can do to modify their risk?

    Dr. Dreicer: So, I'm going to flip the question and answer the last part first.

    Melanie: Okay.

    Dr. Dreicer: There are clearly some risk factors that we believe are modifiable. Certainly diet. Patients who eat a low-fat, well-balanced diet historically, probably have a lower risk. You know, it's a little difficult to say to a man who may be 50 years old that significant lifestyle modifications at that point can impact, but, certainly, a low-fat, well-balanced diet, avoiding smoking, exercising--whether or not it prevents prostate cancer, it's still good for your health. Back to your original question, it's very complicated and there are too many variabilities for me to be able to say "Well, if your test is this, you don't have to have a test for this long." Increasingly, however, we believe that patients who are at low-risk may have longer intervals before screening is really required. So, again, a point to discuss with your physician.

    Melanie: Dr. Dreicer, is there a genetic component to prostate cancer and are there some genetic tests like the PCA-3 that are being done on a regular basis to see if there's this genetic component?

    Dr. Dreicer: So, there's no question that we're learning a whole lot more about this. So, for example, we know that families who have BRCA-1 or BRCA-2 genes not only have higher risks to breast and ovarian cancer, they also may lead to higher risks of prostate cancer in some men. There are things called DNA mismatch repair enzymes that are sort of genetic mutations both, either in germline or somatic. These are also probably risk factors for men. In general, again, family risk, meaning having a brother or father, is probably the most well-characterized risk factor. Routine testing, genetic-wise, is not probably yet indicated.

    Melanie: So, then if you do detect cancer, what's the first line of defense for a man? Because I know it depends on your staging, so explain that just a little bit and the Gleason Score. But then, do you tell--I mean things seem to have changed, Dr. Dreicer, as far as you're not doing as many prostatectomies and taking it all out. So, explain how this process has changed for you doctors.

    Dr. Dreicer: Well, it's very clear that over the last couple of years, and actually there was data presented in a medical journal just this week, that there appears to be lower numbers of patients being diagnosed. The concern, of course, is that that doesn't translate into more men presenting with advanced disease. It's too early to know that. The reason why the screening paradigm is changing in this country is that broad recognition that we're making too many diagnoses of prostate cancer. Remember, there are a lot of men who die of other things who have prostate cancer in their gland and it never bothered them. The concern that the society has is to not over-diagnosis a disease that doesn't need to be treated, but yet not miss prostate cancer when it can be lethal. That’s why this is such a very complex area and it doesn't lend itself to sort of a simple pronouncement about how to manage the disease. It's an area of active research and we're going to need to watch this in terms of whether or not the screening paradigm that's recently changed is either a positive or a negative thing.

    Melanie: So, tell us some exciting advances in immunotherapy being used in prostate cancer--just some things that you see on the horizon.

    Dr. Dreicer: So, there is no question that immunotherapy is active in prostate cancer. The first cancer vaccine was approved in prostate cancer; something called Sipuleucel-T, or referred to a Provenge. But I think the most sort of exciting thing that's happening now, going back to your question about mutations, is that there's no question that we've now begun to identify DNA mismatch repair genes that are targetable by drugs that are called “PARP inhibitors”. So, there's been recent excitement about this and there are very large trials now being undertaken to begin to look at this particular target as new ways to treat this disease that are very different than the ways we've done before.

    Melanie: And tell us about the UVA Cancer Center.

    Dr. Dreicer: So, the UVA Cancer Center is in the midst of sort of explosive growth. We've been very fortunate to get large amounts of institutional support, we've been able to be competitive for grants nationally, the center is growing, and we’ve been able to recruit some outstanding young clinicians who are doing clinical research in a variety of different solid tumor and liquid tumors. This is a very exciting time to be at the UVA Cancer Center.

    Melanie: Thank you so much for being with us. It's great information. You're listening to UVA Health Systems Radio and for more information, you can go to UVAhealth.com. That's UVAhealth.com. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Sat, 20 Aug 2016 18:44:42 +0000 http://radiomd.com/uvhs/item/33654-prostate-health-cancer-risk-factors-and-screening
Treatment Options for Liver Cancer http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=32559-treatment-options-for-liver-cancer treatment-options-for-liver-cancerThe liver is the second most important organ in your body side and liver cancer strikes approximately 33,000 Americans each year.

For patients diagnosed with liver cancer, what treatment options are available?

Learn more from Dr. Reid Adams, a board-certified surgeon and chief of surgical oncology; as well as the chief of liver and pancreatic surgery at UVA Cancer Center

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1629vh3b.mp3
  • Location: Null
  • Doctors: Adams, Reid B.
  • Featured Speaker: Reid B. Adams, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Reid Adams is a board-certified surgeon and chief of surgical oncology; as well as the chief of liver and pancreatic surgery at UVA Cancer Center. His specialties include liver, pancreatic and biliary cancers and diseases.

    Learn more about Dr. Reid Adams

    Learn more about UVA Cancer Center
  • Transcription: Melanie Cole (Host): Have you been told that you might have to have spine surgery? That could be a scary thought, although with some new advances in spinal surgery, recovery may be easier than you think. My guest today is Dr. Jeff Gleimer. He’s an orthopedic spinal surgeon with Lourdes Health System. Welcome to the show, Dr. Gleimer. Tell us a little bit about what reasons people would need spine surgery.

    Dr. Jeff Gleimer (Guest): Yes. Hi, Melanie. Thanks for having me. Spinal surgery is obviously, as you mentioned, a last resort and a concern for a lot of patients out there. One of the major reasons is pain-- pain in the back, pain in the buttock, pain in the leg, weakness in the leg. These issues, that do not improve after physical therapy, anti-inflammatory medications, modifying activities, the pain that just doesn’t go away. At a minimum of six weeks, potentially no longer as six months, people reach an area where surgery on the spine is appropriate and indicated. And, again, everyone is truly an individual when it comes to these problems and it’s really something that must be discussed and really reviewed with a spinal surgeon in detail before surgery is really, truly appropriate for that given patient.

    Melanie: So, people have all kinds of issues with their spine-- scoliosis and stenosis--catch all terms and arthritis and they get that sciatic pain you described; the weakness in the legs and the pain down the legs. What would, then, signal to you, that this is a surgical need? This needs an intervention. When does it come to that?

    Dr. Gleimer: It is, unfortunately, all too common. I think it’s rare if any of us have gone through our lives without meeting someone that has either had back or leg pain at some point in their lives. It’s the pain that just won’t go away. I tell all my patients, “This is never an operation that I will have to sell to you or encourage you to have.” These patients will come in and they know full well they have tried everything like physical therapy and medications and maybe they’ve been through pain management injections, things like epidural steroid shots in their spine and they just get temporary relief from these modalities. And, they just reach a point where they can’t live with the back pain or the leg pain and, at that point surgery, is appropriate. Surgery helps a large majority of these patients that have the right type of problem in their back.

    Melanie: As we mentioned at the beginning, spinal surgery sounds scary- long recovery. Tell us what’s going on, that’s changing the world of spinal surgery for the better.

    Dr. Gleimer: There have been dramatic improvements. As most of us have hoped, with technology there have been dramatic improvements. The goal, always, is to make surgery safer, more efficient, better outcomes in a shorter period of time. One of these advances has been robotic spinal surgery, which really allows for patients to have truly less invasive surgery on their spine. Traditionally, they would need a large incision, a lot of stripping of muscle and tendons off their back. With this new technology, we’re able to make smaller incisions with nearly 100% accuracy in placing pedicle screws, for example, and performing operations to stabilize scoliotic spine and painful spines with degenerative disc disease, arthritis, removing herniated discs. The less invasive our surgeries are, the quicker patients are recovering. The surgery can be done and they can go home the same day.

    Melanie: Wow, fascinating. Tell us a little bit about the Mazor Robotics Renaissance Guidance System. Tell us about this Mazor surgery. What does it entail? How does it work?

    Dr. Gleimer: So, it is a state-of-the-art technology that has been around now for quite a few years and it’s really catching speed here on the East coast. What it is, in essence, is a tiny robot. So, truly good things come in small packages. This is a very small robot that is placed just over the patient when they’re under anesthesia and through a computer system as well as CT scans or a Computed Tomography scan, which is a very, very detailed x-ray, we’re able to see, in detail, the patients spine--the bones in their back. This robot then aligns a special type of drill to perfectly place pedicle screws, specifically. Pedicle screw is a large screw. It looks like a drywall screw for any of the construction folks out there or contractors. And, this gets placed into the spine. This robot that is about the size of a soda allows for nearly perfect trajectory to place these screws into the spine, avoiding all the big, scary concerns people have such as being paralyzed, damaging a nerve, or having a severe amount of pain after surgery. So, the robot really guides the surgeon’s hand. The surgeon is still needed, so we haven’t become obsolete yet, but the robot really has perfected this portion of spine surgery to really make pedicle screw placement nearly perfect.

    Melanie: And, what’s it like for the patient, Dr. Gleimer, in terms of recovery and after-pain?

    Dr. Gleimer: That’s one of the best things, Melanie. Traditionally, spinal surgery is exceedingly painful because of the dissection. What we need to do traditionally to see the right area of the spine to, in essence, place these pedicle screws freehand which takes a high amount of skill, without a doubt, which I’ve been doing for years. So, you can really appreciate using the Mazor Robot that you now can do it through a small stab incision in the patients back, maybe about a centimeter. That’s about it. And the guide is about the diameter of a pencil, that’s placed in the right position. You then drill with a high-speed drill and then you place the pedicle screw directly down this channel and these screws end up in just the right spot much more rapidly and the patient has less surgical time which is always better for the patient . It allows them to recover much more quickly. They don’t have that pain that is typically present from all the dissection that’s needed to put these screws in traditionally. Furthermore, one of the biggest things for myself, who has been doing less-invasive spine surgery, is the robot allows you to minimize the amount of radiation that the patient is exposed to during the surgery. Otherwise, we have to use a lot of x-rays, for the patient, for myself, for any surgeon that’s performing this, there’s a lot of x-ray that has to take place in order to place these screws in an otherwise less-invasive way. And, this robotic technology really negates the need for all these x-rays. We take one x-ray to start, one x-ray at the end and the rest of it is without x-ray.

    Melanie: Are there any people that might not be a candidate for this type of surgery?

    Dr. Gleimer: One of the great things, no. Anyone that meets those indications to have a spinal surgery done that requires screws in their back, what is commonly referred to as a “fusion” operation for that nagging low back pain that just won’t go away with everything that they’ve tried. This allows for near perfect placement of the screws. So, no. There’s no patient that is not a candidate to have this technology for them, if they need the surgery to begin with, of course.

    Melanie: Wow. That is absolutely fascinating information, Dr. Gleimer. In the last few minutes, wrap it up for us about spinal pain, when surgical intervention is needed and the latest technologies--why you’re so excited about these types of procedures.

    Dr. Gleimer: It really allows patients to undergo an otherwise horrifying type of surgery from the stories we’ve heard from our grandparents to our aunts and uncles that have had a friend or a neighbor that has had spinal surgery and was never the same again, I can assure you that there are far more good outcomes from spinal surgeries these days than without. And now, with this Mazor Robotic surgery, it allows it to be that much better. Patients feel better quicker, they get better quicker, and, if I can leave the audience out there with one concept to remember it is that patients that have spinal surgery with the Mazor Robotic technology, they get better and they don’t just get better, they get better quicker than they would without it.

    Melanie: What great advice. And, just tell us Dr. Gleimer about your team at Lourdes Health System.

    Dr. Gleimer: My opinion, one of the best in the country and I’ve been everywhere from Los Angeles and back. They are top notch. There’s a dedicated team that only does spinal surgery. The consistency is key. You have the same team, the same nurses, and the same anesthesia providers that are in the room that just make everything so smooth and perfect, you couldn’t ask for a better place to have the Mazor Robot utilized to get people better, quicker, with less pain.

    Melanie: Well I’m sure they couldn’t ask for a more amazing doctor than you. What a doll you are and thank you so much for being with us today, Dr. Gleimer. You’re listening to Lourdes Health Talk and for more information you can go to LourdesNet.org. That’s LourdesNet.org. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 25 Jul 2016 17:15:04 +0000 http://radiomd.com/uvhs/item/32559-treatment-options-for-liver-cancer
New Partnership Expands Access to Pediatric Liver Transplants http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=32502-new-partnership-expands-access-to-pediatric-liver-transplants new-partnership-expands-access-to-pediatric-liver-transplantsIf your child needs a liver transplant, you'll have a team of specialists at UVA. This team approach ensures your child receives the best therapy during this highly complex process.

How is a new partnership between UVA and Children’s Hospital of Pittsburgh at UPMC expanding access to pediatric liver transplants in Virginia?

Learn more from Dr. Kenneth Brayman, a UVA transplant surgeon.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1629vh3a.mp3
  • Location: Null
  • Doctors: Brayman, Kenneth L
  • Featured Speaker: Kenneth L Brayman, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Kenneth Brayman is a board-certified surgeon and the division chief of transplant surgery at UVA.

    Learn more about Dr. Kenneth Brayman

    Learn more about Charles O. Strickler Transplant Center at UVA
  • Transcription: Melanie Cole (Host): If your child needs a liver transplant, you’ll have a team of specialists at UVA. This team approach ensures that your child receives the best therapy during this highly complex process. How will the new partnership between UVA and Children’s Hospital of Pittsburgh expand access to pediatric liver transplants in Virginia? My guest today is Dr. Kenneth Brayman. He’s a board certified surgeon and the Division Chief of Transplant Surgery at UVA. Welcome to the show. Dr. Brayman, tell us why did UVA and Children’s Hospital of Pittsburgh establish this partnership?

    Dr. Kenneth Brayman (Guest): The partnership was established in an effort to improve access to high quality liver transplantation for pediatric age patients in the Commonwealth of Virginia that require liver replacement. Arguably, the University of Pittsburgh has the premier pediatric liver transplant program in the United States and, in fact, in the world. They have a large number of patients that come to their center seeking liver transplantation. For us in Virginia, we don’t have that high concentration of patients but we have some and we were able to create a win-win situation with the group at Pittsburgh in an effort to increase access to care and quality of care for pediatric age patients that require liver transplantation.

    Melanie: So, how does this partnership work?

    Dr. Brayman: Well, patients that are either referred to the University of Pittsburgh or patients from Virginia are evaluated for transplantation at the University of Virginia and then are transplanted here at the University of Virginia with organs that are procured locally.

    Melanie: So, patients don’t have to go to Pittsburgh to receive their care?

    Dr. Brayman: That’s correct. They don’t have to go to Pittsburgh and, for patients that are based in Roanoke and Richmond and in the Tidewater area, that’s a lot easier for them to be closer to their families to have their transplants done in Charlottesville as opposed to having to go to Pittsburgh.

    Melanie: Tell us why a child might need a liver transplant. What sorts of conditions come up that would require this?

    Dr. Brayman: Well, there are conditions that we’re born with called “congenital liver diseases” such as biliary atresia where the bile ducts are malformed, and that results in progressive fibrosis in the liver, and then liver failure. That is a condition which is not easily treated with anything but liver transplantation. Other conditions would include various types of genetic conditions such as metabolic diseases. There are diseases called “maple syrup urine disease” where there are metabolic conditions that the liver requires replacement. There are other conditions that result in abnormalities of liver resulting in scarring and cirrhosis. So, there are diseases that are peculiar to childhood that have nothing to do with alcohol or hepatitis, which are the primary reasons for adults to receive liver transplants. But, in children, the spectrum of diseases is different but equally life threatening.

    Melanie: Tell us about some of the options for liver transplants for children. We hear in adults that a living donor can donate a part of a liver. Is that the same for children?

    Dr. Brayman: Yes, it is. Adults can donate part of their liver. Usually, it’s what we call the left lateral segment, to a child. It’s very difficult to size match for liver transplants with children because of the requirement for having a donor that’s about the same size as the recipient. So, if you have very small children, there aren’t that many donors that are in that small size range. So, taking part of an adult liver and transplanting it to a child, is a very effective way of providing a new liver in a more timely fashion. And that, of course, can come from a living donor.

    Melanie: Is it very tough to find donors for children’s liver transplants?

    Dr. Brayman: Well, it is challenging. I think that’s one of the reasons why Pittsburgh was interested to collaborate with us because we, obviously, have access to a different donor pool than they do up in Pittsburgh. There is a national system for sharing but it’s regionally based and trying to find livers in a timely fashion for patients with rapidly advancing liver diseases is a national problem. So, in an effort to better serve their patients and also the patients of the Commonwealth, we struck up a partnership with them. And, for the University of Virginia and the citizens of the Commonwealth, we have the great fortune of being able to tap into their expertise and 40-year history of experience with liver transplantation. So, it really catapults the status of our liver transplant program for children from being a very small program to being a national player.

    Melanie: Do children get priority for livers on a waiting list over adults?

    Dr. Brayman: Well, they do get some priority but livers are pretty much distributed on the basis of how ill the patients are. So, there are some factors which will allow children to get some additional points, so to speak. In general, they do compete with adults for transplants.

    Melanie: Tell us about your liver transplant care team at UVA.

    Dr. Brayman: Well, we have a fabulous liver care team. We have very experienced pediatric hepatologists and gastroenterologists that are integrated with our local transplant surgeons as well as a variety of different nurse practitioners. The surgeons and the anesthesiologists from Pittsburgh will be coming down to the University of Virginia to participate in the actual surgeries themselves. There are nurses that are coming down to participate in the post-operative care of the patients that receive liver transplants here. University of Virginia has done a number of pediatric liver transplants successfully but having the collaboration with Pittsburgh is really wonderful because it will increase the volume and the complexity of the patients that we can take on as liver recipients.

    Melanie: Doctor, what’s life like for a child that’s received a liver transplant? What happens afterwards as far as growth factors and nutritionally? What happens for a child?

    Dr. Brayman: Well, it’s amazing. The patients that receive liver transplants, they will resume, essentially, a normal existence. Their liver, if they receive a segment, will grow in size to take up the area in their right-upper abdomen where the liver is situated. They will have normal clearance of toxins, normal production of bile, normal clearance of drugs, and they will grow and develop normally. There are many patients now that have received liver transplants in childhood since the mid-1980s that have gone on to grow up and have normal adulthoods, normal families, normal offspring. It’s remarkable. It basically takes individuals who have very little medical options and completely restores and rehabilitates them with the goal of achieving and living a long, normal life.

    Melanie: Because you’re dealing with parents who, we all know, can worry about the smallest thing--and this not the smallest thing--what do you tell parents every single day about the hope for their child to live this nice, long, normal life?

    Dr. Brayman: Well, it’s very challenging to have individuals that are in the hospital or as outpatients with families that are waiting for that very special call with the message that, “We have an organ for you--a gift of life.” So, we do our best to try to support families both that are here locally within the hospital and long distance, by being available to them and keeping them up to date as to the likelihood of receiving a transplant. We work very closely with the families and families appreciate the availability of our coordinators and our physicians. We offer a very satisfying experience for patients that do require a liver transplant.

    Melanie: In just the last few minutes, Dr. Brayman, how do patients and families benefit from this partnership? Wrap it up for us. And, why should they come to UVA for their transplant care?

    Dr. Brayman: Well, University of Virginia is the only comprehensive transplant program in the State of Virginia meaning that we offer all transplants: heart, lung, liver, kidney, pancreas, adult, pediatric. We offer a very high quality liver transplant and transplant experience. We have a very experienced team of physicians, surgeons and nurses. Our hospital is a premier institution which is very patient-centric. It takes the tension and minimizes it as best as possible, creates a very healthy environment for individuals to undergo a very stressful experience, which is to obtain a transplant. I think that it’s not just about the operation itself, it’s about the whole process--from the evaluation to the support from social workers, financial coordinators, to the ability to arrange for local housing and transportation. The excellent care and surgery that they get, obviously, is important, also; but it really is a very supportive environment to receive complex care.

    Melanie: Thank you so much. What great and such important information. Dr. Brayman. Thank you so much for being with us. You're listening to UVA Healthy Systems Radio. For more information on the new partnership between UVA and Children’s Hospital of Pittsburgh, you can go to UVAhealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Tue, 19 Jul 2016 19:51:50 +0000 http://radiomd.com/uvhs/item/32502-new-partnership-expands-access-to-pediatric-liver-transplants
How Can You Prevent and Treat ACL Injuries? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=32307-how-can-you-prevent-and-treat-acl-injuries how-can-you-prevent-and-treat-acl-injuriesTears of the anterior cruciate ligament, or ACL, happen frequently among athletes. How can athletes reduce their risk for ACL injuries? If they do injure their ACL, what is the typical recovery period?

Learn more from Dr. Mark Miller, a UVA orthopedic surgeon whose specialties include ACL injuries.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1625vh1d.mp3
  • Location: Null
  • Doctors: Miller, Mark
  • Featured Speaker: Mark Miller, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Mark Miller is board-certified in orthopedic medicine and orthopedic sports medicine and serves as division head for sports medicine at UVA Health System. His specialties include caring for patients with knee and shoulder injuries.

    Learn more about Dr. Mark Miller

    Learn more about UVA Orthopedics
  • Transcription: Melanie Cole (Host):  Tears of the anterior cruciate ligament or ACL can happen frequently among athletes. How could they reduce their risk for these types of injuries? My guest today is Dr. Miller. He’s board certified in orthopedic medicine and orthopedic sports medicine. He serves as the Division Head for Sports Medicine at UVA Health system. Welcome to the show, Dr. Miller. Tell us a little bit about the ACL or the anterior cruciate ligament. What is its function as part of the knee?

    Dr. Mark Miller (Guest):  Well, first of all, thank you for inviting me, Melanie. The anterior cruciate ligament is a key ligament for stability of the knee. It allows young people and the athletes and all of us for that matter, to pivot, change direction and play pivoting type sports. So, it’s a critical factor and ability to turn and twist and pivot.

    Melanie:  Why is it so easily injured?

    Dr. Miller:  Well, because it’s vulnerable. So, the problem is it just takes the wrong amount of landing or pivoting or change of direction. The one tiny bit beyond normal and it can be vulnerable for injury.

    Melanie:  So, what type of athletes or normal people are more likely to suffer an ACL injury?

    Dr. Miller:  Well, for some reason, we’re only starting to figure out that female athlete is the most at risk, as much as 4 or 5 times the male athlete. Probably that has to do with the way that they land or their body habitus or the way that their ligament is situated in the notch of their knee.  So, we’re working really hard to try to figure that out and try to reduce the injuries in this female athlete population which is very much at risk right now.

    Melanie:  They are. What does it feel like to injure your ACL? What happens?

    Dr. Miller:  Well, patients describe landing funny and hearing a pop or feeling a pop or both and immediate swelling of their knee. Of course, they are unable to return to play in that same game.

    Melanie:  So, what happens then afterwards? Is this a brace and ice situation? Is it emergent? Do you get right to the doctor? What do you do?

    Dr. Miller:  Well, it’s certainly not emergent but we like to see this patient sooner rather than later because we want to confirm the diagnosis. We want to see if there are additional injuries which are common, such as meniscus tear or articular cartilage injuries and we want to get them on the road to recovery.

    Melanie:  So, do we know why women are a little bit more susceptible to this? Does it have to do with hormones or you know, kinematics, gait? What does it have to do with?

    Dr. Miller:  Yes. This question actually shows up on exams sometimes and the answer is always “all of the above” because there are so many factors that are involved. All those you mentioned plus just simply the way that women tend to land after they come from a jump. They land with their knees, more knock kneed and straight rather than absorbing the jump as they land. So, we’re doing jump training which is called plyometrics. We’re doing counseling. We’re doing injury prevention to try to reduce this risk.

    Melanie:  So, if a girl, soccer player specifically, learns good biomechanics for the way that they pivot or the way that they land, then they could possibly reduce some of these injuries. What do you want coaches and parents to know about plyometrics and teaching some of this good biomechanical moves?

    Dr. Miller:  Sure. There’s some exciting research going on right now at Southern California on this very issue. There are some programs that coaches could get online that could help reduce some injuries. Now, they are not going to go away but, hopefully, we could reduce them and the whole sports society has a program called the “Stop Injury” program that we’re trying to reduce these injuries. So, this is all available online and the American Orthopedics Society for sports medicine has vested interest in promoting this program.

    Melanie:  What happens if it is torn? What’s an athlete to do? Does this require surgery or is it something that could heal itself?

    Dr. Miller:  Now, unfortunately this is something that cannot heal itself because in the knee, for some reason, the joint fluid causes it to almost get like a rubberized coating over it. So, the ligament can’t attach to itself because of the in-the-joint mechanism. So, what we do is we place a tendon graft to replace the ligament. That’s what ACL reconstruction is. You use typically the center of one-third of the knee tendon or the hamstring tendon to replace the torn ligament. That’s what ACL reconstruction is all about.

    Melanie:  Is this performed arthroscopically?

    Dr. Miller:  Yes. And so, it’s certainly arthroscopically assisted. You have to actually make incision to obtain the graft. We’ve learned also to avoid donor grafts in young people—allografts--because there’s a high risk of failure with those grafts.

    Melanie:  So, what’s recovery like for a torn ACL?

    Dr. Miller:  Well, the recovery typically involves a physical therapy, working on range of motion and quadriceps activities. It’s often 3 to 4 months before they could return to even straight ahead running and at least 6 months before they could return to play.

    Melanie:  Are there certain patients that ACL reconstruction is not recommended?

    Dr. Miller:  Certainly. If you’re relatively sedentary and you don’t have an active lifestyle and you don’t do pivoting sports, then you’re probably not going to need to have an ACL reconstruction.

    Melanie:  What about those athletes? You mention returning to play. Is soccer then out for a good long time? Do you skip a whole season into the next season? Do you advise they brace it for a long time? What happens for those athletes?

    Dr. Miller:  Yes. Unfortunately, the female soccer athlete is one of our biggest dilemmas right now. We can get them back to play in 6 or as much as 12 months but the problem is they are still at risk for recurring injury. It’s alarming how high that risk is. Not only to the knee that you operate on, but to the other knee as well. So, this is a dilemma we haven’t quite solved. If the goal of the athlete is to try to preserve their knee health, probably it’s not the best sport for them. But, if they’re adamant about playing soccer, then we’ll do everything we can to get them back to the field.

    Melanie:  So, if they get to have a reconstruction, is there a risk then for the surrounding ligaments and tendons after that fact? Is there a way to strengthen those up along with this new reconstructed ACL?

    Dr. Miller:  Certainly. Quadriceps rehabilitation’s an important part of that. Bracing hasn’t been turned out to be as helpful as we would think because the braces simply don’t work at the speed or the rate that this injuries occur. So, there’s little  you can do, except for aggressively rehabilitate and try to dojump training and avoid re-injury but ,even with that, the risk is still high, especially in that sport.

    Melanie:  Let’s talk about prevention again for a minute. When you talk about the jump training and the plyometrics, how can parents, coaches or athletes themselves work on this? What do you specifically want them doing? Going up and down on a box? Pivoting when they come down? What do you want them to do?

    Dr. Miller:  Yes. The best thing is to find a program that is available online that will teach young people on how to do this. But, the bottom line is they learn to jump off a box and land with absorbing the blow, less extension of the knees, less where their knees go together knock-kneed. The best thing is to have somebody who is trained in this to help the athlete learn on how to do it better.

    Melanie:  So, tell us why patients should come to UVA for their sports medicine care. Tell us about your team.

    Dr. Miller:  Well, the coolest thing about UVA is we take care of 2 separate college teams. We take care a large community group. And, at UVA, we cover all of sports medicine. We have 5 surgeons. They are all specialized in each different area and we have the best care possible for all of our athletes and, even our everyday recreational athletes and patients who are not so athletic. So, we could cover the whole gamut of everything in sports medicine. Nothing gets referred elsewhere because we can take care of everything.

    Melanie:  So, just in the last few minutes, best advice about this common injury that we’re hearing more and more about, especially with girl soccer players--an ACL injury. Kind of give your best wrap up for us.

    Dr. Miller:  Sure. The certain sports where female athletes are at particular at risk. One of them is soccer, another is basketball. The best we could do is to try to prevent this injuries by learning how to jump with our knees more flexed and less knock-kneed and to go online and study about injury prevention and to remain as active and healthy and muscle-toned as possible and do whatever you can to avoid these injuries. If the injuries do happen, then we’re prepared to help and try not only to revise and reconstruct ligaments but also to help with the rehabilitation in getting people back to their sports that they love.

    Melanie:  Thank you, Dr. Miller. It’s great information. You’re listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.




  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: ACL, Sports Injuries]]>
David Cole Tue, 28 Jun 2016 15:20:04 +0000 http://radiomd.com/uvhs/item/32307-how-can-you-prevent-and-treat-acl-injuries
Clinical Trial Examines Epilepsy Medications http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=32269-clinical-trial-examines-epilepsy-medications clinical-trial-examines-epilepsy-medicationsUVA will be part of a unique national trial examining the best medication for treating epileptic seizures.

Learn more about the trial, and how it differs from most clinical trials from Dr. J. Stephen Huff, a UVA specialist in epilepsy.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1625vh1c.mp3
  • Location: Null
  • Doctors: Huff, J. Stephen
  • Featured Speaker: J. Stephen Huff, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Huff was born in Carbondale, Illinois and grew up in Midwest Illinois and Indiana. He attended Butler University for his undergraduate degree. In 1979, he graduated Indiana University School of Medicine. Dr. Huff completed a flexible internship at Methodist Hospital of Indiana and a neurology residency and emergency medicine residency at the University of Cincinnati. He started at UVA in 1995. Outside of work, Dr. Huff's special interests include jazz and improvisational music. He contributes to UVA’s community radio station (WTJU 91.1) on Monday evenings.

    Learn more about Dr. Huff

    Learn more about UVA Neurosciences
  • Transcription:
    Melanie Cole (Host): UVA will be part of a unique national trial examining the best medication for treating epileptic seizures. My guest today is Dr. J. Steven Huff. He's board certified in neurology and emergency medicine at UVA Health System. Welcome to the show, Dr. Huff. Tell us a little bit about this ESETT trial. What is it and what is it seeking to determine?

    Dr. J. Steven Huff (Guest): Sure. ESETT stands for Established Status Epilepticus Treatment Trial. It's a nationally-run study. Jaideep Kapur of neurology here at UVA is the overall coordinating investigator. I'm the site investigator here at the University of Virginia. Lea Becker is the clinical research coordinator. This is being employed and looked at at more than 20 sites across the US. Our goal, as always, is to do excellent, ethical research, compliant with regulations. The basic research question is we don't know what drugs work best for prolonged seizures. We know what class of medications are the diazepines--medications like Valium and others--are good first-line drugs, but if the patient doesn't respond, that is if a seizure continues, we don't know the best second-line drug to be used. So, this is a randomized perspective trial of three drugs that are known to be effective for seizures. There are no experimental agents in this study. The goal is to get enough patients, enough sites together, and enough data so that perhaps physicians will have the good idea to know which drug works best for prolonged benzo-diazapine refractory seizures.

    Melanie: So, what's considered a prolonged seizure?

    Dr. Huff: Generally, for status epilepticus, the definition has changed to the recent years. It's one seizure lasting longer than five minutes. One generalized seizure lasting more than five minutes, a convulsion, or several convulsions without the patient gaining full responsiveness in between.

    Melanie: So, typically, these patients have been treated with benzo-diazapine, like Valium, as you said, and it's not fulfilling what it needs to do at that point?

    Dr. Huff: That's correct. So, typically, rescue squad is summoned. EMS may give medicine like valium or Midazolam or another medication and often that stops the seizures. Then the question is, as I said, if the seizures continue, we physicians just don't know which drug is best after that.

    Melanie: So, how is this trial different than normal clinical trials we discuss?

    Dr. Huff: A couple of ways, basically. This has been a question--study question--that has been present for many years. A cornerstone of clinical research is informed consent. By the nature of this emergency, patients are unable to give informed consent, so we're employing something called EFIC—“Exception From Informed Consent”. This is an FDA-approved research technique. it complies with human research regulations and allows research to be conducted without consent if the life is at risk; if the best treatment is not known and the study might help; and if it's not possible to get instantaneous or contemporaneous permission. When the patient recovers, or when family or a legally authorized representative arrives, then a normal consent process will take place.

    Melanie: Is emergency department care of this established status epilepticus the same everywhere, typically? Do you all kind of follow the same course of action?

    Dr. Huff: It isn't. We know that a second-line drug needs to be given, whether that's Fosphenytoin, whether that's Levetiracetam, or Keppra, or whether that's valproic acid is just not known. There are many causes of seizures. Many times the cause of a seizure, even after extensive investigation isn't discovered, but of these three drugs, they're commonly known, but it hasn't been possible to get any high-level of evidence to give an idea which one is preferred. So, it's been a question that's been present for several years.

    Melanie: So, if the study is looking at different medications to stop these seizures, what are you intending for these medications to do? Are there a few different ones you're going to try and are they going to be able to stop the seizure, hopefully, right away? What's the intention?

    Dr. Huff: So, the idea is to halt the ongoing seizure activity. So, again, there are three drugs that will be studies: Fosphenytoin, Valproic, and Levetiracetam. These are all FDA-approved treatments for seizures and these drugs are prepared in an investigational pharmacy so that the physicians, the other caregivers providing the care won't know which drug is being given. Randomization for this study for the drug takes place before the patient arrival. So, the person arriving will get one of the study drugs and it won't be known until one hour. At one hour, unblinding is possible. Outcomes for this study are at 20 minutes and at one hour. Are seizures continuing? Is the patient improving with their level of consciousness? So, it should provide a high level of evidence because of what's called a “blinded study”. The treating providers don't know which drugs are being given. That's desirable in research because it's thought to avoid bias. Again, these are all drugs that are approved for seizure treatment.

    Melanie: So, each of you doctors are going to like, flip a coin. You're going to just be taking one of these three medications and since there's not the exception from informed consent, what if there's an allergic reaction or any of those kinds of things going on?

    Dr. Huff: Well, certainly, if there's an allergic reaction or an adverse reaction, the infusion would be stopped. It would be very unusual for any of these drugs to have an allergic reaction. There is a method for adverse event reporting which is pretty standard with literature. It's not really flipping a coin. I mean, it's more sophisticated than that in that through a central statistical service, the next drug up is determined. It's given to the different study sites. The physicians at the point of care do not know which one of these three drugs will be given, but it's not like I have a choice between one or three. It's the next drug up--the next investigational packet up will be given. At the moment of treatment, the physicians will not know which drug. But, like I say, this is desirable in research to try to avoid bias.

    Melanie: That's fascinating. How common are these type of seizures or epileptic seizures, in general?

    Dr. Huff: Well, epileptic seizures are pretty common. It's thought that somewhere around 1% of emergency department visits are seizure related. Continuing seizures, continuing generalized status epilepticus, is less common and even less common are seizures that don't respond to benzodiazepines. When given early, benzodiazepines are very effective drugs. So, this is of 20 sites. We're hoping the study's going to accumulate over 500 patients over a couple of years and that number is thought to be necessary in order for good evidence, in order for good statistical interpretation.

    Melanie: Is this something that happens to both adults and pediatric patients?

    Dr. Huff: It does happen to adults and children and many children’s' hospitals are participating in that. We've opted, just for simple logistical reasons, not to use it in patients less than 18 years old here at UVA at this time.

    Melanie: So then, in just the last few minutes, just kind of summarize it for us and tell patients and listeners--this is an emergent situation, so how can they get more information about the trial, as well?

    Dr. Huff: More information about the trial and, in fact, the entire study protocol is posted up at a website that's ESETT.org or you can send an email to seizure@virginia.edu and we'll be happy to provide more information individually. Again, a lot of information about the study is at the ESETT website.

    Melanie: And would you give that website one more time?

    Dr. Huff: Sure. That's www.esett.org.

    Melanie: Thank you so much, Dr. Huff. That is fascinating information, really, and we wish you all the best and applaud all the great work that you're doing. Thanks for being with us today. You're listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole, thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Epilepsy]]>
David Cole Thu, 23 Jun 2016 15:57:43 +0000 http://radiomd.com/uvhs/item/32269-clinical-trial-examines-epilepsy-medications
Preventing Teen Pregnancies http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=32268-preventing-teen-pregnancies preventing-teen-pregnanciesWhy is it so important to continue working to reduce the teen pregnancy rate? How and when should parents discuss this with their children?

Learn more from Dr. Nancy McLaren, a UVA pediatrician who specializes in caring for teens.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1625vh1b.mp3
  • Location: Null
  • Doctors: McLaren, Nancy M.
  • Featured Speaker: Nancy M. McLaren, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. McLaren trained in general pediatrics at Emory University in Atlanta. She has been in Charlottesville for over 12 years and has worked at the Teen Health Center at UVA during that time. She has been fortunate to focus her time and energy on the care of the adolescent patients whom she loves. She's a clinical assistant professor of pediatrics in the UVA Children's Hospital. She also serves on the community-based obesity task force and has been active in pioneering programs that reduce obesity in childhood and adolescence. She also has a special interest in sports medicine that probably developed from the injuries her own children received during their years in competitive athletics. In her spare time she enjoys skiing in Colorado and spending time with her husband and three children (who have taught her so much about adolescents).

    Learn more about Dr. McLaren

    Learn more about UVA Teen and Young Adult Health Center
  • Transcription: Melanie Cole (Host): It's so important to continue working to reduce the teen pregnancy rate. How and when should parents discuss this with their children? My guest today is Dr. Nancy McLaren. She's board certified in pediatric medicine and specializes in caring for adolescent and teen patients at UVA Health Systems. Welcome to the show, Dr. McLaren. Why is it so important to work with teens to reduce this pregnancy rate?

    Dr. Nancy McLaren (Guest): Well, we want to give them a chance at having a better life and the cycles certainly have shown as with teen pregnancy, if someone gets pregnant as a teen, then the possibility is that their child will also have children in their teenage years. It's important really, to give them a better chance at succeeding at other goals that they may have in education and really advancement and really sort of break the cycle of poverty that teen pregnancy can put someone in.

    Melanie: So, what are some of the best ways to reduce? Are we looking at media outlets or are we looking directly to the parents and the loved ones of these teens to be the ones involved reducing this rate?

    Dr. McLaren: Well, the most important person in the teenager's life, or persons in their lives are their parents or their guardians that they're close to. The importance of parents starting to talk to teenagers starts when they're really quite young--when they're 9, or 10, or 11. Really encouraging them to be active in other things in their lives, in school, in sports, in music, and other things that make them feel positive and strong about their lives and really getting them involved. Being involved in the community and their schools and family is a very large protector against teen pregnancy. The other thing is to talk to them also about sexuality and what they feel about their bodies and what's involved with sex, basically—to have the sex talk but start it when they're quite young so that it's not an uncomfortable thing at all when you have to sit down at age 11 or 12 and have this puberty talk. Really start with them when they're quite young, learning about their bodies, and what their bodies do, and feeling good about their bodies and wanting to take care of their bodies. And, again, I say that conversation can happen in the pediatrician's or the adolescent physician's office but it's really important that it happens at home with the parents and having them involved so that the teens get comfortable, the young people get comfortable feeling that they can go to their parents and ask questions.

    Melanie: If the parents don't discuss it, the children are going to learn about these kinds of things from other sources, which may not be reliable. So, how do you tell uncomfortable parents, Dr. McLaren, how to start this conversation? What do you tell them about the fact that some of them believe that if they start this conversation, they're opening the door to permissive sex for their children?

    Dr. McLaren: Well, first of all, what we try and do when parents are coming in with their young ones, even at 8, 9, and 10, is to give them some tools to have. That can be books, reading with their children. There are some great books out there to talk about how your body is changing and what's going to happen and having the conversation even earlier on before the young people get where they're sort of more reserved and withdrawn and more quiet about things. Then to continue that conversation going through the teen years and telling parents, "It may be an uncomfortable conversation, but it's really an important one to have." Otherwise, they are going to get information from their peers and from the media, from the internet, and the information they get from there may not be as reliable or as factual as what they could get from their parents and from their doctors. I think they can—and if the parents are uncomfortable, we'll say, "Why don't we have the conversation together in our office?" and that can be another way of helping with it. And starting it, again, when they're younger, and not waiting until they're 12 or 13 and no one's ever had the conversation.

    Melanie: Well, one thing I appreciate that you pediatricians do is when the teens come in for their well visit, now they get to fill out a form that discusses with them about drug use and that the parents don't get to look at it unless the teen says it's okay so that they feel like they can trust their pediatrician, which is a great resource for them to get some of this information. Now, when the parents are beginning this discussion, do they come at it as "I don't want this to happen"? How do they discuss protection and “if you are going to have sex, you must protect yourself from pregnancy and sexually-transmitted infections”?

    Dr. McLaren: Well, I think you can almost say it in just the way you said it. In the sense that we do know that teenagers are having sex as they go through middle school and high school and the goal would be first to talk to them about the risks of having sex at an earlier age, so if that is going to happen, talking about protection and what ways can they find out and learn about protection, whether it's condom use or whether any of lots of different birth control methods that are out there. Even to say, if you're not comfortable talking with me, let's go to the doctor's office and talk to the doctor. We do give, once they're 11 or 12 years old, we do always want to have a time of privacy with the adolescent to give them freedom to talk about some things. Maybe to help them figure out how to talk to their parents about some of these issues, too, and letting them know that the parents really want to protect them and take care of them and help them through this time and have them see their parents as resources, also.

    Melanie: Is there a role for those after-school specials and scare tactics showing 14-year-old girls with babies and kids that have had to drop out of high school? Do you agree with that kind of way of going about it?

    Dr. McLaren: I think it's--I mean, we certainly in our clinic use humor and information in that way, not as scare tactics, but just to have them think about things. I think that it's better to talk about "if this does happen," and certainly after-school, having young people in activities after school. The time for highest risk for pregnancy with an adolescent is between the 3: 00 - 6: 00 time because people are not around and they have more time alone, so getting them involved in other things. But it's really talking more about what their hopes and dreams are and what they want to be doing. I think it puts it in a different way of having them look that way rather than what's going to happen if you get pregnant. Really trying to get them to think beyond just the moment and what they want to accomplish and how to go about doing that and that preventing pregnancy--teen pregnancy--can make a big difference in helping them accomplish that.

    Melanie: So, in just the last few minutes, give us your best advice for parents about discussing this with their children, when the appropriate time is, and how to begin. Parents don't even know, Dr. McLaren, how to start that conversation.

    Dr. McLaren: Well, it's not an easy conversation to have. I've had to do it with my three kids, and it's just a matter of sitting down and saying, "You know, I have something we need to talk about, I'm concerned about this or that. We want to make sure that you have all the opportunities that you can. We would encourage you not to have early sex but we also understand this may happen. We want you to get the right information from us or from your doctor. So, let's talk about it." And they can even say, "I'm uncomfortable talking about this, too. Let's talk about it now and then we can certainly go to the doctor's office and get more information." And also, I think they do need to bring up contraception and say, "There are really effective methods of contraception and if this is something that is a possibility that is going to happen, let's go and talk to the doctor or the clinician about contraception and what's going to be the most effective method for you to use."

    Melanie: It's so important--that open line of communication—and to know if your child has a boyfriend or girlfriend and then you can discuss those things. And so, now, tell us about your team at the UVA Teen and Young Adult Health Center.

    Dr. McLaren: Well, the Teen and Young Adult Health Center actually was started 21 years ago to prevent teen pregnancy in Charleston and the surrounding area. We have evolved into a full adolescent and young adult health center so that we do total adolescent and young adult care, which can be sports physicals, it can be care for asthma, it can be care for sexually transmitted infections. We do a lot of contraception. In fact, we're probably one of the leaders in this part of the country in providing long-acting contraceptives for adolescents. We also do mental health care. We are developing an eating disorder program. Then, we also have a program for transgender youth and young adults. So, it's really trying to meet a lot of the different needs and issues that come up for adolescents. It's a place that they can come and feel safe and feel welcome. We have a small staff and we get to know them very well. We try and have them see the same provider when they come back. And so, it really is a great, great location. We also do community outreach. We have a person--a health educator who works with peers in the schools and actually gives the peers the right information. So, if a young person goes to a peer, they are getting the right information. We work with Boys and Girls Clubs in the community and with different youth groups. So, it's really a full, comprehensive health center for teens and young adults.

    Melanie: Thank you so much, Dr. McLaren, what great information. We applaud all the great work that you're doing on behalf of teens and young adults. You're listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Teens, Pregnancy]]>
David Cole Thu, 23 Jun 2016 15:39:31 +0000 http://radiomd.com/uvhs/item/32268-preventing-teen-pregnancies
Answering Common Questions About Vasectomies http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=32220-answering-common-questions-about-vasectomies answering-common-questions-about-vasectomiesSperm passes from the testes to the penis in tubes called the vas deferens. A vasectomy is a surgery that blocks these tubes. This makes a man unable to make a woman pregnant.

Get answers to some of the most commonly asked questions about vasectomies from Ryan P Smith, MD, a UVA expert in male reproductive medicine and men’s health.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1625vh1a.mp3
  • Location: Null
  • Doctors: Smith, Ryan P
  • Featured Speaker: Ryan P Smith, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Ryan Smith is fellowship-trained in male reproductive medicine and surgery, and his specialties include male infertility, fertility preservation and testosterone therapy.

    Learn more about Dr. Ryan Smith
  • Transcription: Melanie Cole (Host): A vasectomy is a surgical procedure for male sterilization or permanent contraception, but how do you decide if this is the right procedure for you? My guest today is Dr. Ryan Smith. He's fellowship trained in male reproductive medicine and surgery and his specialties include male infertility, fertility preservation and testosterone therapy at UVA Health Systems. Welcome to the show, Dr. Smith. People hear that word, men recoil. What is a vasectomy? What is it intended to do?

    Dr. Ryan Smith (Guest): Well, you're exactly right, and thank you, again, for having me. So, a vasectomy, just like you said, is meant to be a permanent form of contraception. That is first and foremost something that we reiterate to patients time and again to make sure that this is something that they understand is permanent and they want permanent contraception. The procedure, in itself, essentially what we're doing is that the vas deferens is the tube that carries the sperm, essentially from the testicle and epididymis out through the remainder of the reproductive tract. So, when you do a vasectomy--and there are different modes of performing this--but in its simplest form, you're occluding that vas deferens so that the sperm cannot make the transition from the reproductive tract out the urethra.

    Melanie: So, I guess the first question that men would want to know is, is this a painful procedure?

    Dr. Smith: So, in general, most men are very comfortable with doing this procedure in the office. We often liken it to going to the dentist in terms of you get a local anesthetic and we're able to do all of the procedure through that. Some patients who may be nervous about it, we will give some oral sedation, whether that's Valium or Xanax, or something like that. On a very rare occasion, would IV sedation be necessary for the procedure. So, in general, patients are very comfortable during it and that's our goal is to maintain their comfort throughout.

    Melanie: So, when should a man look at doing this because there is that discussion among spouses; should the woman do it? Should the man do it? And, how do they come to that conclusion?

    Dr. Smith: Well, I think, just as you said, for a couple, it's a conversation that's often ongoing for even years. We know from a lot of the studies that multiple couples will have that conversation, but won't commit to something for several years after discussing it. I think one of the biggest conversations when couples are discussing permanent contraception is whether to pursue a vasectomy or a tubal ligation. In general, when you compare those two as options, they're equally effective, but a vasectomy is faster, safer, only requires local anesthetic, and so it's overall more cost effective compared to a woman undergoing general anesthesia for a tubal ligation, which has other risk factors involved.

    Melanie: So, for the woman, this is a bigger surgery and for the man, this is something that's just a little bit quicker. How much quicker? What's the recovery like?

    Dr. Smith: In general, we tell guys to expect a couple of days of discomfort. So, in general, it's very popular for men to have the procedure say, on a Friday, and by Monday, you can generally return to work for those who maybe don't have an extremely strenuous job. In general, we recommend them you not doing any aggressive or vigorous physical activity, maybe even for upwards of a week, but the recovery time is really just those two days are the crux of it.

    Melanie: Is this a reversible procedure?

    Dr. Smith: It is reversible. Part of that is dependent on the timeframe from when the individual had the vasectomy, but certainly even within the first ten years, you have greater than a 95% chance, in most cases, of a successful reversal in terms of returning sperm to the ejaculate, if that is what the patient desires.

    Melanie: So, what are the odds, I mean, is it an effective procedure? Is there a chance the woman can still get pregnant?

    Dr. Smith: Yes. So, one of the things that we talk about, and every patient gets a pre-procedure consultation where we review risks and benefits, and this is one of the things that we discuss is that you know, no contraception, essentially, is 100% reliable. In terms of a vasectomy failure, a repeat vasectomy is required in less than 1% of cases and we define a failure as when a man still has moving sperm present six months following the procedure. And, again, that's less than or equal to 1% of the time. So, the other way to think about failure is a longer-term failure meaning that the patient followed through and had a post-vasectomy semen analysis, which is essential to show that the procedure is effective. If the patient had no sperm present on that post-procedure analysis and then down the road had a pregnancy, that's about a 1 in 2,000 chance.

    Melanie: Does it ever have to be re-done?

    Dr. Smith: It can be re-done. In the scenario that I mentioned where a patient still has moving sperm at 6 months, at that time, you'd have to have a conversation about potentially repeating the procedure if that was something that the patient desired because that would indicate there continues to be a risk of pregnancy when there's moving sperm at that six month mark.

    Melanie: So, Dr. Smith, is there a time when certain men cannot have that? Are there certain men that you just say, “No, this is not the right procedure for you”?

    Dr. Smith: Sure. So, any time someone comes in for that pre-procedure consultation and there's some hesitancy there or a great deal of uncertainty, or someone who may be saying "Well, I want to make sure that I can reverse this," or "Can I bank sperm before the procedure?" or something like that that may indicate they're not quite ready for a permanent form of contraception. We generally advise those patient that maybe this is not the right time for them to pursue this as a procedure. The only other time where we may counsel someone against pursuing vasectomy is someone who has chronic underlying discomfort in the scrotum for whatever reason that may be, in which case we'll generally advise them that vasectomy may not be the best choice for contraception for them.

    Melanie: So, are there some disadvantages and then, what if you feel, if you as a doctor get the feeling they're being pressured into this?

    Dr. Smith: Sure. So, in general, sometimes couples will come together for their consultation visit. If we felt like there was a lot of outside pressure it may be something that we may discuss with the couple together in that regard. I think most of the men we tend to see are there because they want to participate in the discussions and the procedure with their significant other. So, they've already had those conversations like we talked about initially. And if they go back home after our visit and discuss with their spouse or whomever and decide it's not right for them, well, they ultimately don't return for the procedure. But, you know, as with anything, part of our conversation is again, those risks and benefits and there are some potential side effects of the procedure.

    Melanie: So, what might some of those be?

    Dr. Smith: In general, we talk about hematoma. That would be essentially significant bruising and swelling in the scrotum or a blood clot that forms in the scrotum. There's about a 1-2% chance of that occurring. It generally does not require any sort of secondary procedure, but the patient may be uncomfortable for a longer period of time, even a few weeks for all that hematoma reabsorbs. The infection risk is low--1% or less, and most patients don't need antibiotics for the procedure because of that low infection risk. One other item that we counsel them about is something called “post-vasectomy pain syndrome” and what that is, is kind of chronic discomfort that can linger in the scrotum for even months or a year following the procedure. It's not well-defined but it’s estimated that 1-2% of men may notice that. There's been research done to look at anything that predisposes men to develop that or if there's something procedurally that can be done to alleviate that risk and nothing's really borne out in the literature to show that it's effective in eliminating that risk. It's something that we just counsel patients about so that they're aware of it. You can perform a vasectomy reversal for a patient who had chronic discomfort following a vasectomy and in approximately 79% or more of case, patients will report improvement in discomfort following a reversal.

    Melanie: So, in just the last few minutes, Dr. Smith, tell us what you tell patients every single day--couples, men individually, and their spouse--about vasectomy. What you really want them to know about this procedure.

    Dr. Smith: Sure. So, there's a very good guideline that we use as urologists that's put out by the American Urologic Association and so some of the points that we stress in that consultation visit are that this is meant to be a permanent form of contraception; it's not immediate; that patients need to use another form of contraception until they're cleared by a post-vasectomy semen analysis, which is done approximately 8-16 weeks following the procedure. They must do that semen analysis. Only 50% of patients ultimately follow-through in doing it, but without that semen analysis, we can't provide them with any sort of reassurance that the procedure was effective. I also tell them that the procedure is not 100% reliable, just as I mentioned before, and that a repeat vasectomy is necessary in 1% or less of cases; and that there's still a 1 in 2,000 chance of pregnancy even when a semen analysis has shown no sperm or just a few non-moving sperm following the procedure. And then, just the general procedural complications that we talked about: , the risk of hematoma, infection, and chronic pain are things to be noted, as well. There’s not been any substantial risk in terms of to men's health in general like cancer risk, or heart disease. There have been studies in the past that have called some of that into question; however, those have been reviewed by the American Urologic Association and no substantial risks have been shown to men's health overall.

    Melanie: And, Dr. Smith, why should men choose UVA for their urology and men's health care needs?

    Dr. Smith: Well, UVA is very unique in that we have two fellowship-trained providers who do vasectomies and also male infertility care and we have an andrology lab here that does a lot of research as well. So, we have a very unique sub-specialized, multi-disciplinary approach at UVA that's only available at a handful of centers around the country. So, our patients and we are very fortunate to work in an environment like that.

    Melanie: Thank you so much for being with us today, Dr. Smith. It's really important information. You're listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole, thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Men’s Health]]>
David Cole Mon, 20 Jun 2016 15:25:25 +0000 http://radiomd.com/uvhs/item/32220-answering-common-questions-about-vasectomies
Clinical Trial Tests Treatment for Enlarged Prostate http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=31923-clinical-trial-tests-treatment-for-enlarged-prostate clinical-trial-tests-treatment-for-enlarged-prostateAbout 210 million men worldwide suffer from symptoms such as frequent or painful urination caused by an enlarged prostate, or benign prostatic hyperplasia (BPH).

A clinical trial at UVA is examining a non-surgical procedure for these symptoms called prostatic artery embolization.

Learn more about the trial from Ziv J. Haskal, MD, a UVA specialist in interventional radiology.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1616vh2d.mp3
  • Location: Null
  • Doctors: Haskal, Ziv J.
  • Featured Speaker: Ziv J Haskal, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Haskal is a tenured professor of radiology and medical imaging in the Division of Interventional Radiology at the University of Virginia School of Medicine. Dr. Haskal received his M.D. at Boston University School of Medicine and completed residency and fellowship at the University of California, San Francisco. As a sought after teacher and educator, Dr. Haskal has given more than 500 invited lectures worldwide and been awarded numerous honorary fellowships, national, international and societal awards for leadership, service and research excellence. He has designed, participated or led more than 40 research trials. Dr. Haskal has also published more than 400 scientific manuscripts, chapters, review, abstracts and editorials in journals ranging from Human Gene Therapy and the New England Journal of Medicine, to Circulation, JVIR, Radiology, Hepatology and more. The AHA Guidelines documented he co-chaired and co-wrote has received more than 2,700 citations.

    Learn more about Dr. Haskal

    Learn more about UVA Radiology and Medical Imaging 
  • Transcription: Melanie Cole (Host): About 210 million men worldwide suffer from symptoms such as frequent or painful urination caused by an enlarged prostate. A clinical trial at UVA is examining a non-surgical procedure for these symptoms called “prostatic artery embolization”. My guest today is Dr. Zeve Haskell; he's an interventional radiologist at UVA Health System. Welcome to the show, Dr. Haskell. First, let's talk about BPH or benign prostatic hyperplasia. What is that and how would a man know if they have it?

    Dr. Zeve Haskell (Guest): Melanie, it's incredibly common in half of men aged between 51 and 60 and it increases to about 90% when they hit their 80s. Basically, the prostate is a big gland that sits under the bladder. As we get older, it grows, pushes up on the bladder, and it also squeezes the tube that carries urine outward--the urethra. So, we have symptoms that make it hard to initiate urination—can't start, and hard to empty the bladder, and in some cases, so bad that you're in the emergency room having a catheter placed.

    Melanie: Wow. So, this is something that's so common and as we age as a society, you're seeing more and more men with it. What's the first line of defense when you notice someone has an enlarged prostate?

    Dr. Haskell: Well, in 2010, we estimate that nearly $5 billion were spent on medications for this. So, the first line of therapy is tablets. Many men get some relief with these over several weeks or months. But, in those that fail, we start looking to more invasive options.

    Melanie: So, tell us about some of those and then tell us about the clinical trial that you're doing for minimally-invasive options.

    Dr. Haskell: Well, when the medications fail, folks will generally see a urologist who will discuss the various surgical options. In the rarest case, that will be a removal of the entire prostate. But, in most cases, it's something that's done through the urethra itself using a variety of things using lasers, or cutting tools, or even staplers, to push back the prostate or cut it out from the inside in order to make a larger passage. Those treatments are very effective but they do carry some real complications which are naturally a concern to all of us. Those include incontinence--being unable to hold urine; and sexual dysfunction as well--impotence or retrograde. That is reversed ejaculation. In looking for options that are less surgical or have less of these risks of these complications, we've sought, as interventional radiologists, to extend the types of things that we do for a living. We're choosing high-tech imaging to do minimally-invasive non-surgical treatments for almost everything in the body. And in the setting of the prostate, what we're essentially doing is injecting these tiny microscopic particles to reduce the blood supply to the prostate so it gradually shrinks in place.

    Melanie: Wow. Now, this particular clinical trial is open so it's a national clinical trial, yes?

    Dr. Haskell: Yes, that's right. It's a pilot study that is under the guidance of the FDA. We have it approved by the FDA, so we've chosen to do this rather than simply to offer the treatment to hold ourselves to the highest quality and rigor, to get the best evidence to support the widespread use of this in the US, and at the same time, provide the extremely detailed and high level of service and care when you're involved in a clinical investigation.

    Melanie: So, as a potential alternative to other available and invasive surgical treatments, Dr. Haskell, tell us a little bit more about the PA procedure and what it involves.

    Dr. Haskell: This was pioneered outside of the US and has been performed over a thousand times but the good, solid clinical information in the US is still lacking. As a patient, what it means is that you meet our team of urologists and interventional radiologists at our clinic. You get screened for the study, and if this is something that makes sense, then the actual procedure is done under light-conscious sedation. We have a tiny tube that is smaller than a spaghetti and more flexible than that. We pass that inside of the arteries and through that, an even tinier one directly to the ones of the prostate. We have some sophisticated imaging that allows us to make sure that we're only injecting this material into the prostate, not into adjacent things that we wouldn't want to block off. We do that to both sides and that usually takes us about an hour and a half. Patients are relaxed and awake and many of them are actually watching it on a black and white screen because you can't actually feel anything that is happening inside of the arteries. There are no nerves to feel with. We discharge our patients the next day and then we see them in follow up as part of our protocol which actually mimics what we'd want to do as best care, anyway.

    Melanie: So, how long can they expect to see maybe some symptom relief if the prostate is shrinking from this procedure?

    Dr. Haskell: Well, in some cases, men will experience some improvement within a week or two. More typically, it's gradual over several weeks and we have some patients who have had the same extraordinary good results that have been reported outside of the US and in other centers, as well, which is that those inability to hold urine or having to constantly go have really diminished or set the clock back many, many years, in that respect, without an operation.

    Melanie: That's absolutely fascinating. What do you envision as the future of this procedure? Would it need to be redone, or is it something that's going to last 10 years as our population ages and men get older?

    Dr. Haskell: Melanie, those are fabulous questions, and as a clinical researcher who's been working in this area of interventional radiology and embolization for 20 years, part of my job is to provide the best care but also to provide a beacon for the future of research and for centers elsewhere. So, we're looking to answer those very types of questions while giving our patients the best care. Will this last for 10 or 15 or 20 years? I don't know but we do this for patients with uterine fibroids and have for decades and we're able to repeat for women who grow new fibroids. So, it may be that the same options will be available for men, as well.

    Melanie: How cool is that? And in just the last few minutes here, give your best advice for men suffering from BPH and where they can get more information about this clinical trial.

    Dr. Haskell: Well, the first step is to make sure it is, indeed, the prostate and not the bladder which means being evaluated by a urologist and understanding what you have. We can certainly do that as part of our team approach at the clinic here in which we work in close partnership with our urologists. Everybody gets seen by everybody on the same day. If this is a good option that may spare you some of the surgical complications or you're looking to avoid being exposed to them, then you can reach us at 434-297-7136 or our email, which is uvaprostate@virginia.edu. That's 434-297-7136.

    Melanie: The email is uvaprostate@virginia.edu. Thank you so much, Dr. Haskell, for being with us today. It's absolutely fascinating and we applaud all the great work that you're doing with this clinical trial. You're listening to UVA Health Systems Radio. And for more information, you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Men’s Health]]>
David Cole Tue, 24 May 2016 00:35:50 +0000 http://radiomd.com/uvhs/item/31923-clinical-trial-tests-treatment-for-enlarged-prostate
Keys to a Healthy Pregnancy http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=31659-keys-to-a-healthy-pregnancy keys-to-a-healthy-pregnancyWhat are the most important steps a woman can take to have a healthy pregnancy both for them and their baby?

Learn more from Vanessa H Gregg, MD., a UVA expert in pregnancy and childbirth.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1616vh2c.mp3
  • Location: Null
  • Doctors: Gregg, Vanessa H
  • Featured Speaker: Vanessa H Gregg, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Vanessa Gregg is a board-certified obstetrician and gynecologist at UVA Health System whose specialties include pregnancy and childbirth.

    Learn more about Dr. Vanessa Gregg

    Learn more about University Physicians for Women at Northridge
  • Transcription: Melanie Cole (Host):  What are some of the most important steps a woman can take to have a healthy pregnancy that will benefit both mom and baby? My guest today is Dr. Vanessa Gregg. She is a board certified obstetrician and gynecologist at UVA Health System. Welcome to the show, Dr. Gregg. When should women start preparing to have a healthy pregnancy? How soon before they get pregnant should they start thinking about these things?

    Dr. Vanessa Gregg (Guest):  It’s always a good idea for a woman to check in with her healthcare provider before she becomes pregnant, if at all possible. Some of the things to focus on at that pre-conception visit include any health conditions or medications that may affect planning for a healthy pregnancy. In addition, the provider can look at vaccines and make sure that the woman is up to date on those things. Then, just thinking about planning for a healthy diet and a healthy exercise program going into pregnancy to optimize that healthy state at the beginning of pregnancy. In particular, also, I think it is valuable to start a vitamin in advance of becoming pregnant because it’s really helpful to have a good level of folic acid, in particular, in the system at the time of conception.

    Melanie: What are some of the common misconceptions about what women should and shouldn’t do before and during pregnancy?

    Dr. Gregg:  Certainly, before pregnancy most women don’t need to make very many adjustments, if any, particularly if they already are at a healthy body weight, have a healthy lifestyle and generally not struggling with any serious health problems. During pregnancy, similarly, most women can continue to do most of the things that they were doing before. Women can exercise, travel and enjoy most of the things that they enjoyed before pregnancy.

    Melanie: Okay. So, they can? Women drink and then they say, “Oh, I didn’t realize I was pregnant and I had some drinks.” What do you tell women about alcohol when they’re thinking about getting pregnant but not there yet.

    Dr. Gregg:  Because we don’t know what amount of alcohol could be safe in pregnancy, our general assumption is that no amount of alcohol is safe during pregnancy. Lots of times we hear of women who had a glass of wine and then figured out that they were pregnant. Probably if it’s a small amount and it’s very early on, that probably isn’t going to have any serious impact on the pregnancy. I think that this is an area where it can be challenging for women to make these kinds of decisions because there are some health bodies actually that suggest that women who are contemplating pregnancy should give up alcohol entirely. I think the key is if a woman is in tune with her body, she’s aware of when she is likely to become pregnant and then avoid alcohol if pregnancy is likely already underway. I think that that is probably the safest approach that we can confidently recommend.

    Melanie:  Let’s start talking about things like prenatal vitamins. What are we looking for in those?

    Dr. Gregg:  There are lots of different prenatal vitamins on the market. For the most part, I think almost anything that a woman picks up that is labeled as prenatal vitamins is probably going to be fine. The key things are they are going to have a range of general nutrients. They are going to avoid the things that are thought to be contraindicated for pregnant women. The focus is really on folic acid and then, iron is another important component of prenatal vitamins, which is a little bit different from other women’s vitamins. Another thing that’s become a popular component of women’s prenatal vitamins is DHA. DHA is thought to help promote healthy brain development. DHA can be gotten in the diet through leafy green vegetables, fish and sometimes other dietary sources. Probably not all women get enough of those fatty acids from their diet and so manufacturers have started putting DHA in prenatal vitamins. What I tell women is, I don’t think that DHA in a prenatal vitamin is going to hurt and it may help. We don’t know for sure how much of that DHA is easily accessible out of a vitamin compared to if it comes from a dietary source. I do think a prenatal with DHA in it is a reasonable thing to do.

    Melanie:  What about exercise? Especially in those early days, if someone has been an exerciser can they continue right through their pregnancy or is that not the time to start an exercise program if you’ve never exercised?

    Dr. Gregg:  Women who are already exercising and have a healthy exercise program going should definitely plan to continue that during pregnancy. Even women who have not been exercising prior to pregnancy should plan to work with their healthcare provider and design a safe program for exercise during pregnancy. We know that exercising is good for almost everyone and certainly good for almost all pregnant women. Of course, there will be some exceptions and that’s something the individual woman will want to discuss with her healthcare team. For most women, pregnancy is a time where exercise is safe and appropriate and can help reduce the risk of excessive weight gain and even, in some cases, help reduce the risk for gestational diabetes during pregnancy.

    Melanie:  Are there some types of exercise you’d like to recommend and some types that you would like women to stay away from?

    Dr. Gregg: In general, we want to pick activities that are low impact and thought to be safe during pregnancy. Some of the best choices would be walking, swimming, using a stationary bicycle, low impact aerobics. Some yoga and Pilates could be a good idea but there are certain poses and positions that would be desirable to avoid. Any woman who is going to do yoga or Pilates in pregnancy should just check in with her instructor or with her healthcare provider to make sure that she is making good choices. There are lots of things in those areas – yoga and Pilates and mat based activities--that can be great during pregnancy. In terms of activities to avoid – the biggest things to avoid would be high impact activities like sports where you might be struck in the abdomen. That is something that you would want to avoid during pregnancy. Things that could have extreme effects on the oxygen demands – so scuba diving, sky diving, things at high altitude or underwater--may be challenging though basic swimming at a pool like the YMCA or something like that would be very reasonable.

    Melanie:  What else would you like women to know about a healthy pregnancy and, specifically, nutrition and healthy eating during pregnancy?

    Dr. Gregg:  A lot of the things that are recommended for diet during pregnancy are the same as what we would recommend for all women in general. That is to focus on lean protein, lots of fruits and vegetables, low fat dairy products. Protein is certainly an important component of the diet for pregnant women. There are some things that are a little bit different and are to be avoided during pregnancy. In particular, that would be raw meat, raw fish and with fruits and vegetables, it is important to make sure that things are carefully washed and that the risk for infection from food is minimized just by careful food handling.

    Melanie:  So important. In just the last few minutes, Dr. Gregg, give women your best advice when they’re thinking about getting pregnant all the way through their pregnancy and even after and what you tell women every single day about the best keys to a healthy pregnancy.

    Dr. Gregg:  I think it’s just so valuable to approach pregnancy with a positive attitude and to feel confident that if a woman is taking good care of herself and her body, she is very likely to have a healthy pregnancy. I think focusing on just general good nutrition and low impact exercise is a good recipe for a healthy pregnancy.

    Melanie:  Why should women come to UVA Health Systems for their pregnancy care?  

    Dr. Gregg:  At UVA, we have a wonderful team of doctors, nurses, nurse midwives and other members of our team who are in a great position to take wonderful care of women during pregnancy and birth and beyond. We have a wonderful breast feeding medicine team. We are a baby friendly hospital. We work very hard to keep moms and their babies together and to promote bonding and breast feeding for our families. I think it is also wonderful that we have all the resources that any mom and baby and family could need in the hospital – every resource, every expertise that someone might need during their birth and postpartum care.

    Melanie:  What great information. Thank you so much, Dr. Gregg, for being with us today. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.



     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Women’s Health, Pregnancy]]>
David Cole Wed, 27 Apr 2016 14:17:17 +0000 http://radiomd.com/uvhs/item/31659-keys-to-a-healthy-pregnancy
Head and Neck Cancer: What to Watch For http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=31640-head-and-neck-cancer-what-to-watch-for head-and-neck-cancer-what-to-watch-forWhat are some of the most common symptoms of head and neck cancer?

What treatment options are available?

Learn more from Paul W. Read, MD, a UVA Cancer Center expert in head and neck cancer.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1616vh2b.mp3
  • Location: Null
  • Doctors: Read, Paul
  • Featured Speaker: Paul W. Read, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Paul W. Read, MD., is a board-certified radiation oncologist who specializes in head and neck cancer along with working to develop more effective cancer treatments with fewer side effects.

    Learn more about Paul W. Read, MD
  • Transcription: Melanie Cole (Host):  We hear in the media about celebrities that have head and neck cancers. What are some of the most common symptoms of head and neck cancer?  My guest today is Dr. Paul Read. He is a board certified radiation oncologist who specializes in head and neck cancer at UVA Health System. Welcome to the show, Dr. Reed. When we talk about head and neck cancers what type of cancers are we discussing?

    Dr. Paul Read (Guest):   That’s a great question. Head and neck cancers involve cancers of the sinuses, of the nose, of the mouth, the throat, and the larynx. It can include cancers of the salivary glands that make our saliva, as well as the thyroid gland.

    Melanie:  People always want to know the symptoms. They want to know if they were to experience any of these symptoms. What would they be looking for for head and neck cancers?

    Dr. Read:  That’s a great question. Patients can have swollen lymph nodes in the neck and, particularly if they don’t respond to antibiotics, that’s a real worry that they may have cancer that started in their throat or mouth and it spread to lymph nodes. They can sometimes have pain in the mouth or throat. They could have hoarseness or cough that doesn’t respond, again, to antibiotics; an obstructed sinus that they can’t breathe through their nose that doesn’t, again, respond to typical medications like antibiotics or steroids. They could have bleeding, either from the nose or mouth. That certainly should be investigated. Dentures that don’t fit like they used to fit is a common example of the reason to see a doctor about possibly having a cancer of the gum or the hard palate. Any changes in speech and/or new lumps or bumps on the head or neck region that are new and are slowly growing should be investigated by your doctor.

    Melanie:  Are there certain risk factors, genetic components? What are some things you want people to know about their risk for these type of cancers?

    Dr. Read:  That is also a great question. Smoking is far and away the most common reason that people get cancers of the mouth, throat and the voice box called the “larynx”. If we could have people stop smoking and never smoke again, we’d see far fewer head and neck cancers. The best thing you can possibly do to decrease your chances of getting a head and neck cancer is to stop smoking or using smokeless tobacco as well. Also, smoking can increase other cancers like lung cancer of course we know that as well. Another risk factor is drinking alcohol. Patients who drink alcohol and smoke really increase their risk of getting a throat cancer or a mouth cancer. Trying to use as little alcohol as is reasonable, maybe occasionally having social drink. Clearly, patients who drink every day, for example, are at a high risk. In addition, some head and neck cancers are caused by a virus. The HPV virus in particular is causing a real epidemic of cancers in the tonsil, as well as in the base of tongue. These can occur in patients who don’t drink or smoke at all. It generally happens in patients who are their middle age, in their 50’s and 60’s. These cancers can be caused by drinking and smoking or sometimes even by a virus.

    Melanie:   Let’s talk about diagnosis. When you talk about the oral cavity and the gums and such, are we getting that check when we go to the dentist for our cleaning?  Are they looking for oral cancers? What about some of these others? How are they diagnosed?

    Dr. Read:  A good dentist--the first thing they should do is look for the health of your tongue and your gums and your oral cavity and do a good exam, especially if you are a drinker or smoker. You should let them know. They should be especially careful to look for any areas that don’t look normal. The normal lining of the mouth and throat has a nice, healthy pink looking lining to it, so any red areas or whitish areas that have come up should be investigated and potentially biopsied. If a dentist doesn’t feel comfortable biopsying a patient, then they should be sent to a local ear, nose and throat expert who has expertise in diagnosing early head and neck cancers or sometimes to an oral surgeon as well.

    Melanie:  When we talk about treatment, Dr. Reed, people hear about head and neck cancer and right away they are scared because when you’re thinking of oral cancers and things that involve your face and your throat and eating and all of these things. It can be so scary. What are some of the new, exciting treatments that you’re doing there at UVA?

    Dr. Read:  The treatment of head and neck cancer, of course, depends on where the tumor’s located. Frequently, it involves surgery or radiation or chemotherapy or some combination of all of these treatments. Probably the most exciting thing for treatment that’s happened in the last five to six years is the use of the DiVinci Robot to do surgeries on patients’ throats, particularly tonsil cancer and basic tongue cancer. They used to have to do a very expensive type of surgery where they would have to cut a patient’s jawbone in half to get access to the tonsil or the base of tongue to be able to do surgery. With the robot they can do surgery without having to even touch the jawbone to operate in these areas. It’s really improved our ability to do surgery for patients who have early cancers of the tonsil and base of tongue in particular. This is a type of treatment that’s really only available at a few select sites like in Virginia. UVA is probably the state leader in pioneering this type of surgery for patients. For patients at the other end of the spectrum who have advanced spread of cancer, there are new types of treatment approaches using immunotherapy. If a patient has a spread of cancer from their throat to, say, their lungs to bones and, typically, they would receive chemotherapy for that. There is a new explosion of drugs that uses the body’s immune system to try and fight cancer. There are very good studies going on. There are clinic trials available at UVA for patients to explore the use of immunotherapy to help your own immune system help you live longer and live better.

    Melanie:  If a patient does have to have surgery for an oral cancer and they might need reconstructive surgery or they are very worried about the results afterwards, how they’re going to look or they’re going to look a little bit different in their facial area. What do you tell them, Dr. Reed, to give them some hope?

    Dr. Read:  First of all, you want to be at a place where you feel tremendous confidence for your surgeon if you’re a patient. I can tell you that UVA has some of the best head and neck cancer specialists with respect to surgery that there is. Three of the head and neck cancer surgeons have all done fellowships for reconstruction in doing what we call “free flap reconstruction”. If they were to remove a part of the tongue or a part of the mouth, they can use tissues from other parts of the body to reconstruct this so that you have a good functional outcome and a good cosmetic outcome.

    Melanie:  In just the last few minutes, give your best advice for people to, hopefully, prevent head and neck cancers and why they should come to UVA for their care.

    Dr. Read:  The best thing that patients can do to reduce their risk of head and neck cancer is not to smoke and, if you are smoking, to seek help to stop smoking. To use alcohol in moderation and to be vigilant that if you have the symptoms that we’ve described, see your local doctor to assess these so that you can be diagnosed at an early stage where the treatments that maybe require less surgery or less radiation or maybe even no chemotherapy for their treatment. Why should you go to UVA? I think anyone with a head and neck cancer should get a second opinion at a major medical center. This is a small subset of all cancers – cancers of the mouth and throat, sinuses and so forth. They are very technically challenging to treat; not only to cure people but also to cure people with the best quality of life and best outcomes. You really want to go to someone and a group of physicians who work as a team, who work closely together and who really understand all the new studies, all the new treatment options and how to treat people so that they have their best cure as well as their best functional outcome and best quality of life.

    Melanie:  Thank you so much. What great information, Dr. Read. Thank you so much for being with us today. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.   

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Tue, 26 Apr 2016 14:37:46 +0000 http://radiomd.com/uvhs/item/31640-head-and-neck-cancer-what-to-watch-for
Should Kids Specialize in One Sport? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=31560-should-kids-specialize-in-one-sport should-kids-specialize-in-one-sportHow soon is too soon for kids to specialize in a single sport?

What are the benefits of playing multiple sports?

Learn more from Winston Gwathmey, Jr., MD., a UVA expert in sports medicine?

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1616vh2a.mp3
  • Location: Null
  • Doctors: Gwathmey, Winston
  • Featured Speaker: Winston Gwathmey, Jr., MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Winston Gwathmey is fellowship trained in sports medicine; his specialties include caring for athletic injuries and conditions of the shoulder, hip, knee, and foot/ankle.

    Learn more about Dr. Winston Gwathmey

    Learn more about UVA Orthopedics
  • Transcription: Melanie Cole (Host):  If you are parents with hopes of your children playing in college a particular sport and they’re specializing in that sport, should they be doing that? What else can they be doing that will help them excel in the sport that they specialize in? My guest today is Dr. Winston Gwathmey. He’s fellowship trained in Sports Medicine at UVA Health System. Welcome to the show, Dr. Gwathmey. So many parents see their children and they have these dreams of Olympics and college sports and professional sports. Speak to the parents, please, just for a minute about sports specialization and what they should expect from their children.

    Dr. Winston Gwathmey (Guest):   First off, I think that it is critical for kids and adolescents to be involved in sports. I think sports teach a lot of important things about life and about being healthy and those types of things. I certainly don’t want this to sound like I’m against youth sports. It’s just the concern that we have as physicians is that some kids are playing too much of the same sport. They are overusing their bodies at a young age and they’re getting themselves into trouble because of just not being smart about how they play sports. What it leads to is injuries. It leads to disillusionment with the sport which they play. It leads to kids that could be a lot better off if they were to have a broader athletic experience and just be smarter about how they participate in sports.

    Melanie:  Let’s start with our young ones, then, Dr. Gwathmey. We start them in soccer and in little league softball and baseball. They’re not playing the big, tough sports so much when they’re little. It’s generally those kinds of team sports that may be a little contact-y. Do we need them in these sports or do we have them try basketball, volleyball all at the same time or if we see that they have a propensity for soccer and they’re running down the field, we leave them in soccer and let them work on that.  

    Dr. Gwathmey: I think if a child shows an aptitude for a specific sport, certainly allowing him to explore that aptitude is important. I don’t want someone who shows early signs of being an outstanding soccer player to be forced to play a different sport just because that’s the way it should be. But, I think the kids should be encouraged to consider the seasons and consider playing other types of sports so they have the opportunity to see what their skills are in other types of sports and sometimes other sports translate into the sport in which they are good at. If they play soccer, sometimes just the movement and patterns in basketball or football or these other sports could be helpful for their progress in the sport in which they play. I think that kids should be encouraged to play and to participate in all different types of sports for a number of reasons – just to be well-rounded.

    Melanie:  Certain sports lend themselves to excelling – tennis. You see kids that are really, really into this particular sport, and soccer and some of those. What do you tell parents about off season and what if they live in a place that plays that sport year round?

    Dr. Gwathmey:  Off season is pretty important. I think some of these kids aren’t getting an off season. I think the sport in particular that I see the most trouble with is baseball in which kids who are 10, 11, 12 years old. They watch baseball on T.V. and they see these guys throwing 95 mile an hour fastballs, curve balls and these types of things and all they want to do is become a major league baseball pitcher. At age 11 or 12 years old with a growing skeleton, they’re out there with their dad or their coaches throwing the ball as hard as they can with mechanics that aren’t very well-developed. It puts a lot of stress on the growing shoulder and the growing elbow. If you just do this over and over and over again without having the opportunity to rest and to heal, then you can get into trouble at a young age with elbow injuries and with throwing injuries in a young athlete. Baseball gets the most recognition right now but at any sport, if you do too much of the same thing you can get yourself into trouble. A tennis serve can have very similar mechanics to a baseball pitch. People who run cross country and those types of things, they can just put too much stress on their growing skeleton. I think it’s important that anybody who does the same thing over and over and over again realizes that they are at risk for overuse and the consequences of overuse which might be disability or injury or not being able to play the sport they want to play. They should just be aware of that.

    Melanie:   Even the organizations are coming out, as you say, and with the pitching limits and things. That helps coaches and parents to kind of keep track of that for them. What cross training would you recommend doing other things with these children? Are there certain sports that go together that you could say, “Play basketball at this season and then soccer in the spring and they’re not going to interfere with each other.” Do you have some cross training favorites, Dr. Gwathmey? 

    Dr. Gwathmey:  Classically, football and soccer end up being fall sports, basketball is usually in the winter, baseball and tennis and those types of things are in the spring. I think the sports in which you are active with your lower body like, say, soccer in the fall and baseball in the spring is a good combination because in the fall, you’re running and you’re building quadriceps and gluteal strength and those types of things. You’re building your hand-foot coordination and you’re running and you’re conditioning and that kind of stuff. In the winter, you’re playing basketball or one of the sports where you’re using a combination of the upper extremity and lower extremity and in the spring playing baseball or tennis where you’re using a lot of throwing motion and using your arms and shoulders more. That’s kind of the fit that I’m kind of hoping for. Each given season, you’re not overdoing it with the same muscles and the same joints that you’re using the prior season. For instance, if you’re playing baseball in the spring and then tennis in the summer and then volleyball in the fall and you constantly have this overhead motion, that might lend itself to overuse even though you’re using it a little bit differently. I just think that it is critical to think about your body and think about what you’re doing to the body and work on trying to have a broader experience or, basically, a more diversified portfolio, if you will.

    Melanie:  When our kids are doing these particular sports, say you’ve got gymnastics, should they be weight training along with these sports or do you want them to lay off of strength training and just concentrate on flexibility or plyometrics to avoid injuries, whatever it happens to be?

    Dr. Gwathmey:  The human skeleton between the ages of about 10 and 16 is a pretty interesting machine. The bones are growing at an exponential rate. The muscles sometimes don’t keep up with the bones quite so much. The kids are trying to build muscles for their sport, for the beach and those kinds of things. They do a lot of strength training on a growing skeleton. I certainly think conditioning and some strength training is very important and very helpful but those who go beyond and try to put too much weight on and overuse their muscles and their joints, they can injure their skeleton. I think it is a pretty critical time in a kid’s growth is as they’re putting on bone mass and they’re putting on extra muscle mass not to overdo it. I think plyometrics and conditioning – basically, growing stronger just with the activities that you’re doing out in the field and with your training can be helpful--not necessarily putting all of that time into the actual weight room trying to put the bench press up as high as you can. The extra weight that some kids put on their growing skeleton can be detrimental.

    Melanie:  Dr. Gwathmey, no kid wants to sit out of a sport that they love but give parents some hope. If their child has had some sort of an orthopedic injury, can it right itself if it is a chronic overuse or is it something that might plague them from then on?

    Dr. Gwathmey:  That’s the thing. You have to identify what factors went into the injury in the first place. Like a traumatic injury like an ACL or a sprained ankle or something like that. Sometimes, it’s a freak accident. But, if you have an athlete who has shoulder soreness or a ligament tear in their elbow or something like that, you have to look into what went into that. Was it a mechanical problem? Was it an overuse problem? Once you start delving into that and try to identify the factors that played a role in this, you can start to figure out whether or not it’s going to be effective to treatment as far as recovery. The beauty of taking care of kids is they heal. You have to have a pretty bad injury for a kid not to be able to get back to his sport because the human body in adolescence has a remarkable, almost miraculous, propensity to heal if you give it the proper environment in which to heal; that is, alleviating the stresses on the body, getting good nutrition, making sure you’re eating healthy, and making sure that you’re not doing things that hurt the body over time. I think that all parents and kids can be optimistic about an injury they may have because at age 14, 15, 16 years old, chances are you’re going to heal 100% unless you’re doing something that is chronically causing additional problems. That is just going back to the source of the problem in the first place. As an orthopedic surgeon, we certainly don’t like having kids in our operating room. That’s for sure. That’s why I think the educational portion of this is critical; much more so than the actual surgery.

    Melanie:  Why should families come to UVA orthopedics for their sports medicine care?

    Dr. Gwathmey:  We have a lot of experience treating athletes of all ages. We have kids from 12 years old to 90-year-old kids who are out there playing tennis. We have good experience across the entire gamut of athletics and age groups. We have specialists who take care of every part of the body. I think when you have a group of the orthopedic surgeons that we have here at UVA, with the experience that we have and our interest in helping people, I think it is a good place to come. We’re at the front lines of sports medicine. All of us are involved in policy and the latest research. I think it is a good place to come to have that level of care.

    Melanie:  Thank you so much, Dr. Gwathmey, for being with us today. It is great information. You’re listening to UVA Health Systems Radio. For more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.    

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Mon, 18 Apr 2016 22:53:50 +0000 http://radiomd.com/uvhs/item/31560-should-kids-specialize-in-one-sport
Pulmonary Embolism: Surgery May Be Necessary http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30818-pulmonary-embolism-surgery-may-be-necessary pulmonary-embolism-surgery-may-be-necessaryA pulmonary embolism is a blockage of an artery in the lungs.

The embolism prevents blood and nourishment from getting to a specific area of the lungs.

This may lead to the death of lung tissue in this area.

Damage to the lungs may make it difficult for the lungs to work properly.

In severe cases, a pulmonary embolism can lead to death.

Learn more from Dr. Aditya Sharma, a UVA specialist in aneurysms and vascular disease.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1606vh4d.mp3
  • Location: Null
  • Doctors: Sharma, Aditya
  • Featured Speaker: Aditya M. Sharma, MBBS
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Aditya Sharma is board certified in internal medicine and specializes in vascular medicine, including aneurysms.

    Learn more about Dr. Aditya Sharma

    Learn more about UVA Heart & Vascular Center
  • Transcription: Bill Klaproth (Host):  This is Bill Klaproth in for Melanie Cole.  A pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs. Could this happen to you? Dr. Aditya Sharma is the Director of the Vascular Medicine program at UVA Health Systems and is here to talk with us today. Dr. Sharma, thanks so much for joining us today. How does a pulmonary embolism develop?

    Dr. Aditya Sharma (Guest):  Thank you very much. So, pulmonary embolism is basically a blockage of the blood vessels in the lungs where, typically, the blockage occurs from blood clots that usually form in the blood vessels in the legs and then go up to the lungs. So, how does it occur? Through many different means. One of the things is that it typically occurs after surgery or in someone that has been immobilized for a long period of time and that immobilization can be because they just drove 6-8 hours straight in the car or because they broke their ankle and now they cannot move for some reason or the other. When these things happen, usually, the blood tends to be stagnant for a long period of time in the legs and that causes a clot to form there which then breaks off and goes to the lung. The other ways it can happen is that some people just have some kind of blood clotting disorder which can be genetic and, in some situations, if somebody has cancer, cancer can make the blood a lot more clottable or hypercoagulable and these people also can develop blood clots. Those are the more common ways of getting blood clots.

    Bill:  So, a pulmonary embolism isn’t necessarily age-specific. This can happen to young people and old people alike?

    Dr. Sharma:  That’s a good question. Very interesting question. No, actually there is a difference and typically pulmonary embolism is more likely to occur in older people than younger people. If it happens in a young person, we will look for blood-clotting disorders more frequently. One of the reasons behind why older people are more likely to get pulmonary embolism more is from the fact that the inside of the blood vessels, which is the [inaudible 02:43] after years and years of being exposed to irritants such as smoke and so on, can actually become damaged. I think that’s one of the reasons why they are more at risk of getting blood clots.

    Bill:  When you say “inactivity”, it’s basically sitting, right? It’s sitting for long periods of time. We hear about people on airplanes and really long flights of this happening, too. So, it’s basically in a sitting position? Not laying down?

    Dr. Sharma:  Yes. So, it can be either way. It can be in a sitting position or lying down also. It’s any position in which you’re not using your calf muscles for a long duration of time. This typically tends to be 6 hours or greater, although sometimes people can have it sooner also. Typically, it’s 6 hours or so. Often you’ll hear the case of pulmonary embolisms typically occurring in somebody who takes a trans-Atlantic flight and immediately after the flight is over, their legs are swollen and then they may break a blood clot from their legs which goes into their lungs and causes the pulmonary embolism. But, often, it could be also somebody who has broken their ankle or just had a major surgery and has been lying in bed for hours and hours. Typically, they tend to get blood clots in the legs which can break off and go to the lungs, too.

    Bill:  So, how do you know if you have one? Do you get like a pain in the chest or do you feel the blood clot traveling? Are their common symptoms that somebody should be watching out for?

    Dr. Sharma:  Yes. Typical symptoms that help people recognize that they may have a blood clot in the lung are:  chest pain which will be, usually, sudden onset of chest pain; sometimes it might just be severe chest heaviness; it could be shortness of breath. A lot of times, it’s just severe palpitations. Those would be the typical symptoms. Another thing to look out for is a lot of these people will have sudden onset of swelling in the legs as the blood clot will typically form varicose before it goes to the lungs.

    Bill:  Would there be any pain at all in the legs if a blood clot was forming?

    Dr. Sharma:  Yes. If the swelling is severe, a lot of times people will have pain in the legs, too, but it’s not there always. So, the absence of it does not always rule out pulmonary embolism or a blood clot in the leg.

    Bill:  So, this is a serious thing. You can die from this, right?

    Dr. Sharma:  Yes, it’s true. In fact, it’s considered to be, actually, the 4th leading cause of cardiovascular death in most developed nations and, in fact, pulmonary embolism is thought to be the most leading cause of death in the hospital. So, certainly, it’s a major big problem. It’s a major concern worldwide right now.

    Bill:  Wow. I did not know that. Is there any way to prevent this at all? Exercise as you grow older? Exercise? Diet? Does anything help prevent this from happening?

    Dr. Sharma:  Certainly, so one of the things, in talking about prevention, that the patient can do for themselves or we can do for ourselves is to make sure that we delay the damage within the blood vessels, the endothelial damage. That, typically, can be delayed by not smoking. Smoking, typically, tends to cause that damage and I think, overall, puts people at risk of getting pulmonary embolism in the long run. The other thing that we always advise is that if you are taking a long flight or if you’re driving a long distance, always stop every couple of hours, get out, walk a little bit, flex your calves and then sit back and continue with your flight or your drive. Those are the things we typically suggest. During surgery, now most major centers have standard protocols where we have devices called “sequential compression devices” which constantly pump blood in the leg immediately after surgery and even sometimes during surgery. We tend to give them low-dose blood thinners while they are in the hospital to help them avoid getting blood clots, too.

    Bill:  If you do develop a pulmonary embolism, what is the treatment for it if it’s caught in time?

    Dr. Sharma:  If a pulmonary embolism is caught in time, the most commonly used treatment is blood thinners. We used to have just one blood thinner for many years—almost for the last 50 years, we had only one blood thinner called Warfarin but now, we actually have 4 new blood thinners on the market that we can use, all of which are FDA approved for the treatment of pulmonary embolisms. So, it’s definitely that we have a lot of advances when it comes to that. Beyond that, it depends upon how bad the pulmonary embolism is but, often, at a big center as the University of Virginia, when we have somebody with sort of a high-risk pulmonary embolism as in the blood clot burden is so much that it’s causing stress on the heart and we are worried that this could cause death in the near time, we often will have a multidisciplinary discussion of such patients between the cardiovascular medicine group, interventional radiology group as well as the cardiovascular surgery group and discuss what would be the best option, whether just treating them with blood thinners is fine or should we go in and suck the clot out—a thrombectomy—or break down the clot with lytic agents or actually to open surgery and remove the clots. Often, it’s a fairly complicated solution for the patient and that is something we achieve through more of a multi-disciplinary approach.

    Bill:  So, with treatment you’re generally able to get rid of the clot?

    Dr. Sharma:  If we just use the standard treatment which is blood thinner therapy, over 30% of the time the clot will go away. About 30% of the time, half of the clot goes away. The role of blood thinners is not to take the clot out, but just to keep the blood thin enough so new clots don’t form and, in that period of time, the body actually takes down the clots on its’ own. That’s one of the reasons why, when we have patients with too much blood clot that’s causing stress on their heart, we will often think about going in and actually sucking the clot out with sort of devices or actually doing open surgery and removing the clot.

    Bill:  What is the general prognosis, then, for recurrence if you are unfortunate enough to develop one of these?

    Dr. Sharma:  The likelihood of recurrence depends a lot on under what conditions a person gets a blood clot. If there’s somebody who had a blood clot after major surgery or had a severe  fracture and they couldn’t move their leg for a long period of time and then they get those blood clots, their chances of having another blood clot is very low in the long term. It could be less than 10% in their entire lifetime because people usually have a reason why they developed the blood clot. Clearly, they couldn’t move their leg for a long period of time and ended up getting a blood clot in the leg which went to the lung. On the other hand, we will have people who just suddenly get a blood clot because they may have a genetically predisposed condition to get blood clots or it could be that we don’t even find anything genetic and then they just suddenly got a blood clot for no clear reason at all. In those people, the risk of getting another blood clot is very high and it can be, sometimes, up to 30% in the next 10 years of their life. So, typically, for those people, we tend to keep them on blood thinners for the rest of their lives to avoid getting another blood clot.

    Bill:  Why should patients come to UVA for their vascular health needs?

    Dr. Sharma:  One of the things that we do at UVA in a very nice way is we have a very collaborative environment when it comes to vascular care. Vascular care can be provided by vascular surgery; it can be provided by cardiovascular medicine; it can be provided by even vascular interventional radiologists. Often, all of these groups provide a certain amount of care. At UVA, we all actually work together to provide what could be possibly the best care that we could give for our patients with vascular disease. That’s what I think is one of the positive things about being at UVA because you have the top level surgeons; you have the best interventional radiologists you could potentially find in the country. So, we have all the skill sets, all the techniques and all of us actually come together and decide what would be optimal and treat patients that way. So, that’s why I think it’s one of the best places to get vascular care in the country.

    Bill:  Well, Dr. Sharma, thank you so much for your wonderful work and thanks for being on with us today. For more information, you can go to UVAHealth.com. That’s UVAHealth.com. This is UVA Health Systems Radio. Thanks for listening.



     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Bill Klaproth
]]>
David Cole Mon, 18 Apr 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/30818-pulmonary-embolism-surgery-may-be-necessary
When Should You Get a Colonoscopy? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30814-when-should-you-get-a-colonoscopy when-should-you-get-a-colonoscopyWhen should you have your first colonoscopy, and how often should you have one?

Get recommendations from Dr. Cynthia Yoshida, a UVA specialist in colon cancer and colonoscopies.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1606vh4c.mp3
  • Location: Null
  • Doctors: Yoshida, Cynthia
  • Featured Speaker: Cynthia M. Yoshida, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Cynthia Yoshida is a board-certified gastroenterologist whose specialties include colon cancer and colonoscopies.

    Learn more about Dr. Cynthia Yoshida

    Learn more about UVA Digestive Health Center
  • Transcription: Bill Klaproth (Host):  This is Bill Klaproth in for Melanie Cole. So, when should you have your first colonoscopy and how often should you have one? Dr. Cynthia Yoshida is a board certified gastroenterologist whose specialties include colon cancer and colonoscopies. Dr. Yoshida, thanks for being on with us today. Now, I am of the colonoscopy age. I am over 50 and I’ve got to tell you, I have friends that say, “I’m not getting that. I don’t have colon cancer in my family. I don’t need to do that thing. I’ve heard it’s horrible.” Can you explain to us why it’s so important to get a colonoscopy?

    Dr. Cynthia Yoshida (Guest):  Sure. Absolutely. I hear this all the time. People, even at cocktail parties, will stop me and say, “Why should I have a colonoscopy? I don’t have any symptoms. I feel great. I’m only 50. No big deal.” The real reason that we do this is just about screening. We know that all colon cancers, or the vast majority of colon cancers, start as little polyps which are benign growths. If we do a colonoscopy beginning at age 50, in the average risk population, we can actually find these polyps before they are going to turn into something bad—cancer. We can take them off before they do that. The colonoscopy is really the only screening test that we have out there that can find the pre-cancerous lesions before it turns into cancer.

    Bill:  So, this is really a great form of preventative medicine. I mean, the way I look at it, the technology we have today, you’re not allowed to get colon cancer.

    Dr. Yoshida:  That’s exactly right. It’s my job to make sure my patients don’t get colon cancer. It’s really though. There are sometimes, obviously, when polyps can be missed, but we work hard to find those polyps and take them off before they turn into anything bad.

    Bill:  So, you mentioned the guidelines are starting at age 50. Are there any exceptions to that general rule?

    Dr. Yoshida:  Sure. So, there are a number of exceptions. In African Americans, the American College of Gastroenterology actually recommends that African Americans start at the age of 45 because the risk is a little bit higher. People always think that there’s a difference between the sexes—between men and women. There isn’t. The risk is 50. If you have a family history of colon cancer, if you have somebody who is a first degree relative—so, somebody who is a child or parent or a sibling; a brother or sister who has colon cancer—you’re going to start 10 years before their age of when they were diagnosed with cancer. So, say your brother was diagnosed with colon cancer at age 46. You’re going to start screening at age 36.

    Bill:  Alright, Dr. Yoshida. So then, how often should you get a colonoscopy?

    Dr. Yoshida:  So, it’s different for different people. For most people who have no family history of colon cancer, if you have a great prep and we do the colonoscopy and don’t find any polyps, you don’t have to come back for 10 years. The reason for that is because from the start of a polyp to the formation of cancer, it takes a long time. It usually takes a number of changes for it to happen and it takes well beyond a decade for colon cancers to form. So, a ten-year window is absolutely fine for many people. If you have a family history of colon cancer in a first degree relative, say, a parent or a sibling or a child, then you need to come back every 5 years. If we find pre-cancerous polyps, it depends upon the number and the size of the polyp. For most people, it’s a 5 year window but sometimes if we find many polyps or bigger polyps, we could bring you back anywhere between 1 or 3 years.

    Bill:  And, if you find a polyp, do you remove it right then and there?

    Dr. Yoshida:  Yes. That’s the beauty of colonoscopy as opposed to other screening tests. There are a number of screening tests that are out there that they can look and see the polyps but with colonoscopy, we can actually see the polyps and we can also take it out at the same time.

    Bill:  That’s terrific. For many people, really, the prep is worse than the test, right? 

    Dr. Yoshida:  That’s exactly right. That’s what I tell people. When we’re doing the consent, I usually say to people, “You could back out now, but you’ve done the hardest part.” For the most part, having the colonoscopy is really just getting sleepy and comfortable and it really is a good nap and then somebody take you out to lunch.

    Bill:  So, tell me, what can you expect before, during and after the colonoscopy? Take me through the day?

    Dr. Yoshida:  So, the day before the colonoscopy, you have the prep. That really is the hardest part. We ask that our patients eat or drink only clear liquids for breakfast that day before. Then, that evening, you’ll take a prep. The prep is something called “go lightly”. It doesn’t always go lightly but it is a liquid that stays within your GI tract. So, you drink it. People have this misconception that we have to drink gallons and gallons of fluid. For most people, it’s 4-6 glasses the night before and then 4 hours before your test the next morning, it’s 4 glasses of prep. So, you usually start at about 6:00 pm and you’re going  to drink about 4-6 glasses of the prep slowly. Then, it will start to clear your bowels. Then, you go to bed and the next morning, you wake up prior to 4 hours before your procedure. You take another 4 glasses and then not eat or drink anything 2 hours before the test. It’s really important to remind your listeners that they really have to have a driver. It’s important  that they have somebody who can drive them home because they will be getting sedation and then, in order to make them comfortable, they’ll get sedation through the veins. So, most people will arrive at UVA at our endoscopy unit. They’ll register out in front and will be taken to the back to the endoscopy pre-procedure area where they’ll be met by a nurse and they’ll get basic vital signs. They’ll get your blood pressure and your pulse and you’ll get undressed. They’ll put you in a patient gown and we’ll start an IV. Then, usually, the physician comes in and will tell you all about the procedure; tell you about the risks and the benefits and tell  you why we’re doing the procedure and what we’re doing for that day. Then, we actually get you back into the endoscopy room itself. In that procedural area, again, we get you all connected to our blood pressure monitors, our heart monitors and our oxygen saturation monitors so that we can really closely watch you and monitor you during the procedure while you’re getting the sedation. The colonoscopy itself takes anywhere from 15-30 minutes on average depending upon what you have to do. Then, after the procedure, you go into the recovery area. Usually, in that area, you’re waking up and the nurses have some cookies and some juice and we get you fully awake and make sure that you’re tolerating what you’re eating and drinking. That’s the time that I come back and tell you exactly what we found, describe what we did and if there were any polyps found, what the follow up would be. Oftentimes, we send all the polyps to pathology. So, we’re going to need to mail you those results. I can usually tell by looking at them what I think they are and what the follow up is going to be.

    Bill:  So, you can eat right after you’re done? You don’t have to have any special diet? You just normally after the procedure?

    Dr. Yoshida:  Most people actually can. I have a number of patients who head out and have a hamburger right after. It depends on your tummy and how your belly responds to things but most people can eat pretty much back to normal.

    Bill:  Alright. This may sound like a silly question, but maybe not. What if somebody has hemorrhoids or an anal fissure or something? Is that problematic?

    Dr. Yoshida:  Those are common—for people to have hemorrhoids and they don’t interfere at all for our ability to do the colonoscopy. Oftentimes, what I tell people is the prep itself—because you’re going so much and wiping so much—that you may actually make your hemorrhoids a little worse during that period of time. After the procedure, we tend not to go for a day or so. So, it all makes up for it and they usually get better after that.

    Bill:  Are there any complications ever? I’ve never heard of one—not that I would. But, are there any complications that arise during this?

    Dr. Yoshida:  Sure. You know, the complications from colonoscopy are rare but it’s really important that people understand that this is an invasive procedure and that, I mean, you have to find somebody who is competent and excellent at this; somebody who has done a number of procedures. So, the risks of the procedures, though, are really:  bleeding, infection, poking a hole through the bowel; missing a lesion; a reaction to the sedation that we give you. They are very rare. The chances of them happening are extremely unlikely especially in the hands of somebody who has done a number of colonoscopies but it’s important—and this will be the part that the doctor will talk to you about before doing the procedure to get consent and to make sure that every patient understands what they’re having and what the possibilities are.

    Bill:  Well, thank you so much for this great overview. You really explained it well. I really appreciate it. And, speaking of the great people at UVA, can you tell us  why patients should come to UVA for their digestive health needs and their colonoscopy needs?

    Dr. Yoshida:  I think for their colonoscopy needs, the reason that they should come to UVA is that we have excellent, trained physicians who really care about colon cancer and colon health. We have a multispeciality group of people who are going to make sure that you have a great experience for your colonoscopy and if you have colon cancer or an issue that needs to be taken care of, we have a great group and great team of people that can take good care of you.

    Bill:  Dr. Yoshida, thank you so much, again. I really appreciate it. For more information, you can go to UVAHealth.com. That’s UVAHealth.com. This is UVA Health Systems Radio. Thanks for listening.



     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Bill Klaproth
Tagged under: Cancer, Colonoscopy]]>
David Cole Mon, 11 Apr 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/30814-when-should-you-get-a-colonoscopy
How to Deal with Menopause Symptoms http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30790-how-to-deal-with-menopause-symptoms how-to-deal-with-menopause-symptomsWhat are some of the most common symptoms of menopause, and what are some potential options for dealing with them?

Learn more from Dr. JoAnn Pinkerton, a UVA expert in menopause.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1606vh4b.mp3
  • Location: Null
  • Doctors: Pinkerton, JoAnn V
  • Featured Speaker: JoAnn V Pinkerton, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Board certified in obstetrics and gynecology, Dr. JoAnn Pinkerton is Division Director of UVA Health System’s Midlife Health Center and executive director of the North American Menopause Society.

    Learn more about JoAnn V Pinkerton, MD

    Learn more about UVA Midlife Health Center

  • Transcription: Melanie Cole (Host):  Well, it’s not a disease, but it is certainly a condition that every woman is going to go through at some point in her life but what are some of the most common symptoms of menopause?  How do you know that that’s the time that you’re in and what are some potential options for dealing with them?  My guest today is Dr. Joann Pinkerton. She’s board certified in obstetrics and gynecology and she’s the division director of UVA Health Systems Mid-life Health Center and the executive director of the North American Menopause Society. Welcome to the show, Dr. Pinkerton. When do menopause symptoms typically start?  How does a woman know that we’re starting perimenopause and heading towards that change?

    Dr. Joann Pinkerton (Guest):  Well, first of all, thank you so much for giving me a chance to talk about something I’m so passionate about which is about menopause and the decisions women get to make as they move through it. Most women start to know that something has changed, their cycles are not coming as regular as they normally do. They might come a little bit closer; they might start to skip; they might be heavy one cycle, light one cycle; or they might start to notice that they’re having a few hot flashes a week before their period, more migraines, more PMS, even to where they start to feel a little road rage or even fatigue a week before their period. But, they will start to notice changes and they may start to have hot flashes or night sweats that occur at night. All of those lead up to an average age of menopause at about 52. So, any time around that sort of 45-55 can be the perimenopause. Menopause is when you’ve had a year without periods which means you can only determine it when you look backwards.

    Melanie:  Is there a genetic component to when you’re going to start?  Do you look at your sisters and your mother?

    Dr. Pinkerton:  It has been shown that family occurrences of menopause run together. So, if your mother and your sister had an early menopause, you want to be prepared that you might have an early menopause. If they had a late menopause, you might also have a later menopause. There are other things that might affect it. Like, if you smoke, you might have an earlier menopause. Or, if you’ve had an ovary removed or a hysterectomy, you might have an earlier menopause but, in general, you can look to your mother or your sister for a guideline for when you might go through it.  

    Melanie:  All of these things you mention Dr. Pinkerton, heavy periods, irregular, maybe road rage or insomnia, hot flashes, any of these things, do women want to do something to alter these or deal with these symptoms or is it something we’re just supposed to settle for and let happen to us?

    Dr. Pinkerton:  So, for 75% of women, the hot flashes and night sweats occur, they’re bothersome, they last 30 seconds or maybe their mild. They’re not a major issue. For 25 % of women, they are pretty bad. They might be happening for lasting 10 minutes, eight times a day. They might have soaking sweats where they have to change their sheets or their beds. They might have flooding periods. If you have anything than is more than a minor nuisance, you want to talk about what are your options. For the bleeding, we might use birth control pills around the time of menopause. For somebody with hot flashes, we are going to be thinking about either hormones or non-hormonal options.

    Melanie:  Okay. So, the hormonal options:   some women are, you know, for a lot of years now we’ve heard various controversies such as “you’re trading one problem for another,” “you’re increasing your risk of breast cancer but yet helping your bone density,” and “your risk of heart disease goes down.” So, what do you tell women when they ask all these questions about hormone treatment?

    Dr. Pinkerton:  Well, what’s really exciting is we are working on our 2016 NAMS Position Statement, so I’ve looked at all the data that’s out there including the study that came out in 2012 that scared us so much. That’s the study that said that hormones cause breast cancer and heart disease and dementia and stroke and blood clots and everybody went off of them.  We’ve learned a lot since then. Now, we know if you’re under 60 or within 10 years of menopause and you’re having moderate to severe bothersome symptoms, that estrogen not only can help your symptoms but it’s probably good for you. It may actually help your heart. It may help your brain and you will have fewer sleep disturbances, your dreaming will come back. So, we can not only improve your hot flashes but we can help your health risks if you’re young and you’re under 60. We also have low doses. We have different ways of giving it. So, if a women has a lot of symptoms, she just needs to sit down with her provider and say, “Here’s my health risks; what can I do?  What’s the safest thing for me?”  But, the mantra that you shouldn’t use hormones is gone and even low dose for only a couple of years might be wrong.  It might be what’s the right dose for you and how long should we be using it for you?  Even women who want to stay on it longer because they keep having hot flashes when they go out or when they try to stop, we may talk about using the hormones even longer for those women.

    Melanie:  What are bio-identical hormones?  That’s been thrown around a lot lately, too.

    Dr. Pinkerton:  Well, a bio-identical hormone is a marketing term. It really means the hormones that you used to make before menopause. Primarily estradiol and progesterone. What happened when that scary study came out was that everybody said, “Well, FDA approved hormones must be bad so we’ll go get something compounded and that will be safe.”  But, if you remember the 64 deaths from the contaminated intrathecal steroids, compounding is not always safe. There’s a MORE magazine article that showed that compounding had underdosing and overdosing risks. We have many FDA Approved bio-identical hormones which means that they are hormones that are the same that you used to make before menopause and we can give them as a pill, as a patch, a gel, a lotion, lots of creative ways to give you hormones that match what you used to give.

    Melanie:  So, speaking about gels and things, women hear about hormones and they mostly think of estrogen and estrogen replacement but there are some other hormones that you’re replacing for us and some of them help with various dry…They have intercourse that could be painful, so what do you do for those and are there certain creams that you can use as opposed to taking an oral steroid, or an oral hormone?

    Dr. Pinkerton:   Yes, so we divide the hormone therapy into systemic, which could be oral patch or gel but it’s giving you a systemic level. So, we have to look at risk for your heart and your brain as well as the benefits of helping your hot flashes. For women who have dryness, though,  we have estrogen cream, tablets, and ring that are low dose, go in the vagina, prevent the vaginal dryness, prevent the pain with intercourse without giving you the same systemic risks. In fact, we just went to the FDA, came from UVA and from NAMS to ask them to remove the box warning from these very low dose vaginal products because so little gets into your system that your blood levels are the same as in a normal post-menopausal woman so that you can safely use these products and treat that painful sex. There’s also a new oral, what we call a designer estrogen, it’s called ospemifene or sold as Osphena. It’s an oral tablet that is a combination estrogen/anti-estrogen that actually treats pain with intercourse. So if women are having pain with intercourse please, please come see us. Talk to your doctor, find out what you can do. If the over-the-counter lubricants and moisturizers don’t work, we can use these creams. For women who haven’t had sex for a long time, we can use dilators with the estrogen creams so that for many, many women we can restore a part of their life that they’ve lost.

    Melanie:  Okay. So, when we talk about sexual intercourse and things women think, “Oh, I’m in perimenopause. I’m in menopause. I can have sex now I don’t have to worry about finally getting pregnant.”  Is that a myth?

    Dr. Pinkerton:  If you are a year without a period and you’re around your 50’s, you don’t have to worry about pregnancy. But, the second highest unintended pregnancy rate is women in their 40’s because you’re cycles are irregular, then you might ovulate when you’re bleeding, you might ovulate early or late, so we actually worry more about pregnancy prevention in the 40’s and for women who are having a late menopause into the 50’s. The oldest spontaneous conceived delivered baby was in Ireland in at age 57. So, if you have a late menopause you might be able to have a late child. So, we have to think about pregnancy.

    Melanie:  Wow. So many good things for us to think about. What else do you tell women every day, Dr. Pinkerton about menopause, about this change of life that we’re all going to go through and give us some of your best advice.

    Dr. Pinkerton:  Everyone goes through this. This is something that we’re all going through and everybody goes through it a little different and everybody has different health risks. We want to sit down and figure out, what’s your breast cancer risk?  Have you had a mammogram?  Did your mother have breast cancer?  How bad are your symptoms?  We need to think about your bones. Are you taking calcium?  Do you get it in your diet?  Do you drink milk?  Are you taking a calcium supplement that’s got some Vitamin D?  What about avoiding that weight gain?  Menopausal women can gain 12-15 pounds and we don’t want that. We don’t want that extra belly fat. They’ve shown that if you exercise, if you avoid being sedentary, that you can actually make going through menopause better. Your hot flashes will be less intense and your mood will be better. Now we’re looking at are you sleeping?  Do we need treatment for hot flashes?  Are we preventing bone loss?  What about your heart?  How are you doing with your cholesterol?  Are you getting enough aerobic exercise for your cholesterol?  And then, sleep. Women need 7 hours of sleep a night. I don’t know very many women who are getting that much sleep. They’re worried about their kids. They’re worried about their parents. They’re worried about their jobs. It’s hard to fit it all in. There is a lot of evidence that we can help our brains as we age if we not only exercise and eat right, but if we also sleep. I look at menopause as a time to say, “Okay, here are your health risks. Here’s where you’ve gotten off track. What can we do to get you back on track?”  Someone says, “Well, I can’t do an hour of exercise three times a week.”  But, you could do ten minutes three times a day and you could take that extra set of stairs; you could eat a more Mediterranean diet, a more healthy diet; you could work on getting to sleep earlier. If you have significant symptoms, if you’re having really bothersome hot flashes, we can talk about hormone therapy but we’ve also got non-hormonal therapy that can work. We can use cognitive behavioral therapy – things like dream therapy or hypnosis has shown to help hot flashes. Acupuncture helps some women. All of the anti-depressants – a medicine called Gabapentin can help hot flashes. We have so many choices for hormone therapy if people need it that going through menopause ought to be something that you do with your doctor so that you can make the decisions as you go along. You know, you make a birth plan but you know that real life sometimes gets in the way of your birth plan. Same thing for menopause. You can decide how you’re going to handle it and then, you have to wait and see what nature throws at you.

    Melanie:  In just the last minute here, why should women come to UVA’s Mid-Life Health Center for their care?

    Dr. Pinkerton:  The beauty of our physicians here is that we’re specialists. We’re actually credentialed menopause specialists. We’re very active in our organization called the North American Menopause Society and we believe in looking at women as an individual, looking at health risks, getting tests that we need to do and in helping women navigate this process. If someone wants to navigate it without any medications, we will do our best to help them do that. If people want to navigate with medications, we’ll try to pick and choose the best medicines and also continue following them, help them go off and then watch them as they age. We want those vibrant 90-year-old women who are still serving on boards, who are still active, who are still in great health. Our goal is you go through menopause is to get you set so that’s who you become.

    Melanie:  Wow. So beautifully put. Great information, Dr. Pinkerton. Thank you so much clearing so much of that up for us and being with us today. You’re listening to UVA Health Systems Radio. For more information you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Menopause & Postmenopause, Women’s Health]]>
David Cole Mon, 04 Apr 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/30790-how-to-deal-with-menopause-symptoms
How a Midwife Can Help You http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30749-how-a-midwife-can-help-you how-a-midwife-can-help-youMidwives are probably best known for helping women with childbirth, but they provide a wide range of care for women.

Learn more from Kate Becker, a certified nurse midwife at UVA.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1606vh4e.mp3
  • Location: Null
  • Doctors: Becker, Kate
  • Featured Speaker: Kate Becker
  • Guest Name: Null
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  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Kate Becker is a certified nurse midwife who specializes in all aspects of women’s health needs, including pregnancy and childbirth.

    Learn more about Kate Becker

    Learn more about UVA Children’s Hospital and Women’s Health
  • Transcription: Melanie Cole (Host):   Midwives are probably best known for helping women with childbirth but they do provide a wide range of other care for women. My guest today is Kate Becker. She’s a certified nurse midwife who specializes in all aspects of women’s health needs including pregnancy and childbirth at UVA Health System. Welcome to the show, Kate. Explain briefly just a little bit about what a midwife is.

    Kate Becker, CNM, MSN, RN (Guest):   I am a certified Nurse Midwife. That means I’m a Master’s Degree prepared nurse. As you said, midwives tend to focus on pregnancy and childbirth but we also do other types of women healthcare including gynecology and some primary care as well.

    Melanie:  So, you really run the gamut. How do you work with women? Do they go through a physician first or do they come directly to you? How does that work?

    Kate:  They can come directly to us. Some women are referred though their physician. For example, we have some wonderful physicians here at UVA who may meet with a woman, prenatally, for example, and in talking with her think she might be a good candidate for the midwife. I would say that a lot of our patients are sort of self-selected in that they’ve heard of midwives; they’re aware and familiar with midwifery and the kind of care we provide and decide that they want that for themselves and they can just make an appointment directly with use.

    Melanie:  So, how is delivering your baby with a midwife different? People here midwife and they think “alternative type medicine”, “water births”, “only home births” but that’s not really necessarily the case, is it?

    Kate:  No, it’s not. Here at UVA, we do attend births in the hospital so we do have all the support here in the hospital we need as necessary but our goal really is to talk to the woman prenatally to get to know her; to figure out what’s important to her and, for a lot of our women, that is having a natural childbirth without medication and we have a lot of things we can do to help her achieve that. With that being said we do have women who opt for pain medication, for an epidural and we are very supportive of that as well. So, we really want the experience to be what the woman is looking for and we’re there to support her in her choices and educate her about what her choices are.

    Melanie:  When you say “what her choices are”, what are some those choices of home birth and how they can do that and do women tend to be scared that if something goes wrong and they’re not in the hospital setting?

    Kate:  Well, home birth is certainly an option for women. The midwives at UVA, we only do births in the hospital. So, we don’t offer home birth services. There are other midwives in the community that do that. So, the women who come to us are ones that have decided to have their babies in the hospital and I would say that over 99% of babies in this country are born in a hospital. So, that’s definitely, by far, the most common choice. What we are trying to do is make the hospital to be more of a home-like environment so that people feel comfortable and feel supported and maybe have it be a quieter atmosphere, dimly lit. As I said, those labor support pieces that midwives are so skilled at providing.

    Melanie:  So, tell us about some of those labor support pieces because it sounds lovely the way you describe it with the lower lighting and maybe some soft music and how is that different from standard care that people are used to seeing or hearing about?

    Kate:  Well, as I said, I think it’s really about what the woman wants. You mentioned water births, for example, here at UVA, we don’t actually have mom give birth in the tub but we do have a tub available on labor and delivery for the labor part of it. Another thing that we love to use is putting the woman in the shower while she’s in labor which can be extremely helpful. We can use massage techniques to help with, for example back pain in labor. We have different things like massage or position changes or things like that to sort of help out with that. A lot of it, I think, is also sort of working with the woman to find her own strength and to sort of help her let the natural process unfold while closely monitoring it to make sure that everything is still normal.

    Melanie:  If a woman has a midwife present, does that mean that she’s not planning on having an epidural? Does that change sometimes?

    Kate:  Definitely, we do have women who do opt for an epidural. Some women start out wanting to see the midwives because of the personalized prenatal care that we provide. Here at UVA, we’re a small group of midwives so it’s just a little bit more of a personalized setting. I feel that we are lucky in that we get to know our patients a little bit better than if they were seeing a larger group of providers and we can give them a little bit more individual attention. We don’t have a policy saying they can’t have an epidural or anything like that. We, as midwives, want to support the women and what they want and we’re not there to dictate to them what they can and cannot do.

    Melanie:  And, are midwives involved in some after pregnancy care for women?

    Kate:  We are. We do a lot of providing contraception and helping educate women on their choices for birth control. We do annual gyn exams so, PAP smears, follow up of abnormal PAP smears, menstrual  problems; again, the birth control piece. We do some preconception counseling which we always like if a woman is thinking about getting pregnant. We love for her to come see us and talk to us about if she has any medication conditions or any lifestyle things she might want to change before pregnancy and then, also, gynecologic problems—yeast infections and things like that are also things that we can take care of.

    Melanie:  How does someone go about getting an appointment with a midwife?

    Kate:  They would call the main phone number for the ob/gyn clinic and ask to see one of the midwives. If they’re pregnant, they would call the clinic at the Battle building which is 434-924-2500. If someone is not pregnant and wants to see one of the midwives for their annual exam or for a problem visit or some kind of preconception visit, they will call 434-924-1955 which is the ob/gyn clinic at the primary care center.

    Melanie:  In just the last few minutes, Kate—what great information. I applaud all the great work that you’re doing for women. Give your best information and advice about midwifery and what it really is so that women can understand that this is a person you can choose that’s a little bit more personalized.

    Kate:  As I said, I think that the thing about midwives is that we are really specialists in normal pregnancy, normal labor and delivery. We can handle some complications but if things get very complicated in a pregnancy, we do tend to consult our physician colleagues. Occasionally, we will transfer a woman to physician care but most women in this country have a normal, healthy pregnancy and we, as midwives, love pregnancy and birth and we love helping women through it and being involved and being a partner with the woman and her family so that she can understand her choices and decide what works well for her.

    Melanie:  Why should women have their children and receive their healthcare at UVA Health System?

    Kate:  Well, I think we have the best of so many worlds here. We have the midwives. We also have wonderful physicians in maternal/fetal medicine and general obstetrics. We have a NICU where if there are issues with the baby, the baby can be taken care of by the best NICU in the region. So, I think we really have everything that we can to provide that home-like environment while still having the technology that most of our patients don’t need but occasionally they will. Then, it’s right there for them.

    Melanie:  Thank you so much for being with us today, Kate. You’re listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Women’s Health]]>
David Cole Mon, 28 Mar 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/30749-how-a-midwife-can-help-you
The Importance of Becoming an Organ Donor http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30748-the-importance-of-becoming-an-organ-donor the-importance-of-becoming-an-organ-donorWhy should you consider becoming an organ donor?

Learn more from Dr. Ken Brayman, a UVA specialist in transplant surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1605vh4e.mp3
  • Location: Null
  • Doctors: Brayman, Kenneth L
  • Featured Speaker: Kenneth L Brayman, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Ken Brayman is a board-certified surgeon and serves as the division chief of transplant surgery at UVA. His specialties include islet cell transplants.

    Learn more about Dr. Ken Brayman

    Learn more about UVA Charles O. Strickler Transplant Center
  • Transcription: Melanie Cole (Host):  More than 123,000 men, women and children currently need life-saving organ transplants. But what's involved in becoming an organ donor? My guest today is Dr. Ken Brayman. He’s a board certified surgeon and serves as the Division Chief of Transplant Surgery at UVA. Welcome to the show, Dr. Brayman. What's the biggest need right now in organ donation? What are you seeing the most?

    Dr. Ken Brayman (Guest):  Hi, Melanie.  Thank you for having me. The biggest need for an organ transplantation is organ donation. With 123,000 people on the wait list, we have a need for more donor organs. The number of transplants has remained relatively stable but the number of people waiting for transplants increases every week. So, the availability of donor organs has not kept pace with the number of people that need transplants and that's the biggest problem we have in transplantation today.

    Melanie:  Speak about organ donation. There are a few different types. People think that there's only cadaver donation or when somebody's brain dead, but speak about all the types for us.

    Dr. Brayman:  With regard to organ donation from an individual that has been declared brain dead, that’s fairly standard. There are also organ donations that take place of individuals that haven't met the legal criteria of brain dead, but then they are allowed to donate after they die. So, those individuals are labeled “donation after cardiac death”. Of course, there’s live organ donation where an individual who's healthy donates a kidney or part of their liver. So, there are really three different types of organ donations that take place.

    Melanie:  We hear about living donors or people giving a part of their liver or a kidney to a complete stranger. What you want people to know about volunteering to become a live donor?

    Dr. Brayman:  Well, the technical term for that is an “altruistic donor” and every year, a number of people of contact transplant centers such as our own to tell us that they would like to donate a kidney or part of their liver and it’s the most gratifying gift that one could possibly give. Of course, the donors are screened very closely to make sure they are medically suitable. That’s true whether you’re a relative or an altruistic donor to make sure that the donor isn’t hurt long-term by having donated a part of one of their organs.

    Melanie:  Speak about liver transplantation a little bit. You just take a piece, correct?

    Dr. Brayman:  Well, for a living donor liver, we would use a portion of the donor’s liver so that the remaining part of the liver would stay in place and then it does regenerate in both the donor and recipient. With kidney donation, a whole kidney is removed and the kidney doesn’t regenerate but the patients have been followed for years and years and there is no increased incidence of kidney failure in individuals that have donated kidneys.

    Melanie:  What do you want people to know about becoming an organ donor? On the back of our license; telling our loved ones what our wishes are?

    Dr. Brayman:  Well, it’s very important that that information is shared with your loved ones because in the context of a stroke or a car accident, it's very difficult to muster the answers to difficult questions. So, it is true that besides signing up to be an organ donor at the motor vehicle registry, it’s very important to talk with your family members and your loved ones about what your wishes are with regard to organ donation. With regard to live organ donation, obviously, that's something that an individual could choose to pursue. The best way to find the one solution about that would be to contact the transplant center. We have individuals whose job it is to speak with people either in person or on the phone about their interest in possibly donating an organ.

    Melanie:  So, let’s bust up a few myths about organ donation, Dr. Brayman.  People hear about things and they're scared to actually say, “I will donate an organ if I am brain dead or in cardiac arrest.” So, speak about some of the myths that if somebody is in that situation that organs would be taken before all measures have been used to try and save that person.  Just break up a few of those myths you must hear all the time.

    Dr. Brayman:  Well, that’s true, Melanie. There are myths that exist around organ donation primarily, as you alluded to, where there are individuals who feel like they won’t get  the whole full court press to save their lives if they sign up to be an organ donor. That’s absolutely not true. I mean, the job in the emergency room and in the intensive care units and so forth is to save the life of the individual. It’s only when those individuals have been determined to either meet the legal criteria of brain death or not to be salvageable that they’re actually referred for consideration for organ donation. So, there are a lot of checks and balances in the system at the level of the emergency room, the intensive care unit, the organ procurement organs and so forth to make sure that people are not inappropriate referred for organ donation.

    Melanie:  So, if someone has a history of medical illness, can they still donate various organs?

    Dr. Brayman:  It’s possible. It really is up to the professionals who are involved in screening donors to determine individual suitability. So, I would never rule somebody out either for deceased donor or for live donation until a transplant professional has been consulted to look at the entire picture.

    Melanie:  I think one of the barriers to organ donation is also that the donor feels it’s going to cost them a lot of money, like they’re going in for surgery for themselves. So, speak about that a little bit.

    Dr. Brayman:  Sure. Well, with regard to living donors, all of the costs associated with the evaluation, surgery and the follow up of the living donor is paid for by the recipient’s insurance. So, we instruct donors to not pay any lab tests or hospital bills related to the organ donation process but send them to the transplant center if they’re inadvertently received at home because they’re supposed to be paid for by the recipient’s insurance. That’s something which is standard in the industry.

    Melanie:  What about the recipients? Do they know who the donors are? Do they ever get to meet up if it’s a live donor?

    Dr. Brayman:  Well, that’s up to the donor for the most part. There are people who are altruistic donors who want to meet the recipient eventually. There are some who don’t. With regard to deceased cadaver donation, the way that that works is that if a recipient wants to get in touch with a donor family, they usually write a note and it’s given to the coordinators at the transplant center and forwarded to the organ procurement organization who then forwards it to the family and the family can decide whether to respond to the recipient directly or indirectly. So, it is possible to contact the donor but there are safeguards in place to protect the anonymity of the donor.

    Melanie:  Dr. Brayman, organ and tissue donation:  does that mean that the body is disrupted? Some people like to have an open casket funeral for someone that they’ve lost. Is that affected?

    Dr. Brayman:  No, it’s not. When somebody donates abdominal organs or chest organs such as a heart or a lung, the body is posed up. The face and the extremities are intact and with appropriate clothing, there’s no way that individual would know that somebody had donated by looking at them in the casket.

    Melanie:  In just the last few minutes, Dr. Brayman, and this is wonderful information, I applaud all the great work you’re doing. Give the listeners the information you really want them to know about the importance of organ donation and why patients should come to UVA for their transplant care.

    Dr. Brayman:  Sure. Well, in the United States every day there are 18  people who die waiting for organ transplant It's really unfortunate because of the University of Virginia is the only comprehensive transplant center in the state of Virginia and by that, I mean comprehensive  in doing the 5 major organ transplants:  kidney, liver, pancreas and heart. So, it’s life-saving therapy for end-stage diseases of the lung, the heart, the liver, the kidneys—even for diabetes, with pancreas transplants. However, there’s an organ shortage. So, it’s really important that we have maximum availability of donor organs. The University of Virginia has been doing organ transplants for 50 years. The results of transplantation at the University of Virginia are outstanding. I would feel comfortable sending my family or even having my transplant here because the physicians and the surgeons and the nurses and all of the people that are involved in transplantation are highly professional. They’re highly committed and the results are really some of the best in the country. So, we have a great organ transplant group. We’ve been doing the procedure for a long time and the results are fantastic. We don’t just treat the patient, of course, we focus on treating the family. We’re very sympathetic to the stressors associated with the entire family during the transplant process.

    Melanie:  Thank you so much, Dr. Brayman. You're listening to you UVA Health Systems Radio. For more information, you can go UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Transplant]]>
David Cole Mon, 21 Mar 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/30748-the-importance-of-becoming-an-organ-donor
Innovations in Minimally Invasive Heart Surgery http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30826-innovations-in-minimally-invasive-heart-surgery innovations-in-minimally-invasive-heart-surgeryInnovations in minimally invasive heart surgery are providing additional treatment options for patients.

Learn more from Dr. Gorav Ailawadi, a UVA expert in minimally invasive surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1608vh3b.mp3
  • Location: Null
  • Doctors: Ailawadi, Gorav
  • Featured Speaker: Gorav Ailawadi, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Gorav Ailawadi is a board-certified surgeon whose specialties include minimally invasive heart surgery and treatments for heart valve disease.

    Learn more about Dr. Gorav Ailawadi

    Learn more about UVA Heart & Vascular Center
  • Transcription: Melanie Cole (Host):   Over the past decade, minimally invasive cardiothoracic surgery has grown in popularity and is, in large part, due to the benefits for patients such as decreased pain and reduced surgical trauma. My guest today is Dr. Gorav Ailawadi. He's a board-certified cardiothoracic surgeon whose specialties include minimally invasive heart surgery and treatments for heart valve disease with UVA Health System. Welcome to the show, Dr. Ailawadi. What are some of the newest breakthroughs? What's going on in the world of minimally invasive heart surgery right now?

    Dr. Gorav Ailawadi (Guest):  Melanie, first, thanks for having me on the radio. I think this is an exciting time for cardiac surgery. Things are really changing and have changed pretty dramatically in the last 3-4 years with so much more new innovation coming down the pike that we haven't seen before, and especially, since probably the 60's or 70's. So, much of the types of surgery that we have performed for the last 50 years are steadfast and true. Things like valve replacement surgery, valve repair surgery, or bypass surgery to try to improve blood flow to the heart. Those are really tried and true techniques that work but patients have long been asking for less invasive options to help them get back to recovery. That really is the benefit both for young patients who need to get back to work, provide for their families, as well as for elderly patients who are worried about what is the biologic toll that a big open-heart operation is going to take on their life and recovery and pain. So, really, approaches to minimally invasive span all types of patients. Where we started with this is we learned to perform similar types of operations that we do through an open chest, through the breastbone, through less invasive approaches, typically, through the side or through partial incisions to try to mimic the same operation, or do the same operation. Now, if a patient needs a lot of things done to their heart, they need more than one valve, they need multiple valves, they need bypasses plus valves, then it's not really feasible often to do that purely through a minimally invasive approach. But, if it is an isolated thing like a valve or a single vessel bypass, then most of those patients often can be evaluated an often can get a minimally invasive approach where we're doing the same operation through a smaller incision. What that means for the patient is, typically, the pain can be a little bit less but the recovery is dramatically less with often no broken bones. They get back to driving sooner; they get back to their normal life; they get back to work sooner. If they're elderly, they oftentimes don't even need to go to rehab or they can get out of rehab sooner, as well. Now, where we're headed is, really, in the last 3-5 years, we have been involved in a number of new trials, new valves, where we can replace the valve with no incision, or we can go through the groin. This is particularly true with the aortic valve. Each of us have four valves in our heart. The most common valve that is affected is the aortic valve. With the wear and tear, that valve becomes tight and narrow. It's not related to our diet or smoking. It's just wear and tear on the heart valve similar to our knees and our back. It gets bad. So, what we can do is go through the groin with a wire up to the heart using x-ray and a new valve is collapsed on a stent. We blow up a balloon which pushes the old valve out of the way and then we go ahead and blow up the new valve on a stent. The stent stays in place and the new valve starts working immediately. Now, those valves have been approved for very high-risk patients who cannot get open heart surgery and we've been performing trials in low-risk patients. We have a very new trial coming out in the near future where we'll be looking at any patient, regardless of how young or old they are, who could potentially get this type of approach. The benefit for that is, they often leave the hospital in two or three days with no incision and get back to the routine far quicker than with any open heart or even minimally invasive surgical approach. So, this same type of technology is now expanding beyond just the aortic valve. We have ways to repair the mitral valve. The mitral valve is the valve between the lungs and the heart, so when the heart squeezes, this valve is supposed to close to keep the blood from going back to lungs. This valve often can leak in certain types of patients and when it leaks, the blood goes back to lungs and the patients feel short of breath. So, we have ways, not only to fix it with open surgery, a common way is with minimally invasive surgery where we go through the side and we can repair and replace the valve. A third option now is also to go through the groin and put a small clip called the “mitral clip” that can clip the parts of the valve that are leaking. It's a good approach for the right type of patient and the beauty of it is that it is very minimally invasive and the patients often go home the next day or two days after. That is also approved for high-risk patients who have the right type of leaking valve anatomy that they can get that. Now, there are many new devices that are coming out, many of which that we're a part of at UVA, like devices that can replace the mitral valve .We can put rings on the valve to cinch it up. We can put new cords so the mitral valve actually is like two parachutes, side-by-side with little strings, or “cords” we call them. Those cords, in some patients, can become torn or elongated. There are new devices coming out where we can place a new cord through a small incision on the chest without the heart-lung machine, using ultrasound to guide us. So, there are lots of new things and this is a really exciting time in our field.

    Melanie:  Wow, that is absolutely fascinating and how well-spoken you are, Dr. Ailawadi. There are such interesting innovations that are going on today. Are there certain people who would not be candidates for minimally invasive type surgeries? Then, in which case, for them, they have to have what? The full open heart?

    Dr. Ailawadi:  Yes. I think there are multiple things that we're looking at when we're evaluating patients for any of these devices or approaches. I think one of the biggest benefits is that we do see patients as a team. So, oftentimes, we'll have multiple different specialties, not just a heart surgeon but also a cardiologist that specializes in valve disease. Oftentimes, we'll have a specialist cardiologist who focuses just on the imaging, see the patient together and decide together what's best for each individual patient. So, it's really a team approach kind of like you hear about for cancers--there's a tumor board. We literally have a valve board. Every week we meet and talk about all patients considering any of these options. So, for the aortic valve--I think we ought to split it up into the aortic and mitral valve. For the aortic valve, we traditionally had only been able to offer this for patients that are higher risk with new trials that we're going to be a part of. We're going to be able to offer this for lower-risk patients through a clinical trial. Essentially, some of the anatomy is important, meaning the size of the valve, the size of the arteries in the groin. We need a road to the heart and we have multiple different ways to get there. The groin artery is going to be the easiest for patients to recover but we have other approaches where we can go in between the ribs and go into the heart directly, if the groin arteries are too small. So, we're looking at a lot of things in terms of the anatomy, as well as a lot of things in terms of the patient, if it's a suitable candidate. There are subtle things, like how much calcium and things like, that that may weigh in on our decision one way or the other. For the mitral valve, it’s actually a bit more complex because the valve can leak in multiple different ways. For the aortic valve, it's pretty straightforwardit gets tight, we replace it, whether we do it with surgery—and we have multiple different ways to do it with surgery. We have valves that don't need stitches and we also have the valve through the groin called the TAVR. For the mitral valve, it's a bit more complex because the valve can leak in different ways and depending on how it's leaking, that will dictate how we want to fix it--whether we want to repair it, whether we want to replace it, how we would want to repair it. And so, those things all weigh into the decision as to what that patient can get ranging from traditional open heart surgery, to minimally invasive surgery, to the percutaneous through the groin, mitral clip or the new devices that are coming down the pike. Certainly, if their anatomy is suitable for a mitral clip, for example, and they meet the patient criteria, meaning they're typically high-risk and not good candidates for surgery, we can oftentimes offer that. That's also true with all the new technologies. In terms of minimally invasive, pretty much any patient that has just a valve problem, we really consider strongly for a minimally invasive approach and there are just a few things that may weigh on us and change our decision that we need to do it in a traditional approach. That's if they have a very weak heart or a lot of calcium around their heart, or calcium around their arteries in the groin--those types of things. Or, if they have more than just the valve, like if they have multiple valves or are needing a bypass plus a valve. Those things traditionally can't be done through a minimally invasive approach alone. Now, sometimes we do combinations or hybrid approaches where we may have our cardiologist stent some of the blocked arteries and then we would fix the valve, or vice versa. That's where that team approach is really important to figuring out what's best for each patient.

    Melanie:  So, Dr. Ailawadi, in just the last few minutes, and even if we're talking about the transcatheter aortic valve replacement, the outcomes for these, do they have to be replaced? Does minimally invasive surgery affect the outcome as far as how long they last or any of those kinds of benefits?

    Dr. Ailawadi:  Well, I think we probably need to probably compare two things. So, if we compare open heart to minimally invasive and then open heart to the percutaneous approaches. So, when we talk about open heart to minimally invasive certainly the goal should be we provide as good a correction of the problem, whether it's replacement or repair than through an open approach. It's just that it's done through a smaller incision and potentially without breaking bones, or breaking less of the bone, to help with recovery. So, really the goal should be the exact same type of operation. Sometimes, honestly, the procedure is better for the patient through minimally invasive because I think we do sometimes do a better job with repairing the valve in that approach. When we compare surgery to percutaneous approaches, I do think, right now, the bar changes meaning, patients and physicians will accept less effective therapy, meaning we don't get as good a result with a valve repair, with a mitral clip as we do with surgery. However, for the type of patient we're talking about, if they're just not a good candidate for surgery or have other things going on, that's probably okay. We don't want to put them through an operation that needs a lot of recovery if they're very frail. So, the bar does change depending on the approach but I think the team approach really will help guide the patient and, ultimately, the patient's decision as to what they think is best for them.

    Melanie:  Thank you so much. It's absolutely wonderful and fascinating information, doctor. Thank you so much for being with us today. You're listening to UVA Health Systems Radio and for more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Sat, 19 Mar 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/30826-innovations-in-minimally-invasive-heart-surgery
Making More Lungs Safe for Transplant http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30744-making-more-lungs-safe-for-transplant making-more-lungs-safe-for-transplantEx vivo lung perfusion is a leading-edge technique designed to make more lungs suitable for transplant, making it possible for more patients to receive a lifesaving lung transplant.

Learn more about this technique from Dr. Mark Roeser, a UVA specialist in lung transplants.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1609vh3c.mp3
  • Location: Null
  • Doctors: Roeser, Mark
  • Featured Speaker: Mark Roeser, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Mark Roeser is a board-certified surgeon whose specialties include lung transplantation.

    Learn more about Dr. Mark Roeser

    Learn more about UVA Children’s Hospital
  • Transcription: Melanie Cole (Host):  Ex Vivo lung perfusion is a leading edge technique designed to make lungs more suitable for transplant making it possible for more patients to receive a life-saving lung transplant. My guest today is Dr. Mark Roesser. He is a congenital heart and transplant surgeon at UVA Health System. Welcome to the show, Dr. Roesser. Briefly explain a little bit about what EVLP is to the listeners.

    Dr. Mark Roesser (Guest):  EVLP was designed – it came out of a lot of basic science research. It kind of hit its head in the 90’s and early 2000’s. The problem is there is a shortage of lung donors out there, especially quality lung donors. Whenever a patient is a donor they are declared brain dead. Whenever that happens to your body, it releases a lot of chemicals. Those chemicals can cause swelling in certain areas – one of those areas is the lungs. So, as they are laying there in bed, they are unable to cough because they’re brain dead. Their lungs slowly don’t do as well. So, it’s harder to get lungs from donors than it is other organs, such as livers or kidneys. What EVLP does is that it lets us take those lungs out of donors that may be questionable. It may not be the perfect lung to put into somebody. It puts it in a wait station which is a circuit with a ventilator and they perfuse and lets us see if these are actually going to be good lungs for somebody or are they, in fact, not good lungs for somebody. Instead of taking the risk of putting them into a living patient and then seeing what the results are, it is a wait station to see if these will be adequate lungs for donation.

    Melanie:  Is there any controversial issue with this type of procedure?  Do the families of the donors question what you’re doing to get these lungs at that time?  

    Dr. Roesser:  Everybody is informed that these will be Ex Vivo lungs and they sign off. Whenever we call them in we say, “We’re going to give you an Ex Vivo lung or we’re not” and if they refuse, even though they have written consent, if they refuse on that call in, we don’t penalize them at all. We say, “That’s not a problem.” Then we go to the next person on the list. That person won’t lose their spot in line or anything like that. It’s not allocated that way. It is allocated for the best person for that set of lungs – who’s the sickest. These lungs don’t necessarily come from high risk donors. Some people are very sick and they say, “I’ll take donor lungs from a high risk donor.” It may be somebody who has some needle marks. We test for HIV, we test for Hepatitis C but those tests aren’t 100% accurate. If you’re a healthy person, you may turn down those lungs. If you’re a sick person or you’re a person who doesn’t really care about those risks you’ll say, “Yes, I’ll take those high risk lungs.” Ex Vivo doesn’t really fall into the infection category. It falls into where the donors or the lungs weren’t doing very well. Once we take them out and we put them on the Ex Vivo circuit, we will not use those lungs if they don’t meet the standard criteria that we’d use for lungs that came straight from a donor. Even though we take lungs that are sub-par, we make sure that they are going to be adequate before we actually use them. If they are not adequate, then we don’t use them. What it does is help mitigate the risk that we would rather try to avoid.  

    Melanie:  How has this changed the world of lung transplantation?  

    Dr. Roesser:  It’s going to open up the donor pool quite a bit. At our center, we actually have a National Institutes of Health grant where we are actually going to give chemicals to modify these lungs. The great thing about the Ex Vivo circuit is it has no blood or blood products in it. We’re not exposing these lungs to any additional antibodies or blood-borne infections. We are just taking them out of a donor where they are in a bunch of cytokines chemicals that are making them sicker. We’re taking them out of that situation, putting them on a ventilator and a circuit that kind of separates this fluid. What that fluid does – it’s a special solution called “Steen” – it helps to take all of the free water out of these lungs and kind of dry them out. It gives us a better idea of how these lungs are going to work. I think the future of it is we’re going to be manipulating these lungs to actually make them healthier before we put them into somebody. I think that’s really going to explode lung transplantation.

    Melanie:  Can it reverse some previous lung injury that you might find in some of these higher risk donors? 

    Dr. Roesser:  Exactly. That’s exactly what it will help do. Initially, this was designed to see if they were good lungs but we found out that the circuit will actually help. If you have a pulmonary edema or any extra fluid in your lung, this circuit will actually help to get that out. Let’s say there is a lot of snot or mucus and stuff. I can actually go in there and suck all that snot and stuff out and really get a good feel for how the lung is going to perform whenever I put it into a human.  

    Melanie:  Wouldn’t that be amazing if you could do that inside a human body and reverse some of those injuries? I just wonder, do you see that is something that might be coming in the future that we might be able to do something like this for working lungs?

    Dr. Roesser:  Our lab is actually working on that. We have some pigs and we are injecting the pigs with this compound that makes their lungs get sick. Kind of like if you had a very bad pneumonia and you got sepsis. This compound kind of does that. What we’re trying to do is see if we can reverse those outside of the pig’s body. If those experiments work, then we’re going to go and start doing them inside while the pig – we’ll open up the pig and we’ll actually put cameras in the pig. We’ll put them on by-pass and we’ll isolate the lung and see if it will work that way. If we can show it on animal models, then my hope is that, in the future, we can use small catheters and wires in your groin. Let’s say you or your loved one or is very sick, we could actually go in and help the lungs out while they are in your own body. It wouldn’t be for a person who needed a lung transplant but it may be to prevent somebody who is very sick from needing additional procedures or it might help to rehab their lungs faster than it would otherwise.

    Melanie:  That is amazing, Dr. Roesser. Now, tell us about the risks for the surgery for the recipient. You said that if they are at end-stage kind of situation, they are not going to be as worried about what you’re giving them as long as you’re giving them something. But, besides rejection, are there other risks that people are concerned about?

    Dr. Roesser:  They actually did a national trial here. It was written up in the New England Journal of Medicine and got FDA approval or  approval. There were equivalent outcomes between someone who had lungs that were placed on this machine and given to them and lungs that were just given to them. Our data shows there is no change at all in their risk of this lung. The good thing is, if you take these lungs that may not be the greatest lungs and you put them on the circuit and they look great, then you feel confident to putting them into somebody. If they don’t look great, then you just throw them away or do your research on them. All you really lose with that is money and time but you aren’t really affecting any humans or the quality of life which is really why us surgeons are very happy and excited about it. Lung transplantation, per se, may not extend your life. The average life expectancy after lung transplant is only 5.4 years. What we are really trying to do is to give people very good quality of life for the remaining time they have left. If you give them a lung that’s not very good, that quality of life is not going to improve. We’re very risk adverse. We only take very good lungs to give to people. What this will do is increase the donor pool of very good lungs to give to people.

    Melanie:  That’s what’s so amazing is the donor pool seems to be one of the hardest parts for any kind of transplant. Tell us a little about UVA and your team there at UVA Heath System. 

    Dr. Roesser:  Our team consists of two pulmonologists and three surgeons. We also have four nurse practitioners and then, we also have a very predominant lab that does a lot of research. What we’re doing is using our research in the lab and helping to translate that over into our clinical activities. One of our researches is in adenosine compound. What these compounds do is, they kind of help reverse injury in the tissue. Our grant is to put this compound inside the recipients and inside lungs and see if that will help reverse any damage due to the fact that they are in a brain dead donor, due to the fact that you’re taking an organ out of somebody and putting it into somebody else. In the lab, we’ve shown that this is very helpful and now we’re ready to move into clinical trials on it.

    Melanie:  Wow. What an amazing job that you have. We applaud all of the great work that you are doing, Dr. Roesser. Thank you so much for being with us today.  You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.   


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
]]>
David Cole Mon, 14 Mar 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/30744-making-more-lungs-safe-for-transplant
What is a Herniated Disc? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30925-what-is-a-herniated-disc what-is-a-herniated-discHow can a herniated disc affect your back, and what treatments are available?

Learn more from Dr. Hamid Hassanzadeh, a UVA expert in spine surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1608vh3a.mp3
  • Location: Null
  • Doctors: Hassanzadeh, Hamid
  • Featured Speaker: Hamid Hassanzadeh, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Hamid Hassanzadeh is a fellowship-trained spine surgeon whose specialties include minimally invasive spine surgery, complex spinal deformities and herniated discs.

    Learn more about Dr. Hamid Hassanzadeh

    Learn more about UVA Orthopedics and UVA Spine Center
  • Transcription: Melanie Cole (Host):  Between 60 and 80 percent of people will experience low back pain at some point in their lives. Sometimes called a “slipped” or “ruptured” disc, a herniated disc most often occurs in your lower back and it's one of the most common causes of low back pain. My guest today is Dr. Hamid Hassanzaddeh. He's a fellowship-trained spine surgeon whose specialties include minimally invasive spine surgery, complex spinal deformities and herniated discs at UVA Health System. Welcome to the show, Dr. Hassanzaddeh. Tell us, what is a herniated disc? People hear this term and they're not even sure what that means.

    Dr. Hamid Hassanzaddeh (Guest):  Good morning. Thanks for having me. So, our discs are built up out of two portions:   an outer portion and inner portion. When we get older, that outer portion ages a little bit faster and what happens is, you get small tears into the outer portion and part of the inner porter can come into the canal and pinch our nerve and create back pain and leg pain and so on.

    Melanie:  So, the spine and the discs--how are they designed and are they supposed to be moving around like that?

    Dr. Hassanzaddeh:  Absolutely. So, there are cushions for our cord and the mobility of our spine. We're able to move our back and neck because of part of it is because of the joints and part of it is because of the discs. Discs take the pressure when we jump and when we sit and that's where you're more prone to injuries and more prone to herniation or rupture. And, that's one of the first things that would cause a back problem when we get older.

    Melanie:  Let's talk about what causes it first and then we'll get into some symptoms.  What are some causes? How does somebody herniate a disc?

    Dr. Hassanzaddeh:  One of the biggest causes is genetic. Like, everything else, our genes basically predispose us to better quality or lesser quality of discs. People that have a family history of disc herniation or disc problems tend to have more problems when they become older than those patients that do not have the family trait. Other activities like bending forward--you feel the pressure. People try to lift something. It's a very common scenario that's the most of us try to lift that heavy box or that sofa, and a sharp pain in the back is a very common scenario. What happens when we bend over is, there's the highest pressure on the disc and we add some weight onto that. It increases the pressure in the disc and creates tears and creates the herniation. So, activity and genetics and some of it could be overuse that could cause this disc disease.

    Melanie:  Is a herniated disc the same as a bulging disc?

    Dr. Hassanzaddeh:  Not quite. A herniated disc means where a portion of the disc came into the canal and pinched some part of the nerve. Basically, herniation means part of the disc literally tears out of the disc into the canal. A bulging disc could be absolutely normal. When we get older, we lose some of the fluid and some of the height of our discs and the disc doesn't look quite juicy. It's a little like a flat tire and that appearance of a flat tire called a “bulging disc” could be absolutely asymptomatic and all people have it without knowing it.

    Melanie:  So, what are some symptoms that people experience? People have low back pain from a myriad of reasons such their mattress, or as you say, they just reach something wrong or lift something improperly. What are some symptoms that this is actually an issue?

    Dr. Hassanzaddeh:  Back pain, per se, is a multi-factorial problem. It could be a structural, or some bony structure, it could be disc or muscle, or all combined to cause back pain. A disc herniation, is very typical, especially in the lumbar spine. Disc herniation could also get in the neck and thoracic spine but the lumbar disc herniation is the most common problem and that is the most common area that it occurs. The lumbar disc herniation--the typical story is that they did something and felt a sharp pain initially and then that pain migrates or radiates down to the lower extremities. That's a very common description of disc herniation symptoms.

    Melanie:  So, if someone has that pain going down their leg and they say, "Oh, I've got sciatica," then what do you do for them? Give us some of your first lines of defense, Dr. Hassanzaddeh, with some non-surgical treatments; things that you can try at the beginning and then we'll see if it needs to have surgery.

    Dr. Hassanzaddeh:  Absolutely. The majority of people who have a disc herniation will not need surgery. So, what happens with discs is our body has some healing potential. We absorb the herniated disc and that makes it better. Time usually plays the rule into that. Secondly, we could help with treatment which could include injections. A steroid injection will decrease the inflammation around the nerves and alleviate the pain significantly. We tend to go, after the injection and once the pain is better controlled, we tend to send the patient to physical therapy to increase their core muscles. That’s a very important component of the entire stability of the spine and will prevent further damage and further degeneration of the disc. So, usually, if someone comes to me with acute disc herniation, then my task is, then, before we get even advanced imaging, if they have don’t have a neurological deficit, we send them for an epidural steroid injection followed by physical therapy and wait to see how they do.  If the patient is resistant to non-operative management, which includes at least a minimum of six weeks of non-operative management and sometimes as much as three months, then a surgical indication were given. But, like I said, a majority of patients will do well without surgery.  

    Melanie:  How often are you willing to give an epidural steroid injection? Some people want to come in for them every couple of months or every six months. How often can somebody get one of those before it's enough?

    Dr. Hassanzaddeh:  So, in my practice I do not like to have more than three injections, for those, a third injection, per year. So, if three injections fail to improve the symptoms, then we have to change our management plan, our management strategy.

    Melanie:  Now, let's talk about prevention. Is there a way to prevent herniated discs and general back problems? What do you tell people, Dr. Hassanzaddeh?

    Dr. Hassanzaddeh:  So, a strong core muscle could prevent a lot of back issues, if the muscles are very strong. The core muscles include the abdominal muscles, the back muscles, the thigh muscles, the chest muscles--they're all part of the core muscles. A very strong core muscle can prevent disc herniation, disc degeneration, and all other types of cause of back pain. So, my biggest recommendation to prevent back pain and disc disease is to keep your core muscles strong and stay active.

    Melanie:  So, doing regular bits of exercise and in just the last few minutes here, you mentioned at the beginning some movements that people do. So, learning proper lifting techniques, because in my practice, Dr. Hassanzaddeh, I’ve seen people lift a weight and then they turn to set it down somewhere and right then and there you can see the pain. What do you tell people about these proper lifting techniques so that they don't do that sort of thing?

    Dr. Hassanzaddeh:  Absolutely. So, this exact scenario you discussed is very common. Lifting and turning around creates increased pressure in the shear force which is a bad combination that could cause a tear in the outer portion. So, usually, I try to tell my patients to not lift from a bending position. Try to go kneel and lift this heavy object. Twisting, usually with the bending position, is not a great exercise for the back and could create inflammation; it could create tears, and so on. I think, overall, if they work on their core muscles, stay active, and do some activity modification, which also includes prolonged sitting, by the way. When we sit down, this is the time when the pressure is the highest on the disc. So, avoiding prolonged sitting, changing positions, standing for a minutes and doing some general modifications will really prevent a lot of trouble for our back.

    Melanie:  Why should patients come to UVA Spine Center for their care?

    Dr. Hassanzaddeh:  So, we have a phenomenal team of a multi-disciplinary approach. We have a great team management system and great interventional system where we the patient could receive their injections. We have a broad spectrum of experts including the spine surgeon and neurologists and interventionists that could help the patient to get everything in one place and world-class.

    Melanie:  Thank you so much for being with us today. You're listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Back Health]]>
David Cole Mon, 14 Mar 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/30925-what-is-a-herniated-disc
Eye Health and The Importance of Annual Eye Exams http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30942-eye-health-and-the-importance-of-annual-eye-exams eye-health-and-the-importance-of-annual-eye-examsYour eye is a complex and delicate organ, and working on it requires a high level of expertise.

Whether you need the removal of a stye or a tumor, you should trust your eyes to the most skilled hands. An annual eye exam is crucial to good eye health. 

Learn from Evan Kaufman, OD, a board-certified optometrist at UVA Health about the importance of good eye care.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1607vh4e.mp3
  • Location: Null
  • Doctors: Kaufman, Evan
  • Featured Speaker: Evan Kaufman, OD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Kaufman is a clinical optometrist at the Medical College of Virginia. He was appointed to the faculty in 2008. Dr. Kaufman moved to Charlottesville, VA in 2014 to join the faculty at the University of Virginia. He is involved in training residents, fitting specialty contacts and running a primary care clinic.

    Dr. Kaufman grew up in Charlotte, North Carolina and got his undergraduate degree from Southern Illinois University. He then went on to earn his doctorate at the Indiana School of Optometry. After graduation, he continued his education and completed a residency in ocular disease at the University of Kentucky. He is an adjunct clinical instructor at the New England College of Optometry. He also is a fan of UVA football and loves to tailgate at the games.

    Learn more about Dr. Kaufman

    Learn more about UVA Ophthalmology
  • Transcription: Melanie Cole (Host):  Your eyes are so precious. Periodic eye and vision examinations are such an important part of preventive healthcare. My guest today is Dr. Evan Kaufman. He is a board certified optometrist at UVA Health. Welcome to the show, Dr. Kaufman.  How often should people have an eye exam? Are there some red flags that would signal that it’s time to get in and have your eyes checked?

    Dr. Evan Kaufman (Guest):   Thank you very much, Melanie, for having me on the show. When we talk about eye health and how quickly you should get in, it’s usually a good idea to have a complete or routine eye exam once a year. What I tell most of my patients is that sometimes we are not even consciously aware of our vision and if it’s getting worse. That’s why we suggest eye exams once a year. I compare it to watching a child grow. If you see the child every day, you don’t see them grow an inch or two inches or three inches but if you see them at six months or every year they grow like weeds. Just like our vision on a day to day basis, we don’t really see the small visual changes that occur in our eye but if you get your eyes examined every year, an optometrist, ophthalmologist or an eye care provider can track those changes. I also compare it to high definition TV. I did not want to get high definition TV myself but just like the rest of America, we did get a high definition TV. When I look back at the analog I think my eyes are blurry. People’s perception of vision is what they see every day. Sometimes, when we can make micro changes in a person’s prescription or identify a pathology, we can heighten the person’s vision by changing their prescription.

    Melanie:  Dr. Kaufman, how important is patient history when you’re giving somebody an exam?   

    Dr. Kaufman:  As a primary care provider the history is one of the things that I spend the most time on. It’s kind of one of those things where I want to know what your daily routine is, what your visual needs are. Somebody sits in front of a computer doing a data analization has a different visual need than somebody that might be outside and doing some manual labor versus someone that might be a surgeon and has to look at something that’s at an arm’s length away has different visual needs. The first thing I ask is, “Tell me about what you do in daily life. Are you reading 10 hours a day? Are you on the computer 10 hours a day?” What are the visual needs? The second thing is, is I want to know that the old prescription is or if they’ve ever worn glasses before because that kind of gives me where we’re starting from. If a patient says, “I’ve never worn glasses. I’m coming in because my primary care doctor says I need to have an eye exam” and their acuity, let’s say, is in the 20/40 range, which is just about where the DMV wants you. Anything less than about 20/40, the Department of Motor Vehicles doesn’t like that too much and can restrict your driver’s license. If the patient says, “But I don’t have any problems” maybe they are not consciously aware that they could see better. Or, maybe they are not consciously aware that they could have some type of ocular pathology. Understanding A, what a person’s visual needs are and, too, what their previous history with glasses, contacts, any systemic history is very important, especially a history of diabetes. Diabetes is one of the leading causes of blindness in the United States today in adults over the age of 40. Diabetic screenings once a year is crucially important because diabetic retinopathy or damage to the eye due to high blood sugar can start before a patient is actually aware that they are losing vision. They come in and they say, “I’m seeing fine.” But, we look in the back of the eye and say, “Oops, there is some leakage of blood vessels or there are some early ventricular changes which is what we call early cataracts. These are all things that we want to know about and then we can communicate back to a patient’s primary care provider to maybe either get better blood sugar control or maybe change the medication.

    Melanie:  Dr. Kaufman, is there a genetic component to what goes on with our eyes?

    Dr. Kaufman:  It depends on who you talk to. In my opinion, yes. A lot of people say, “My parents wore glasses so I will probably have to wear glasses.” That’s not necessarily true. The latest research is that if you are going to be far-sighted or near-sighted it is “programmed into your DNA” but it’s multi-factorial which means that some of the signal comes from one gene and another one comes from another gene. It has to be a combination of multiple genes in order for them to illicit the trait. Basically, the environment that you put yourself into can illicit whether you are going to be near-sighted or far-sighted. There are some really interesting studies that are going on right now – I was just at a meeting – where they were dealing with how much light is in a classroom. If there is more light, maybe people will not be so near-sighted when they are in class and working on assignments in their class. This is out of Southeast Asia. The study hasn’t been conclusive yet, so I don’t want to say that it all has to do with one particular component but there is a trend to think that there is a genetic component to being either far-sighted or near-sighted but we haven’t mapped it down. We can’t test your DNA and tell you if you are going to be near-sighted or far-sighted because it comes from such a complex, multi-factorial component.

    Melanie:   Dr. Kaufman, there is so much information. We could speak for an hour about this. Now, tell us about the tests. People hear that you are going to dilate their eyes and they get nervous that they can’t drive afterward. What tests do you do? Are you taking pictures of our eyes or blowing air into our eyes? What are these tests that you’re doing to see what’s going on with our eyes?

    Dr. Kaufman:  In a standard routine exam, the first thing that we do is something called a refraction. A refraction is where we use a multitude of optical lenses in order to focus an image on the back of an eye at the retina. That can tell us if a patient has normal vision or not. People say, “Do I have normal vision?” 20/20 is really what we call standard vision but just because you don’t have 20/20 vision doesn’t mean that it’s not normal. It’s just kind of where we put the standard. A refraction will tell what the best possible vision a patient can get. If a patient does not have 20/20 vision and it’s worse, then we look for components of disease such as cataracts, glaucoma, macular degeneration, a variety of conditions. The best way that we do that is by dilating the eye. When we dilate the eye, we give medications in the eye that is just temporary that numb the iris, or the color part of the eye, in order to make it very large. It does not constrict. The reason that we want to make it large is that we want to look in the back of the eye through a window not a keyhole. If a patient’s not dilated, looking through a keyhole is very difficult. We can only see what directly passes in front of that keyhole versus that if we do a dilated exam, the pupil dilates and then we have a much bigger window to look up and down and left and right in all parts of the eye. No type of pathology escapes the provider.

    Melanie:  In just the last few minutes--what great advice – there’s so much that we could cover, Dr. Kaufman. Give your best advice for people to maintain their eye health.

    Dr. Kaufman:  First of all and foremost, yearly eye exams is probably the most important and that is because nothing sneaks up on you such as diabetic retinopathy or any type of refractive error. The second thing is a healthy a diet is important with eye health. I tell my patients that Omega 3 fatty acids, which is found in fish, is very good for the retina and it is also good for dry eyes that a lot of people suffer from. Those are the two things that I would do is have yearly eye exams and eat healthy.

    Melanie:  Why should someone come to UVA ophthalmology for their eye care?

    Dr. Kaufman:  UVA ophthalmology is unique because we are a multi-diverse department. We have everything from neuro-ophthalmology that deals with people who have neurological problems with the eye to corneal problems which is people who have infections and ulcers of the eye, to glaucoma and retinal specialists for diabetic retinopathy. In addition to having that, we also run a clinic for specialty contact lenses which deals with people that can’t wear glasses; that have to wear contact lenses. We also have a very large primary eye care clinic where people can just come and get their routine care. It is a very complete package of a department. If you had a condition that needed multiple specialists, we can manage that within the department without having to outsource any care.

    Melanie:  Thank you so much for being with us today, Dr. Kaufman. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.   

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Eye Health]]>
David Cole Mon, 14 Mar 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/30942-eye-health-and-the-importance-of-annual-eye-exams
Recovering from a Ruptured Achilles Tendon http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30949-recovering-from-a-ruptured-achilles-tendon recovering-from-a-ruptured-achilles-tendonWhat causes Achilles Tendon ruptures, and what is the recovery like?

Learn from Dr. Truitt Cooper, a UVA expert in foot, ankle and leg injuries.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1608vh3c.mp3
  • Location: Null
  • Doctors: Cooper, Minton Truitt
  • Featured Speaker: Minton Truitt Cooper, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Truitt Cooper is a board-certified orthopedic surgeon whose specialties include caring for patients with foot, ankle and leg injuries.

    Learn more about Dr. Truitt Cooper

    Learn more about UVA Orthopedics
  • Transcription: Melanie Cole (Host):   The Achilles tendon is the largest tendon in the body. It connects your calf muscle to your heel bone and is used when you walk, run, and jump. While it can withstand great stresses from running and jumping, it is vulnerable to injury. My guest today is Dr. Truitt Cooper. He's a board certified orthopedic surgeon whose specialties include caring for patients with foot, ankle and leg injuries at UVA Health System. Welcome to show, Dr. Cooper. Tell the listeners first of all, what is the Achilles tendon? What does it do?

    Dr. Truitt Cooper (Guest):  Basically, the Achilles tendon is the bundle of collagen, just like all of our tendons, that connects, like you said, the calf muscle, the gastrocnemius and the soleus muscles, to the heel bone--the calcaneus. It helps us during weight-bearing by letting us push off with the forefoot. Basically, that's its role.

    Melanie:  So then, how is it injured? Women wear high shoes, we step off of curbs; we do all sorts of things. What are some of the most common injuries to the Achilles?

    Dr. Cooper:   Actually, if you're wearing a shoe with a higher heel, you're probably less likely to injure your Achilles because it's at rest when the foot's flexed like that. The most common injuries are with sort of high-impact cutting sports and jumping sports, when the foot has sort of a sudden and unexpected dorsiflexion, or the foot's forced up when you're landing or trying to decelerate.

    Melanie:  Okay. Let's get to this first. Is there a way to prevent these types of injuries, as you say, in sports injuries or kids playing sports, quick movements, deceleration, jumping. Is there something we can do to sort of calm this injury?

    Dr. Cooper:  Potentially. The most common group of people that rupture their Achilles tendon would be males between 37 and, say, 42. A lot of these people are sort of what we would call the "Weekend Warrior" where they're sedentary all week and then they go out on the weekend and participate aggressively in sports, and that, I think, is a set up for injury. With the sedentary week, you're developing tightness and potentially weakness in some of those muscles as well as in the tendon itself. So, I think a good overall fitness program that includes strengthening and stretching can help prevent some of those injuries as well as warming before activity.

    Melanie:  What would the symptoms be to know? Are they going to hear a pop? Are they going to feel something roll up? What are they going to feel if they've really torn their Achilles?

    Dr. Cooper:  With an acute, sudden injury where the Achilles is completely or nearly completely ruptured, it's a pretty dramatic event, usually. It's variable in how much pain one has. Usually, they'll feel a pop. A lot of times people will, if they're playing, say, squash, they'll say they thought that their partner or their opponent hit them in the back of the heel with a racquet. Some people will say they felt like they were kicked in the back of the heel and then they look around and no one's there on the soccer field, or something like that. So, it's a pretty sudden, usually a pretty dramatic pop-type injury. The amount of pain is variable. It’s usually very painful, initially, but often it's not terribly painful within a few hours.

    Melanie:   Now, these "Weekend Warriors" that you're discussing, if they don't rupture it but they do strain it, or something happens where it's really just very sore at the bottom of the calf muscle and they know they moved wrong, what do you recommend people do for home treatment?

    Dr. Cooper:   Yes, I think with a strain, often the strains occur, like you said, at the bottom of the calf muscle or even up higher in the calf muscle. Those usually respond really well to a period of rest, ice, and then gradual return to activity. If they're more severe, sometimes people will go into a walking boot or not be able to put much weight on it for a few days with those types of injuries. The other issue we run into are the tendonitis-type issues where the Achilles tendon becomes either inflamed or a little bit unhealthy in the tendon itself. Those, often, will respond, again, to rest, ice, good stretching, eccentric-type exercises, which is a particular type of strengthening and stretching exercise which is often done with a physical therapist. Those types of things.

    Melanie:  So, people, Dr. Cooper, do calf raises and they think these are just great and they do them off of a stair. Then, they go really, really low and then you hear people at the gym say, "Oh, I ruptured my Achilles," or "I tore my Achilles doing those calf raises too low." Do you tell people not to go below neutral; not to go low-floor height? Or, to do that gently and stretch them long?

    Dr. Cooper:  Well, I think it depends a little bit on where the problem is with the Achilles. If you have, say, a tendonitis, or an irritation, where the Achilles actually attaches to the bone, down really low on the back of the heel, I think going down below the stair is definitely harmful and can cause more inflammation with that. If you have like a tendonitis or something that you're trying to treat with some stretching and strengthening activities and it's higher up, in the middle part of the Achilles, then going down a little bit below neutral is okay. But, the people that tend to have a rupture during an exercise like that, or something, usually have a longstanding problem with the tendon where it's actually unhealthy tendon tissue.

    Melanie:  What do you do? If someone comes to you and it's swollen and they had that acute event and it was dramatic, then what? Is this a surgical thing? It requires that intervention?

    Dr. Cooper:  Yes. There are really two optionsyou can treat them either with surgery or without surgery. Probably 20 years ago or 25 years ago, there was a feeling that anyone with an acute Achilles tendon rupture required surgery to fix it or that there were some papers that showed that they had a really high rate of re-tearing the Achilles if they didn't have surgery. They were just treated in a cast. Then, in the last, say, 10 years or so, in America, at least, there have been some good studies that have shown that actually you can treat these without surgery. So, I think that, in certain situations, you can either treat it with surgery and get a good result or you can treat it without surgery and get a good result. They key thing for the people, especially if you're going to treat them without surgery, is not immobilizing them for too long. You can't just put them in a cast and give them crutches for three months because the tendon will heal but it won't heal with the appropriate strength. They do have a higher risk of re-rupturing. So, a lot of patients choose to have surgery for this because there's a feeling that you can get back more of your strength and get back to activities quicker. I think that gap between the two treatments is closing, certainly in America. In some other countries, they're treating almost all of these without surgery.

    Melanie:  Yes. It certainly used to be RICE and now it's MRICE, and now there's movement, or RISEM. Now, they add movement in there. When you were talking about that eccentric strengthening protocol, tell the listeners what you mean by that because if they're going to try and really do this and work their Achilles so that they don't injure it, explain what that is.

    Dr. Cooper:  First of all I think that in a lot of cases, it's really helpful for people to see a physical therapist maybe one or two times to help develop this program but what eccentric strengthening is, is basically you get on a stair, or something like that, and you go up on your toes fairly quickly. That's not the part of the exercise that matters. So, you do an easy toe raise, and then, the part that matters is coming down very slowly so that the muscle is sort of contracting as it lengthens. That has been shown, in these more chronic situations, to help the tendon heal and improve the structure of the tendon and help it get back more to normal.

    Melanie:  Where are shoes and orthotics in this picture? People use them for plantar fasciitis and arch problems but are they involved in the Achilles issues, as well?

    Dr. Cooper:  Yes. I think in people with Achilles tendon problems, especially if they have a significant, well, I guess what we would call a “deformity” of the foot, the orthotics can help. It can help take the load off the Achilles and help calm things down a little bit. They probably don't have a huge role in preventing ruptures of the Achilles tendon but some of this chronic situations, I think orthotics can help rest it. As far as shoe wear goes, there's been a lot of shift back and forth both ways as far as running shoes go in the last five to ten years where they went from a shoe with a thick heel to five years ago there was a big push towards the minimal barefoot-type shoe. At that time, I was seeing a lot of people with Achilles tendonitis overuse problems because they switched too quickly. If you have a shoe with a thick heel, it sort of lets your Achilles tendon rest a little bit; it doesn't put as much strain on it. Then, if you switch to the minimal shoe, you Achilles and your calf are doing a lot more work. Now, there's sort of a push back going the other way toward more cushiony shoes. So, I think that the big thing is, you pick the shoe that's comfortable but if you're going to change, you have to change gradually, over time. I think that's where people get into a lot of problems, both with their shoe wear as well as their training. You know, increasing their mileage too quickly or their intensity too quickly.

    Melanie:  In just the last few minutes here, why should patients choose UVA orthopedics for Achilles tendon surgery and for their sports medicine care?

    Dr. Cooper:   I think here at UVA, we've got a unique situation where we have for foot and ankle, anyway, we have three full-time orthopedic fellowship-trained foot and ankle surgeons. We kind of specialize in the whole pathology of foot and ankle and I think we're very conscientious of each individual patient and their needs, so not everybody that comes in here is going to be pushed towards surgery if it's not right for them. We'll work out a treatment plan that includes physical therapy and other things like that, if that's appropriate.

    Melanie:  Thank you so much for being with us. It's great information, Dr. Cooper. You're listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.



  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic]]>
David Cole Mon, 14 Mar 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/30949-recovering-from-a-ruptured-achilles-tendon
What You Need to Know About Dry Eye and Lasik Surgery http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=31003-what-you-need-to-know-about-dry-eye-and-lasik-surgery what-you-need-to-know-about-dry-eye-and-lasik-surgeryCan lasik surgery help with your dry eyes?Your eyes need constant moisture in order to help keep them healthy. If your eyes aren't producing enough tears or moisture, you could suffer from chronic dry eye which its symptoms include burning, stinging, itchy eyes, excessive mucous, sensitivity to smoke and wind, difficulty wearing contacts, and excessive tearing.

Unfortunately even though lasik surgery can help correct eyes with poor eye sight, after the surgery it can cause your eyes to become dry and irritable.

What treatment options are available?

Learn more from Dr. Jeffrey Golen, a UVA ophthalmologist who specializes in treating cataracts.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1608vh3d.mp3
  • Location: Null
  • Doctors: Golen, Jeffrey R.
  • Featured Speaker: Jeffrey R. Golen, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Jeffrey Golen is a fellowship-trained ophthalmologist whose specialties include cataracts and cataract removal.

    Learn more about Dr. Jeffrey Golen

    Learn more about UVA Ophthalmology
  • Transcription: Melanie Cole (Host):  Your eyes are so precious but when your vision is compromised or you suffer from dry eye, you realize how important it is to get the best care. My guest today is Dr. Jeffrey Golen. He is a fellowship trained Ophthalmologist at UVA Health System. Welcome to the show, Dr. Golen. Tell us a little bit about dry eye. People have heard this term and they don’t even really know what it means.  

    Dr. Jeffrey Golen (Guest):   Hi. Thank you for having me. There are actually two different types of dry eye. There’s a dry eye where you don’t produce enough tears. Then, there is another type of dry eye where we do produce enough tears but our tears are really not adequate to keep our eyes lubricated. They don’t have the right components and there are some inflammatory problems with the tears.

    Melanie:  What are some of the complications? We all need to keep moist eyes and be able to make tears. What can happen if you can’t?

    Dr. Golen:  I think a lot of people get confused about dry eye. They try to compare it to dry skin, I think. For a lot of men who might have dry skin, they don’t really get too worked up about it. But, the problem with dry eye is that it will not only lead to discomfort but will actually cause issues with vision. It can cause blurred vision or issues with glare. It actually does affect our vision.

    Melanie:  What do you do? How do you even know, first of all, that you have it? Will your eyes be itchy? Will they feel that dryness? Like you say, like dry skin, but will it feel itchy and like you just need something in there? What does it feel like? What are some symptoms?

    Dr. Golen:  It really does depend on the patient but oftentimes the patient will complain of eyes that feel dry or irritated or, sometimes in severe cases, it will actually feel like something is in the eye.

    Melanie:   If they’ve got any of these, they get to an ophthalmologist pretty quickly because you don’t want to mess around with your eyes. What do you do for them? How do you find out this is what is going on? 

    Dr. Golen:  First we check their vision and examine the patient. There are a number of different tests we can do to check to see how dry one’s eyes are or if they are having issues with dry eye. After we do these tests and properly make the diagnosis, then we move forward to the treatment. There are a number of different modalities we use to treat this. We typically start with artificial tears, actually. It’s usually the most simple way to start. It’s not always adequate for every patient but artificial tears are available over the counter.  I think one of the most common problems that patients make is that, instead of buying artificial tears, they will actually buy eye drops that are designed to get the red out. In fact these drops, while they do a good job of getting the red out, are not designed for long term use. What will happen is, the patients will be on these drops and their eyes will be perfectly white but they will not be adequately lubricated.

    Melanie:  If they are using those products, which are not the right product for this situation, do you put them on a product that they then have to be on long term, Dr. Golen? Is this something that maybe comes and goes?

    Dr. Golen:  It can come and go depending on the environment. It’s typically worse in the winter because there is less humidity in the air. I talk to patients about modifying their environment so that it’s the best possible environment for their dry eye. For example, recommending staying away from fans at night time, using a humidifier if possible in their house--things such as this.  For the artificial tears, we typically start as an as needed basis. If the patients are doing fairly well with environmental modification, just as needed. But, if the patients are still having issues with dry eye, then we are going to go up on the artificial tears and use them more frequently.

    Melanie:  People have also heard about LASIK surgery, Dr. Golen. They hear it on commercials and late night television. There are people all over the country that talk about this now. What is the connection between LASIK surgery and dry eye?

    Dr. Golen:  That’s a great question. There, actually, are quite a few connections. First off, people who have dry eye oftentimes do worse in contact lenses. Our patients who have issues with contact lenses are usually the first patients who want to get LASIK. Unfortunately, they are not always the best candidates because it is a fact that LASIK, or its cousin procedure PRK, will make the eye, actually, more dry. This is definitely something to keep in mind for someone who does have dry eye.

    Melanie:  It sounds like a vicious circle, if you have dry eye and you want to use contacts but you can’t because you have dry eye. You’re the person who wants to have LASIK but it can make the situation worse. What do you tell people--that they are just going to have to stick with glasses and use the artificial tears and go from there? What can they do?

    Dr. Golen:  They can be evaluated by an ophthalmologist to determine how bad their dry eye is. If it’s mild dry eye, typically, we can proceed with a procedure such as LASIK.  As long as the patient is educated that afterward they will need to lubricate their eyes more aggressively, then it’s fine. If they have more severe dry eye, then we might think twice about doing the procedure. It really depends on the scale of the dry eye – the actual problem.

    Melanie:  Are there certain people who are more at risk for dry eye?     

    Dr. Golen:   Yes, the elderly are more likely to have dry eye. In addition, women tend to have dry eye worse than men.

    Melanie:  Wow. Why is that? Do we know?

    Dr. Golen:  We don’t know exactly. We think it’s related to hormones, though.

    Melanie:  Doesn’t everything just seem to be related to hormones? What else can you tell the listener about LASIK surgery and how to find somebody if you are somebody who maybe doesn’t suffer from dry eye and you’re somebody who really wants to consider LASIK surgery, how do you find somebody who is really good at it and that you can trust?

    Dr. Golen:  You want to find a doctor who is willing to have the discussion about whether or not you are an ideal candidate for the procedure. Ideally, you should be a patient who has had a very stable refraction, meaning your glasses prescription hasn’t changed recently. You can’t be pregnant and you can’t have any history of eye trauma to the eye, ideally. We don’t want anyone with corneal scarring. There are a few different things that make a patient a non-candidate for LASIK. There are other tests that we do in addition to rule out a patient for the LASIK procedure. Things that we are looking for are thin corneas, or corneas that have an abnormal shape. You wouldn’t really know this unless you saw an ophthalmologist and had the appropriate tests taken but we do this for safety. Patients who get LASIK, typically, have otherwise healthy eyes and they see quite well with glasses. They are perfectly healthy. They just need the glasses. As a result, we don’t want to operate on eyes that are anything less than perfectly healthy.

    Melanie:  What do you tell people when they ask you, “Is this a permanent condition now? Am I going to be able to get LASIK surgery and be able to see perfectly and not have to do this again or never have to wear glasses – I can throw them away?” What do you tell people as a realistic outlook from this?

    Dr. Golen:  That’s a great question. It really depends on the patient’s current situation but I never promise that it’s permanent because it’s almost never permanent. The reason why is what we do is, we reshape the cornea so that the patient, at any given time of surgery, can see very well ideally at distance. If the patient is over the age of 45, they will probably need some form of reading glasses to see up close, especially, if we set them for distance. In addition, if we’re dealing with patients who are a little bit older they, perhaps, might develop cataracts in the future which would be another issue. With your typical LASIK patient who might be in their 20’s or 30’s, they’ll, typically, have at least 10 years of good vision without glasses in the best case scenario but it is almost never a permanent situation like that.

    Melanie:  Dr. Golen, in just the last few minutes, give listeners your very best advice about LASIK, about dry eye, and why they should come to UVA Ophthalmology for their care.

    Dr. Golen:  If you do have dry eye and you are considering LASIK, you should get evaluated for dry eye first, in my opinion, because the LASIK procedure can actually worsen the dry eye. One of the first things that any ophthalmologist will tell you is start with an eye drop such as artificial tears. I, typically, prefer preservative free artificial tears because preservatives can sometimes irritate the surface of the eye. After we lubricate the eyes adequately, we can go from there but there might be other procedures that are needed. For example, if people have severely dry eyes we can actually put little plugs in their eye lids and that can help hold in more natural tears.

    Melanie:  Why should they come to UVA Ophthalmology? Tell us about your team a little bit.

    Dr. Golen:  We’ve got a very strong team here. We cover every discipline of ophthalmology and we have an optometrist who specializes in difficult to fit contact lenses. We really have everyone across the board in one department. We have excellent specialists, no matter whether you need an ocular plastic surgeon, a retina specialist or a cornea specialist. We’ve got everything covered. We communicate very well with each other.

    Melanie:  Thank you so much, Dr. Golen. What great information. So beautifully put.  You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.    


     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Eye Health]]>
David Cole Mon, 14 Mar 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/31003-what-you-need-to-know-about-dry-eye-and-lasik-surgery
Serving Dental Patients with Complex Health Needs http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=31004-serving-dental-patients-with-complex-health-needs serving-dental-patients-with-complex-health-needsIf you’re a dental patient with complex health needs – such as cancer or heart disease – should you consider a dental practice based at an academic medical center?

Learn more from Dr. Thomas Leinbach, a UVA expert in dentistry.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1608vh3e.mp3
  • Location: Null
  • Doctors: Leinbach, Thomas E
  • Featured Speaker: Thomas E Leinbach, DDS
  • Guest Name: Null
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  • Guest Bio: Dr. Thomas Leinbach is the chair of the Department of Dentistry at UVA Health System; his specialties include caring for patients with facial pain.

    Learn more about Dr. Thomas Leinbach

    Learn more about UVA Dentistry
  • Transcription: Null
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Dental Health, Heart Disease, Cancer]]>
David Cole Mon, 14 Mar 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/31004-serving-dental-patients-with-complex-health-needs
What to Expect During a Coronary Artery Bypass Graft http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=31015-what-to-expect-during-a-coronary-artery-bypass-graft what-to-expect-during-a-coronary-artery-bypass-graftCoronary artery bypass grafts, or CABG, are among the most common heart surgeries.

What can you expect as a patient during one of these procedures?

Learn from Dr. John Kern, a UVA expert in heart surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1609vh3a.mp3
  • Location: Null
  • Doctors: Kern, John
  • Featured Speaker: John A Kern, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. John Kern is a board-certified thoracic and cardiac surgeon who specializes in adult heart surgery, including coronary artery bypass grafts.

    Learn more about Dr. John Kern

    Learn more about UVA Heart & Vascular Center
  • Transcription: Melanie Cole (Host):  Coronary artery bypass grafts are among the most common heart surgeries but what should you consider if you're somebody that has coronary artery disease?  My guest today is Dr. John Kern. He's a board certified thoracic and cardiac surgeon who specializes in adult heart surgery, including coronary artery bypass grafts at UVA Health System. Welcome to the show, Dr. Kern. Tell us, who might be somebody that would be a candidate? Who might need coronary artery bypass surgery?

    Dr. John Kern (Guest):  Well, many patients with coronary artery disease might, in fact, need coronary bypass surgery. Coronary artery disease is when the arteries that supply blood flow and oxygen to the heart become blocked and that's the main cause of heart attacks. So, there, fortunately, are many different ways to treat coronary disease. Some patients might just need medications or changes in their lifestyle. Some patients, fortunately, can have their blocked arteries treated with stents but for a significant proportion of patients, depending on the number of blocked arteries and their other medical problems, it turns out that the best treatment, the best long-term treatment, would be coronary artery bypass surgery.

    Melanie:  How would somebody know if they have coronary artery disease?

    Dr. Kern:  Well, for a lot of patients, the first symptoms can be quite dramatic, meaning they're fine one day and the next day, they start developing chest pain and may be so unfortunate as to actually have a heart attack. Of course, those patients go to the hospital get evaluated, and treated, and probably get a cardiac catheterization, and then, depending on those findings, we decide, should those patients be treated with stents or should they undergo surgery?  A lot of patients, the symptoms can be much more subtle. They aren't so dramatic. So, patients may be fine, but ,over the course of time, they develop some chest pain that they've never had before and if they're good about going to their doctor, they'll have it evaluated further. They may undergo a stress test, and then, ultimately, their coronary artery disease may be diagnosed.

    Melanie:  So then, you spoke that some people might start with medication. What would those be? What would be the first line of defense if you determine somebody has these blockages and coronary artery disease?

    Dr. Kern:   Well, a lot of the medications are designed as what we call "risk factor modification." So, certainly, aspirin or some form of anti-platelet therapy, medications to control blood pressure, medications to keep the heart rate under control, and then, other forms of medications to treat any kind of cholesterol or lipid imbalances which may also contribute to the development of blocked arteries.

    Melanie:  So, if medicational intervention does not work and you've determined that somebody might need bypass surgery, what's involved? What can they expect as a pre-surgical intervention and then, what's it like?

    Dr. Kern:  The pre-surgical interventions are mostly all diagnostic and are tests that are done to ensure as safe an operation as possible. In this day and age, coronary artery bypass surgery is remarkably safe. Nearly 99% of the patients who undergo coronary artery bypass surgery recover just fine with no complications. The time in the hospital is roughly five days. Most people are able to go home after surgery and all we do is ask them to take it easy for three to four weeks. The incisions we use in this day and age are much smaller than they used to be. A lot of people have friends or family who had coronary artery bypass surgery 10 or 20 years ago and they have very long incisions, either on their chest or they have long incisions on the leg from where we take some of the vein to use for the bypasses. These incisions are much smaller now, and, in fact, the incision on the leg is sometimes only an inch long because we use scopes to take the vein out, and so, the postoperative recovery is a lot quicker now than it used to be.

    Melanie:  So, speaking of taking that vein, the saphenous vein, whatever vein you choose, how does that work? You take a piece? Can they deal without a piece of their vein?  What do you do with that?

    Dr. Kern:  Absolutely. Fortunately, the body is a remarkable machine and it's made with a lot of backup systems in place. When you talk about veins, even anyone can look at the back of their hand and see all of the blue veins on their hand and you might imagine that you can do without one of those and all the other veins take over its job.

    Melanie:  That's absolutely fascinating. So, once you do that and you've grafted this piece of vein in there, does the body create a collateral circulation or does it all run through what you've just grafted?

    Dr. Kern:  Exactly. The whole purpose of coronary artery bypass surgery is to provide a conduit for the blood flow to flow through around the area of blockage in the artery on the heart. So, we don't remove the blockage, we just provide another pathway for the blood to flow. Sometimes we use vein from the leg for that. Most of the time, for the main artery on the front of the heart, we use an artery on the inside of the chest wall called the "internal thoracic artery". That's very important because, that particular artery, when used as a bypass, stays open for the entire lifetime of the patient. In addition, we sometimes use an artery  from the arm. The forearm has two arteries and we sometimes use one of the arteries from the arm. So, we have lots of options for alternative blood vessels to use for bypasses.

    Melanie:  And, what is the outcome? What is their life after surgery like this take place? Back in the day, Dr. Kern, as you say, you asked them to take it easy, but there was no exercise, no nothing. Are you getting them up pretty quickly? Asking them to move around and get some exercise pretty quickly after that or, what is their life like?

    Dr. Kern:   Oh, absolutely. It starts right after surgery. Some of the things I hear from patients, again, is they had friends or family who had this operation 10 years ago and they remember they were on the breathing machine for three days and long times in the hospital. Now, this operation  is like many other operations we do where the breathing tube is taken out and they're off the breathing machine within an hour of surgery. A lot of folks are sitting up that night of surgery and we're getting them out of bed and walking around, really, within 12-24 hours. And then, once the initial recovery is over, we really encourage everyone to engage in some form of cardiac rehab. There's really nothing too fancy about that, but what it is, is it's a dedicated exercise program done a few times a week which is done under some medical guidance. It reassures the patient that their heart is fine and they can gradually work up to pursuing their active life and maybe being even more active than they were before because they're no longer being limited by their chest pain.

    Melanie:  How long can these grafts last in somebody?

    Dr. Kern:   So, that's what I was referring to earlier. The artery that we use from the inside of the chest, literally has a 99% patency rate over the course of the lifetime. So, it's very unlikely for that bypass would ever block back up. The veins that we use to do bypasses don't have quite that high of a long-term patency rate, but, in this day and age, with the new medicines that patients are able to take after surgery; the statins to help keep the cholesterol and lipids under control and better blood pressure medications and staying on aspirin. The long-term patency of even these vein grafts can be very, very good.

    Melanie:  Dr. Kern, as a cardiothoracic surgeon, give your best advice to the listeners so that maybe they don't have to come see you.

    Dr. Kern:  Well, the best advice is you can never start too early when it comes to living a heart-healthy lifestyle. Many of us, we come, we grow up, we're in our teens, our 20s, our 30s,  and we're invincible, but you really have to start all the way back in your teens living a good, healthy lifestyle. So, proper diet, and don't smoke; good exercise; don't get overweight. All those things contribute to the development of coronary artery disease.

    Melanie:  And, in just the last minute, Dr. Kern, it's such great information and you're so well-spoken, why should patients come to UVA Heart and Vascular Center for their heart surgery and for their heart care?

    Dr. Kern:  The unique thing about UVA is we have is what we call a true multi-disciplinary, collaborative heart team. When you come to UVA with a heart problem, you will not see just one individual, you will see a group of individuals with their own expertise in the area of heart disease. You will see the cardiologist, the interventional cardiologist, the cardiac surgeon, the specialized nurses, the exercise folks, the rehab folks, the physical therapists--the entire team that an individual would need to regain their heart health.

    Melanie:  Thank you so much for being with us. Really, really great information. You're listening to UVA Health Systems Radio and for more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Bypass, Heart Health]]>
David Cole Mon, 14 Mar 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/31015-what-to-expect-during-a-coronary-artery-bypass-graft
Protecting Your Voice http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=31085-protecting-your-voice protecting-your-voiceWhile you may hear about voice problems encountered by singers, people in a variety of fields who use their voices extensively can encounter ear, nose and throat problems.

Learn more – including what you can do to protect your voice – from Dr. James Daniero, a UVA expert in voice conditions.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1609vh3b.mp3
  • Location: Null
  • Doctors: Daniero, James
  • Featured Speaker: James J Daniero, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. James Daniero is a otolaryngologist whose specialties include ear, nose and throat problems in people who use their voices extensively, such as singers, coaches and teachers.

    Learn more about Dr. James Daniero

    Learn more about UVA Otolaryngology
  • Transcription: Melanie Cole (Host):  While you may hear about voice problems encountered by singers and people in a variety of fields who use their voices extensively, they can also encounter ear, nose and throat problems and many other people can, as well. My guest today is Dr. James Daniero. He's an otolaryngologist whose specialties include ear, nose, throat problems in people who use their voices extensively, such as singers, coaches, and teachers at UVA Health System. Welcome to the show, Dr. Daniero. So, tell us a little bit about some of the common voice conditions you encounter at the UVA Voice and Swallowing Clinic.

    Dr. James Daniero (Guest):  Sure, first of all, thank you for having me on the show, Melanie. Some of the voice disorders that we encounter at the University of Virginia, most commonly is just a persistent hoarse voice. That can be broken down into several categories, the most common of which is just a sort of misalignment in the way we produce our voice and then other things that can be associated, such as benign lesions that grow on the vocal cords.

    Melanie:  So, what are some symptoms? What are some things that people would notice if you're somebody in a profession--you're a singer, or you talk for a living--what might you notice besides hoarseness that would send you to see you?

    Dr. Daniero:  Sure. Obviously, the number one thing is the change in the voice, which most people characterize as a "hoarse voice", but also neck pain or soreness that develops in the front of the throat, typically throughout the day as the more their voice is used  and that's associated with a "vocal fatigue", as I call it. Patients will notice that their voice starts out strong and, in the middle of the day, it starts to fade. By the end of the day, they feel like they're really straining and just having exhaustion from voice use. And then, there's also pain with swallowing or pain with voice use that can be associated symptoms.

    Melanie:  What do you do to test somebody for issues that you think that they might be experiencing?

    Dr. Daniero:  In our clinic, we run a multi-disciplinary clinic, and that is a speech-language pathologist as well as myself, the physician and surgeon, is present for the initial interview with the patient. We ask a lot of detailed questions about how they use their voice and what their behaviors are in regards to taking care of their voice. If they have any consideration of how to care for their voice at that point, and then, we also will look at their vocal cords, not only at the structure and looking at them with a very detailed, high-definition camera, but also the way it functions. So, we'll videotape the voice being produced in the various configurations. That videotape can then be slowed down to get a very detailed analysis of how the vocal cords are vibrating to produce the voice which can often identify the problem.

    Melanie:  Wow. So then, I'm an exercise physiologist, Dr. Daniero, so I know that exercise helps various ailments and things. Are there exercises you'd recommend people  to do to protect their voice and possibly prevent some of these problems?

    Dr. Daniero:  Absolutely. Certainly, for people that are professional voice-users, and that's not limited to just singers, but anybody that uses their voice for their profession. There are a number of different exercises that, when trained by a voice specialized speech-language pathologist, patients can learn to care for their voice and also rehab their voice through these exercises. They usually have to be performed or taught through a speech-language pathologist that has some knowledge of specifically how to do the exercises.

    Melanie:  So, people can do these exercises and make their voices stronger? Do you advise people that are in these kinds of professions to either use their voice more limited or softer? People yell at their kids and they yell out on the streets. Is that really damaging our voices?

    Dr. Daniero:  Well, I think everything in moderation is the key there. There are some people that have a tendency to use their voices more forcefully, loudly, and are loud, frequent talkers and they, if they're professional voice users, might need to have some consideration of the amount and volume of voice use that they're using throughout the day, to limit it in certain situations. Then, there's others that are generally voice conservationists. They don't really speak out loudly. They speak softly and they're more introverted personalities and tend not to have issues with voice conservation.

    Melanie:  So, now what about some of the benign lesions and things that you might find? What do you do about them? Is there surgical intervention necessary? Do they go away on their own?

    Dr. Daniero:  Well, it depends on the type of growth or lesion that's on the vocal cord. A good portion of them will go away on their own if they have proper intervention such as vocal exercises and what we call "vocal hygiene" and behavioral modifications to prevent or limit the trauma on their vocal cords.  A good portion of them will avoid surgery if those measures are instituted. Then there's a  much smaller portion that does require surgery eventually. That's the type of micro-surgery that I do in the operating room.

    Melanie:  So, if you're doing microsurgery on somebody, what is that like? What is the recovery like? Is somebody then prohibited from speaking for quite a while? Tell us just a little bit about that.

    Dr. Daniero:  Sure. The surgery is generally an outpatient surgery. They go home the same day. Typically, it's around an hour, maybe an 1 1/2 hour of surgery but the key to the recovery is actually what happens after that. So, we typically will have patients that have anywhere between three to seven days of absolute voice rest. That means no noise coming from the vocal cords in coughing, throat-clearing, humming or voice use. During that time period, we're trying to get an area of surgery, the incision, to heal up well without the vibration irritating that area from producing the voice. Then, after that time period, we'll generally have them begin a rehab treatment. Similar to the way, if you had an orthopedic surgery for a shoulder or a knee, you would begin physical therapy after that, we do the same for the voice. We do a physical therapy for the voice that begins with the speech-language pathologist retraining the patient to use their voice in a much more efficient and less traumatic fashion.

    Melanie:  Dr. Daniero, are there other conditions, co-conditions, that can contribute to vocal problems? Reflux, sinus conditions? Do any of these contribute?

    Dr. Daniero:  Absolutely. Often, when we initially perform an assessment, those are things that I inquire about in detail; those are symptoms of acid reflux or even risk factors for acid reflux. We know there's a group of patients that may not have any symptoms of acid reflux but might have the findings.  Some of that could be throat clearing or frequent belching but not the classic heartburn symptoms that you would associate with acid reflux.  Then, allergies and sinus complaints often will produce thick mucus that drains down onto the vocal cords and that could, again, create an issue of chronic inflammation and hoarse voice, as well. 

    Melanie:  In just the last few minutes, first, tell the listeners your best advice for people to protect their voice with voice hygiene, as you called it, and what they can do.

    Dr. Daniero:  Sure. The simplest thing is to make sure that we're well-hydrated. The classic recommendation is 8-10 glasses of water per day and very few of us actually reach that if we keep track throughout our day how much water we're drinking. The other thing is the amount of caffeine that we consume. Our vocal cords are just a few inches away from our mouths and we all know if we're drinking a lot of caffeine, we'll tend to get a dried-out mouth. So, when we're using our voice with these dried out vocal cords, we're causing a little bit more trauma.  So, hydration can just eliminate a lot of the trauma that we're seeing there just by sort of lubricating the system. Other things in hygiene that are involved are managing our mucus, as we discussed, acid reflux and allergy symptoms, but then, also limited the trauma of our voice use in general--not calling across the house to our children that may be in a different room and actually walking over there to speak with them; simple behavioral interventions.

    Melanie:  Always great advice. And why should people with voice conditions come to UVA Otolaryngology for their care?

    Dr. Daniero:  We have a multi-disciplinary approach with the speech-language pathologist and the physicians creating a consensus that we can understand the problem from both the behavioral as well as the medical and surgical perspective. Also, we just understand the plight of a patient that has a voice problem. This is what we specialize in and we can help them.

    Melanie:  Thank you so much for being with us today, Dr. Daniero.  You're listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
]]>
David Cole Mon, 14 Mar 2016 17:00:00 +0000 http://radiomd.com/uvhs/item/31085-protecting-your-voice
When Should You Consider a Pacemaker? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30731-when-should-you-consider-a-pacemaker when-should-you-consider-a-pacemakerA permanent pacemaker is a heart rhythm device implanted through a minor surgery.

You're usually a candidate for a pacemaker if you have an abnormally slow heart rate with symptoms of fatigue, shortness of breath, lightheadedness or passing out.

Could a pacemaker help you better cope with a heart rhythm condition?

Learn more from Dr. Mike Mangrum, a UVA specialist in heart rhythm disorders.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1606vh4a.mp3
  • Location: Null
  • Doctors: Mangrum, Mike
  • Featured Speaker: Mike Mangrum, MD
  • Guest Name: Null
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  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Mike Mangrum is board-certified in internal medicine, cardiovascular disease and cardiac electrophysiology; he specializes in treatments for heart rhythm disorders.

    Learn more about Dr. Mike Mangrum

    Learn more about UVA Heart Rhythm Disorders
  • Transcription: Melanie Cole (Host):  Doctors recommend pacemakers for many reasons. Could a pacemaker better help you cope with a heart rhythm condition? My guest today is Dr. Mike Mangrum. He’s board certified in internal medicine, cardiovascular disease and cardiac electrophysiology at the UVA Health System. Welcome to the show, Dr. Mangrum. Tell us, what is a pacemaker? People don’t always understand what this even is intended to do.

    Dr. Mike Mangrum (Guest):  Yes. Well, a pacemaker is a small device that emits a low-energy electric pulse that prompts the heart to beat. Now, to fully understand what it does, you have to sort of step back and have a better understanding of the heart’s electrical system and I’ll describe that briefly. The heart has 4 chambers to it. It has the two upper chambers which are called the “atria” and the two bottom chambers are called the “ventricle.” The heartbeat actually starts in the upper chambers—the right atrium—in an area called the “sinus node.” The electrical pulse, normally, is emitted from that. It’s conducted to the middle part of the heart called the “AV node” and then down to the ventricles. So, when that happens normally, you get a nice, normal heartbeat; but, what an electrical pacemaker does is that it takes over those particular functions of the heart in which the patient may have either a slow heart rate or there’s a problem with the conduction of their electrical system.

    Melanie:  Okay. What a great explanation. That was fantastic. And, to think of the heart as an electrical pump really is a great way to think about it. So, what types of conditions—because when someone has something like “atrial fibrillation,” and they hear all these things--when is a pacemaker generally indicated?

    Dr. Mangrum:  Well, that’s a great question and how I would think about it is that a pacemaker is to treat slow heart rates. There are other devices that treat fast heart rates, but a pacemaker is used to treat slow heart rates. When I talked about the different components of the heart’s electrical system, the pacemaker really is indicated for 3 reasons. The first reason is when the electrical impulse fails to trigger. That’s called “sinus node dysfunction.” The second indication is when there is a problem with the conduction from the top to the bottom chambers of the heart and that’s called “AV node” conduction problems or “heart block.” Then, the third indication is actually there is an indication for congestive heart failure when there is, in addition to the congestive heart failure, some conduction problems below that AV node that we spoke about. So, those are really the indications for a pacemaker. It’s sinus node dysfunction, heart block and, in a subcategory, a patient with congestive heart failure that has conduction problems.

    Melanie:  Okay. So, if we’re talking about heart block or congestive heart failure, which you hear more and more about it. Dr. Mangrum, with the pacemaker, you insert these. How long do these last? Somebody with congestive heart failure, they confuse that with heart attacks all the time but it’s not. How long does this last? Is this something you live with for a very long time or do you have to change them or just the batteries?

    Dr. Mangrum:  Yes. The pacemaker—and I’ll speak about what I would say is about 99% of the pacemakers. The pacemaker has two general components to it. There are the wires that are called “leads” and then, there is the hard part of it which is called a “pulse generator.” The pulse generator is generally implanted underneath the skin below the collar bone. In that pulse generator is the battery and the circuitry for emitting the pulse. The battery lasts, on average, around 7-8 years. Now, there are some patients that it may last 10 or even 15 years. It depends a little bit on the usage of it. What would happen after that period of time is that that area would have to be opened back up underneath the skin and that pulse generator would be removed and another one placed back in there. The wires, or the leads, would be retained in the heart and it’s just a matter of replacing that pulse generator. Now, I said that that represented about 99% of the pacemakers. What I just wanted to mention is that there is an evolving pacemaker called a “leadless pacemaker.” I think, as time goes on, we will see more and more of these but these are implanted by way of a large vessel in the leg and actually inserted into the heart muscle itself and then everything is removed. So, there’s only a very small piece that is implanted inside of the heart that’s about the size of a bullet and that stays inside the heart. In that, it has all the circuitry and battery and everything is in there.

    Melanie:  How cool is that? That is absolutely fascinating. So, Dr. Mangrum, let’s bust up a few myths about pacemakers. People have always heard if they have a pacemaker, they can’t use a microwave oven; they can’t use, oh, cell phones; they might set off something at the airport; and, what about exercise and pacemakers? If it’s meant to maintain the pace of the heart, what if your heartbeat goes up because you’re exercising? So, answer some of those questions.

    Dr. Mangrum:  For most people, with a pacemaker, you would live your normal life. Most pacemakers that are implanted now are even MRI conditional, meaning that you can have an MRI with your new pacemakers. With the older pacemakers, there may be some issues with that but the new pacemakers now, most of them are what’s called “MRI conditional.” You don’t need to worry about microwave ovens any more. We recommend for cell phone usage to use the opposite hand of where the pacemaker is implanted. Remember I said the pacemaker is usually implanted underneath the collarbone? So, you would use the other hand and try not to store the cell phone in your breast pocket where the pacemaker is. Another common question is going through airports. What you would do is, you would show the security there, before the scan, that you have a pacemaker. The body scans are okay for the pacemakers. The ones that are detecting metal, you would tell the security people that you have a pacemaker and they will search you manually.

    Melanie:  That’s so cool. Now, it would seem that pacemakers, because they’re helping that slow pumping of the blood and helping to maintain a good, normal sinus rhythm, do they strengthen the heart, Dr. Mangrum? Do they help in someone, maybe with congestive heart failure, can they actually help to, not necessarily reverse, but maybe help a little bit with the strengthening of some of those nodes?

    Dr. Mangrum:  Yes. Yes. If you have conduction problems and congestive heart failure, then there is a special type of the pacemaker—it’s called a “biventricular” pacemaker, or a “CRT” which stands for “cardiac resynchronization therapy.”  It’s a pacemaker that has 3 leads to it. A pacemaker can have 1 lead, 2 leads or 3 leads. In this particular one, you would have 3 leads. In about 70% of patients who have heart failure with this conduction problem--and this conduction problem is called “bundle branch block.” About 70% of those patients will have a significant improvement in their heart function and not only in their heart function, but also in their function in terms of their being able to ambulate, walk around, less shortness of breath and that sort of thing.

    Melanie:  In just the last few minutes, Dr. Mangrum—and it’s such really great information and so beautifully put. Why should patients come to UVA for treatment of their heart rhythm disorders? Give your best advice for people that are suffering from these.

    Dr. Mangrum:  Well, I’ll tell you. The University of Virginia established the first heart rhythm center in the state of Virginia. This was in 1981. Over the years, UVA has been at the forefront of technologies, both with slow heart rates and with fast heart rates. There is a very comprehensive group of physicians. We have 7 adult electrophysiologists, which are the doctors that really focus on your heart’s electrical system, and one pediatric electrophysiologist. So, I would say we have a lot of experience. Speaking of pacemakers today, we put about 500 pacemakers in per year, for instance. So, we have a large volume. We have a lot of experience and we have access to some of the newer technologies like the leadless pacemakers that are coming out. I think UVA, for those of us who live in central Virginia, I think it’s a great resource for us. Who should consider a pacemaker?  I think if you have slow heart rates and there’s no reversible cause for those slow heart rates, then you may be a candidate for a pacemaker.

    Melanie:  Thank you so much for being with us today. You’re listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Mon, 07 Mar 2016 19:00:00 +0000 http://radiomd.com/uvhs/item/30731-when-should-you-consider-a-pacemaker
Vascular Skin Lesions: When Should You Be Concerned? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30727-vascular-skin-lesions-when-should-you-be-concerned vascular-skin-lesions-when-should-you-be-concernedVascular lesions are not always harmful; birthmarks, for instance, are a type of vascular lesion.

Learn when vascular lesions should be a cause for concern from Dr. Barrett Zlotoff, a UVA dermatologist who specializes in these lesions.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1605vh4d.mp3
  • Location: Null
  • Doctors: Zlotoff, Barrett
  • Featured Speaker: Barrett J. Zlotoff, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Barrett Zlotoff is board certified in dermatology and pediatric dermatology; his specialties include pediatric dermatology and treating vascular lesions.

    Learn more about Dr. Barrett Zlotoff

    Learn more about UVA Dermatology
  • Transcription: Melanie Cole (Host):  Vascular lesions are not always harmful.  Birthmarks, for instance, are a type of vascular lesion but when should you be concerned?  My guest today is Dr. Barrett Zlotoff.  He’s board certified in dermatology and pediatric dermatology at UVA Health Systems.  Welcome to the show, Dr. Zlotoff.  First, explain what vascular lesions of the skin are.

    Dr. Barrett Zlotoff (Guest):  Like you mentioned, vascular lesions are birthmarks that are made of blood vessels.  There are many different types and that’s one of the things I find so interesting about vascular lesions.  They can be made of small blood vessels called “capillaries” and they are called a “hemangioma”.  If you have collections of veins, you can have venous malformations.  If you have collections of lymphatics, you can have a lymphatic malformation.  You can have port wine stains, arterial venous malformations and you can have various combinations of all of these types of blood vessels to make different sort of vascular lesions.

    Melanie:  First of all, if a child has one of these lesions is--it automatically a cause for concern?  When do they run in and see a doctor?

    Dr. Zlotoff:  No. There are many vascular lesions that are just birthmarks that have no worrisome associations and don’t cause any problems.  Some infantile hemangiomas can even go away on their own with no treatment and get better by themselves.  I think that most vascular lesions should at least be discussed with your pediatrician at “well child” visits and the pediatrician can help you determine if the lesion could cause problems.  Some of the issues occur when vascular lesions are near the eyes, around the mouth, on a central face or places where vascular lesions can cause issues with vision, feeding, breathing or cause disfiguring changes in the face or other areas.  When vascular lesions are bleeding or have sores in them or ulcers are forming, we should also evaluate them as soon as possible or if they are growing really rapidly.

    Melanie:  Birthmarks was one of the first things that we mentioned and those can be anywhere on a child.  If they are on their temple or anywhere around that, does a parent keep an eye on those?  How does that work?

    Dr. Zlotoff:  I think we can definitely keep an eye on them but there are things that can be associated with different birthmarks.  Birthmark, as the name suggests, can be a marker to suggest other things.  So it’s really important that all kids who have birthmarks just at least have them looked at by their pediatrician in their “well child” visits and discuss them and get an idea if there should be any concern or not.

    Melanie:  When does somebody take their child to the doctor to have something done?  What kinds of vascular lesions do you like to treat?

    Dr. Zlotoff:  We treat a lot of infantile hemangiomas, which are kind of the strawberry hemangiomas that are the most common vascular lesions that we see.  They are so common that we see them in about 5% of kids.  They are a normal thing and many kids have them.  There are great new treatments for these hemangiomas. Oftentimes, we see them on the face or areas where they’re going to cause problems in the future or they could stretch out the skin and cause difficulties later on down the line; so then, we will treat them.

    Melanie:  What kind of treatments are available?  What do you do for them?

    Dr. Zlotoff:  Well, this is an exciting time for vascular lesions in general and hemangiomas in particular.  There are a lot of recent advances in treatment for vascular lesions that are super exciting.  There are new medications. Propranolol is one of the ones that’s been in the news lately.  Propranolol is a blood pressure medicine that was recently accidentally discovered in France to shrink hemangiomas down when they gave to a kid when they had high blood pressure they noticed that all their hemangiomas kind of melted away.  So, we’re doing exciting things with some medications like propranolol and erythromycin.  There are new ways to do sclerotherapy where medicines can actually be injected into vascular lesions to shrink them down.   There are surgical techniques to remove many types of vascular lesions and there are a lot of new lasers out, too, a few of which we have here at UVA that can treat vascular lesions, even like port wine stains that can very easily be lasered now.

    Melanie:  Working with children with these things is there any plastic surgery involved?  Is there any worry from parents about leaving scars?

    Dr. Zlotoff:  We work very closely with pediatric plastic surgery and plastic surgeons in general in our multi-disciplinary vascular lesions clinic and some of these lesions do require some surgery.  The plastic surgeons are very good at minimizing surgical scars.  A lot of times, our goal is to get at these lesions as early as possible and as early an age as possible so that we can prevent scars and we can prevent disfiguring surgeries down the line which is why I think it’s so important that they be evaluated at an early age.

    Melanie:  So, even when they’re little babies, that’s an okay time to look at these?  You don’t wait and watch them and see if they grow with the baby?

    Dr. Zlotoff:  No, I think that’s the best time to get on top of them and really see what we’re dealing with so we can come up with a treatment plan.  Sometimes, the plan will be do nothing and just watch the lesion but if you make that decision early, you have a lot more options for treatment and you may not be doing the treatment right away but you will at least know the treatment plan.

    Melanie:   Are there any, Dr. Zlotoff, that are cause for concern that you say, “We have to treat this because there could be complications”?

    Dr. Zlotoff:  The big ones are vascular lesions that are going to cause functional issues.  So, we see vascular lesions on the tongue sometimes; we see them in the throat, in the neck, in areas that are going to push on the larynx or the breathing tube and cause issues with breathing.  We see vascular lesions that are near the eyes that can cause issues with vision and that’s a big one for kids.  If the eyes are in any way blocked for even a few weeks in a developing child, you can have lifelong issues with vision and blindness.  So, we’re really aggressive about treating those types of lesions that are causing functional issues.

    Melanie:  In just the last few minutes, Dr. Zlotoff, when should patients and why should patients get their dermatology care at UVA Health Systems?

    Dr. Zlotoff:  I think the great thing about UVA is the number of specialists that we have that can address vascular lesions in so many different ways.  We have so many tools at our disposal and now we have just started up a new multi-disciplinary vascular lesions clinic.  It’s a multispecialty interdisciplinary team that works together so it includes dermatologists, radiologists, interventional radiologists, surgeons, hematologists, oncologists, ear nose and throat doctors and a variety of other specialists that all meet together to discuss complicated cases and vascular lesion cases.  So, we can all work together, we literally all sit in the same room, look at the imaging together and say, “How are we going to approach this case?  Maybe this case could do better with surgery; maybe it could be a good combination of sclerotherapy and surgery.   Maybe we could do a little laser first and then supplement that with surgery later.”  But, the plan of care is discussed together by all the providers and this is a really innovative approach and, I think, a special way to do it so that a patient doesn’t have to see ten different providers and the providers can actually communicate face to face to really come up with a plan together and I think that’s a really unusual and valuable service that UVA provides.

    Melanie:  Wow.  That’s incredible.  I applaud all the great work that you’re doing and thank you so much for being with us.  You’re listening to UVA Health Systems Radio.  For more information on dermatology at UVA you can go to UVAHealth.com.  That’s UVAHealth.com.  This is Melanie Cole.  Thanks so much for listening.
     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Skin Health]]>
David Cole Mon, 29 Feb 2016 19:00:00 +0000 http://radiomd.com/uvhs/item/30727-vascular-skin-lesions-when-should-you-be-concerned
Palliative Care: Helping a Wide Range of Patients http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30918-palliative-care-helping-a-wide-range-of-patients palliative-care-helping-a-wide-range-of-patientsMany people associate palliative care with end-of-life care, but it can help a much wider array of patients.

Learn more from Dr. Leslie Blackhall, a UVA expert in palliative care.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1607vh4d.mp3
  • Location: Null
  • Doctors: Blackhall, Leslie
  • Featured Speaker: Leslie Blackhall, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Leslie Blackhall is board certified in internal medicine, along with hospice and palliative medicine; she specializes in palliative care.

    Learn more about Dr. Leslie Blackhall

    Learn more about UVA Palliative Care
  • Transcription: Melanie Cole (Host):  Many people associate palliative care with end of life care but it can help a much wider array of patients. My guest today is Dr. Leslie Blackhall. She is board certified in internal medicine along with hospice and palliative medicine at UVA Health System. Welcome to the show, Dr. Blackhall. I’d like to ask you to begin by describing what palliative care is and what it’s designed to do.  

    Dr. Leslie Blackhall (Guest):   Thanks so much for having me. I think, in a way, the best way that I can use to tell you what palliative care is, is to describe what I do. I work, along with my colleagues here at University of Virginia, with people with serious illnesses like cancer, heart disease, emphysema, and help improve their quality of life. To give you an example, I work in the cancer center – this is one of the places I work – with patients with cancer at any stage of illness, including those who have been cured of their cancer, are undergoing curative therapy, or those who have more advanced and serious cancers. I work with them to help them with pain control, control of symptoms related to the cancer, but also side effects of the treatment, like nerve damage in the feet, fatigue, nausea. We work together alongside the oncologists to help patients tolerate their treatments better or to help them get their lives back after they’ve completed treatment or, in people who have incurable cancer but may live for very long with those cancers, as people do now. We help them be as functional as possible and to have as normal a life as possible. I think, in general, that is the goal of palliative care to work with people who have serious illnesses; to work alongside their doctors who treat those illnesses and help improve their function, their quality of life and their ability to lead as normal a life as possible with their illnesses.

    Melanie:  People hear the word “hospice” and their hear “palliative” and they think they are the same thing and that if someone is involved in palliative care – and as you have explained – but that it means that they are now near the end of their life.  Please, explain the difference.  

    Dr. Blackhall: I think that, actually, the most accurate way to think about hospice is as an insurance benefit that provides certain types of care for people in the last months of life. To be eligible for hospice, you have to have six months to live. In general, most people are on hospice for a much shorter period of time usually because there is no further treatment for, say, their cancer or their heart disease and their goal is to remain at home and have their symptoms treated. I see patients for years and years, some of whom have been cured of their cancer. While both hospice and palliative care focus on symptom management and improving quality of life for patients, palliative care doesn’t have the restrictions of short life expectancy or that the patient has given up treatment for their cancer or heart disease or whatever it is. I do take care of patients on hospice but that is a small percentage of actually what I do.  

    Melanie:  If someone is involved in palliative care, can they continue treatment, too? As you say, they can be cured of their cancer or in remission and still get palliative care. Some people are afraid that if they sign up for palliative care, it means that they are no longer going to be treated by their doctor and no longer are going to be able to get restorative care.

    Dr. Blackhall:  That’s a great question and absolutely if patients sign up to see me, they don’t need to give up any other type of care. In fact, the oncologists I work with consult with me in the hope that I will work alongside with them and help their patient tolerate their treatment better. For example, people getting radiation for an illness like head and neck cancer, it can be a very hard treatment to tolerate. It causes problems with swallowing, with pain in the neck and depending on the type of treatment, nerve damage in their feet or severe fatigue. Some of those people need to undergo therapy for seven weeks. They wouldn’t make it through their treatment unless we worked alongside of our oncologic colleagues to help them tolerate the treatment well enough by controlling their pain, by helping them with problems eating, by working with other professionals like dieticians and social workers and things like that to help people continue to tolerate the treatments that may even cure them. Once they have completed that treatment, there are often some lingering side effects that people need help with. I see our job is to work that side of the aisle while freeing up the oncologist’s time to focus on disease-specific treatments for the cancer itself.

    Melanie:   When we speak of palliative care, what does that even mean as far as actual treatments, Dr. Blackhall? Are we talking about psychological support and nutritional advice and dietary information, medication, pain management? Explain really what it means.

    Dr. Blackhall:  I would say all of the above. Whether I see the patient in the hospital or in the clinic, over in cardiology or in the cancer center, one of the questions I often ask people is, “What is it that you are having trouble doing that’s important to you in your life and what’s making it difficult for you to do that?” Sometimes the treatment people are undergoing is making them so fatigued that they can’t get out of bed, hardly, and that’s making them depressed. They can’t enjoy their time. We focus on sort of a holistic assessment of is it the chemotherapy, is it an anemia, is it some sleep disorder or some other problem? The treatments might include referrals to physical therapy, medications to help with sleep, or other medications to improve focus and concentration. Sometimes people have become very depressed or anxious and then I’ll work with a psychologist and the social workers and people like that and occasionally prescribe medication. Often it is pain. People with cancer or heart disease or other serious illnesses often suffer quite a lot of pain, either as a result of the treatments or because of the underlying disease itself. Then, our job is to be really good at trying to treat people’s pain without making them have a lot of side effects from treatment and without having those medications interfere with their other drug interactions or interactions with the treatment of whatever their underlying disease is. People may be having trouble eating, either with their appetite or they are nauseated or whatever, to try to determine what the underlying cause of the nausea is and then treat that effectively. I would say that is our focus. I always say that the oncologist is looking at the tumor and how to shrink it. Obviously, my oncologic colleagues care very much about the whole patient but my job is to look at the patient and their symptoms in the same way that maybe the oncologist looks at the CT Scan or the cardiologist looks at the cardiac ultrasound and try to look at what are the things that are keeping people from actually leading their lives? People nowadays live very long lives despite having chronic illnesses but what we focus on is trying to make sure they can really live those lives; that those lives are full of what they want to do so that they are not sort of stuck at home suffering from so many symptoms that they can’t enjoy the time that medical treatments are bringing them.

    Melanie:  Wow. How beautifully put. I applaud all of the great work that you do, Dr. Blackhall. UVA was recently named one of eleven palliative care leadership centers. Can you just tell us what that means?

    Dr. Blackhall:  Yes. We were named a palliative care leadership center because of our work in outpatient palliative care, meaning in the clinic setting. In the past, a lot of palliative care has been done when people are in crisis in the hospital. So, the cancer patient who comes in with pain completely out of control or the heart patient who is having trouble breathing and having a lot of life problems related to their heart failure or the emphysema patient who chronically is having trouble managing at home. The problem is, once people get discharged how do we continue to follow them up? Or, even more importantly, how do we work with these patients before they end up in the hospital to prevent them from having to go to the E.R. where nobody wants to go – let’s face it – to get treatment. Here at UVA, in fact when I came in 2001, we started an outpatient clinic in the cancer center. It was one of the earlier ones. We now have one of the larger outpatient programs which we have had many grants and awards to expand. What it means for us to be a national palliative care leadership center is that other programs that wish to develop similar projects will be coming to us or one of the other eleven sites to be trained in how to do this.

    Melanie:  That is absolutely fascisnating. Thank you so much for being with us. What great information. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.    

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Palliative Care]]>
David Cole Mon, 29 Feb 2016 19:00:00 +0000 http://radiomd.com/uvhs/item/30918-palliative-care-helping-a-wide-range-of-patients
Ankle Sprains: When Should They Be Checked by a Doctor? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30916-ankle-sprains-when-should-they-be-checked-by-a-doctor ankle-sprains-when-should-they-be-checked-by-a-doctorWhen does your sprained ankle need rest and ice, and when do you need to see a doctor?

Learn more from Dr. Winston Gwathmey, a UVA expert in sports medicine whose specialties include foot and ankle injuries.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1607vh4c.mp3
  • Location: Null
  • Doctors: Gwathmey, Winston
  • Featured Speaker: Winston Gwathmey, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Winston Gwathmey is fellowship trained in sports medicine; his specialties include caring for athletic injuries and conditions of the shoulder, hip, knee, and foot/ankle.

    Learn more about Dr. Winston Gwathmey

    Learn more about UVA Orthopedics
  • Transcription: Melanie Cole (Host):  A sprained ankle is a very common injury. Approximately 25,000 people experience it each day. A sprained ankle can happen to athletes and non-athletes, children and adults. My guest today is Dr. Winston Gwathmey. He is fellowship trained in sports medicine and his specialties include caring for athletic injuries and conditions of the shoulder, hip, knee, foot and ankle at UVA Health System. Welcome to the show, Dr. Gwathmey. An ankle sprain – people hear the word “strain” and “sprain” and they don’t know what any of those mean. Please explain it for us.

    Dr. Winston Gwathmey (Guest):   There is actually a common misconception about strain versus sprain. Technically, a strain includes a muscle. So, if you strain your hamstring or strain your calf muscle or something like that it simply involves a muscle. You ice it, rest it or those kinds of things to get that better. A sprain – with a “P” as opposed to a “T” – usually involves a ligament, which is the structure that connects two bones together. You can sprain the ligaments in your ankle. You can sprain your knee and that involves a joint typically speaking, the ankle being, by far, the most commonly sprained joint.

    Melanie:  Why is it so common? Is it that unstable? What are we doing to our ankles?

    Dr. Gwathmey: We’re walking on them.  We spend a whole lot of time – a lot of steps. If you imagine how many exposures your ankle has in a given day to injury. People these days count every step they take. People are doing 5,000 to 10,000 steps per day. That’s a lot of potential chances to take a bad step and sprain your ankle. It doesn’t take much with the force of gravity and just an awkward step to injury the ankle.

    Melanie:  If we’re looking at the mechanism of injury as you’re saying, there are so many opportunities every single day. When you see it, is it usually something that is relatively minor or is it something that tears? Tell us a little bit about that mechanism.

    Dr. Gwathmey:  When I see it, it’s usually a little bit more severe. Everyone has tweaked their ankle or taken a misstep. The way the ankle is built, it’s a joint that connects your shin bone and your foot. There are really three bones involved here. The tibia or the shin bone, the fibula or the small bone on the outside part of the leg, and then the ankle bone we call the “talus”. They are connected by ligaments. When you roll your ankle, generally speaking, most people roll their ankle inwards. So, they take a misstep off of a curb or something like that and they roll their ankle inward and they feel discomfort on the outside portion of the ankle. That’s really where the ligaments have been stretched or strained or torn. That’s generally what we speak about when we talk about an ankle sprain. When I see them, they are typically more high-grade. They are involving athletic type injuries or higher energy mechanisms. Those are people who get big and swollen and they can’t put weight on it and those kinds of things. I guess what we have to determine is whether or not you’ve got a simple low-grade ankle sprain that you can heal in a couple of days or something that needs more treatment or x-rays or MRI. That’s where I come in and try to help you figure out exactly what you should do.

    Melanie:   First line of defense, if someone does step off the curb or women in high heels--my goodness that’s a big source of problems right there – and the heel slips out. We feel that in our ankle. Is RICE still what we’re using or is there an “M” in front of it now? Are we using a little movement as well?

    Dr. Gwathmey:  Of course. RICE is always sort of the first line – rest, ice, compression, elevation. Let’s take a step back. People roll their ankle and what ends up happening is the ligaments on the outside portion of the ankle get stretched or even torn. It’s really critical for the inflammation associated with that to be controlled and get the swelling down. That’s where the rest and the ice, the compression and the elevation comes in because you want to get the ankle comfortable. As long as the body’s responds to an injury is to create inflammation in that region, that’s really what hurts. At the same time, we also want to make sure that we stabilize the ankle and allow it to heal in a functional position. That’s where the “M” comes in. We’re trying to get the ankle mobilized and moving so that as the ankle heals, it heals in a functional situation so that it can continue moving and you can get back to your activities as quickly as possible. At the same time, it does take some time to heal so it’s not like just by moving the ankle you’re suddenly going to be better. There is some healing that needs to take place and we’ve got to make sure that we control that. We monitor it to make sure that we are doing the right things to immobilize it and provide a safe treatment option.

    Melanie:  Are some people more susceptible, Dr. Gwathmey, to unstable ankles? You see people with really little, thin ankles. If they are, then every time they do that do they develop scar tissue and then, as a result, an arthritic condition?

    Dr. Gwathmey:  There are some people who have a higher propensity to injure their ligaments. People who have loose joints, for instance, you have people who are double jointed. Sometimes, they can put their joints in positions that allow them to become injured more easily. I certainly see a lot more ankle sprains with women who are really flexible, who have these loose joints. If they have repetitive ankle sprains, they certainly can build up scar tissue in the front of the ankle or on the outside of the ankle. There are really two conditions to be worried about before we worry about arthritis. One is chronic instability where the ankle is just unstable and two is the scar tissue that you talked about that builds up in the ankle that creates impingement inside the ankle. That can be a painful condition.

    Melanie:  What about bracing if people feel like, oh, they are going to play tennis and they are worried about rolling their ankle? Can we use those ankle braces or do you not recommend that?     

    Dr. Gwathmey:  We recommend them in certain situations.  Obviously, people who have a propensity to sprain their ankles, it’s nice to protect them and immobilize them. I’m not sure I’ve ever seen a basketball player play a game without his ankles taped just because that is such a high exposure to ankle injuries. But at the same time, you want the muscles and the dynamics of the stability of the joint to be there so I don’t like people to rely too heavily on braces. To some degree, your body needs to be able to stabilize your joints dynamically and your muscles are really involved there. People who are in high risk situations, we certainly support bracing or taping or ankle support or even high topped shoes, boots – those kinds of things. I often tell people who have ankle instability that a supportive shoe can be very helpful as opposed to a high heel. Maybe wearing something that actually supports the ankle a little bit better.

    Melanie:  It’s certainly true. Speaking of high topped shoes, what about prevention? Are there some exercises we can do to strengthen those tendons and ligaments in the ankle or calf raises or do the shoes help a lot? Give us some prevention.

    Dr. Gwathmey:  The key to prevention, there are a couple things. One is strengthening the dynamic stabilizers, the muscles of the calf, the muscles of the shin and those kinds of things to help to stabilize the ankle. Number two is something we do a lot with our athletes and that is neuromuscular training where we try to train the ankle to land properly with jumping and with pivoting and stuff like that so that people can keep a good foundation when they are doing athletic activities. As far as footwear, there is certainly footwear that we prefer over others that provides support and stability of the ankle. High heels not being one of them. For the most part, we do try to train our athletes, especially those who are rehabbing from an ankle injury, how to strengthen the muscles around the ankle as much as possible and how to train the joints so that it doesn’t put itself at risk for injury. That is called “neuromuscular training” and a good therapist can work with that pretty well. 

    Melanie:  In the last few minutes, Dr. Gwathmey, what great information. You’re so good at what you do. Can you please just give us your best advice about ankle sprains that people do every single day and why should they come see you at UVA Health System?    

    Dr. Gwathmey:   There are a couple of things that you certainly want to worry about. Sometimes you roll your ankle and you try to walk it off and it still hurts. Sometimes you do need to get it looked at to make sure you haven’t broken a bone or something like that because that might be a different treatment all together. Not all ankle rolls are just simple ankle sprains. It is certainly good to be looked at by somebody who specializes in ankles just to make sure you don’t have something worse. There is also a different kind of ankle sprain. Sometimes you may have heard of it and it’s called a “high ankle sprain” which is a little bit different and it acts a little bit differently. You might want to deal with it a little different as far as how you treat that. That can be diagnosed by a good orthopedic surgeon. Lastly, if you have a high-grade ankle sprain and four, five or six weeks and it isn’t getting any better, a lot of times we recommend getting looked at, maybe even getting an MRI to make sure you don’t have a complete rupture of your ligament or even cartilage damage inside your ankle joint which may be something we would consider doing surgery for more acutely then just a general ankle sprain. I think if you just roll your ankle and the swelling isn’t too bad and you are able to put weight on it, then it’s probably okay to see if it will just heal on its own. But, if three, four or five days after your injury, if it is still big and swollen and you can’t put a whole lot of weight on it, you probably ought to see somebody and make sure you don’t have something that’s more severe.  

    Melanie:  Thanks so much. What great information. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.    


     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Bone Health]]>
David Cole Tue, 23 Feb 2016 19:00:00 +0000 http://radiomd.com/uvhs/item/30916-ankle-sprains-when-should-they-be-checked-by-a-doctor
How Old is Your Heart? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30688-how-old-is-your-heart how-old-is-your-heartDo you know how old your heart is?

If it’s older than you – based on conditions such as high cholesterol and high blood pressure – you’re at higher risk for heart disease and stroke.

Learn more about how to live a heart-healthy lifestyle from Dr. Brandy Patterson, a UVA specialist in cardiology.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1605vh4c.mp3
  • Location: Null
  • Doctors: Patterson, Brandy
  • Featured Speaker: Brandy Patterson, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Brandy Patterson is board-certified in cardiovascular medicine and internal medicine; her specialties include women’s heart health.

    Learn more about Dr. Brandy Patterson

    Learn more about UVA Heart & Vascular Center
  • Transcription: Melanie Cole (Host):  Do you know how old your heart is?  If it’s older than you, based on conditions such as high cholesterol and high blood pressure you’re at a higher risk for heart disease and stroke.  My guest today is Dr. Brandi Patterson.  She’s board certified in cardiovascular medicine and internal medicine.  Her specialties include women’s heart health at the UVA Health System.  Welcome to the show, Dr. Patterson.  Tell us a little bit about the factors that make your heart age faster.

    Dr. Brandi Patterson (Guest):  Thank you for having me on Melanie today.  So, some of the factors that make our heart age faster are things like smoking.  Smoking really tends to make plaque build-up in our arteries, not only in our hearts, but also in the carotid arteries leading to the brain as well as the arteries in our legs at a much faster rate, much more aggressively.  It really leads to early onset heart attacks and strokes and peripheral arterial disease.  I have actually seen this in my practice in very young women in their early to mid-twenties who have smoked a pack or two or three a day for ten years and they’ve already come in with heart attacks and they’ve already come in with strokes.  So, smoking really increases the age of your heart very quickly as does diabetes, especially uncontrolled diabetes as well as high blood pressure, cholesterol that’s uncontrolled, poor diet and physical inactivity. 

    Melanie:  How can you learn how old your heart is?

    Dr. Patterson:  It’s actually a great tool that ClubRedUVA.com has online.  So, you can go onto ClubRedUVA.com and take the heart age calculator test.  It’s designed to give you an overall idea of the health of your heart and, basically, a general idea of how your personal lifestyle related factors may have affected your heart.  Now, I have to put in a disclaimer here.  The calculator is meant to be used for people ages 30-74 years old who have no history of cardiovascular disease, meaning you have not had a heart attack, you have no history of a stroke, peripheral arterial disease or heart failure.  It is a good method for determining if you’ve made great lifestyle choices, you can visually see this on a calculator in front of you that by making good lifestyle choices, your heart age may be the same as your chronological age or even younger.  So, you may actually be younger at heart but if you’ve made poor lifestyle choices your heart may age at a much faster rate because of those lifestyle choices.  It puts this on a screen for you so you can visualize it and you can see.  I think it has a very powerful impact when you can see that you’re 30 years old but your heart is actually 65 or 70.  The bottom line for that is that, if you’re a 30-year-old man or a 30-year-old woman and your heart age is 65 or 70, you are at higher risk for having a heart attack or stroke.

    Melanie:  Wow.  So, if you do have that higher risk, if you have an older heart than your actual age, can you reverse the process?  Can you make it young again and reduce your risk?

    Dr. Patterson:  Yes.  You know, you can.  Fortunately, it’s not impossible to turn back the hands of time when it comes to your heart.  So, everyone deserves to be young at heart and you can start making changes in your lifestyle choices as soon as you can to reduce your heart age.  What I advise my patients is a really simple tool – use you’re A, B, C’s – aspirin, “A” for aspirin when appropriate, “B” for blood pressure control, “C” for cholesterol management, “S” for smoking cessation.  By exercising regularly, watching your diet, and not smoking, people really can do a lot to reduce their risk of heart disease and make their hearts younger.  In fact, more than 75% of heart disease cases can be prevented by making the right lifestyle changes.

    Melanie:  Wow.  So, obviously, there’s some genetic component because you always get that question, “Did anyone in your family have a stroke or heart attack before the age of something?”  Dr. Patterson, what is the age when it’s considered a genetic component?  Is there an age when it’s not?

    Dr. Patterson:  Yes. So, if you have a male relative that’s in his 60’s and a female relative in her late 50’s or mid-50’s that has a cardiac condition, then it really becomes concerning to us.  While any cardiovascular disease at any age is a concern and we want to know about any family history of heart disease, the younger people are when they get their disease the more precautions or the more aggressively, we like to treat the patients that have the earlier onset heart disease in their family.  So, for instance, for an example, if you have a mother that had the onset of heart failure when she was 45 years of age and a father that had a heart attack when he was 60 years of age, those two ages are very concerning to us.  The fact that there are two first degree relatives involved is very important to us.  That’s not to say that siblings aren’t important.  Siblings are very important, too, but, really, it’s the first degree relatives that we really need to know the most information about cardiovascular disease.  If you have a family history that extends beyond your mother and father, meaning your grandparents had heart failure or heart attack in their 30’s or 40’s and their grandparents had heart attacks in their 30’s and 40’s, obviously, that’s a very concerning trend that we also need to know about.  The more information we can get the better.

    Melanie:  Well, certainly that’s true.  Do you take into account if somebody says, “I had a grandfather who had a heart attack but it was 1932” and maybe they didn’t know as much.  Do we still take that into effect?

    Dr. Patterson:  Yes.  I would, personally.  I would, personally, and I agree that medicine has really advanced since then and the things that we can do now for folks with heart disease is really much more advanced than we had in the past.  The testing that’s used now to detect cardiovascular disease is much more advanced. However, again, I think the more knowledge that your doctor has about your family history, the better.

    Melanie:  Dr. Patterson, when do you feel that stress testing and testing to see if you have peripheral artery disease or any kinds of build-up, when do those come into play?

    Dr. Patterson:  I think it comes into play when you know what the risk factors are for the patient as well as, obviously, if the patient is having any symptoms.  For example, for peripheral arterial disease a symptom would be when they are walking a block, they start to get severe cramping in the legs, the calf muscles, the thigh muscles, the buttocks, either or.  When they stop, that pain gets better.  If somebody came to me with that symptom and let’s just say they have a smoking history, I would be very concerned about aggressive plaque formation in the arteries in the legs.  It’s really, Melanie, a combination of risk factors plus symptoms and with that, again, of course, family history, knowing when to test the patient depending on those three items – family history, risk factors and symptoms.

    Melanie:  Now, we certainly know women, Dr. Patterson, we are the caregivers of society and if we don’t put our own masks on first we can’t put the masks on of our loved ones.  We don’t always, as you know, pay attention to our own symptoms as much as we do to everybody else’s, running around going “What did you just feel?  What did you just feel?”  What do you want women to know about heart disease and our risk and our different symptoms?

    Dr. Patterson:  Well, I think you need another segment for that!  There’s a lot to talk about with that topic.  I think the bottom line is that women need to know how prevalent cardiovascular disease is--it’s not just a man’s disease.  Today is actually “wear red” day for women with heart disease and it’s a very important day.  It increases awareness for women that heart disease is a major risk--that one in three--and some form of cardiovascular disease affects one in three women.  Now, I think we all know someone in our life – a mother, a sister, a grandmother that has had some type of heart disease.  While we all have these female family members--if not family members, then friends--with heart disease, and we rarely think it’s going to happen to us.  I think the important part of this is that, again, it goes back to your risk factors. You need to know what your risk factors are for having cardiovascular disease.  That is diabetes, smoking, high blood pressure, high cholesterol, diet, physical inactivity or physical activity and your family history.  So, knowing these things about yourself, what is your risk for having heart disease?  Has your mother had problems in her 30’s, 40’s, and 50’s?  What was your grandmother’s cardiovascular history like? I think the more that women are knowledgeable about their own risks and understand that those risks place them at an increased chance of having not only heart attack but also potentially valve disease, rhythm disease or heart failure, I think the better we are able at recognizing symptoms in ourselves.  Symptoms of heart disease can really be much different in a woman than a man.  We don’t have to have the elephant sitting on the chest.  I actually saw a woman the other day in the clinic who had pinpoint needle pricks in her chest – that was the symptom--prior to her stent placement.  It could be as mundane as just being fatigued and that’s really difficult because, my gosh, if we don’t get a good night’s sleep and we’re fatigued the next day is our heart or the fact that we haven’t’ slept?  I think having an awareness of how your body normally functions, how you normally feel, is this fatigue, is it lasting 24 hours or is it lasting a week even though you’ve gotten enough sleep the next couple of nights?  If it’s lasted a week and you’ve gotten enough sleep over the last couple of nights, boy, something may be wrong and it may actually be your heart.  Shortness of breath, discomfort in the stomach, abdominal pain, nausea, vomiting, numbness and tingling in the hands, the arm, the jaw.  Again, I think it’s important to know your risk factors.  I think it’s important to know that women’s symptoms are different than men’s and I think it’s important to know the prevalence.  It’s very common for women to have some form of cardiovascular disease.

    Melanie:  In just the last few minutes, what great information, Dr. Patterson.  We sure covered a lot in this time.  Why should patients choose the UVA Heart and Vascular Center for their heart care?

    Dr. Patterson:  UVA has expertise in all areas in cardiovascular disease from cardiovascular disease prevention to heart replacement in both the American College of Cardiology and The Society of Thoracic Surgeons clinical data registries.  UVA’s heart program actually ranks in the top 10%.  This is based on measures that really matter like survival from heart attacks.  I, personally, think that’s why patients should choose the UVA Heart and Vascular Center for their heart care.

    Melanie:  Thank you so much.  What great information.  For more information on Club Red and the UVA Heart and Vascular Center you can go to UVAhealth.com.  That’s UVAhealth.com.  You’re listening to UVA Health Systems Radio.  I’m Melanie Cole.  Thanks so much for listening.

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Mon, 22 Feb 2016 19:00:00 +0000 http://radiomd.com/uvhs/item/30688-how-old-is-your-heart
Treating and Preventing Tennis Elbow http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30876-treating-and-preventing-tennis-elbow
What treatments are available for those suffering from tennis elbow?

Learn more from Dr. Nicole Deal, a UVA expert in elbow injuries.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1607vh4b.mp3
  • Location: Null
  • Doctors: Deal, Nicole
  • Featured Speaker: Nicole Deal, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Nicole Deal is a board-certified orthopedic surgeon and hand surgeon whose specialties include caring for patients with hand, wrist, elbow and upper arm injuries.
  • Transcription: Melanie Cole (Host):  Tennis elbow is a painful condition of the elbow caused by overuse and, not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities can also put you at risk. So, what can athletes do to reduce their risk for tennis elbow?  My guest today is Dr. Nicole Deal. She’s a board certified orthopedic surgeon and hand surgeon who specialties include caring for patients with hand, wrist, elbow and upper arm injuries at UVA Health System. Welcome to the show, Dr. Deal. Tell us a little bit about what tennis elbow is. People have heard this term for years. What exactly is it?

    Dr. Nicole Deal (Guest): Well, thanks, Melanie. It’s an overuse injury, as you said. It’s a painful condition about the outside or the lateral part of the elbow which is really a tendonitis – an inflammation of where the muscles insert on bone in that region of the elbow.

    Melanie:  What are the causes of this injury?  Is it strictly overuse?

    Dr. Deal:  In general, yes, it is overuse. It’s a myth that it’s always caused by tennis. In fact, I frequently see it in patients who don’t play tennis, although I do see it in tennis players also. It’s a really common condition.

    Melanie:  So, what other activities?  Does golf cause this?  What about the pitchers who now have pitching limits on how many times they can pitch?

    Dr. Deal:  Sure. That tends to be an unrelated thing in younger athletes. This is more of  30’s to 40’s to 50’s type of age range and sometimes we see it in people who go out and do an overuse activity--sort of a weekend warrior type of a thing. Another example is people who are taking up weight lifting. Golfers can get it but that tends to be more on the inside part of the elbow. It’s just when people don’t listen to their body and they try to push through an activity that’s really causing them a lot of discomfort.

    Melanie:  Let’s start with prevention, then. Is there anything that you recommend people can do to prevent this painful condition?

    Dr. Deal:  Sure. What I just said, I think, is the very most important and that is just to really listen to your body. If you’re going out and doing an activity that is actually painful--you know, we all get sore from time to time and we all want to be physically fit--but if you’re doing something that’s really bothering you and that lasts for a long time after the activity and limits your ability to do your daily activities, then you’re doing too much. You really need to back off and see someone and learn how to get fit without hurting yourself. I would say that’s number one. Number two is, really think about stretching before you do activities. If you’re feeling a little bit of discomfort after an activity, consider icing after activity and sometimes anti-inflammatory medications, like ibuprofen, can be really helpful on an intermittent type of basis. You don’t want to take those all the time but if you have a little flare up, sometimes those of us who are in that age range need a little help.

    Melanie:  You said stretching. People really don’t know to stretch the area and the tendons around the elbows. Give us some advice.

    Dr. Deal:  Sure. There are some good online resources about that. If you have tennis elbow, you’ll notice that tone of the most painful activities is holding your arm away from your body with your elbow straight and trying to raise your wrist. That really tends to hurt, so if you can get in a position where you’re doing that activity but you’re stretching the wrist down and pulling gently on those muscles and sort of warming those up before you begin to do your activities, that can really help quite a lot.

    Melanie:  Then, you mentioned icing afterward and we’ve seen the athletes with their elbow jammed into a bucket of ice and then, what?  Some people like to brace Dr. Deal. What do you think about bracing?

    Dr. Deal:  Sure. So, a lot of people come in with what’s called a counterforce brace on their arm and you can get those over the counter. They are straps that go around just below the elbow to sort of hold your arm. What I see people do--and some people love those--but what I see people do that’s an error is wearing it extremely tight because that actually exacerbates the problem. I think if you’re going to use that particular type of brace, you should use it as a reminder to yourself how “my elbow’s a little sore. I better not do those extreme activities” but don’t wrap it so tightly that it’s really pinching that part of the elbow because that’s not helpful either. One brace that is helpful can be a wrist brace and that sounds strange but we talked at the beginning about how these muscles are the muscles that are on the outside part of the elbow, they actually don’t work they elbow, they work the wrist. If you can rest your wrist, you really rest those muscles that are constantly working to pull your wrist up.

    Melanie:  If they do some strengthening exercises like forearm exercising, flexion and extension of the wrist, do those help or are they counterproductive?

    Dr. Deal:  They can help. I think once you’re in the acute inflammatory phase, strengthening is not a good idea. You need to get out of the extremely uncomfortable phase before you can begin to strengthen. The first thing is to really stretch it out, rest it, let those tissues heal. You can think of this as a micro-tearing of the muscle, if you will. So, it’s actually an injury that needs to heal before we can begin to strengthen again.                                                                                                                                                                         
    Melanie:  That’s such great advice and if it does become really, truly problematic and somebody is an athlete and they really need to kind of get through this, what treatments are available?

    Dr. Deal:  There are a few things. The first thing we do, even in athletes, is really have you see our therapist because they can educate you in ways to prevent this becoming a chronic problem and also begin strengthening you in safe ways. We brace your wrist when we see you the first time, too, for a few weeks, and put you on a course of anti-inflammatories. If those modalities fail to alleviate all your symptoms, we can consider doing cortisone injections into the region. That is not always beneficial for people. Some people have great relief and some people don’t.

    Melanie:  I’m glad you brought up cortisone because some people do want to come in for those more than is indicated. If they do work, how many are you willing to give somebody before you say “no more”?

    Dr. Deal:  Not more than a couple and not more frequently than a couple of times a year. If you’re having them more frequently than that, you can weaken the tissues and also it’s putting a band aid on something that you really should be trying to heal using other methods. Sometimes--very, very rarely--this does become a surgical problem and we do operate on this. I would say that’s a very uncommon thing to have to do.

    Melanie:  In just the last few minutes, kind of reiterate your best advice about maybe cross-training, resting and using flexibility and stretching it, ice. Kind of wrap it all up for us.

    Dr. Deal:  Sure. I think if you’re having symptoms of tennis elbow, you know, we all want to just push through and keep doing that activity. “Hey, I want to have stronger arms, etc.”  Back off a little bit. Do a little more cardio, do your legs. Let your body have a chance to heal and then see someone. Let us help you figure out the way that you can achieve your physical fitness goals or get back to the level of activity you want in a safe way that you’re not going to consistently inflame this area and make it a chronic problem.

    Melanie:  Dr. Deal, why should patients come to UVA Orthopedics for elbow and other arm injuries?

    Dr. Deal:  Well, we have a great center called the “UVA Hand Center” and we have four specialty-trained upper extremity surgeons and two physician assistants on site who specialize in treatment of the arm, including tennis elbow. In additional, we have our therapists right on site with us. We can take x-rays if we need to and we can do injections right there in the UVA Hand Center also.  So, it’s a one stop place to go to have all of your diagnosis and your treatment in one spot.

    Melanie:  That’s great information. Certainly very useable things people can do right now, today. Thank you so much, Dr. Deal, for being with us. You’re listening to UVA Health System Radio. For more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
     

  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic]]>
David Cole Tue, 16 Feb 2016 19:00:00 +0000 http://radiomd.com/uvhs/item/30876-treating-and-preventing-tennis-elbow
Alternative Treatment for Depression http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30687-alternative-treatment-for-depression alternative-treatment-for-depressionApproximately one-third of patients with depression don’t respond to standard treatments.

Learn more about an alternative treatment called transcranial magnet stimulation, or TMS, from Dr. David Hamilton, a UVA psychiatrist who specializes in this treatment.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1605vh4b.mp3
  • Location: Null
  • Doctors: Hamilton, David
  • Featured Speaker: David V. Hamilton, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. David Hamilton is a board-certified psychiatrist whose specialties include TMS therapy for depression.

    Learn more about Dr. David Hamilton

    Learn more about UVA Psychiatry
  • Transcription: Melanie Cole (Host):  Approximately 1/3 of patients with depression don’t respond to standard treatments. When should you consider alternative treatments for depression?  My guest today is Dr. David Hamilton. He’s a board certified psychiatrist whose specialties include TMS therapy for depression at UVA Health Systems. Welcome to the show, Dr. Hamilton. So, what are some of the standard therapies that you prescribe for depression that generally the population would hear about?

    Dr. David Hamilton (Guest):   I think the mainstay of the treatment of depression is really two-fold. It’s medication on the one hand and there are a variety of medication classes of anti-depressants and other classes of medications that we use in addition to anti-depression medications that have been shown to augment their response. The second thing would by psychotherapy. There is science showing in regards to medications and psychotherapy both are useful but, really, the whole is greater than the sum of the part. They tend to work better together.

    Melanie:  Okay. When does it come down to trying other treatments?  How do you know that these standard course of treatments together or separately are not working for someone?

    Dr. Hamilton:  The patients that I see here at UVA are patients that have tried a variety of treatments, both a number of medications in different classes as well as psychotherapy and they either are not responding or they are having an incomplete response that is still leaving their lives not functioning in the way that they want to.

    Melanie:  So then, what?  What’s the first course that you would look at as complimentary medicine?

    Dr. Hamilton:  Well, I think the first thing that we do is make sure that the person has tried medications that are appropriate to the symptoms that they are experiencing. Not all anti-depressants are created equal and then, not all depressions are the same. Some patients have depressions where anxiety is a huge component of their depression and other patients have depressions where just they feel like they can’t get out of bed and they have a lack of energy. Matching the appropriate anti-depressant medication to the symptoms that a person is experiencing is job number one. Now, if that’s been done and the patient has still failed to respond to a good trial of medications, then we start to look at techniques like TMS which stands for Transcranial Magnetic Stimulation.

    Melanie:  Tell us what that is.

    Dr. Hamilton:  We are beginning to understand, primarily through the advances in neuro imaging, the different parts of the brain that are in control of our mood and we know that primarily mood is something that exists very deep in the brain. So, it’s very hard to access. However, there are areas on the outside of the brain, newer parts of the brain, if you will, that are control centers for those deeper parts that we can’t access. TMS allows us to target those areas to improve their functionality and their ability to control the deeper emotional parts of the brain.

    Melanie:  That’s fascinating. How often does someone have to have a TMS session?

    Dr. Hamilton:  Well, a group of sessions is every day. One session lasts 37 minutes. It’s pretty brief but it is a commitment because it’s Monday through Friday for 4-6 weeks. Then, we do a taper for three sessions a week for a week, then two, then one. So, it is an investment in time.

    Melanie:  Does this work in long term doctor?  Is it something that they have to keep re-doing?  How does that work?

    Dr. Hamilton:  Well, there’s been a variety of responses. Generally, people don’t need to keep getting sessions. Sometimes, if people begin to experience symptoms of depression again then, we will do an abbreviated course – a few sessions to sort of touch them up and when they begin to respond then we’ll stop. Rarely sometimes people need a complete course again if they’re having another full blow major depressive episode.

    Melanie:  How do you work with patient’s doctor about other kinds of remedies for depression?  Maybe mind/body therapies, cognitive behavioral therapy, exercise where do you include all those?

    Dr. Hamilton:  Sure. When I’m working with a patient in developing a treatment plan, I think of it as, and the metaphor I often use, is of a chair having four legs. Each leg is important. First leg is medication but I think very often people want a pill that’s going to fix everything. Very rarely is that the case in depression. Medications are an important part of treatment. The second leg of the chair, if you will, is psychotherapy and, as you mentioned, there are a variety of different kinds of therapy. Cognitive behavioral therapy, psychodynamic therapy--that’s the more sort of classic long-term insight-oriented therapy. Short term therapy that’s focused more on developing specific coping skills. The third leg or pillar of treatment plan is the things that we put into our body. That includes diet as well as substances – alcohol, drugs, both illicit and licit--in addition to things like vitamins and nutraceuticals that we know are helpful in treating depression.  Finally, and certainly, last but not least is exercise. Exercise is as important as any other aspect of a full treatment plan. Of course, when somebody is in the midst of a full blown depression, it can be cruel to say, “You should start exercising.”  Very often, it’s the job of the medications and therapy to get people to the point where they can start having a lifestyle consistent with recovery from depression.

    Melanie:  Such great information. In just the last few minutes, Dr. Hamilton, why should patients choose UVA for their psychiatric care?

    Dr. Hamilton:  I think at UVA, we have the advantage of being inside of a large university system and we’re able to bring all of the resources to bear. Rather than being just a TMS Clinic, we are able to really take a look at patients as individuals and decide, what is the appropriate course of treatment for this particular patient?  It may be that TMS or some other kind of treatment modality is appropriate. We’re able to really customize and individualize treatment plans based on the individual needs of a patient. We’re more, I think, patient focused than focused on the clinician and what we happen to offer since we have so many different modalities to offer.

    Melanie:  Thank you so much. Great information. You’re listening to UVA Health Systems Radio. For more information you can go to UVAhealth.com. That’s UVAhealth.com. This is Melanie Cole. Thanks so much for listening.

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Mental Health, Depression]]>
David Cole Mon, 15 Feb 2016 19:00:00 +0000 http://radiomd.com/uvhs/item/30687-alternative-treatment-for-depression
Who Can Receive a Stem Cell Transplant? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30857-who-can-receive-a-stem-cell-transplant who-can-receive-a-stem-cell-transplantStem cell transplants can help patients with certain blood cancers, including leukemia.

Learn more about the process and who can be considered for a stem cell transplant from Dr. Michael Keng, a UVA expert in hematology.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1607vh4a.mp3
  • Location: Null
  • Doctors: Keng, Michael K.
  • Featured Speaker: Michael K. Keng, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Michael Keng is board certified in internal medicine and specializes in hematology, including caring for patients with leukemia.

    Learn more about Michael K. Keng, MD

    Learn more about UVA Stem Cell Transplant Program
  • Transcription: Melanie Cole (Host):  Stem cell transplants can help patients with certain blood cancers, including leukemia.  My guest today is Dr. Michael Keng.  He’s board certified in internal medicine and specializing in hematology including caring for patients with leukemia at UVA Health System.  Welcome to the show Dr. Keng.  People hear this word in the media—“stem cells” and “stem cell transplants”.  Please tell them what this means.

    Dr. Michael Keng (Guest):  Absolutely.  Thank you for having me today.  I want to first just begin saying that stem cell transplants are something that involves a huge medical team in that we are all here in regards to our patients.  Stem cell transplant is basically deriving stem cells from a patient, whether that’s from the bone marrow or the blood itself or umbilical cord, and it’s the process of taking one of the stem cells from these sources and delivering them to a particular recipient that needs the stem cell transplant.

    Melanie:  Who would be a recipient?  What type of patients would require stem cell transplantation?

    Dr. Keng:  That’s a great question.  There are many types of indications for stem cell transplant.  I usually think of them as patients that have malignant versus non-malignant diseases.  What I mean by that are patients with malignant cancers such as leukemia, including acute myelo leukemia, acute lymphoblastic leukemia and also other special bone marrow disorders, such as myelodysplastic syndromes and also myeloproliferative  disorders.  If a patient has a relapse or a refractory disease in multiple myeloma and Hodgkin’s lymphoma or non-Hodgkin’s lymphoma, these patients can also proceed to stem cell transplant.  Non-malignant cases, meaning cases that are not considered cancers, can also require stem cell transplant such as thalassemia, sickle cell anemia, aplastic anemia and other immunodeficiency syndrome.

    Melanie:  Dr. Keng, before I ask you about the people that are donating the stem cells, is there a pre-treatment that patients have to go through before they can have a stem cell transplant?

    Dr. Keng:  Absolutely.  It honestly depends on what your baseline diagnosis is.  For example, if you are a patient that has been diagnosed with leukemia, a patient must be in remission before heading to a stem cell transplant.  Remission treatment usually involves chemotherapy or other targeted therapies to suppress or remove these cells altogether from your body.  If you have specific non-malignant cases like I discussed earlier, these may not require intensive therapies but a stem cell physician would be able to tell you specifically when would be the best timing for a stem cell transplant.

    Melanie:  Where are you getting the stem cells?  That’s been such a source of controversy both in politics and the media but it’s really not the same thing is it, what you’re talking about?

    Dr. Keng:  No.  These stem cells are not embryonic stem cells that has created such controversy in the media.  These stem cells are what we call “hematopoietic stem cells”.  Hematopoietic basically means derived from the bone marrow.  These stem cells only have the ability to grow into the common cells that we are concerned about such as white blood cells, red blood cells and platelets and other bone marrow cells.  We get these cells from the bone marrow itself or the proliferal blood or umbilical cord blood.

    Melanie:  So, when you’re getting these stem cells who are you getting them from?  Are these willing donors?  Are people, then, step up if it’s someone in the family?  Do you have to be a match?  How does the donation work?

    Dr. Keng:  All bone marrow donors are coming from volunteers.  They are 100% volunteers that do not receive any payment for stem cell transplant.  What we typically look for, depending on what type of transplant one condition needs; for example, if someone needs an autologous stem cell transplant, these are when stem cells are used from the patient themselves.  There’s something called “allogeneic” stem cells where stem cells are from a donor that’s not the patient.  An autologous stem cell transplant is probably the lease controversial because these are stem cells that are collected from the patient himself or herself and will be used and infused to the patient at some other time in the future when the disease is taken care of.  However, in allogeneic stem cell transplant is when stem cells are derived from a donor other than from the patient himself or herself.  These donors are all volunteer based, like I said, and what we prefer is a matched sibling donor. If a sibling is not available, we commonly look in the National Bone Marrow Registry to see if there is a non-related match available.  However, if a non-matched donor is not available, we can look at umbilical cord blood and also newer technology involves using what we call “half-matched” donors that could provide stem cells for the donor himself.

    Melanie:  Dr. Keng, does it hurt to donate stem cells to someone that you love?

    Dr. Keng:  No.  It does not hurt.  Actually, it is something that will probably give you a lot of satisfaction and just meaning that you’ve donated life literally to a patient or to someone that you love.  There are procedures that are done prior just to make sure that you are an adequate candidate to donate stem cells, meaning without infections or other disorders that would prevent you from donation.  The actual donation process, depending on whether the source is from bone marrow or peripheral blood, can be tailored according to what is needed.  There are various procedures that allow these stem cells to be received without any pain.

    Melanie:  What happens once you give the stem cells to a patient?  How long does it take for them to start regenerating and helping this person to get better?  Is this a permanent situation or do they have to have this kind of transplant on a regular basis?

    Dr. Keng:  When a patient needs to undergo a stem cell transplant, this is done in the hospital, in the in-patient setting. What I will be referring to is first autologous stem cell transplant--patients who need stem cells from himself or herself would undergo chemotherapy and/or radiation.  This would allow the current bone marrow to be completely removed and allow stem cells to be infused back in.  This process of bone marrow recovery would take approximately 10-14 days.  However, if you are receiving an allogeneic stem cell transplant, meaning stem cells from another donor, this process can be a little bit longer.  The preparatory regimen to remove the current bone marrow can be quite aggressive but the stem cells that are infused in should be able to begin recover in the time period of 14-20 days.  Everyone is a little bit different but this is why everything is individually based when it comes to stem cell transplantation.

    Melanie:  UVA as received accreditation from FACT and from the National Marrow Donor Program.  Explain a little bit, Dr. Keng, what those recognitions mean.

    Dr. Keng:  Absolutely.  FACT is an accreditation that allows us to be able to obtain and to be able to appropriately process and to be able to deliver stem cells back to a particular recipient.  This is given after many checks and balances that would allow us to do this successfully without any complications.  It’s not given to all institutions.  You have to show that you follow specific policies and protocols that are set forth by the FACT accreditation.  The NMDP, which is the National Bone Marrow Registry Program, allows us to be able to access donors who are willing to provide stem cells for our patients.  Once again, this is a particular accreditation that is not given to any program that wants to perform stem cell transplants.  You must show that you have an appropriate team, that you have good quality measures to be able to perform stem cell transplants appropriately before receiving this accreditation.

    Melanie:  That’s fascinating, Dr. Keng.  I applaud all the great work that you’re doing.  How cool is that what you get to do?  In just the last minute here, why should patients come to UVA Cancer Center for treatment for their blood cancers?

    Dr. Keng:  The University of Virginia is a growing program and it is amazing to see what is being done with acute leukemia and stem cell transplantation programs.  We have a multi-disciplinary team including physicians, nurses, pharmacists, physical occupational therapists, nutritionists and also social workers who all come together to care for the individual patient.  No one patient is the same for us and we love to be able to call each one of our patients family because they are with us through this process. Once you become a part of UVA as a patient, you are forever a patient with us and we love the privilege and the honor to be able to take care of all patients who chose UVA.

    Melanie:  How beautifully put, Dr. Keng.  Thank you so much for being with us.  You’re listening to UVA Health Systems Radio.  For more information you can go to UVAHealth.com.  That’s UVAHealth.com.  This is Melanie Cole.  Thanks so much for listening.

     
  • Length (mins): 10
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  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Tue, 09 Feb 2016 19:00:00 +0000 http://radiomd.com/uvhs/item/30857-who-can-receive-a-stem-cell-transplant
Treatment Options for Peripheral Arterial Disease http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=30674-treatment-options-for-peripheral-arterial-disease treatment-options-for-peripheral-arterial-diseasePeripheral arterial disease (PAD) usually occurs when arteries outside the heart and brain become narrowed or blocked.

PAD most often occurs in the arteries of the pelvis and legs.

Narrowing or blockages are usually caused by the buildup of plaque in the arteries, creating a condition known as hardening of the arteries (atherosclerosis).

Left untreated, serious cases of PAD can lead to loss of circulation in the legs, gangrene and amputation of the affected limb.

Learn more from Dr. William Robinson, a UVA specialist in vascular surgery, about treatments for this condition and ways to reduce your risk from a UVA specialist in vascular surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1605vh4a.mp3
  • Location: Null
  • Doctors: Robinson, William
  • Featured Speaker: William Robinson, MD
  • Guest Name: Null
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  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. William Robinson is a board-certified specialist in surgery and general vascular surgery. His specialties include aneurysm repair and caring for patients with peripheral arterial disease.

    Learn more about Dr. William Robinson

    Learn more about UVA Heart & Vascular Center
  • Transcription: Melanie Cole (Host):  If left untreated, peripheral arterial disease can have serious long term affects. My guest today is Dr. William Robinson. He is a board certified specialist in surgery and general vascular surgery at UVA Health Systems. Welcome to the show, Dr. Robinson. Briefly explain, what is peripheral arterial disease or PAD.

    Dr. William Robinson (Guest):    Thanks Melanie, it’s great to be here and be on your show. Peripheral arterial disease is atherosclerotic disease that leads to obstruction of the peripheral arteries. The peripheral arteries are any artery in the body other than the coronary arteries. So, peripheral arterial disease can involve many arteries in both the limbs as well as the chest and abdominal cavities. It can be both symptomatic and actually silent.

    Melanie: So, it can be silent. Who as at risk for this disease? And then, how would you even know that you have it?

    Dr. Robinson:  The risk factors for peripheral arterial disease are actually fairly well established and they overlap a good bit with the risk factors for heart disease. The major risk factors are: male gender, age – so with our aging population this is becoming an increasing problem. Other risk factors include smoking, hypertension, diabetes, and hyperlipidemia. Those are really the major risk factors that can lead to peripheral arterial disease.

    Melanie: How is it diagnosed and what symptoms? Dr. Robinson, if you are somebody who walks on the treadmill and gets a pain in your legs – this claudication – people don’t know if it’s just muscular or if it’s something more.

    Dr. Robinson:  That’s exactly right. The most common area that peripheral arterial disease affects is the lower extremity. In that example that you just gave, that would be sort of a classic symptom. What we call “claudication,” that is a cramping a pain in either the calf or sometimes the thigh or buttocks due to insufficient blood supply when the patient exercises or walks. That is one way to recognize that peripheral arterial disease may be present. In that case, you would need to see either your primary care doctor or a specialist in order to differentiate that from other causes of muscular pain that might occur with activity.

    Melanie:  How is it diagnosed? Is this a simple procedure to diagnose whether there are arterial problems in the lower extremities?

    Dr. Robinson: Actually, the diagnosis is made based on the symptoms and the examination by a physician and then sometimes supplemented with very simple testing. If you have symptoms that are consistent with peripheral arterial disease such as claudication and you are found to have abnormal pulses in the lower extremity, that would be sufficient for a diagnosis of peripheral arterial disease. In patients who are asymptomatic the diagnosis is made by measuring blood pressures in the leg, specifically at the ankle. If we see that they are reduced below a level that we would consider normal, that is sufficient for diagnosis of peripheral arterial disease.

    Melanie:  If somebody is diagnosed with this – and, as you say, a simple blood pressure test in the lower extremities can help you determine – then, what do you do for them?

    Dr. Robinson:  The treatment for peripheral arterial disease, really, first off, should be focused on prevention. The best way to treat it, as with many diseases, is to prevent it. The prevention is aimed at control of all those risk factors that I mentioned just a few minutes ago. That means having diabetes under good control, having hypertension under good control, having your fats and lipids under good control and not smoking. Those are the major things that can be done for prevention. Even after the diagnosis is made, those things remain the most important part of the treatment. Although the blockages will not be reversed by changing your diet or losing weight or getting better control of the diabetes, if those things are done, the disease will become less progressive and, therefore, less likely to lead to symptoms or complications. When we see patients with more advanced symptoms, there are definitely options for treating it. For example, in the lower extremities, if a patient has either claudication or more severe pain due to more severe peripheral arterial disease, we have a variety of options. Some of those options include endovascular therapy where we would be able to open the blockages with a combination of either ballooning or stents, for example. Other options would include surgical therapy in order to bypass around the blockage to restore blood to the lower extremity. It’s important that people realize that control of the medical risk factors and keeping a good, healthy active lifestyle is always the first line. Those treatments that I just mentioned, such as surgery--those should really be reserved for the most severe cases.

    Melanie:  Dr. Robinson, even if you do the endovascular stenting and ballooning and you open these back up and they still get that claudication, does this limit their physical activity because it is kind of like a vicious circle. You want them to be active and you want them to exercise and sometimes it can be quite painful.

    Dr. Robinson: That is an excellent, excellent point and actually an excellent question. You are exactly right. The first line is to have people exercise as much as they can and to control their medical risk factors. However, if they are at a point where they can’t get that exercise, that is what we call “claudication which is lifestyle limiting.” That is a severe form of claudication. In that case, we would often do either endovascular therapy or surgery in order to increase the patient’s ability to walk.  That can have benefits both on prevention for the future as well as preventing heart disease and other unwanted medical affects that come with inactivity.  It’s really a balance. You have to sort of make sure that all of the medical conditions are under control and the patient is being as active as possible but you have to offer therapy when the claudication or the pain is extremely limiting.  

    Melanie:  In just the last few minutes, Dr. Robinson, and it’s great advice, give your best advice for prevention of peripheral artery disease and why someone should come to UVA for their treatment.

    Dr. Robinson:  I think, really, the best advice for prevention, I think, is to never smoke. That is particularly important for any younger patients and older patients, too, because even if a patient has a long-standing smoking history stopping smoking even later in life will help prevent the progression to the most severe form of peripheral arterial disease which is actually what we call critical limb ischemia which can be a limb threatening condition. I can’t emphasize enough how important it is to stop smoking and to never have started smoking in the first place, actually. In terms of, if you do have advanced symptoms, I think that coming somewhere you can get comprehensive care and comprehensive options for addressing your particular PAD in the best way is why I would advise patients to come to UVA. Obviously, there are a variety of medical specialists who specialize in all of those risk factors, in controlling them and treating them as best as is possible. We have a variety of interventionists both in surgery and in other fields who can offer both endovascular therapy and surgical therapy. When you come to a place where all of the options are on the table, I think that helps a patient get a treatment plan that is best tailored to their particular disease and their particular goals.

    Melanie:  Thank you so much, Dr. Robinson. So, beautifully put and such great information.  You’re listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That’s UVAHealth.com.  This is Melanie Cole. Thanks so much for listening.

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Mon, 08 Feb 2016 19:00:00 +0000 http://radiomd.com/uvhs/item/30674-treatment-options-for-peripheral-arterial-disease
Hypersensitivity Pneumonitis: What Are the Most Common Causes and Treatments? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=29987-hypersensitivity-pneumonitis-what-are-the-most-common-causes-and-treatments hypersensitivity-pneumonitis-what-are-the-most-common-causes-and-treatmentsBreathing in certain substances often causes hypersensitivity pneumonitis.

Learn more about the causes and the two types of hypersensitivity pneumonitis from Dr. Diana Gomez-Manjarres, a UVA specialist in pulmonology.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1547vh5e.mp3
  • Location: Null
  • Doctors: Gomez-Manjarres, Diana
  • Featured Speaker: Diana Gomez-Manjarres, MD
  • Guest Name: Null
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  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Diana Gomez-Manjarres is a board-certified physician in internal medicine whose specialties include hypersensitivity pneumonosis and interstitial lung disease.

    Learn more about Dr. Diana Gomez-Manjarres

    Learn more about UVA Pulmonary & Respiratory Care
  • Transcription: Bill Klaproth (Host):  This is Bill Klaproth in for Melanie Cole. Breathing in certain substances often causes hypersensitivity pneumonitis. What are the two types of hypersensitivity pneumonitis and what are the causes and treatments? Here with us today is Dr. Diana Gomez. She is a UVA specialist in pulmonology, a board certified physician in internal medicine whose specialties include hypersensitivity pneumonitis and interstitial lung disease. Dr. Gomez, thank you so much for being on with us today. Let’s start right here. What is hypersensitivity pneumonitis or HP?

    Dr. Diana Gomez (Guest):  Good afternoon. Hypersensitivity pneumonitis is a lung condition that is caused by inhalation of some type of allergen that is in the environment, usually mold or a bird antigen and when I say that, I mean an exposure to chicken or feathers could cause it. What you see in the lungs is some inflammation, sometimes its scar tissue. The reason why this happens is because it is an immune response to these allergens that are in the environment. It can happen from exposures that you have at home or actually in your work environment.

    Bill:  When you say “inhaled substances” such as mold or chicken feathers, things like that, I’m thinking of a guy on a construction site inhaling sawdust or concrete dust or some type of insulation dust. Can somebody get hypersensitivity pneumonitis from that, too?

    Dr. Gomez:  What usually happens is the dust that you get exposed to in a construction environment causes a different type of condition. It’s not hypersensitivity pneumonitis. It’s called “pneumoconiosis,” which is completely different. Hypersensitivity pneumonitis happens when people are exposed to organic allergens.

    Bill:  Okay, now I understand. Very good. I just wanted to clarify that for people listening right now. Are there different levels of HP?

    Dr. Gomez:  Yes. The presentation is different. The big groups are acute presentation and chronic presentation and the symptoms vary accordingly. When a patient has acute hypersensitivity pneumonitis, the most common symptoms happen four to six hours after the exposure. Usually, people have fever, flu-like symptoms. They feel tired, headaches, chest tightness, cough, shortness of breath. Those last for a few hours until the exposure is resolved. It is acute and improves in a few hours. The other type is called “chronic HP” or “chronic hypersensitivity pneumonitis” and that happens to patients that are being exposed without them knowing that they have the exposure. They don’t have this acute presentation. They just start feeling short of breath and start coughing over time. When we see them in clinic, they already have scar tissue in the lung. They never had an acute presentation or they maybe just thought it was a viral infection and they just disregarded it. When they come to clinic, it is a little advanced, if you want to say it that way. There is already scar tissue in the lungs.

    Bill:  Someone with acute the symptoms come on hard and fast. Do they go away, then?

    Dr. Gomez:  Yes, they go away. They usually go away after they stop exposure to the allergen.

    Bill:  Someone with chronic, this is where they are constantly coughing, maybe having tightness of chest, breathing issues where they are constantly having it?

    Dr. Gomez:  Right. They present with a more chronic picture. Like, it happens over a month, most of the time.  

    Bill:  What are the classic symptoms then? Is it mainly the coughing and shortness of breath?

    Dr. Gomez:  For the chronic one, yes. Cough, shortness of breath. Some people have some unintentional weight loss.

    Bill:  How can someone be diagnosed with HP?  

    Dr. Gomez:  Unfortunately, we don’t have a system that is evidence based yet because it is a condition that we need to have much information before we come to the diagnosis. Basically, we need to get a very good history from the patient. We always ask them about exposures and, as I said, mold exposures. We usually see this in people who have humidifiers, dehumidifiers at home, any water damage in their basement, or they live on a farm and they have moldy hay. In the history, the patients have to tell us about the exposure. The next step will be some blood work. If the patient is unaware of exposure, the blood work may tell us if they are being exposed to something that could cause this condition. The next step is a CT scan or some type of chest imaging and there are some changes. One of them is scar tissue, some inflammation in the lungs. There are certain patterns that we see that make the diagnosis higher on our list. After the CT scan and all of the blood work, then we may consider something called “bronchoscopy:. That is when we go inside the lungs with a camera and get some fluid washings and then some type of cells that we get from those washings will make the diagnosis, again, more possible. Sometimes just with exposure with the CT scan and the bronchoscopy, we can make the diagnosis but if it still unclear to us why the patient has this issue we may need to get biopsies. The way that we do them is doing the same procedure as the bronchoscopy. When we do the washings, we will do some cell bronchial biopsies. They actually have a high yield to make the diagnosis. But, if those are unrevealing the next step will be a surgical lung biopsy. Of course, it is patient based. We want to make sure that the patient’s lung function is good enough for them to undergo that type of invasive procedure. We need different information before we come up with the diagnosis. There is not a straightforward diagnosis.

    Bill:  If someone is diagnosed with HP then, it is really incumbent upon them to find out what in their environment is causing this. Correct?

    Dr. Gomez: That is correct. Actually, sometimes when we send the blood test in and it comes back positive for mold exposure or chicken exposure, sometimes they have to have the house professionally inspected because sometimes they are unaware of the exposure.

    Bill:  Right. Then, you know. If left untreated can this disease lead to something more serious?

    Dr. Gomez:  The acute presentation the patients usually do okay, meaning they stop the exposure and then they improve. But people who present with chronic HP, they can progress to respiratory failure, meaning they will need oxygen. They may retain carbon dioxide. It’s a little more serious once the lungs are scarred down and, unfortunately, we don’t really have medications to get rid of the scar. If it’s inflammation, we can use medication to improve the inflammation but once there is scarring in the lungs, then, unfortunately, there is not much that we can do at that point.

    Bill:  So, it’s crucial to find out early what in the environment is causing the HP and get rid of it so you don’t wind up in a situation where you do have scarring of the lung. What treatment options are available to somebody with HP?

    Dr. Gomez:  As you said, actually, the main goal is to identify the allergens and avoid further exposure. If there are birds, remove them. If the patient has been exposed at work, then they need to change jobs. Actually, some people actually had to change houses just because they were exposed and they couldn’t remediate the mold. It’s that serious. If they fail to resolve the allergen exposure, that will, of course, increase the chance of progression and development of this irreversible lung damage.  

    Bill:  They’ve got to find it and get out of there. Right. Why should someone come to UVA Pulmonary and Respiratory for treatment?

    Dr. Gomez:  One thing I wanted to add, in terms of management, the therapy.

    Bill: Okay. Go ahead.

    Dr. Gomez:  There is some medication called Prednisone that sometimes we use and it will help the inflammation to come down. What we see on the CT scan is mostly inflammation. It doesn’t take care of the scar tissue but it improves inflammation and that may help the patient to feel a little better. All of the medications because it is an inflammatory condition. You want to fight the immune system, it weakens the immune system. The ongoing inflammation may be taken care of by all of the medications. What I mean by that is there is something called Isoptin or Mycophenolate that we usually try. Those take care of the inflammation so that we don’t have to use the prednisone in the long term. We don’t think it is a good medication chronically because it has so many side effects and those include diabetes, high blood pressure and other problems.

    Bill: It’s good to know that there are ways that you can relieve some of the symptoms with somebody with HP.

    Dr. Gomez:  Right.

    Bill:  So, why should someone come to UVA Pulmonary and Respiratory for their treatment?

    Dr. Gomez: I think the main reason why people should come to UVA is because we have very experienced physicians that we have seen many cases and then we know how to approach this condition and how to get the patient’s work up. We have all the resources that the patient needs to come up with a diagnosis and then therapy for them. It is a very experienced team and we’ll do what’s best for the patient.

    Bill:  That sounds great. Dr. Diana Gomez, thank you so much for being on with us today. We really appreciate it. For more information please visit UVAHealth.com. That’s UVAHealth.Com. I’m Bill Klaproth in for Melanie Cole. This is UVA Health Systems Radio. Thanks for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Lung & Respiratory]]>
David Cole Mon, 21 Dec 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/29987-hypersensitivity-pneumonitis-what-are-the-most-common-causes-and-treatments
How Can Sarcoidosis Be Treated? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=29986-how-can-sarcoidosis-be-treated how-can-sarcoidosis-be-treatedCaused by inflammation in the lungs, sarcoidosis can cause an array of symptoms.

Learn more about the causes and symptoms, along with treatment options, from Dr. Andrew Vranic, a UVA specialist in pulmonology.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1547vh5d.mp3
  • Location: Null
  • Doctors: Vranic, Andrew
  • Featured Speaker: Andrew Vranic, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Andrew Vranic is a board-certified physician in pulmonary medicine and critical care medicine whose specialties include sarcoidosis.

    Learn more about Dr. Andrew Vranic

    Learn more about UVA Pulmonary & Respiratory Care
  • Transcription: Bill Claproth (Host):  Hi. This is Bill Claproth in for Melanie Cole. Sarcoidosis is caused by inflammation in the lungs and can cause an array of symptoms. What are the causes and symptoms along with treatment options? Joining us is Dr. Andrew Vranic, a UVA specialist in pulmonology, board certified physician in pulmonary medicine and critical care medicine whose specialties include sarcoidosis. Dr. Vranic, thank you so much for being on with us today. Let’s start right at the beginning. What is sarcoidosis?

    Dr. Andrew Vranic (Guest):  Thank you for having me today, Bill. Sarcoid is actually an idiopathic disease which means that we actually don’t know what causes it. We assume that in certain susceptible individuals something in their environment triggers it for them to develop this type of inflammation in their body called “granuloma inflammation”. This inflammation usually affects the lungs but it can actually affect any part of the body. Again, it most commonly affects the lungs which is why it is treated by lung doctors like myself. Outside of the lungs, it can affect almost anything. More commonly after the lungs, things like the skin, the eyes, other lymph nodes in the body and even sometimes, in rare cases, the heart and the brain. So, it can go pretty much anywhere.  

    Bill:  Does it always start in the lungs?

    Dr. Vranic:  The symptoms that bring it to light don’t always necessarily have to do with pulmonary symptoms but almost everybody with sarcoid will have some lung involvement.

    Bill:  What are the common symptoms associated with sarcoidosis?

    Dr. Vranic:  Interestingly many patients won’t have any symptoms at all with sarcoidosis. They may come to light incidentally, such as when they get an x-ray for some other reason. Maybe their primary care doctor orders an x-ray for bronchitis or pneumonia but the x-ray ends up showing some findings suggestive of sarcoid and then they are sent to us. If they are going to have symptoms, usually the symptoms are lung related because, again, the lungs are the most commonly involved organ. They may have symptoms like shortness of breath, chronic cough, occasionally chest pains. Many of them will have non-specific symptoms such as fatigue. Like I said earlier, because sarcoid can involve any other part of the body besides the lungs, you need to look out for the heart, the skin, things like that as well.  It can actually present in a myriad of ways but most often with pulmonary symptoms.

    Bill:  If someone comes to visit you, how is it traditionally diagnosed then?

    Dr. Vranic:  Usually by the time they get to see me we have a pretty good suspicion already based on the x-ray and they probably had a CT scan of their lungs as well. Once you suspect it, you almost always want to do a biopsy to see if they actually have that type of inflammation that I mentioned earlier – that granuloma inflammation. You want to biopsy the easiest thing to get at. So, if they have a rash that is usually a good place to start because the skin biopsy is pretty easy; it’s fairly non-invasive. In general, though, most of these patients, because most of them have some pulmonary involvement, most of them will get a lung biopsy which is done via a procedure called a bronchoscopy. Most of the time people with sarcoid will actually have enlarged lymph nodes or glands around their airway. We actually do a very cool procedure these days called an EBUS which stands for “endobronchial ultrasound”. That actually allows us to get inside their airways. Through, this very small ultrasound on the end of our scope we can actually look through the airway, outside of the airway, visualize the lymph nodes sitting outside the airway, and actually visualize our needle going through their airway into that lymph node. The cool thing, too, is we usually have a pathologist in the room with us when we do this, so they can tell us almost instantly whether or not we’ve gotten the diagnosis.

    Bill:  Is sarcoidosis confused with other diseases? It seems like this is kind of like an unknown disease. It sounds like you are getting to the point now where you can easily diagnose this, where you know right away instead of “you may have this; you may have that”. Is that correct?

    Dr. Vranic:  That’s, more or less, correct, yes. Most of the time, sarcoid presents fairly straightforwardly--again, usually with pulmonary symptoms or abnormal x-rays, or abnormal CT scans of the lungs. But, as you mentioned earlier, it certainly can be confused with a lot of other things, in part because it can affect so many organs of the body outside of the lungs. I’ve certainly had patients who had no problems breathing but they presented with difficulty walking, difficulty with their gait and balance and ended up having sarcoid in the brain. Patients present with palpitations and, again, their lungs were fine, but they had sarcoid involving the heart that is causing them to skip beats and have palpitations and things like that. Because it can present in so many ways, it can often be confused with many different diseases and often is quite a complicated diagnosis to make. Most of the time, that’s not true, but certainly it can be true.

    Bill:  What treatment options are available to patients suffering from sarcoidosis?

    Dr. Vranic:  The nice thing about sarcoid is that in the vast majority of patients, they are going to do just fine. About 50-75% of them are going to experience a resolution of the disease within a few years, usually without treatments. For the majority of the patients we see in clinic, it is more watchful waiting to make sure they don’t develop any manifestations of sarcoid that does need treatment. In the small subset of patients that do require treatment, they can often be quite sick. In about 5-10% of those patients, they might have very severe fibrosis in their lungs from their sarcoid or they may have heart involvement or brain involvement that requires treatment. In those patients, the disease can be quite debilitating and life limiting. For those patients, we usually put them on medicines to suppress the immune system or weaken their immune system, if you will, and thus calm down that inflammation that I alluded to earlier that’s causing all the problems. Traditionally, patients have been treated with steroids although the problem with steroids like prednisone is that when they are given long term, they can often have really terrible side effects, sometimes worse than the disease itself:  things like osteoporosis, issues with their sugar, blood pressure, weight gain, fluid retention, cataracts, etc. There are other drugs sometimes referred to as “steroid-sparing agents” that can be given long term that will weaken the immune system enough to suppress the sarcoid without causing all of those terrible side effects.  

    Bill:  You said in a high percentage of patients, it just goes away.  

    Dr. Vranic:  It does, yes. So, again, most patients present with mild sarcoid and most of those patients – about 50-75% of them--will experience resolution of the disease without treatment at all. Their symptoms are mild, if present at all. Again, most of the time, our job is to do no harm and to monitor them should they develop things like heart involvement or worsening lung disease that would require treatment.

    Bill:  Is it fair to say, then, most people will live a normal life after being diagnosed?

    Dr. Vranic: I think that’s a very fair statement. I think that the vast majority of patients with sarcoid can and will live a normal life with their disease. It’s just that small subset of patients that develop that very severe pulmonary fibrosis or disease outside of the lungs that can often be quite sick.

    Bill:  Are there certain environmental conditions that exacerbate it? I happen to have a nephew that has this and cold weather makes it worse for him. Is it true that where you live can make a difference in this?

    Dr. Vranic:  In general, no, environmental factors don’t play much of a role in sarcoid. Some people with sarcoid will actually have involvement of their airways as opposed to the lung tissue, the lung parenchyma itself. In those patients, they can often have what acts like asthma almost. In those patients, changes in the weather and things like that do make their symptoms worse. They have more of a cough and perhaps more shortness of breath as well.

    Bill:  Who is more susceptible to get this? Is it anyone or a certain type of person that would have a higher incidence to get this?

    Dr. Vranic:  Absolutely. That’s a great question. In general, this is a disease of younger people. Most of the time it comes to light usually between the ages of 20-40. It affects younger people, not older people. It is more common in African-Americans than in whites or Caucasians and a little bit more common in women as opposed to men.

    Bill:  Okay. Interesting. Dr. Vranic, thank you so much for being on with us today. Last question. Why should someone come to UVA Pulmonary and Respiratory for treatment?

    Dr. Vranic:  We actually have a clinic at UVA specifically tailored to patients with diseases like sarcoid called “The Interstitial Lung Disease Clinic”. Sarcoid, like so many of these lung diseases, is pretty rare and it is often complicated and it is a disease that many pulmonary physicians don’t see on a regular basis. I think there is a lot of evidence out there, the best example being something like cystic fibrosis, that when you have a really complex illness, you want to see a group of physicians that focus on just that one disease and take care of only these patients on a daily basis. By doing so day in and day out, they get to be truly experts of managing that disease. I think that they have better outcomes. There are currently three of us in the ILD clinic at UVA--Dr. Borna Mehrad, Dr. Diane Gomez and myself--that focus just on these diseases – these interstitial lung diseases like sarcoid. We really enjoy taking care of patients with those diseases. We really enjoy treating them. I think that’s my reason.

    Bill:  Absolutely. We’ve been talking with Dr. Andrew Vranic a UVA specialist in pulmonology. Thank you so much again for your time today. Very interesting. For more information please visit UVAHealth.com. That’s UVAHealth.Com. I’m Bill Claproth in for Melanie Cole and this is UVA Health Systems Radio. Thanks for listening. 

     
  • Length (mins): 10
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  • Hosts: Melanie Cole, MS
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David Cole Mon, 14 Dec 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/29986-how-can-sarcoidosis-be-treated
Should I Be Screened for Lung Cancer? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=29985-should-i-be-screened-for-lung-cancer should-i-be-screened-for-lung-cancerWhich groups of patients may benefit from a lung cancer screening?

When should lung cancer screening be considered?

Learn more from Howard Malpass, a UVA specialist in pulmonology.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1547vh5c.mp3
  • Location: Null
  • Doctors: Malpass, Howard
  • Featured Speaker: Howard Malpass, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Howard Malpass is a board-certified physician in pulmonary medicine and critical care medicine whose specialties include lung screenings.

    Learn more about Dr. Howard Malpass

    Learn more about UVA Pulmonary & Respiratory Care
  • Transcription: Melanie Cole (Host):  Should you consider lung cancer screening? And, what’s involved? My guest today is Dr. Charles Malpass. He is a board certified physician in pulmonary medicine and critical care medicine whose specialties include lung screenings. Welcome to the show, Dr. Malpass. Have there been any recent changes to the screening criteria and what exactly is cancer screening?

    Dr. Charles Malpass (Guest):  Absolutely. A large part of this is based upon a publication from 2011 in the New England Journal of Medicine. It actually showed that we can save lives by doing a low dose lung cancer screening CT scan of the chest. There are three societies that have weighed in on what is the target population for lung cancer screening. But, the big piece to know is that at age 55-75, someone who has smoked for greater than 30-pack years. To do the calculation, if you smoked one pack of cigarettes for one year, that’s a one-pack year, so 30-pack years in total. Or, if you were, let’s say two packs a day. That’s only 15 years of smoking. And, the person who is a current smoker or has stopped smoking in the past 15 years has really been our target population for lung cancer screening.

    Melanie:  What’s involved in the screening? Is this a complicated thing?

    Dr. Malpass:  No. It’s very simple. It’s a low dose CT scan of the chest. This is a radiation exposure comparable to a mammogram or, basically, a few chest x-rays. There are no IVs. There are no medicines given to you for that and it only takes a few minutes in the CT scanner to obtain the study.  

    Melanie:  If people have been 30-year pack smokers, or 15, or even a half a pack a day, are they somebody who should get screened? Who do they talk to, first of all? And is this something that insurance will recognize?

    Dr. Malpass:  Absolutely great questions. Really, what was done with the study and what we are doing now to try to mirror the findings and the work process of the study is trying to capture that highest risk population which would include people that had recently quit smoking within the past 15 years and who have had a large exposure with that 30-pack year history. We do not know the answer to the question of if you’ve smoked for a 15-pack year history, is this a beneficial screening study for you? That answer is just not known and has not been studied yet. We chose the highest risk population to say, “Could we exert a benefit for these patients with that?” We just don’t know that second question yet.

    Melanie:  If somebody does get screened, what are you looking for in that screening?

    Dr. Malpass:  What we’ve done here at UVA is had the radiologists pattern their practice of reviewing the CT scan in identifying small nodules. What we want to do is be able to find lung cancer early so that we can enact change upon it, mostly through surgical methods of curative intent.  The problem with lung cancer is the lung does not sense pain itself. So, by the time someone develops symptoms associated with their lung cancer often it’s too late. We can’t make huge differences in their care as far as complete removal of that lung cancer. If we find it early, we really can embark on improving their mortality and also markedly improve it there. What we want to do is be able to find small nodules in the earliest stage of lung cancer in the lung itself.  

    Melanie:  Dr. Malpass, we use the word “screening”, so it’s not a diagnostic test. Is this something that goes on a permanent record because people hesitate to go in to have something that they think is going to follow them.

    Dr. Malpass:  It is a study that the results of will be in your medical record. Though and I completely agree that it is not a definitive test in that you can identify a nodule of the lung, but it really takes following that nodule over time and/or a diagnostic procedure of sampling that nodule to be able to say what it is from. If we look at our population as a whole here in central Virginia and across the eastern seaboard, there are a very large number of people who have never smoked and that are going to have lung nodules on their CT scan which should not affect their healthcare or their access to their healthcare and can be a very benign finding. With the screening CT scan, we often do find something and that’s why we want to target the highest risk population of those former smokers to be able to increase the probability of that being a possible cancer in our diagnostic procedures.

    Melanie:  What about the non-smokers? Can they get screened as well?

    Dr. Malpass:  At this time, I do not think it’s beneficial for those people to get a screening CT scan. Lung cancer does occur in the non-smoker, though to a much smaller extent in comparison to the smoker. It’s a balance of exposing those people to radiation that they don’t need to be exposed to. If we do find something, exposing those people to potentially the risk of a diagnostic procedure whether it be a biopsy or further radiation screening. We do not think that is immediately beneficial for those people in that screening process.

    Melanie:  Does insurance cover this particular screening?

    Dr. Malpass:  Good question. If done correctly and mirroring the trial that it was done where you have the discussion of the benefits of screening, the risks of screening, the radiation exposure, and also targeting the right population, if that’s done correctly in concert with a smoking cessation intervention, it should be covered most often by insurance providers in this process with the appropriate documentation.

    Melanie:  Are there any recent advances and exciting things that you want to quickly discuss in the field of lung cancer treatment? Things you want the listeners to know about what’s going on out there in the field of research?

    Dr. Malpass: Absolutely. What we’re trying to do on the pulmonary side, which often is on the front end and diagnostic end, identifying patients that do have lung cancer and appropriately getting them into oncological care and surgical care as appropriate, is that we have methods of minimally invasive methods of sampling the lung and identify what that process is. Here at University of Virginia, we offer bronchoscopic procedures that would facilitate a sampling of lymph nodes central into the chest which is a same day procedure and can be done under minimal sedation--the same sedation that would be done for a colonoscopy. We offer procedures where we can target legions from the inside bronchoscopically navigating through a CT scan. Also, on the radiology side, they offer comprehensive services as far as diagnosing from the outside and in biopsy via a CT scan, as well, too, abnormal legions. Additionally, and importantly, if it is a malignancy, targeting that person’s malignancy through genetic testing. We offer TruSight genetic screening panel which is done on all non-small cell lung cancers that are of adenocarcinoma and can really allow us to do some targeted new therapies which are exciting in practice.

    Melanie:  That’s absolutely fascinating. In just the last minute, Dr. Malpass, why should someone come to UVA Pulmonary and Respiratory for their treatment?

    Dr. Malpass:  Absolutely. I think we do an excellent job of coordinating our services. On a weekly basis, we meet as a group and allow close face-to-face communication of providers that are all helping take care of patients. So, if, unfortunately, someone does develop lung cancer, face-to-face I’m talking to surgeons that can potentially provide curative care. I’m talking to the oncologist. I’m talking to radiologists that are specialized in thoracic imaging. Additionally, I’m talking to radiation oncologists. Under one roof, you have specialists in all fields of medicine to compliment that care to try to get them early, aggressive care in treating their process.

    Melanie:  Thank you so much. You’re listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That’s UVAHealth.Com. This is Melanie Cole. Thanks so much for listening.  
     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Lung Cancer]]>
David Cole Mon, 07 Dec 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/29985-should-i-be-screened-for-lung-cancer
Treatment Options for Interstitial Lung Disease http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=29984-treatment-options-for-interstitial-lung-disease treatment-options-for-interstitial-lung-diseaseInterstitial lung disease causes scarring of the lungs and can be a lifelong, chronic health concern.

Learn more about the causes and potential treatments from Dr. Borna Mehrad, a UVA pulmonologist who specializes in lung disease.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1547vh5b.mp3
  • Location: Null
  • Doctors: Mehrad, Borna
  • Featured Speaker: Borna Mehrad, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Borna Mehrad is a board-certified physician in pulmonary medicine and critical care medicine whose specialties include interstitial lung disease.

    Learn more about Dr. Borna Mehrad

    Learn more about UVA Pulmonary & Respiratory Care
  • Transcription: Melanie Cole (Host):  Interstitial lung disease causes scarring of the lungs and can be a lifelong chronic health concern. My guest today is Dr. Borna Mehrad. He is a board certified physician in pulmonary medicine and critical care medicine whose specialties include interstitial lung disease. Welcome to the show, Dr. Mehrad. What is interstitial lung disease?

    Dr. Borna Mehrad (Guest):  Hello. Interstitial lung disease is really not one disease. The best way to describe it is as a category of illnesses. There are perhaps 200 illnesses that fall under this umbrella term interstitial lung disease. All of these, what they have in common is varies degrees of fibrosis, scarring and inflammation in the lungs. Because there are a large number of illnesses that fall into this category, it is very important to identify which specific one a patient has because the treatment and outcome and so on of the illnesses are quite different.

    Melanie:  What are some of the risk factors and symptoms and potential causes of these diseases?

    Dr. Mehrad:  The most common, or the one that has the most press, is an illness called “idiopathic pulmonary fibrosis”. IPF is an illness of unknown cause that results in scarring of the lungs. Smokers are overrepresented in patients with idiopathic pulmonary fibrosis. There is often a remote history of smoking. In addition, there are also increasing numbers of genetic conditions that are being discovered with patients with idiopathic pulmonary fibrosis. However, many patients that are labeled as idiopathic pulmonary fibrosis--in other words, they are labeled as this person has pulmonary fibrosis and we don’t know the cause--once you look into the illness in a lot of detail and assess it, you find an identifiable cause for the interstitial lung disease.  I’ll give you some examples of that. There is a condition called “hypersensitivity pneumonitis”. That’s a mouthful. This is a condition where the body’s immune system that is meant to be fighting off infection makes an error and attacks inhaled substances that it should be ignoring. As a byproduct of this attack, it results in inflammation and scarring of the lung. This is very common in our practice. We see people who have had exposures – even low level exposures to things like mold in their environment or agricultural environments or pet birds – and, as a result of this, they develop lung inflammation and scarring that is often mistaken for idiopathic pulmonary fibrosis. This is a really important distinction, though, because both the outcome and the treatment for hypersensitivity pneumonitis and IPF are very different. Another example of an interstitial lung disease that can be mistaken for IPF are autoimmune diseases. The most famous of these are illnesses like lupus and rheumatoid arthritis. These are illnesses where the immune system actually attacks parts of the body by mistake. These illnesses can affect many organs in the body but almost all of them affect the lungs. In our practice, we often see patients whose lung symptoms predominate over their other problems. They may or may not have skin problems or joint problems but when they are really short of breath and progressively short of breath, that’s the thing that brings them to the doctor. When we look at it in detail, we find that, in fact, instead of having IPF, they have one of these autoimmune diseases. Again, the illnesses, treatment and prognosis are very different and really quite better than IPF.

    Melanie:  What symptoms would someone notice? People cough or they think it’s bronchitis. These symptoms can be nonspecific. What would send them to see you?

    Dr. Mehrad:  The lung only has one of a few ways in letting you know that something is wrong. The most common complaint is progressive shortness of breath. The person has shortness of breath. They notice that in carrying the groceries in from the car or going up a flight of stairs, they get more short of breath then they used to be. This is something that slowly progresses over time. Now, compared to six months ago compared to a year ago, they’re more short of breath. As you said, cough is also a symptom, although this shortness of breath is the most common thing that we see. Most patients who have shortness of breath in this way, initially go to their general doctor and often they get a chest x-ray and so on. Often patients with interstitial lung disease are initially thought to have something else. It’s not rare for our patients to have initially been treated for other more common lung diseases, such as asthma or COPD. After some period of time, when their symptoms don’t resolve, often months pass and then, eventually, they get referred on when the diagnosis is made.

    Melanie:  What are some treatment options that are available - medication, oxygen, therapy? Do we do pulmonary rehab using spirometer? What do they do for interstitial lung disease?

    Dr. Mehrad:  The first thing when we see a patient with interstitial lung disease is, we want to really work hard to identify the cause. Part of identifying the cause we do, as you said, spirometry depending on the severity of the illness, CT scan, and a bunch of blood tests. Depending on what we find, that guides further workup as to the cause, as to the underlying etiology. Your question is about treatment. A couple of things in pulmonary medicine have been clearly shown to prolong life in people with significant lung disease regardless of the actual cause of the lung disease. The first is, anybody who smokes has to stop smoking. Stopping smoking definitely prolongs life. The second is that we want to make sure that people are up to date on their vaccinations because people who have severe lung disease are more predisposed to more severe respiratory infections and if they get them they will do badly. We want to make sure that we reduce the likelihood to ensure that they have had their flu and pneumonia shots. The third issue, which is a very important issue is oxygen. In people, basically the way we measure oxygen is using a machine called a “pulse oximeter”. This measures oxygen as a percent saturation of hemoglobin. A normal saturation is about 95%. Expert data shows the longer a person spends below the threshold of 88%, the shorter the time they are going to live. So, we want to make sure that we give patients that have below 88%, however much oxygen they need to make them stay above 88% the whole time. These are generic treatments not specific to interstitial lung disease but they are extremely important treatments because they prolong life. Depending on the specific cause of the illness – what is the cause of their interstitial lung disease – we want to attack the underlying process. That depends, as I say, very much on what they have. For many of these illnesses, the high percentage of pneumonitis that I mentioned, for example, identifying the environmental exposure that caused the illness is very important. So, you want to avoid that. For these immunological illnesses such as autoimmune diseases and hypersensitivity pneumonitis, immune weakening medicines often have a role. And, most importantly, in the past year, two new drugs were approved by the FDA for the treatment of idiopathic pulmonary fibrosis. These drugs really transformed the landscape of how these patients are treated. University of Virginia was the center for testing one of these drugs – Pirfenidone. In the appropriate person--in the person who has idiopathic pulmonary fibrosis and not one of these other etiologies--treating the underlying disease with one of these drugs is an excellent choice because it slows the progression of the illness.

    Melanie:  In just the last minute, Dr. Mehrad, why should someone come to UVA Pulmonary and Respiratory for their treatment and your best advice for someone who is suffering from lung disease?

    Dr. Mehrad:  What we offer is real world experience. These illnesses are not a common part of the practice of a general primary doctor, even an excellent primary doctor.  We have three physicians that all we do is see people with interstitial lung disease. Our volume of patients is very large and, necessarily, our experience in dealing with them is very large. The second reason is we have a multidisciplinary team of lung doctors, radiologists, pathologists, and a number of ancillary services that we put our heads together and provide the best information about what the person has to try to help them. Lastly, research. We are a center for research in these diseases trying to find new treatments to try to help patients. Patients have the opportunity to get enrolled in clinic trials contributing new knowledge about their illness.

    Melanie:  Thank you. It’s such great and very important information. You’re listening to UVA Health Systems Radio. For more information you can go to UVAHealth.com. That’s UVAHealth.Com. This is Melanie Cole. Thanks so much for listening.  

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
]]>
David Cole Mon, 30 Nov 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/29984-treatment-options-for-interstitial-lung-disease
“Jersey Finger” – A Common Injury for Athletes http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=29983-jersey-finger-a-common-injury-for-athletes jersey-finger-a-common-injury-for-athletesWhile playing sports such as basketball or soccer, it’s easy to snag a finger on an opponent’s jersey and suffer an injury.

Do you need ice or to see a doctor?

Learn more from Dr. Bobby Chhabra, a UVA specialist in hand surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1547vh5a.mp3
  • Location: Null
  • Doctors: Chhabra, Bobby
  • Featured Speaker: Bobby Chhabra, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Bobby Chhabra is Chair of UVA’s Department of Orthopedic Surgery and a board-certified orthopedic surgeon. His specialties include hand, wrist, and elbow trauma and arthritis, with a particular interest in athletic injuries and congenital hand surgery.

    Learn more about Dr. Bobby Chhabra

    Learn more about UVA Orthopedics
  • Transcription: Melanie Cole (Host):  While playing sports such as basketball or soccer, it’s easy to snag a finger on an opponent’s jersey and suffer an injury. Do you need ice or do you need to go to a doctor? My guest today is Dr. Bobby Chhabra. He’s chair of UVA’s Department of Orthopedic Surgery and is a board certified orthopedic surgeon. Welcome to the show, Dr. Chhabra. Explain the injury commonly referred to as “jersey finger.”

    Dr. Bobby Chhabra (Guest):  Thank you very much, Melanie. Jersey finger is a fairly uncommon injury, except in certain sports, particularly football or soccer, but mainly football. It’s when an individual player is trying to tackle another player and the finger gets caught on the jersey and then gets hyperextended at the most distal joint. The finger, while they are gripping, gets forcibly hyperextended while they are trying to make a tackle. What ends up happening is, the tendon that inserts on the bone, the most distal bone in the finger, gets ruptured off of the bone so you lose flexor tendon function. It’s fairly common in football players.   

    Melanie:  Are there certain positions that are more susceptible to this than others?

    Dr. Chhabra:  Really, any time someone is trying to make a tackle. So, really any of the defensive players would be susceptible to this and the ring finger is the most common. It’s felt that it’s the finger that is needed the most for forced grip and it’s the one that is injured most frequently. Often people just think they’ve sprained their joint and it will get better on its own. It often takes a while before they realize that they cannot make a full fist and they can’t bend that last joint of the finger.   

    Melanie:  That was my next question – symptoms. Maybe it gets caught, maybe they keep playing and then it’s sore--really sore. What are some of the symptoms that people would notice that would send them to see a doctor instead of just using ice?

    Dr. Chhabra:  A very good question because you’re right. Frequently, these players will keep playing. They think they’ve just jammed their finger or sprained their finger which are very common injuries. Later on, after the game, after the adrenaline has worn off, they’ll notice that they’re sore. They may have some swelling and then ecchymosis, or black and blue around the distal fingertip and tenderness along the palm side of the finger where their tendon had been pulled off the bone. So, they would be tender along the course of the finger and when they try to make a fist, they’ll be able to bend the joint closer to the palm but they won’t be able to bend the furthest joint from the palm. They may not notice that they can’t do that for some time. They think that they are just sore but if they are having persistent swelling and pain along the flexor tendon there and they notice they have the inability to make a full fist, it’s important--it’s imperative--that they see a hand surgeon, truly. These are injuries that are not handled by general orthopedic surgeons or primary care physicians. These jersey fingers always require surgery in the young athletic individual. Normally, these injuries occur only in the young athletes. 

    Melanie:  Tell us a little bit, quickly, about hand surgeons and orthopedic surgeons. Are hand surgeons also orthopods and vice versa?

    Dr. Chhabra:  That’s a very good question and it’s not a straightforward answer. Hand surgery or hand, wrist and elbow surgery is a subspecialty and requires fellowship training after you’ve completed either a full orthopedic surgery training residency program or a plastic surgery training residency program. About 85-90% of hand surgeons in this country have completed an orthopedic surgery training program first and they are board certified in orthopedic surgery and they have also done an additional year of training in hand surgery which often includes hand, wrist and elbow surgery. The Hand Society has a certificate of added qualification or a subspecialty certification which, once you have completed your hand fellowship, you can take an exam and have your practice reviewed and be board certified in hand surgery as well. So, for instance, I’m board certified in orthopedic surgery and board certified in hand and upper extremity surgery.

    Melanie:  Thank you for clearing that up for us, Dr. Chhabra. If someone has jersey finger, do you recommend that they ice while they see the doctor while they are going through whatever treatment you have decided – we’ll speak about treatments - but is ice something that is going to be the first line of defense?  Something you want them to do right away?

    Dr. Chhabra:  Frequently, they may not know the severity of their injury, so ice always helps when you’ve jammed the finger or when you feel like you have injured a joint. Ice will help initially to keep the swelling down and resting that joint so you don’t aggravate symptoms will be important as well for a first line of treatment. But, ultimately, and particularly for jersey finger--and I know we’ll discuss this in just a minute—but, these require more significant treatment options than just rest and ice.  

    Melanie:  So, let’s discuss those treatment options. What do you do for it?

    Dr. Chhabra:  The one thing that’s very important is, it needs to be diagnosed early because, frequently, the tendon gets ripped off the bone and because there is tension on the tendon because the muscles are in the forearm, the tendon is going to pull back. If it pulls back into the palm, then you have a limited time window to fix that. Really, within seven to ten days that should be surgically repaired. So, the tendon is actually retrieved from the palm and attached back to the bone with various techniques and then requires a very involved therapy program that will last about three months. So, return to full activity will not be sooner than three to four months after an injury like this, if it needs surgical repair. Sometimes the tendon doesn’t pull back or retract back that far and maybe you can wait a little bit longer–a couple of weeks--to have it fixed. But, it is imperative that you are seen soon by a hand surgeon – these injuries are fixed by hand surgeons and those who are certified in hand surgery – because they require various techniques. There is a high rate of stiffness if appropriate therapy is not done. When the results aren’t what you desire after treatment, sometimes a second surgery is needed to relieve scar tissue to allow the tendon to glide so that the full range of motion can be obtained.

    Melanie:  Are you splinted after surgery?

    Dr. Chhabra: Yes, you are splinted in a splint initially and therapy starts usually three to five days after the surgery and you do what is called “passive motion” for a while in most scenarios where you don’t actively move that finger but you use your other hand to bend the tip so the tendon glides a little bit. But, you can’t do active motion right away because you need the tendon to heal and if you put too much stress on the tendon it will just rip off the bone again while it’s healing. Usually, more aggressive therapy doesn’t start until about four weeks and you’re splinted for almost six weeks after this injury. You’re wearing a splint to protect that tendon repair.

    Melanie:  Dr. Chhabra, it’s absolutely fascinating information and you’re so well spoken. In just the last few minutes, please give your best advice for people that think that they may have suffered jersey finger or who want to prevent it and why they should come to UVA Orthopedics for their treatment.

    Dr. Chhabra:  Thank you, Melanie. If you’ve injured a finger, the first thing to know is whether you have full motion of that finger. You are going to be stiff and swollen, so it will be hard to make a full fist and to move every joint. But, you should be able to move it once your swelling is better, and you have some ice and it is calmed down a little bit--maybe some anti-inflammatory medication – ibuprofen, Aleve, if you can take that. You should know within a day or two whether you can move every joint. If for some reason, you can’t move the joint, you should be concerned for either a fracture in the finger or a tendon injury. That’s when you should see a hand surgeon soon. If there is any suspicion that you have a tendon injury, then you should see your local hand surgeon soon. As I mentioned, some of these injuries are very time sensitive for surgery, so the sooner you get in the better because if you delay surgery for these injuries, particularly if the tendon is retracted back into the palm, if you wait two or three weeks to have it fixed, then there is a higher rate of stiffness and overall less than desirable outcome. If you can’t move all of your joints, if your pain persists for a couple of days, then you should see a hand surgeon very soon. As for UVA Orthopedics, I’m fortunate to work in a department - I’ve spent my entire career there at UVA. We were just recently named one of the top 100 great orthopedic programs by Becker’s Hospital Review. We’re fortunate in that we have every specialty represented. We have joint surgeons, hand surgeons, joint replacement surgeons, sport surgeons, spine surgeons. I work at the UVA Hand Center which has six specialty-trained hand surgeons. We have experts in every field of orthopedics that can provide the highest level of care. I am also thankful that we were recognized by the Women’s Choice Award recently for the National Patient Satisfaction Award. So, I feel you’ll get great comprehensive care at UVA Orthopedics. You’ll have specialists who are fellowship trained in an individual joint or problem and you’ll have the best chance of having the best outcome.

    Melanie:  Thank you so much. You’re listening to UVA Health Systems Radio. For more information you can go to UVAHealth.com. That’s UVAHealth.Com. This is Melanie Cole. Thanks so much for listening.  


     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic]]>
David Cole Tue, 27 Oct 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/29983-jersey-finger-a-common-injury-for-athletes
Bone Fractures in Children http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=29611-bone-fractures-in-children bone-fractures-in-childrenWhen children are active, injuries are always possible, including bone fractures.

What are some of the most common fractures, and what steps can parents and kids take to reduce their risk?

And how is treating these fractures in children different than in adults?

Learn more from Dr. Leigh Ann Lather, a UVA specialist in pediatric orthopedics.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1543vh5c.mp3
  • Location: Null
  • Doctors: Lather, Leigh Ann
  • Featured Speaker: Dr. Leigh Ann Lather
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Leigh Ann Lather is board-certified in pediatrics and specializes in pediatric orthopedics, including bone fractures.

    Learn more about Dr. Leigh Ann Lather

    Learn more about UVA Orthopedics
  • Transcription: Melanie Cole (Host):  When children are active, injuries are always almost possible, including bone fractures. What are some of the most common fractures and what steps can parents and kids take to reduce this risk? My guest today is Dr. Leigh Ann Lather. She's board certified in pediatrics and specializes in pediatric orthopedics, including bone fractures. Welcome to the show, Dr. Lather. Tell us a little bit about the most common bone fracture that you see in kids.

    Dr. Leigh Ann Lather (Host):  Yes. Thank you. If you don't mind, first, if I can clarify that bone fractures are broken bones. It's amazing how many times we tell folks they have a fracture and they ask, "So, is it broken?" Yes, it's broken.

    Melanie:  Good point.

    Dr. Lather:   You can have small breaks or pretty bad breaks that might need surgery. They all hurt but the most common ones that we see in kids are usually involving the arms and the legs. So, with arms, we see a lot of elbow fractures, forearms, wrists and fingers, and then, the legs, knee, ankles and the shin bone and some femurs--the thigh bone.

    Melanie:   So then, tell us a little bit about what causes these injuries. If we’re talking, forearm and thigh area, what will generally predispose a child to having these kinds of injuries?

    Dr. Lather:  Well, I think there are a lot of things that parents can do to reduce their children’s’ risk of fractures. I like to think of it as a three-pronged attack:  good nutrition, plenty of exercise and god safety--avoiding unnecessary risks. So, as far nutrition goes kid s are growing fast and you want them to grow long strong that are more resistant to injury, then you need to make sure they are getting plenty of calcium and vitamin D every single day. Then, with exercise, kids should get at least 30 or 60 minutes of exercise a day Exercise build stronger bones. Our muscles are attached to our bones and as the muscles pull on the bone, the bone reacts by building more, stronger bone. So, exercise is also very important. Then, for the safety piece and avoiding unnecessary risks, kids are going to play and they are going to fall down. They are going to get injured. There are some things that we know are high risk. As far as different age groups go, toddlers tend to fall and one injury we see commonly that people are unaware of is foot entrapment on a slide. So, if you’re riding down a slide with your small child on your lap, please make sure to keep those feet tucked in. Elementary-aged kids turn to get hurt on the play ground. Playgrounds are great but the monkey bars are what cause most our arm injuries, especially about the elbow. So, if you’re at a playground with your kid and you’re on the monkey bars, consider just standing underneath them in case they fall .It's a long fall and they tend to land on the arm. Then, with older kids, we see mostly sports injuries--sports related injuries. So, I think it's important to avoid early specialization in one sport where we turn to see overuse injuries and avoid playing in multiple teams in one season and continue to cross-train around all different kinds of sports and activities. Then, the last high risk thing I should probably mention is trampolines and trampoline parks. Trampolines are great. They are great fun and exercise but we see most of the injuries in situations where there's more than one bouncer at a time on the trampoline. Usually, it's the smaller kids that get hurt.

    Melanie:  I'm sure that usually is. That's such good advice about risk assessment and where those injuries happen. Now, let's start with some sports injuries because parents tend to think, “Well, these kids are wearing pads. They’ve got helmets on. The coach knows what they are doing. Especially in contact sports, or even in lateral movement sports, where, you know, just one little movement. So, you spoke about  sports specific training, overuse injuries, overtraining, but were broken bones are concerned, does that equipment that they are using protect them or is that pretty much a myth for parents?

    Dr. Lather:  I think there is some equipment that is protective. Certainly, the helmet is important for football and then, for skiing and sports were you’re riding a motorized vehicle, it's very important to wear the protective equipment but it doesn't prevent all bone fractures. If you get hit hard, you’re going to get hurt. So, sometimes it will tend to give kids an inflated sense of protection and they are likely to hit each other harder on the football field because they think they are protected. They tend to have that Superman complex anyway, where they feel like they will never get hurt.

    Melanie:  Yes, they do. They certainly do. Now, when we are talking abbot bone fractures and broken bones, if a parent has a child with a broken bone, you call 911 right away. We've heard stories of bones sticking out and all of these things with kids. What do you do for them? What's the first line of defense when you know there is a broken bone and then, what are the risks that a child is going to have some sort of aftereffects from it?

    Dr. Lather:   Right. Well, I think the first thing to do when your child gets hurt is to take a deep breath. Yes, sometimes there are bad broken bones, where it's obviously an emergency but most injuries not that bad, fortunately. So, the best thing to do immediately is to have the child rest that body part. Don't use it; don't walk on it. You can apply ice. You can wrap it for compression to decrease swelling and you can elevate that body part higher than heart. The sooner you do these things, the better off they are going to be. It makes a huge difference in healing if you immediately respond that way.

     Melanie:  So then, what do you do? You set that bone back. You get it ready because kids’ bones are in ossification and they’re growing. Is this something that can just takes time and it will heal once you've set it?

    Dr. Lather:   Yes. I think it's really important when your kid gets hurt to look at the injury. If there is any deformity; if there are cuts in the skin; if there's exposed bones; if the hand or foot feel cold distal to the injury, that child needs to go to an emergency department. That's truly an urgent or emergent situation. But, if none of those things are the case, make a child comfortable, use the ice, give them ibuprofen, wrap it, elevate it and you really don't need to pay for urgent or emergent care. If you think they need pre-medication above and beyond Ibuprofen or Tylenol, then you may need to seek care more urgently so that you can get good pain medicine. If that’s not the case, you really can keep your child comfortable and call your regular doctor’s office during office hours, tell them exactly what happened. Tell them you suspect a broken bone, even if it's not badly broken and they may send you directly to an imaging center or you can ask for a referral to an orthopedics office where you are likely to get the most efficient care.

    Melanie:  One thing I want to make sure to mention, Dr. Lather, is so many of these kids are using skateboards and scooters and things and they fall, and, as you mentioned, forearms and wrists, what can we do in those situations as parents, to say, “Let’s reduce that risk,” because they flip over these things all the time.

    Dr. Lather:  I know and I think that's just going to happen and a certain number of injuries are just going to happen when you let tour kids be active. It's important to let them be kids. They can wear elbow guards and wrist guards but sometimes they are going to get injured anyway and, you know, we are fortunate here at UVA that we have pediatrics orthopedic specialists and sports specialists. Kids have unique types of injuries. They may involve the growth plates and so, I think it is lucky that we can take our kids to place with knowledgeable, specialized care. Kids often need half the time in a cast than an adult would need and they are much less likely to need surgery. So, if you go to a pediatric orthopedist, I think you are going to get the most appropriate advice as far as treatment needed, whether it’s a splint, brace, cast or even surgery. You’re going to get the best advice about return to play for sports. Sometimes, if you go to a doctor who doesn't see a lot of trauma, you may be held out too long or sent back into you sport too soon before you’re really healed.

     Melanie:  In just the last minute or so, why should families come to UVA orthopedics to get treatment for children sports injuries?

    Dr. Lather:  I think for all the reasons that I just mentioned, it's good to go to a place where you’re going to get specialized care. We have people in the office all day, every day. We can fit people in on an urgent basis if they have injuries and we've got a specialized team of staff and nurses that treat kids all the time. So, it's like going to your pediatrician’s office where they know how to deal with children of all ages and talk to kids of all ages. It's just that we happen to do all orthopedics but it is a pediatric office. It's set up to make it easier for kids with televisions to distract them while they are getting their casts and colorful casts and waterproof casts. Then, we have physicians in the office who are there all the time. We also have two surgeons who can respond if an injury needs that kind of care.

    Melanie:  Thank you so much. It's great information. You’re listening to UVA Health Systems Radio. For more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health, Bone Health]]>
David Cole Tue, 20 Oct 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/29611-bone-fractures-in-children
Options for Treating Spinal Cord Injuries http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=29610-options-for-treating-spinal-cord-injuries options-for-treating-spinal-cord-injuriesSpinal cord injuries often profoundly affect a patient’s life.

What treatment options are available for these serious injuries?

Learn more from Dr. Dennis Vollmer, a UVA specialist in spinal surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1543vh5b.mp3
  • Location: Null
  • Doctors: Vollmer, Dennis
  • Featured Speaker: Dennis Vollmer, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Dennis Vollmer is a board-certified neurosurgeon who specializes in spinal surgery.

    Learn more about Dr. Dennis Vollmer

    Learn more about UVA Neurosciences Center
  • Transcription: Melanie Cole (Host):   Spinal cord injuries often profoundly affect a patient's life. What treatment options are available for these very serious injuries? My guest today is Dr. Dennis Vollmer. He's a board certified neurosurgeon who specializes in spinal surgery. Welcome to the show, Dr. Vollmer. First, tell us, what are some of the most common causes of spinal cord injuries?

    Dr. Dennis Vollmer (Guest):   Well, in general, the most common cause of spinal cord injury is motor vehicle accidents. But, in certain age groups, particularly the elderly, falls then become a very common cause. Less common things that people need to at least be aware of are injury mechanisms like diving into shallow water and also certain athletic events carry some risk of spinal injury. Things like skiing and some competitive sports, one needs to be coached in the proper techniques to avoid these risks.

    Melanie:   So, what can people do to avoid those risks? If you're going to go skiing, would a helmet keep you from getting a spinal cord injury? Does a seatbelt help in a car? Tell us about any way that we can, that would give people a little bit of prevention advice.

    Dr. Vollmer:   Well, you know, some injuries are just not entirely preventable but certainly safe defensive driving practices are a good place to start in the car, wearing your seatbelt, making sure your car is in good operating condition so that the tires have adequate treads. All of these kinds of things can reduce your likelihood in being involved in a serious accident where you can sustain a spinal cord injury. Now, when it comes to falls, that's a very common area where simple adjustments in how one lives their life can reduce their risk. In the elderly, often falls are caused by environmental hazards:  loose rugs, slippery surfaces, poor shoes, and also things like impaired vision. So, making sure your vision care is up to date so you can see the hazards. Poor lighting is another issue. So, there are many things that elderly folks can do to reduce their own fall risk and if there are questions or they've fallen before, they should really get with their physician to make an assessment of how this could be prevented.

    Melanie:  People hear the word spinal cord injury and right away they think “paralysis”. Does it always lead to paralysis? And, please explain those types--paraplegia and quadriplegia--so people have a better understanding.

    Dr. Vollmer:  So, to answer the first question, spinal cord injury is a continuum. Unfortunately, the margin between a partial injury to the spinal cord and a complete injury is relatively narrow. But that being said, many patients come to medical attention after an injury with residual function and that's a world better situation when it comes to the likelihood of some return of function. The term quadriplegia, quadriplegia literally means paralysis of all four limbs. Paraplegia refers to paralysis of the lower extremities and that has more to do with the level of injury, in other words, a quadriplegia relates to injuries of the cervical spinal cord in the neck versus paraplegia where it's generally something that occurs below the nervous outflow to the arms and affects the legs primarily. Of course, in both instances, bowel and bladder function can also be affected, so these are very devastating injuries.

    Melanie:  Are there treatment options available? Because nerves take so long to heal, in the case of a spinal cord injury, do they heal or is this something permanent?

    Dr. Vollmer:  Well, nerves do have some capacity to heal. If somebody has a complete injury with complete loss of function below the injury, generally the prognosis is quite poor. People who have residual function across the injury site do have the potential to recover. In many respects, once the injury has occurred, certain things cannot be recovered. Our focus in the health care system is to optimize the situation and prevent what we call “secondary injury.” That is injury that can occur because of associated problems. For instance, somebody who is involved in a motor vehicle accident may injure their spine and thereby their spinal cord but can also have problems with a lung injury or other types of trauma that an effect their ability to recover from the spinal cord injury. So, a comprehensive approach has to be taken in that patient to address all of these other associated injuries to minimize their effect on the healing spinal cord.

    Melanie:  So, speak about treatment options and even therapy afterward to resume some sort of normalcy in life.

    Dr. Vollmer:  The treatment options, initially, when someone presents with a spinal cord injury, unfortunately, there is no silver bullet to reverse many effects of the injury. Our goals in many patients are to repair the associated spinal damage to prevent further injuries:  stabilize the spine, realign the spine, and protect the cord in that respect. In some cases, the cord can be decompressed and this can help, but it doesn't necessarily reverse things. There are clinical trials that are ongoing. We're participants in a large multi-center trial here at UVA of some promising investigational drugs to try and reverse some of the effects or prevent secondary injury. But, again, these are really investigations. We are optimistic but the data is still pending as to how effective these things will be. Some of the treatments really are directed at optimizing function in the context of some irreversible or only partially reversible injury. That's where comprehensive rehabilitation efforts come into play. At UVA, we have people who specialize in physical medicine and rehab of the patient with spinal cord injury. These physicians and specialists will work with patients to teach them how to function in the context of some deficit, whether it's some weakness or numbness or an increase in muscle tone that sometimes occurs that we call “spasticity”. All of these things can limit mobility and function and then, we have ways, both physical modalities of treatment as well as drug therapies, that help with that.

    Melanie:  Dr. Vollmer, what do you want the loved ones of those who have suffered a spinal cord injury to know? What do you tell them, generally?

    Dr. Vollmer:  Well, I try and tell them that a spinal cord injury, that while it may initially appear devastating, may not preclude that person from living a very satisfying, rewarding life. I've worked with patients who've had severe, complete cervical cord injuries that have gone on to get married, raise a family, hold a full time job and even drive a vehicle. So, these injuries, while they're quite devastating, and, especially to the families who love these individuals, they're not the end of hope. Many times, there is improvement as well. So, if the patient is cared for, optimally, there can be recovery, particularly with incomplete injury. When the injury is incomplete, we certainly have a high degree of optimism that we're going to see improvements.

    Melanie:  In just the last minute, why should patients come to the UVA Neuroscience Center for their care for their spinal cord injuries?

    Dr. Vollmer:  Well, of course, many times these things happen suddenly and patients don't have a lot of time to weigh their options. Many times, there aren't options. You need to get them into care as soon as possible. The thing about UVA is that it has a broad range of surgical and medical specialists who are available to provide really comprehensive care for patients who have suffered these unfortunate injuries. Much of the optimization of care really goes beyond what we do in the spinal surgery realm and includes people like respiratory therapists, pulmonologists, cardiologists, intensive care physicians and a whole range of others. Those kinds of teams of expertise are not available just anywhere and that's why I think UVA stands out, certainly in our region, as a leader in this kind of care.

    Melanie:  Thank you so much, Dr. Vollmer. That's great information and I applaud all the great work that you do. You're listening to UVA Health Systems Radio. For more information you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Bone Health]]>
David Cole Tue, 13 Oct 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/29610-options-for-treating-spinal-cord-injuries
Identifying and Treating Chronic Total Occlusion http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=29609-identifying-and-treating-chronic-total-occlusion identifying-and-treating-chronic-total-occlusionChronic total occlusion is a potentially serious heart condition that sometimes has no symptoms.

Learn more about the risk factors for chronic total occlusion and the available treatments from Dr. Michael Ragosta, a UVA specialist in chronic total occlusion and coronary artery disease.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1543vh5a.mp3
  • Location: Null
  • Doctors: Ragosta, Michael
  • Featured Speaker: Michael Ragosta, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Michael Ragosta is board-certified in cardiovascular disease and interventional cardiology; his specialties include coronary artery disease and chronic total occlusion.

    Learn more about Dr. Michael Ragosta

    Learn more about UVA Heart & Vascular Center
  • Transcription: Melanie Cole (Host):  Chronic total occlusion is a potentially serious heart condition that sometimes has no symptoms. My guest today is Dr. Michael Rogosta. He's board certified in cardiovascular disease and interventional cardiology. His specialties include coronary artery disease and chronic total occlusion. Welcome to the show, Dr. Rogosta. Let's start by telling the listeners a little bit about coronary artery disease and some of the things that go along with it.

    Dr. Michael Rogosta (Guest):  Thank you. Yes, as you know, coronary artery disease is a very common condition and, essentially, there's plaque in one or more of the coronary arteries. That plaque may obstruct or limit the blood flow in the coronary artery and that can cause symptoms such as chest pains, shortness of breath, fatigue and, of course, it can lead to heart attack and other more serious problems down the line.

    Melanie:  Are there certain risk factors for coronary artery disease as a whole? And then, we'll speak about chronic total occlusion.

    Dr. Rogosta:  Yes. So, you should first consider chronic total occlusion as a subset of coronary disease. That's the nature of it. It's a total occlusion of the artery instead of a narrowing to some percentage and it's been there for a long time. That's what is meant by chronic total occlusion. As a subset of coronary artery disease, it has the same risk factors as patients with other less severe forms of coronary artery disease. That includes high cholesterol, smoking history, diabetes, hypertension, and, of course, family history. So those are the important risk factors that lead to coronary artery disease.

    Melanie:  So, speak about chronic total occlusion as a subset of coronary artery disease. You mentioned symptoms – some of the symptoms you might experience – but often sometimes you don't experience these. How would you even know if you have coronary artery disease?

    Dr. Rogosta:  That's a great question and in a lot of people it is asymptomatic. For a lot of those folks it is asymptomatic because it's not causing a particular problem with the blood flow. So, it's a very prevalent condition but in a lot of folks who don't have symptoms and don't have any serious sequelae from the blockages, we just treat that medically with the goal to be to treat the risk factors that might lead to progression. So, it's really only when the disease becomes more severe and is obstructing blood flow and leading to some of the symptoms that we would then recommend more aggressive treatment which are the revascularization procedures such as stenting or coronary bypass surgery.

    Melanie:  And how is it diagnosed, Dr. Rogosta? Is this something you have to go in and have an angiogram to figure it out or can you tell by what they're experiencing?

    Dr. Rogosta:  Well, the symptoms would then lead you to probe more deeply. Usually, the first line of diagnosis is a stress test which shows you essentially the effect these blockages may have on the circulation of the heart in terms of how the heart is functioning or how the pattern of blood flow appears in an image that is done non-invasively. If that test comes back normal, then usually we treat that medically and, again, treat the risk factors of coronary disease. However, if the stress test does show evidence of lack of blood flow to the heart, then we would go to a more invasive approach like a coronary angiogram which is a type of cardiac catheterization procedure. That is considered the gold standard for diagnosing blockages in the coronaries because we can see the artery in fine detail and know exactly how blocked it is and that leads to how we would usually treat from the angiogram.

    Melanie:  So, speak about treatment then. What would be the first line of defense? If you've performed these exams and determined there's a total blockage, then what?

    Dr. Rogosta:  So, it depends on how severe the patient's symptoms are and how much it's affecting the blood flow to the heart. In some patients that have a chronically occluded artery, it leads to minimal or no symptoms and there's adequate blood flow to the heart because the heart actually creates what's called “collateral channels” which are essentially a rerouting of the circulation around the blockage. So your heart does that by itself. If that's adequate--in other words, if there's adequate blood flow to the heart through these collaterals, then we just treat the risk factors and treat medically those patients. However, if the symptoms are not controlled with medicines or there's really a large area of the heart muscle not getting blood flow during stress, then we would warrant more aggressive treatments. Chronic occlusions historically have been very difficult to treat with the catheter-based techniques like angioplasty and stenting. However, recently, in the last maybe 5-10 years, there have been great advances in the percutaneous treatment of chronic total occlusions that have led to greater successes. So, our success rate now is in the 80-90% range for a chronically occluded artery, to be able to open that using a catheter-based technique; whereas, historically, it was only in the 40-50% range.

    Melanie:  Isn't that amazing that the heart can actually make that collateral circulation? It always fascinates me. Now, what about after the procedure. What kind of lifestyle does that patient have afterward and what can they expect as far as their ability to exercise and conduct normal life?

    Dr. Rogosta:  Yes. If they were pretty symptomatic before the procedure and we're successful in restoring the blood flow, then usually we see a great improvement in their ability to exercise, in their exercise tolerance and in their symptom control. Many patients that we've been successful have had resolution of their angina, which is the chest pain syndrome that you typically get with a chronic total occlusion or their shortness of breath syndrome which also may be a manifestation of the chronic occlusion. So, usually, if they're very symptomatic they get a lot of symptom relief with this and are able to exercise more and then are able to do the more healthy things they need to do to maintain their health over a long time.

    Melanie:  What about it coming back? Does that happen in that area that you've cleared out? I mean, if there's a stent in there does that mean that it's not going to close up again?

    Dr. Rogosta:  No, unfortunately. Just like a stent placed for a less severe stenosis, the blockage can reoccur in the stent. Now, it is a different process. It tends to be scar tissue related rather than the atherosclerosis buildup that started the process in the first place. However, those can often be treated successfully with an additional procedure and, at the end of the day, if the stent procedures fail and they do occur, there's always the option of coronary bypass surgery which is also a treatment option for these patients if we aren't successful and are able to open their artery.

    Melanie:  In just the last few minutes, Dr. Rogosta, why should patients with chronic total occlusion come to UVA Heart and Vascular Center for their care?

    Dr. Rogosta:  Well, a couple of reasons. I think first, we have a really great team approach to patients with complex coronary disease and this would be a form of complex coronary disease. What I mean by that is, a lot of these patients are evaluated by the interventional cardiology group, which is the catheter-based techniques, but also by heart surgeons. We, together, decide what may be the best options for that patient. So, the team approach is very, very valuable at giving the patient the best care. In addition, we have a lot of interest in managing these types of complex diseases and have spent a lot of effort and time learning the special techniques that are needed to be successful and we really focus on this so our success rate is very high. So, for those reasons, that's a big advantage of coming to the University of Virginia.

    Melanie Cole: Sounds like a great multidisciplinary approach to helping those with vascular disease. Thank you so much, Dr. Rogosta. You're listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole, thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Tue, 06 Oct 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/29609-identifying-and-treating-chronic-total-occlusion
Preparing Your Child for Surgery http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=29200-preparing-your-child-for-surgery
What can parents do to help ease their child’s concerns?

Learn more from Kristina L. Berg, a child life specialist with UVA Children’s Hospital.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1538vh5b.mp3
  • Location: Null
  • Doctors: Berg, Kristina L.
  • Featured Speaker: Kristina L. Berg
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Kristina L. Berg is a child life specialist in pediatric hematology/oncology at UVA Children’s Hospital.

    Learn more about UVA Children’s Hospital
  • Transcription: Melanie Cole (Host):  Surgery or any other medical procedure can be so scary for both children and their parents. What can you do to ease your child's concerns? My guest today is Christina Berg. She's a child life specialist in pediatric hematology/oncology at UVA Children's Hospital. Welcome to the show, Christina. So, as a child life specialist what do you do to help children at UVA get ready for surgery or procedures?

    Christina Berg (Guest):  That's a great question. After assessing, the situation I always ask the child first to tell me in their own words what they know about their upcoming surgery.  I then ask if they would like to learn more about it. If they do, I explain what the surgery is for and how it's going to help them. I discuss the sequence of events and sensory experiences including things they might see, smell, taste and feel. Throughout preparation, I use visual teaching aids including pictures of what they'll see and actual medical equipment such as an anesthesia mask. I utilize medical play during preparation which allows additional insight into a child's understanding and fears of the procedure. This is a really great opportunity to address fears and their misconceptions. Finally, as a child life specialist, I plan and rehearse coping strategies with the child in order to give them a sense of mastery and control over their situation. These things include things like deep breathing, guided imagery, muscle relaxation or choice of their distraction.

    Melanie:  So, when a child asks you these questions and you say you give them sensory input on what they can expect to see and hear and smell. Do they express their concerns to you? Are you able to, Christina, help them with those fears as far as, “What if my parents aren't right there next to me?” How do you allay those fears?

    Christina:  That's a really great question. As a child life specialist, we always advocate for a parental present, and we get permission from the anesthesiologist. If not, we are actually able to go back into the OR with children and to provide that continued support and utilize those coping strategies that we planned. A really big question children ask is, “How is anesthesia going to make me feel? How do I fall asleep?” So, this is a great opportunity to utilize medical play with the anesthesia mask. We practice breathing through the anesthesia mask. We let them decorate their mask. We really kind of try to make it fun and relaxing for them during this kind of stressful time.

    Melanie:  That's so important and I would think one of the biggest questions children have is, "Will it hurt?" What do you say when they say that?

    Christina:  Well, as a child life specialist it's our job to be as honest as possible with them. So, if something is going to hurt we do say in a simple, friendly way, “It might feel uncomfortable. It might burn your skin, it might feel like your skin is tingly, you might feel sleepy.” We do let them know if something is going to be slightly painful, we do let them know. We never say, “No, it won't be painful if it could be.”

    Melanie:  So, that speaks to the trust issue with children where they're looking at you as a child life specialist and trusting you that the information you're giving them is really what's going to happen and their parents as well. Is there any feeling of mistrust where the kids really think that you guys are just telling them things to get them where they need to be?

    Christina:  With their goal for them not to feel that way and we always do relay the message to parents as well to try to keep them as honest as possible with their children. We explain the importance of this so that they do continue to build trust with their children and so, if they do have future procedures, the child knows that they can ask questions to their parents and they'll know that their parents are going to tell them the truth and they'll know what to expect.

    Melanie:  Now, for the parents:  what tips do you--when you're working with the parents on this too--what do you tell them about getting their children ready to even go to the hospital that day or the night before?

    Christina:  I always encourage parents to be as honest as possible with their children about what they are going to experience and use age appropriate language in their explanations and preparation. I encourage them to encourage their children to ask questions and make sure to keep the lines of communication open. Let them know that it's okay to ask questions. I remind them to try to remain calm. This is important because children really feed off of their parents' reactions and they can sense when their parent is anxious or stressed. It really does help when parents remain calm. I continue to encourage them to stay positive and provide reassurance that whatever feeling their child has, that those feelings are okay and give them opportunity to express those feelings.

    Melanie:  That's a huge point, Christina that children feed off their parents. And how can a parent not be nervous when they know that their child is going in for surgery? You work in pediatric hematology and oncology so you must see children with cancer and things. How do the parents maintain that sense of calm on the outside when inside they are really terrified?

    Christina:  You now, it is a very interesting topic because on one side, you want the parents to remain calm during stressful times, during procedures, but at the same time you're encouraging your child--you're trying to let your child know that, “If you feel scared, if you feel worried, that's okay, too.” So, there are times when parents say, "Well, I don't want to breakdown in front of my child. I don't want to cry around them." And sometimes you have to say, "Well you know, it's okay. That will let them know that it is okay to cry and it is okay to be upset if you're scared." But during really stressful times and procedures, I try to prepare parents as well. I let them know what their role is during that time for their child so they can be there to support them as best as they can.

    Melanie:  And in just the last few minutes, what's your best advice for parents who are considering having surgery or procedure for their child and why should families come to UVA Children's Hospital for their care?

    Christina:  I think my best advice would be to provide preparation for your child in advance and let them know what to expect and talk about some of those things, use those tips that I provided. I think families should come to UVA for their care for the great comfort and care that they receive throughout their stay.  Staff members as a whole really goes extra mile here to make sure children and their families are as comfortable as possible. 

    Melanie:  Thank you so much and I certainly applaud all the great work you do at UVA Children's. You're listening to UVA Health Systems Radio. For more information you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Tue, 29 Sep 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/29200-preparing-your-child-for-surgery
Car Seat Safety http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=29199-car-seat-safety car-seat-safetyHow long does your child need a child safety seat?

How can you be sure your child’s car seat is safely installed?

Learn more from Diamond Walton, an injury prevention specialist at UVA Health System.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1538vh5a.mp3
  • Location: Null
  • Doctors: Walton, Diamond
  • Featured Speaker: Diamond Walton
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Diamond Walton is an injury prevention coordinator in the trauma program at UVA Health System.

    Learn more about UVA Trauma Program
  • Transcription: Melanie Cole (Host):  How long does your child need a child safety seat and how can you be sure your child's car seat is safely installed? My guest today is Diamond Walton. She's an injury prevention coordinator in the Trauma Program at UVA Health System. Welcome to the show, Diamond. So, tell us a little bit about car seats safety. Who needs a car seat? And let's go from infancy up a little bit. Give your basic recommendations.

    Diamond Walton (Guest):  Yes, absolutely. All children ranging from newborns all the way up to around 7-8 years old should be in some type of a car safety seat. So, of course, as the child grows you want to graduate to different types of car safety seats but they all serve the same purpose--to ensure that the child remains secure in their seat and protected from injuring in case of a crash. So, once the child is tall enough to sit against the vehicle's back seat with their knees bent and comfortably over the edge of the seat, then they probably should be wearing the regular seat belts but until then they should be in a car safety seat.

    Melanie:  So, when we start with little infants, the day you leave the hospital, those little car seats that face backwards--the rear facing seats—

    Diamond:  Right.

    Melanie:  How long should babies be in them? And what if somebody is leaving a hospital and they can't afford a car safety seat?

    Diamond:  Yes, those are great questions. According to the National Highway Traffic Safety Administration, children should be in rear-facing car safety seats up until around the age of three. And then, they'll graduate to forward facing car safety seats until the age seven and then they can move on to booster seats up until they’re around the age of around 12. But all of this is very much dependent on the weight and the height of the child. So, it's important to look at the bottom of the car safety seat when you purchase it, to look at the appropriate weight and size of the infant that's supposed to be using that seat and then purchase your seat accordingly. But, if you aren't able to afford a car safety seat, there are a number of programs in communities, especially through Departments of Health who distribute free car safety seats for individuals who are eligible. You can also reach out to local organizations like churches or nonprofits who distribute them as well. 

    Melanie:  So, once your child is done with the rear facing and then you've turned them back around, should you be adding any of those little cushions on the seat belts to make it look more comfortable? Because parents look in their rear-view mirror and they say, “Oh, well, that looks like it's cutting into them,” and they add these little things. Tell us about that.

    Diamond:  Right. Unfortunately, that happens a lot and there are a lot of advertisements trying to push a lot of really cute toys for the children while they're in their car safety seat but it's really important to use a car safety seat as the manufacturer has intended because that's how the seat was tested during crash testing to ensure that it actually works. So, it's really important for parents and caregivers to use the seat without any kind of extra padding or extra things in the seat because the seat is safe as it is.

    Melanie:  And when do they get to move from the car seat to more of an adult car seat to the booster seat?

    Diamond:  Around seven years old. So, forward-facing, usually children, if the child is a little bit larger, around three years old, they can be in the forward0facing car seat until around seven years old. And then, they'll be in a booster seat. But they'll be able to wear just a normal seatbelt once they are around eight years old because that's usually around the age where the bones start rounding out around the hips and so the seatbelt will actually fit and stay on the hips and stay on the shoulder bones the way that it would on an adult.

    Melanie:  Now, you've mentioned eight years old. Does height has much to do with it? Height and/or weight? What if they are a tiny eight-year-old?

    Diamond:  Oh yes! If they are a tiny eight-year-old, then they should stay in a booster seat but if their feet can touch the ground and if their back can sit up against the back of the seat in the car, then they are at the appropriate height to wear just the regular seatbelt.

    Melanie:  And what about the front seat, Diamond? Because some parents like to put their kids in the front seat way too soon and the airbags are not really set for children, are they?

    Diamond:  No, not at all. It's very much recommended that if a child is in any type of car safety seat, whether that's rear facing or a booster seat, that they should be in the back seat. And it's also recommended that even once the child graduates to a regular seat belt, they should remain in the back seat until around 13 years old. Mostly because that's just the safest place for a child to be in the car.

    Melanie:  What advice do you give parents when they say, “My child is arguing with me? They say I'm too big to be in a booster seat,” but knowing that's much safer and that the lap belt--the seat belt—is not hitting them properly, what do you tell parents to tell their kids?

    Diamond:  I would definitely just remind them that they are doing this for their safety and that you are kind of setting an example also for their friends and for other parents as well. I think a lot of times whether parents make their child stay in their car safety seat while they are in their own car, they may not be as strict when their child is travelling with their grandparents or with a neighbor. And so, it's really important to keep that messaging consistent whether that's in your car, whether your child is riding with their grandparents or with a neighbor that a child should remain in a car safety seat until they are of the appropriate weight and height.

    Melanie:  And what about installing them correctly? Because they have a lot of latches these days especially for the infant car seats. Diamond, how do you that you are installing it properly and you're putting the belt through all the little latches it's supposed to go through?

    Diamond:  Yes, I mean, it's hard. A lot of times there are a lot of latches but it's important to read one, the manual for the car safety seat. They have a lot of great instructions, very specific to the car safety seat that you purchased, as well as your car manual, because cars are different makes and models and so the anchors for the car safety seats are in different places. So, make sure to read the safety seat manual as well as your car manual and to determine how to properly install it. But I would also recommend that parents and caregivers visit their local fire department, police department or health department because one of those local organizations will likely have a registered individual who knows how to properly install car seats and they don't necessarily need to install it for you but they can at least check to see if it's been installed correctly.

    Melanie:  That's exactly what I did. I went to the local fire department and they were happy to help me figure out how to put my car seat in when I had a new baby. It was so easy. How do you find out more about car safety seats?

    Diamond:  Well, the National Highway Traffic Safety Administration has a great website so, parents can visit www.safercar.org and you can click on “Parents Central” and it has just a myriad of resources for parents and caregivers.

    Melanie:  In just the last minute, Diamond, why should patients come to UVA for their trauma care?

    Diamond:  UVA Trauma Center has been designated as a Level One trauma center since the ‘80s and recently we have been verified by the American College of Surgeons as a Level One trauma center. So, this puts UVA as one of two other ACS verified Level One trauma centers in the state of Virginia. This is a big deal and what this means to the public is that UVA is committed to not only treating injured patients but preventing injury, providing the best care if the injury does occur and then ensuring that there is a quality rehabilitation so that patients can resume their lives.

    Melanie:  Thank you so much for such great and so important information. You're listening to UVA Health Systems Radio. And for more information you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole. Thanks so much for listening.

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Tue, 22 Sep 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/29199-car-seat-safety
What Are Thyroid Nodules? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=28904-what-are-thyroid-nodules what-are-thyroid-nodulesThyroid nodules are among the most common endocrinology conditions in the U.S. What are they, and what could they mean for your health?

Learn more from Dr. Katarina Topchyan, a UVA specialist in endocrinology.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1534vh5c.mp3
  • Location: Null
  • Doctors: Topchyan, Katarina
  • Featured Speaker: Katarina Topchyan, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Katarina Topchyan is board-certified in internal medicine and specializes in endocrinology, including thyroid conditions.

  • Transcription: Null
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Thyroid]]>
David Cole Tue, 15 Sep 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/28904-what-are-thyroid-nodules
What Are Aortic Dissections? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=28903-what-are-aortic-dissections what-are-aortic-dissectionsAortic dissections are a serious, potentially fatal condition affecting the aorta, a large blood vessel in your chest.

Learn more about the causes and treatments available from Dr. John Kern, a UVA thoracic surgeon who specializes in aortic dissections.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1534vh5b.mp3
  • Location: Null
  • Doctors: Kern, John
  • Featured Speaker: John Kern, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. John Kern is a board-certified thoracic and cardiac surgeon whose specialties include treating aortic dissections.

  • Transcription: Melanie Cole (Host):  Aortic dissections are a serious, potentially fatal condition affecting the aorta, a large blood vessel in your chest. My guest today is Dr. John Kern. He is a board certified thoracic and cardiac surgeon, whose speciality includes treating aortic dissections. Welcome to the show, Dr. Kern. What is an aortic dissection? It sounds to some listeners like a type of surgery but what it is really and what causes them?

    Dr. John Kern (Guest):   Well, thank you, Melanie. As you pointed out, an aortic dissection concerning to be a life threatening problem. If you think of the aortas, as you pointed out as the largest blood vessel in the body, as a hose that has three layers:  an inner layer, a middle layer and an outer layer. You imagine that the inner layer develops a crack in it and then the fluid in the hose; in this case, the blood, can get into that crack and dissect, hence the name dissection, dissect along the length of that hose. Fortunately, in the aorta, the outer layer contributes the most strength to the aorta. So, an aortic dissection can be immediately life-threatening but can very often be treated successfully.

    Melanie:  So, I'd like to start then with risk factors. Are there some certain risk factors that someone would have for aortic dissection?

    Dr. Kern:  Yes, certainly there are. In fact, aortic dissections occur most commonly in two periods of your life. In the earlier age populations, those folks in their twenties and thirties and then as we get older in our sixties and seventies. In the younger patients, those folks, their risk factors tend to be connective tissue disorders. So, patients with Marfan syndrome and other connective tissue disorders, which renders the aorta more susceptible to developing a dissection. In older patients, it tends to be a combination of uncontrolled blood pressure and enlarge aortas, so, if you have an aneurysm or if you have a family history of an aneurysm anywhere in your aorta, you should probably be screened to make sure you are not at risk.

    Melanie:  What about symptoms? Everybody always wants to know symptoms. A lot of things can cause pain in the chest and such, so how would you that this something that's going on?

    Dr. Kern:  Well, that's exactly right. Aortic dissections certainly do have a classic symptom complex and that tends to be an absolute sudden, out of the blue, if you will, tearing type of chest pain. It can start in the front and go to the back. It can start in the back between the shoulder blades and continue down the back and that literally comes from those layers of the aorta separating. So, that's the most classic symptom complex. For dissections, it’s interesting because we often call dissections “the great imitator.” So, dissections can cause symptoms ranging from a heart attack or a stroke. In fact, dissections can cause a heart attack, so that's why you may have more the classic symptoms of heart attack type chest pain. Since aortic dissections can cause a stroke, so that’s why you may present with a true stroke being paralyzed on one side of your body, but dissections can often be very subtle. Sometimes the pain is not so severe. Sometimes patients just have this nagging back pain or they have belly pain or abdominal pain. Sometimes patients come in because the dissection has occluded blood flow to arm or to a leg. So, they come in with their arm or leg not feeling correct. So, dissections really can be the great imitator. I have seen patients with dissections be misdiagnosed with anything from the flu, all the way down to gall stones and they have ended up having their gall bladder taken out.

    Melanie:  Well, I would imagine it would be quite confusing because many of these symptoms can mimic other conditions. So, how do you find out? If somebody does get a little nervous about their symptoms, if they got to see a doctor or if they go to an emergency room, is there some sort of diagnosis or exam that would show that this what's going on?

    Dr. Kern:  Yes, good point and that's the main thing. With dissections, unlike other things that can cause pain and some of these other symptoms, pain from a dissection or the discomfort really won’t go away and it is really quite severe. So, patients often do end up in the emergency room but the key there then is very rapid and prompt diagnosis. So, it’s a matter of getting to medical attention quickly and then having the appropriate examination done because once you have examined the patient, it becomes pretty clear what might be going on. Really, the critical step then is usually a CAT scan. A CAT scan in this stand age will absolutely tell us if someone is having a dissection, where the dissection has begun and that has important implications from the standpoint of treatment and what other complications are going on as the result of the dissection.

    Melanie:  So then, what treatments are available? If it can be life threatening and you are worried about an aortic rupture, what do you do? Is this like a race for time kind of thing? What are the treatments?

    Dr. Kern:  Sometimes it can be a race for time. As minutes go by, the risk of mortality goes up in patients with a dissection. The treatment options really depend on what area of the aortas is involved or where the dissection has begun. So, if the dissection involves what we call the ascending aorta or the aorta directly above the heart, that truly is a surgical emergency. That is when we drop everything we are doing and those patients need to go right to the operating room and they need to be operated on in order to save their life. In patients whose dissection does not involve the ascending aorta; it starts further from the back, those patients have a number of treatment options available to them depending on the severity of the dissection and what other complications it may be causing. Also in this day and age, we are midst of all kinds of healthcare reform and one of those things is a change in the way we potentially treat dissections. The advent of minimally invasive techniques and new technologies and things called “stent graphs” allows us to treat patients with a very low risk of that treatment and potentially cure them of their dissection but it really is a matter of getting the medical attention as quickly as possible and making the diagnosis as quickly as possible to determine what treatment option is best for that patient.

    Melanie:  Does that make the person more risk for aneurysm or valve issues? Is that something you look at as well?

    Dr. Kern:  Absolutely. Patients with dissections involving their ascending aortas--the type that is a surgical emergency--they often do have an associated valve problem. Their main valve in the heart is leaking as result of the dissection. So, part of the operation is intended to fix the valve problem as well. The association with aneurysm is a little bit complex. Patients with aneurysm can be prone to having a dissection within that aneurysm but patients can have dissections without aneurysms, but what happens down the road is you lose the integrity; you lose the strength of the aorta. So, with time, aneurysms can develop in the area of the dissection and that’s the importance for on-going medical surveillance in patients who have had a dissection.

    Melanie:  Tell us about the prognosis. Can people have an aortic dissection and then go on to live a normal life afterwards or is this something you always have to keep an eye on?

    Dr. Kern:  Well, the answer to that is also complex and it’s sort of “yes” to both of those and certainly patients, depending on the extent of their dissection, if their dissection just involves the ascending aorta and we are able to completely repair it surgically, they can live a completely normal life. They do need to be evaluated, have periodic CAT scans to make sure everything stays ok, but completely normal. Patients who have more extensive dissections, they certainly need to cut back early on after their treatment, whether we treat them with just medicines or we treat them with stent graphs or surgery but with time, and once we see the aorta stabilize or if they require subsequent operations to totally replace, in time, their entire aorta, then they, too, can lead completely normal lives with normal life expectancy, get back to work and do all those normal things but there may be a period of time when they are not able to do those things.

    Melanie:  What an amazing topic and fascinating truly. In just the last minute, Dr. Kern, why should patients come to UVA Heart and Vascular Center for their care?

    Dr. Kern:  Well, I think that at the University of Virginia Heart and Vascular Center, we have the full spectrum of collaborative multi-disciplinary cares specialists who know everything there is to know about dissections. We are also fortunate in that, we have available to us all of the latest treatment options including experimental options; including the latest clinical trials; the latest devices that we are able to put in to tiny incisions in the groin. All of these options are available to treat patients with dissections in the most appropriate way for that individual patient. So, we are not just locked into one form of therapy and we have all the specialists to help treat their medical conditions, the interventionalists, the surgeons, the intensive care doctors and they really get the full spectrum of care.

    Melanie:  Thank you so much. You’re listening to UVA Health Systems Radio and for more information on the UVA Heart and Vascular Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Tue, 08 Sep 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/28903-what-are-aortic-dissections
Enhancing Palliative Care for Patients with Cancer and Heart Failure http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=28902-enhancing-palliative-care-for-patients-with-cancer-and-heart-failure enhancing-palliative-care-for-patients-with-cancer-and-heart-failureA new palliative care service at UVA CARE Track is helping patients with heart failure and advanced cancer better manage their pain and symptoms.

Learn more from Dr. Leslie Blackhall, a UVA expert in palliative care.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1534vh5a.mp3
  • Location: Null
  • Doctors: Blackhall, Leslie
  • Featured Speaker: Leslie Blackhall, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Leslie Blackhall is a board-certified specialist in palliative medicine, helping patients manage pain and symptoms caused by serious conditions or intensive treatments.

  • Transcription: Melanie Cole (Host):  A new palliative care service at UVA, CARE Track, is helping patients with heart failure and advanced cancer, better manage their pain and symptoms. My guest today is Dr. Leslie Blackhall. She is a board certified specialist in palliative medicine, helping patients manage pain and symptoms caused by serious conditions or intensive treatments. Welcome to the show, Dr. Blackhall. I'd like to start by having you explain the difference between palliative care and hospice care. People hear palliative and they think end of life care.

    Dr. Leslie Blackhall (Guest):  Thanks so much for having me on. I am delighted to be able to talk to you about that. I have been working at UVA with palliative care since 2001 and since that time, we have been there in the Cancer Center--now the Emily Couric Clinical Cancer Center--and our job there is to help people with cancer in that setting at any stage of their illness, including people who are cured of cancer but still have problems. Sometimes even after you finish your treatment, you’ll have on-going symptoms like pain or nerve damage in your feet, fatigue or mood problems that are related to the cancer or treatment of the cancer. So, for palliative care, our job is to help people with those kinds of symptoms, whether they are caused by a cancer that is now cured or cancer undergoing curative therapy or a cancer undergoing treatment, the purpose of which is to prolong life that is unlikely to completely cure the cancer. Really the difference is that hospice care is done for people who are terminally ill, expected to not live for six months and they have their symptoms taken care of. In palliative care, folks like me felt like that type of care, why should only be reserved for patients who are likely to die of their cancer? Why can't all of us who have those kinds of serious illnesses get that kind of treatment, really directed at improving quality of life, and by that I mean function—the ability to lead a normal life while you are undergoing these treatments.

    Melanie:  Do you still see your regular internist or oncologist or cardiologist while you are involved in palliative care?

    Dr. Blackhall:  Absolutely. One of the things I really loved about working in the Cancer Center, and now, with the cardiologists, is the ability to work as a part of the team. If you are undergoing chemotherapy, if you are getting treated for a serious heart condition, you want your oncologist or your cardiologist to be focused on treating that underlying illness but there is need to also be somebody who focuses on treating things that are either side effects of treatment such as chemotherapy related nausea or fatigue or other side effects of treatment and so you need both of those. It’s really a team effort within an illness as serious as this. This is something I think we have known about for oncology for a long time but, it’s really a breakthrough if we think about cardiology in the same way. I think as we have treatments that may not completely cure an illness but prolong peoples’ lives for a long time, we have to be really aware of how much we want that life to be one that’s as normal as possible, so people can continue to live in a normal way and enjoy every moment.

    Melanie:  I understand that UVA now offers a program called CARE Track. How does it work? Tell us a little bit about it.

    Dr. Blackhall:  Sure. I think many years ago--maybe twenty year ago--I was at something called Cancer Care Initiative that was a nationwide effort to improve the care of people with cancer and to improve their pain control specifically, which can be very difficult. I remember commenting to one of the people at this meeting that we would probably paying more attention to pain if we have like a blood test, that told people what your pain level was because that is the sort of documentation that the doctors tend to pay attention to. The CARE Track Program actually came as the idea that sort of idea that if you look in someone's medical chart, what you see is what their blood counts are, what their kidney function is, a lot of numbers related to their care. But until the CARE Track Program, we didn't really have a good way to keep track in the same visible way of how the patient is feeling, their ability to get up and around, their ability to function due to pain, their fatigue, their shortness of breath. So, in 2012, Dr. Paul Read and myself along with our colleagues, Jim Harrison and George Stukenborg, got a large national grant to develop a program that would track patient symptoms using a specific type of questionnaire that’s built into medical record so that every time patient comes, they answer these sets of questions and there is a trigger that goes off in the electronic medical record for people who are starting to struggle. Are getting fatigued that they’re having trouble with getting up and out of bed? Are they having so much pain that they find it difficult to interact? Are they incredibly anxious? And when that trigger goes off, it alerts a whole group of supportive care specialists, physicians, social workers and dieticians and folks like that to help come and deal with those symptoms in the same emergent way you would have if somebody’s white blood cell count went way down or their kidney function became threatened. So, CARE Track Program stands for “Comprehensive Assessment with Rapid Evaluation and treatment. So meaning, we don't wait until someone is so ill that they end up in hospital. We try to get to them as quickly as we can prior to that point and support those types of symptoms because what we do know is that those things tend to make people end up in the emergency room. Our program has shown a lot of success at the Cancer Center in keeping people out of the hospital and in getting them to feel better. So, we have now expanded that into another group of patients which is people with advanced heart failure.

    Melanie:  So, that was going to be my next question. Which patient is CARE Track designed to help?

    Dr. Blackhall:  It started off for people with very advanced cancers and that’s from 2012 until this July. Those are the folks that we reached. Then starting in July, we got another award called the “Buchanan Award” at University of Virginia because of the success of this program to extend it into cardiology. So, there an advanced heart failure clinic at University of Virginia with Drs. James Burgin and Jamie Kennedy and they’ve expressed interest in having this type of program to help support the seriously ill people in their unit, who also suffered from pain, problems with functioning, getting up and about and the fatigue, and shortness of breath often. So, we are developing for the heart failure clinic, a similar group of palliative and supportive care specialists, who will be there to help support those patients and have their symptoms taken seriously as we work side by side with our cardiology colleagues as well.

    Melanie:  What a wonderful program. I certainly applaud your work. In just the last few minutes, Dr. Blackhall, please give the listeners your best advice, what you want them to know about pain management, palliative care and the care track program that you've developed and why patients should come to UVA for the palliative care.

    Dr. Blackhall:  I think it’s important that people know that palliative care is about taking good care of people. Studies have shown the patients with cancer who have followed in a coordinated way by palliative care specialists and oncologists not only feel better, they actually live longer because part of taking extra care of patients is taking care of the whole patient, not just the tumour but all of them. Similarly, I think people with serious illnesses like heart failure need that same type of team based coordinated care. There not that many places that have dedicated so many resources to helping our patients in this way and I just want to say I feel incredibly grateful to be working at an institution which had the foresight to allow us to develop this sort of coordinated care program where there is a team-based approach to help all patients feel their best, no matter how seriously ill they are.

    Melanie:  Thank you so much for such great information. You are listening to UVA Health Systems Radio and for more information you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole and thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Failure, Cancer, Palliative Care]]>
David Cole Tue, 01 Sep 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/28902-enhancing-palliative-care-for-patients-with-cancer-and-heart-failure
Treating Hip Injuries http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=28599-treating-hip-injuries treating-hip-injuriesWhat are the most common hip injuries?

Are there certain sports or activities where hip injuries are more likely?

Listen to learn more – as well as more about the available treatments – from Dr. Winston Gwathmey, a UVA orthopedic surgeon who specializes in hip injuries.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1525vh5e.mp3
  • Location: Null
  • Doctors: Gwathmey, Winston
  • Featured Speaker: Winston Gwathmey, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Winston Gwathmey is an orthopedic surgeon whose specialties include arthroscopic hip surgery and sports medicine.

    Learn more about UVA Orthopedics
  • Transcription: Melanie Cole (Host):  Are there certain sports or activities where hip injuries would be more likely and be more common?  What are those most common hip injuries and how do you prevent them?  That’s the most important thing. My guest today is Dr. Winston Gwathmey. He’s an orthopedic surgeon with UVA whose specialties include arthroscopic hip surgery and sports medicine. Welcome to the show, Dr. Gwathmey. Tell us a little bit about sports or activities where our hips seem to be more at risk for injuries.

    Dr. Winston Gwathmey (Guest):  Thank you. The hip is sort of the new frontier of sports medicine in that injuries that, 20 years ago were really unrecognized or we just really didn’t understand the pathology behind it, we are starting to recognize a lot more often now. To be honest, it’s sort of an exciting topic to discuss. So, your question about what sports predispose you to injury, really any sport where you’re moving at a high speed, pivoting, changing direction, where you are loading the joint, the hip can be at risk. I think that what athletes need to understand is that sports that may injuries, there’s also elements of the human body that may predispose injury as well. I think it’s an important concept to understand when you are dealing with hip injuries.

    Melanie:   Well, we are even seeing more of these which we never would have seen in younger people. As soccer becomes more prevalent and these, as you say, the stopping and turning, and those kinds of sports are becoming more common. People are playing weekend soccer and injuring their hips. What about the things that don’t involve sports?  Things that we could do that would injure our hips that are just functional things every day.

    Dr. Gwathmey:   I think I need to back track just a touch and that it’s not that the hip injuries are more common now; I think we are starting to recognize sort of what’s causing them. It’s a combination of two things really that make it pretty simple. One is the way you’re shaped and two, is what you expose your hip to. The normal hip is pretty tolerant to most activities but there are certain elements to the way the pelvis might be shaped that might make you at risk for having a hip injury with sports or even with just routine activities. What I mean by that is, sometimes the ball and socket of the hip joint just don’t fit together that well and it’s either a developmental things or it’s sort of built into your genetics--sort of the same reason why some people go on to have arthritis and some people don’t. I think that what we are starting to recognize is, there are certain elements of the skeletal morphology that might make you at risk for having hip injuries.

    Melanie:   When do we know that it’s actually a strain or an injury?  When would we go see a doctor?

    Dr. Gwathmey:   So, normally hip injuries will be pain localizable to the groin. The hip joint is actually directly in the groin. It’s not out in the side. It’s not really in the back. Most people who have hip injuries recognize discomfort in the groin and it’s usually worse with the loading the hip. So, if you are putting impact onto the hip or when you are sitting for a long period of time with your hip flexed, sometimes you will feel some discomfort. Sometimes standing up from a long car trip, you’ll feel pain from the hip or sometimes when you’re playing a specific sport and you to a certain twist or turn, you’ll feel that pain. That’s when really we start thinking more and more about the hip joint as being part of the problem.

    Melanie:   What do you do about it?  What’s the first line of defense?  Icing the hip or resting? You know, you think about the knees are easier, but what do you do about the hip?

    Dr. Gwathmey:   The hip, like you say, the knee is right there, the hip is deep down within the body so even putting a bag of ice on it, it takes a while for that cold to get down to the hip joint. I think rest really is the first thing I would try. Just try to calm things down. Ice is very helpful for some of the inflammation that might be around the hip. Anti-inflammatories are always very helpful because there’s usually an inflammatory component to it.  Hip pain that’s real localizable to the groin that doesn’t get better after a couple of weeks, you probably ought to at least see somebody to try to make sure that you don’t have something more sinister going on.  

    Melanie:   What if you do?  When you go see a doctor, what is it you’re going to do?  Can an x-ray show things or do you have to have an MRI?

    Dr. Gwathmey:   I think that’s a very good question. I think, and this is sort of my gestalt, if you will, that the x-ray is really the gold standard for diagnosing hip pathology. What I mean by that is, going back to what I said previously, is that the way that your body and your pelvis is shaped is very important when you’re trying to understand hip injuries. There’s a term that’s kind of a complicated term. It’s called femoroacetabular impingement or FAI. The femur is the thigh bone, acetabular is the socket and, basically, it’s when the ball and the socket don’t fit together that great. That’s recognized really on x-ray really to be honest. You can see sort of the way the ball and the socket is shaped and see if there’s going to be a risk factor for having a hip injury. Let’s just say that you do have that shape to your pelvis, an MRI can be very helpful to make sure the labrum, which is basically the seal, the lip around the hip joint, the cartilage, the soft surface of the hip, to see if there’s damage there or the muscles around the hip.

    Melanie:   I’m even hearing about some younger people requiring hip replacements, Dr. Gwathmey. When does it come to that and especially we hear about that in our older patients all the time. Hip replacement being one of the easier to recover from, certainly more than a shoulder or a knee, but when does it come with the younger people to something so drastic?

    Dr. Gwathmey:   So, let me tell you, my goal--my specialty--is to avoid hip replacement. I’m a hip preservation specialist so I try to do everything I possibly can to prevent the progression of arthritis, to address injuries in a minimally invasive manner to avoid the ultimate salvage which is the hip replacement. All that being said, a hip replacement is an outstanding surgery. It has got probably the best positive track record of any orthopedic surgery that we offer but it is metal inside the body.  If you can maintain your own anatomy and your own tissue, you’re a lot better off in the long run. So, what I would try to do is recognize the pathology that might predispose you to having arthritis and do what I can to either correct it or at least ameliorate it to a point where you can put off getting a hip replacement much, much later in your life.

    Melanie:   Dr. Gwathmey, when I hear people complain of hip pain and right away they want to do something about it or, as you say, look into replacement, sometimes there’s a simple solution. As a hip preservationist, how important do you think shoes or heel lift or orthotics play that role if we find out our hips are uneven or something’s going on in our spine that’s causing pain that we think is in our hips. How important do you think it is?

    Dr. Gwathmey:   My first line for all hips is trying to address the environment in which the hip is. So, whether it be a misbalance of the pelvic stabilizers, whether there be a spine issue like you’re saying, whether it be shoe wear, limb length discrepancy, a lot of times I’ll start with a therapy routine to try to get a functional assessment. So, a therapist can take a look at you and see how you walk, see if there is something just in the way you do things that might put your hip at risk. That really is a first line for all people with hip problems just to make sure that you correct what can be corrected before you go forward with something like surgery. To be honest, most people get better without surgery. As far as hip preservation,  that’s where I come in and I do arthroscopic surgery of the hip and so if the therapy doesn’t work or if there’s pathology that can’t be addressed from an external standpoint, that’s where I come in and do what I can do to try to make the hip feel better.

    Melanie:   I agree completely and I see so many people and have myself had hip problems that were solved very simply with a better pair of shoes or an orthotic or a heel lift. So, these kinds of solutions are something that people really can look to. What role do you think that exercise plays in keeping those good strong hip muscles?  What are your favorite exercises to recommend to people to strengthen up their pelvis and all around their hip muscles?

    Dr. Gwathmey:   I start with the core, typically. I think the core is really where the foundation for the entire gait cycle, the way your hips move, the spinal stabilizers, the pelvic stabilizers and things like that. The hip abductors and adductors are very critical as far as keeping the pelvis balanced. But, again, you have to have your range of motion first before you can imagine strengthening stuff so I work on symmetry. Whatever’s going on good with the hip that’s working, I try to make the bad hip match that one.

    Melanie:   That’s great information. In just the last minute, why should patients that are suffering from hip pain come to see you at UVA for their care?

    Dr. Gwathmey:   Again, I am a surgeon that specializes in arthroscopic hip surgery. So, let’s just say that all the stuff we throw at your hip, it’s still not getting any better and we get an MRI and you have a labral tear or you have FAI--this impingement thing that we’re talking about--what I can do and what I think that sort of sets me apart as a surgeon is, I can address those elements with a video camera and two tiny holes in your hip. Now, it sounds simple but it’s actually a very challenging procedure and it’s actually pretty challenging to come back from but it is a technique that we can utilize here that gives a minimally invasive approach to hip pathology. So, I do think that there is a role for trying to do everything we can to get the hip better without surgery but when it comes to surgery, I think I can provide a pretty good tool bag as far as things that I can do to help the hip.

    Melanie:   Thank you so much. You’re listening to UVA Health Systems Radio. For more information you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic]]>
David Cole Tue, 18 Aug 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/28599-treating-hip-injuries
Chronic Tendon Injuries: How Are They Diagnosed and Treated? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=28211-chronic-tendon-injuries-how-are-they-diagnosed-and-treated chronic-tendon-injuries-how-are-they-diagnosed-and-treatedChronic tendon injuries, or chronic tendinosis, can cause constant pain; however, new treatments are available.

How is chronic tendinosis different from tendonitis?

What are some symptoms of chronic tendinosis, and what treatments are available?

Learn more from Dr. Jennifer Pierce, a UVA specialist in chronic tendinosis.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1525vh5d.mp3
  • Location: Null
  • Doctors: Pierce, Jennifer
  • Featured Speaker: Jennifer Pierce, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Jennifer Pierce is a board-certified radiologist who specializes in musculoskeletal radiology.

  • Transcription: Melanie Cole (Host):  Chronic tendon injuries or chronic tendinosis can cause constant pain. However, there are new treatments that are available. How is tendinosis different from what you hear about, tendinitis, and what are some of those symptoms of chronic tendinosis, and what treatments are available? My guest today is Dr. Jennifer Pierce. She’s a board certified radiologist who specializes in musculoskeletal radiology at UVA. Welcome to the show, Dr. Pierce. What is a chronic tendon injury or chronic tendinosis, and how does that differ from what people have heard so much about, tendinitis? 

    Dr. Jennifer Pierce (Guest):  Well, thank you for having me, yes. The answer to your question, what is tendinitis and tendinosis, tendinitis means inflammation. And they found on a cellular level a lot of these damaged and degenerated tendons don’t have inflammation. So doctors use the term “tendinosis” because it just means that there’s disease or tendon pathology. So it really is the same term or two words for the same entity. Chronic tendon injury, this means that you have tendon-related symptoms like pain and burning and weakness for a certain timeframe, and that usually means longer that three to six months. Chronic tendon injury can be from a single traumatic event that lasts that long, the pain and the symptoms, or it can be brought on by just long-term repetitive overuse. That kind of typically happens unfortunately as we age. 

    Melanie:  Are there certain areas that are more subject to these kinds of injuries than others? 

    Dr. Pierce:  Well, tendons can degenerate as we age due to overuse, and I would say kind of going from head to toe, first the shoulder is a common area, the rotator cuff. That’s an area that we overuse and you can have a tendinosis there. The elbow, especially the outside or the lateral aspect of the elbow, commonly called tennis elbow. And that’s due to become an extensor tendonitis. It actually involves 1 to 3 percent of our population. Some other tendons would be hamstring tendon, Achilles tendon, and also the plantar fascia, which is on the sole or the heel of your foot. 

    Melanie:  These are painful conditions and ones that I deal with daily myself, Dr. Pierce. What’s your first line of defense? What do you recommend people do? For example, they’ve got plantar fasciitis, which can be incredibly debilitating and painful, or rotator cuff tendon problems that just make them wake up in the night when they roll over on their shoulder. What do you tell them? 

    Dr. Piece:  Well, they should go see their primary care doctor to make sure that that is really the issue, that it is the tendon issue. Because joint pain can be somewhat cryptic. It can be from the tendons. It can be for something inside the joint, like the cartilage, those kind of things. So once it’s decided it is the tendon, really asking questions and a physical exam so that we can pick out the tendon that’s causing the pain is really the first line of diagnosis. If there is a need, imaging—and that’s where radiologists come into play. They’re the doctors that look at imaging, such as x-rays, CTs, MRIs, and ultrasound. And sometimes those imaging modalities can really help their clinician diagnose tendinosis and tendon problem. 

    Melanie:  Then what treatments are available? Because people tend to think, Dr. Pierce, of cortisone shots, and anti-inflammatories and ice, which is always a good one. What do you recommend for treatments? And as a radiologist, what do you see as some good long-term outcomes? 

     Dr. Pierce:  Yes, tendon problem is a huge industry, and that really involves a lot of patients in our society. And you mentioned a lot of them. I think the first line, for example, like you mentioned is that RICE therapy—rest it, ice it, put that compression, and maybe elevate to that joint or tendon. But here at UVA, we are doing some other things. You mentioned the steroid injection and radiology. We are using image-guided techniques to actually make sure that needle is placed right in the tendon and placing the steroid. Another thing we’re doing is what’s called Tenex. That’s a company name, but it is called Percutaneous Needle Tenotomy. I don’t know if you’ve heard of that, and with ultrasound guidance. And what we do is we can look at the tendon with ultrasound and see actually the areas of degeneration, the true pathology in the tendon. And then with those areas, we can target it and place our needle right there, and that’s why it’s called image guidance. And when we place that needle there, what happens is this specialized needle has an inner needle and an outer needle, and that inner needle oscillates at a really high frequency, basically at 28,000 times per second. And it sort of acts like a jackhammer, if you will, but gently removes that area of disease or degenerated tendon that we can spot on our ultrasound imaging. And we put some saline there, and it helps to breathe and irrigates that irritated tendon. And people are doing very well, very good outcomes and long-term outcomes. You mentioned steroids. That has been good for patients but really short-term, maybe six weeks, maybe three months. But we found with this new procedure, patients are pain-free, for example, with tennis elbow problem, even one year out, maybe even two years out on some studies. 

    Melanie:  Wow, Dr. Pierce. That’s absolutely fascinating and if someone is suffering from a soft tissue injury, whether it’s tennis elbow or golf elbow or tendinitis of the Achilles, this Tenex, how fast would they see results? Are they going to be pain-free? Does it take a couple of weeks for it to kick in? We know that cortisone shots may take a few days or up to a week. How fast does Tenex work? 

    Dr. Pierce:  That’s a great question. Tenex is completely different than the steroid. It doesn’t respond as quickly. However, what I’ve noticed in my patients is that there’s a lot of variability. I’ve had patients that say that night it felt so much better, I didn’t need to take the pain medication. Most patients however are noticing that their strength, their decrease in pain and increase in flexibility really start kicking in about three to five weeks after the procedure, and then it even gets better and better. The pain-free situation, it’s usually even at a year and two-year follow-up, which is really incredible since a lot of the treatments that we’ve talked about before are more short-term. 

    Melanie:  And what about prevention altogether? We only have a few minutes left, but is there prevention, or are some of these just age-related, tendon breakdown soft tissue from chronic overuse and various things that we do? Is there prevention?  

    Dr. Pierce:  That’s a great question. I think if you keep doing the activity, you can start getting degenerated tissue, especially if there’s no strengthening. So what I recommend at the first signs of tendon pain, really go in, maybe get some physical therapy. There’s a lot of great information online to start strengthening that tendon and that kind of thing, but sometimes we can’t eliminate what you do on a daily basis, because we do use our tendons and our extremities, especially if you do a lot of labor and that kind of thing. So I would just make sure that you’re strengthening, you’re staying fit, and that kind of thing. And we can’t sometimes stop the degenerative process. 

    Melanie:  We certainly can’t, but this has been such great information. In just the last few minutes, your best advice for people with soft tissue injuries and tendinosis treatments and why patients should come to UVA for their care. 

    Dr. Pierce:  Yes. Well, at UVA radiology, we have lots of specialists. In fact, we have every specialist for all the medical specialties. Medicine is so vast, and so to have a specialist really focusing on that branch of medicine is important. At UVA, the radiology specialists are really working hand in hand with the clinical specialists. You have doctors talking to each other, and that’ll really give you the best care. In terms of MSK radiology, we offer comprehensive radiology, so from x-rays to CTs to ultrasound to MR. We read it all, and we can really use all those modalities to help diagnose things. And, especially with the procedures that I’ve been talking about, whether it’s steroid injection or the Tenex, we actually see where we place that needle so that image guidance is really great. We’re not blindly injecting. Especially for deeper tendons, it’s really helpful to see where you’re putting that needle. 

    Melanie:  What great information. Thank you so much. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thank you so much for listening and have a great day. 

     
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic]]>
David Cole Tue, 11 Aug 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/28211-chronic-tendon-injuries-how-are-they-diagnosed-and-treated
Treatment Options for Tremors http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=28172-treatment-options-for-tremors treatment-options-for-tremorsTremors are involuntary shaking of the body or limbs, as from disease, fear, weakness, or excitement.

Tremors can be caused by a variety of conditions.

Learn more about what causes tremors and the available treatment options from Dr. Matthew Barrett, a UVA specialist in movement disorders.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1525vh5c.mp3
  • Location: Null
  • Doctors: Barrett, Matthew
  • Featured Speaker: Matthew Barrett, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Matthew Barrett is a board-certified neurologist whose specialties include movement disorders.

  • Transcription: Melanie Cole (Host):  Tremors can be caused by a variety of conditions. My guest today is Dr. Matthew Barrett. He’s a board certified neurologist whose specialties includes movement disorders at UVA Neurosciences Center. Welcome to the show, Dr. Barrett. Tremors, people first see their hands shaking, they don’t know what the problem is, they right away go to the worst possible outcome: it’s Parkinson’s, it’s something terrible. Tell us what constitute a tremor, and what are the most likely causes? 

    Dr. Matthew Barrett (Guest):  Sure. A tremor is any involuntary rhythmic movement of a body part. I want to underscore that it’s rhythmic. There are certainly other movement disorders that may not be tremors, and I think that’s where a movement disorder specialist can be helpful. The tremor can involve either the jaw, voice, head, arms, or legs. I think most often people think about arms and hands being involved by a tremor, and I would say that probably is the most common thing I see. One main distinction in classifying the tremors is whether they occur when a body part is at rest or if it’s involved with an action. And that really is one of the primary things we use to help distinguish between a Parkinson’s disease tremor and maybe a tremor from another cause. Tremors associated with Parkinson’s disease do present with other symptoms typically, and then other findings that we would see on an exam. And an essential tremor, which is another common cause of tremor, the tremor usually occurs without other neurological symptoms, hence the name essential tremor, that it really stands alone. And then I think I’d also mention that there are some drug-induced tremors, and then there are a number of other rare conditions that could be associated with a tremor. 

    Melanie:  Can it be also associated with age, if someone is 90 years old and just their hand shakes when they go to grab a glass? Can this be an age-associated thing as well? 

    Dr. Barrett:  Yes, definitely. I think more historically a term called senile tremor, there is some tendency to do develop a tremor as someone ages. And I would say both with Parkinson’s disease and essential tremors, both of these things become more common if someone gets older. I guess the distinction would be really about how severe a tremor is and whether it’s interfering with daily activities, whether it should be treated or not. 

    Melanie:  If somebody gets really nervous, they’ve got this -- and as we said, they go to the worst outcome, but they come to see you. How do you even diagnose this? 

    Dr. Barrett:  Yes. I think you bring up a very good point about bringing up stress, anxiety. I would say that everybody under a certain degree of stress will probably have some tremor. Someone who drinks too much caffeine, doesn’t get enough sleep, a tremor is possible, or works out too hard. I think all of us have experienced that at some point. And I would term that a physiological tremor. And under these certain circumstances that cause stress, that’s an enhanced physiological tremor. One of the distinctions in our evaluation really is whether that’s what we’re dealing with, or is this an essential tremor that is present without some identifiable underlying cause? 

    Melanie:  Okay. People have these things. You look at what they’re doing. Do you run them through a series of tests? Do you get them to recreate whatever it was they were doing to find out if that tremor only happens, as you say, during activity or at rest? 

    Dr. Barrett:  That’s exactly right. I think the distinction between a rest tremor and action tremor is a very important one. And I think the rest tremor can frequently either just be seen during the interview portion of an exam or brought out with certain activating maneuvers during the exam. It’s not uncommon that a Parkinson’s rest tremor will come out when someone is walking. It’s a part of my exam is having them walk up and down the length of a hallway. An essential tremor, like you said, may only come out with actions. And if that’s what I’m suspecting, I may have people write, pour liquids, and even moving a full glass of water back and forth, just because sometimes it’s only under those circumstances that the tremor becomes apparent. 

    Melanie:  Okay. What about medication? What do you do for them? Is there anything? Does physical therapy or stretching, exercises, anything, can that help with the tremors or relieve them a little bit? 

    Dr. Barrett:  Sure. I think, really, regardless of what the cause of tremors, unless we can identify some medication that may be inducing it, there are some medications, oral medications that can help. And with Parkinson’s disease, that opens up a whole area of medicine. Usually, we start with medications that somehow replaced the dopamine deficit in Parkinson’s, and with essential tremor there are other medications, different medications that we would use to start that sort of treatment. For treating a tremor, there is this issue of diagnosis, but whether to treat it or not really comes down to how much it interferes with the person’s life. For example, if someone is still working and they have a tremor, that may be something they socially and for their work life would like to eliminate. A person who is not working, a tremor may not interfere with their activities, so they don’t necessarily want to treat it. Of course, if it’s get to the point that it’s interfering with eating or drinking or performing other daily activities, then it is something we would treat, and we usually start again with the oral medication. 

    Melanie:  Do isometric exercise 00 if the tremor is in the arm, in the legs or the hands, if you stop that tremor, can you grab the muscle? Can you grab the limb, whatever it is, and push against it? Does anything along those lines help to relieve the tremor at all? 

    Dr. Barrett:  With a rest tremor in Parkinson’s Disease, I think individuals often find that if they activate the limb—usually the hand, but sometimes the leg that’s affected—that the tremor will go away. I could see how even just sort of -- even not necessarily moving the limb but just tensing those muscles or focusing on that tremor does allow someone to usually be able to stop it. That’s in the case of a Parkinson’s tremor. With an action tremor, they become a little less easy to control. There isn’t that aspect that there’s some control over the tremor. There are some techniques people have developed. I think there’s a specific utensil that can be used. Sometimes using a heavier object is actually better for the tremor. And there are utensils that have been developed that can entrain to the tremors so that it doesn’t cause food to fall off a spoon or fork, as it would otherwise.

    Melanie:  Is there any surgical interventions that you go to at some point, brain stimulation? Is there anything that you do to relieve a tremor if it’s really so bad that is affects the person’s quality of life?  

    Dr. Barrett:  Definitely. I think it’s when we have tried the oral medication and they have failed, or there are side effects that make them not able to be tolerated that we move on to at least discussing the possibility of a neurosurgical procedure. And at this point, the deep brain stimulation is the standard surgery that is used. Some of the primary indications are essential tremor and the Parkinson’s disease tremor that the sites that are targeted with deep brain stimulation may be different. It depends on the patient whether that’s something they want to pursue, but certainly, like you say, if the disability is great and we haven’t made any headway with medications, then I think surgery is a very appropriate thing to consider for some patients. 

    Melanie:  You mentioned stress, and I would just like to discuss that for just another minute here. Where does stress play a bigger role whether someone has Parkinson’s? Because obviously then they’re going to have that anxiety. But can stress cause tremors and things that just if we managed our stress will help to relieve those? 

    Dr. Barrett:  That brings up a great point. A common thing I will say is that stress worsens any movement disorder, regardless of the cause. And I think tremor is a perfect example of that. Managing stress, identifying the underlying cause, treating it however it needs to be treated certainly can improve tremor. I think exercise is something I recommend. Anyways, they are certainly for patients with Parkinson’s disease. There’s some evidence that it may slow the progression of the disease. Probably by relieving stress also will improve the tremor that someone might be experiencing and that would, again, be worsened by stress. 

    Melanie: In just the last minute, please give your best advice, Dr. Barrett, for people that are suffering or people who have loved ones that are suffering from tremors and why they should come to UVA Neurosciences Center for their care. 

    Dr. Barrett:  Yes. First I should say that correct diagnosis is really important because the treatments are going to vary depending on what the underlying cause is and that no one should suffer from the effects of a tremor without seeking a specialist’s opinion. Including myself, there are four movement disorder specialists at UVA who are trained to diagnose tremors, and it’s even possible that what’s being called a tremor may be another movement disorder. For treatment of tremors that don’t respond to oral medications, we talked about the use of deep brain stimulation. UVA has an established DBS program. It’s been in place for a long time with a dedicated medical team. That therapy is available if it wants to be pursued. And then the other thing is that UVA is a pioneering center for the application of focused ultrasound, which is a new experimental technique being used to treat tremors in a mechanism similar to deep brain stimulation but without incision. It’s very possible that in the next few years, this new surgical technique, focused ultrasound, will be available at UVA as another treatment option. 

    Melanie:  That’s great information. Thank you so much. You’re listening to UVA Health Systems Radio. For more information, you can go uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
]]>
David Cole Tue, 04 Aug 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/28172-treatment-options-for-tremors
Treatment Options for Critical Limb Ischemia http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=28171-treatment-options-for-critical-limb-ischemia treatment-options-for-critical-limb-ischemiaCritical Limb Ischemia (CLI) is a condition where blood flow to the legs and feet is blocked.

When blood flow is blocked to an arm or leg, that limb is in danger of not surviving.

Left untreated, critical limb ischemia can lead to amputations.

Learn the symptoms and available treatments from Dr. Kanwar Singha, a UVA Heart & Vascular Center specialist in vascular disease.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1525vh5b.mp3
  • Location: Null
  • Doctors: Singh, Kanwar
  • Featured Speaker: Kanwar Singh, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Kanwar Singh is a board-certified physician in interventional cardiology, cardiovascular disease and internal medicine whose specialties include critical limb ischemia and peripheral arterial disease.

  • Transcription: Melanie Cole (Host):  If left untreated, critical limb ischemia can lead to amputations. My guest today is Dr. Kanwar Singh. He’s a board certified physician in Interventional Cardiology, Cardiovascular Disease, and Internal Medicine whose specialties include critical limb ischemia and peripheral artery disease at UVA Heart and Vascular Center. Welcome to the show, Dr. Singh. Tell us a little bit about what critical limb ischemia is. 

    Dr. Kanwar Singh (Guest):  Good morning, and thank you so much for the opportunity to share some thoughts about critical limb ischemia. Critical limb ischemia is defined as breath pain, tissue alteration, or gangrene as the function of abnormal circulation to the leg.  

    Melanie:  Wow! What would cause this? Why would somebody even have these kinds of problems? Is it associated with certain diseases, diabetes, peripheral artery disease? 

    Dr. Singh:  Absolutely. I tell patients all the time that artery disease is artery disease, meaning people who have coronary artery disease in their heart’s arteries or carotid artery disease in their neck’s arteries are the same types of patients who develop the same sort of blockages in their leg artery. If a person has eczema, a rash on their elbows or a rash on their knees and a rash on their neck, we don’t describe them as having neck eczema, knee eczema. We describe them as having eczema. It’s a total body condition. It’s a rash. And an artery disease is much the same way. The same things that cause the blockages in other important parts of the body contribute to the development of blockages in the legs. Namely, tobacco smoke is the number one risk factor. People who are smokers are at a substantially increased risk of developing clogs in their arteries that threaten the very existence of their legs. They lose their toes, they lose their ankles, they lose their knees, or even higher up. Diabetes is another major contributor. It tends to affect the smaller artery, typically of the lower legs, meaning the calf and below down into the feet, and it’s a major cause of amputation in this population. And then certainly, the other traditional risk factors, such as high cholesterol or high blood pressure, can also be contributors. But really, it’s the smokers and the diabetic folks who suffer the most at the hands of this condition. 

    Melanie:  The risk factors—smoking, diabetes—is this a hereditary thing in peripheral vascular disease, just arterial lower limb disease? Is this something that’s hereditary?  

    Dr. Singh:  It certainly can be, and we certainly know families where artery disease runs rampant among parents, uncles, aunts, relatives, et cetera. There aren’t so much genetic predictors that we’re looking at in terms of doing screening or blood testing or things like that to identify people at particular risk. It’s not as if it’s an inherited condition that is so classically or elegantly associated with a gene deletion on such and such a chromosome. It’s more of an overall risk factor that can run in families. Frankly, I think a lot of families who share risk factors genetically also share risk factors socially, namely self-injurious behaviors, like smoking to excess or even being around excess amounts of smoking, even if you’re not the primary tobacco user yourself. 

    Melanie:  And even being overweight can run in families. Obesity can contribute to this. What about sedentary lifestyle? And what role does exercise play? I’m an exercise physiologist, Dr. Singh, so to me, keeping that blood flow in the legs, keeping your body moving gets that blood and keeps it from pooling. Does that contribute to this? 

    Dr. Singh:  That’s such an excellent point. I’m so glad you brought it up. Exercise, exercise, exercise in the form of low level walking. It needn’t be necessarily going out for a trail-busting run. It need not be necessarily getting one’s heart rate up over 150 beats per minute. In fact, that may not be necessarily the most helpful thing to do. But plain, good old-fashioned walking, walking, walking is a tremendously valuable tool in the armamentarium of patients to help prevent developing peripheral artery disease, and more importantly the symptoms that peripheral artery disease can lead to. So even if one has blockages in the legs, the more active you remain, the less likely you are to develop a sore or an ulcer that thereby leads to an infection and that thereby increases your risk of developing an amputation. 

    Melanie:  Women especially get concerned when they start to feel pains in their calves if they’re walking or if they’re exercising and they’re busy around the house. They always think right away blood clots or constrictions in their legs. Are there certain symptoms, red flags? Do they have to look for certain things to worry about lower limb clots or blockages? 

    Dr. Singh:  That’s another great question. It’s important to distinguish what I call the northbound and the southbound traffic of blood flow. The southbound traffic would be blood that’s flowing from your heart down toward the leg, muscles, and the skin of your lower extremity. And that’s of course being pumped by your heart through our artery. The blood then gets to our lower legs, and it then pools in the venous circulation, and then it’s transported back up the leg towards the heart in veins that are responsible for the venous return of circulation. And believe it or not, the conditions that affect the veins and that affect the arteries are very, very different and completely unrelated. There are lots of young folks under the age of 35 who might have venous problems, either varicose veins or incompetent valves of their veins that result in leg swelling or spiders or varicose veins that folks can see and might identify. Those sorts of things, those vein problems can actually cause symptoms in the calf muscles or thigh muscles or a sense of leg fullness simply because there’s this sort of soggy leg with lots of blood that’s not getting great blood return out of it back up towards the heart. That’s very different from the southbound traffic problem, where there’s a constriction of blood flow because of a clog or some sort of blockage in the arterial blood flow that’s going down the leg. The symptoms to be aware of, classically speaking, are things like leg heaviness, leg fullness, cramping, pain, or occasionally tingling that is most present with exertion. That is the typical hallmark pattern symptom complex of arterial insufficiency, arterial blockage. It’s pain that develops in the calves or in the thighs or occasionally, in the buttocks muscles—because they need blood flow too—on exertion that is relieved by rest. 

    Melanie:  Then what do you do for them? Does it always require surgery? Is it something with blood thinners, something that can be taken care of with medication? What’s the first line of defense? 

    Dr. Singh:  I tend to think of this as two separate buckets of treatment. The first bucket of treatment is to deal with the symptoms that the patient is experiencing. Those symptoms can be thought broadly into categories also. The person who has leg symptoms when they walk and is relieved by rest, that is more commonly a very stable situation. In other words, it’s unlikely to rapidly progress and deteriorate. Those folks will say, “Gosh, doc. I walked a city block or I walked out of my driveway to my mailbox and back, and my calf muscles are burning. But by the time I get back inside, I rest, I feel fine and I’m okay.” Those patients who have symptomatic, what we call claudication or muscle pain on exertion, they will most often respond to a prescribed exercise regimen and don’t at all necessarily require treatment, either with balloons, and catheters and stent, the kind of work that I do, or with surgery, bypass surgery or clog opening surgery called endarterectomy or bypass that my surgical teammates and colleagues do at UVA. That’s sort of one category of symptoms, the stable claudicate, “my legs hurt when I walk.” The second category of symptoms are the critical limb patients. Those are the ones who have pain at rest or tissue ulceration or gangrene at rest. In other words, there’s just not enough blood flow getting down the leg to keep the very skin alive on the outside of their leg, and that’s an emergency. That’s something that needs attention in the next one to two days to be seen by someone and then a plan made for how to get that circulation back and relieve the symptom of pain or the risk of amputation. Overall, that’s sort of one bucket. It does not at all necessarily require surgery, although many times what is recommended are minimally invasive procedure with balloons and catheters and stents to relieve the blockages, restore blood flow, and optimize the benefits of healing and getting that skin back to be intact. That’s the first bucket, treating the symptomatic leg. The second bucket is recognizing that these patients who have leg artery blockages, the most likely reason that they’re going to end up getting sick enough to be at risk of death is something like heart attack or stroke. And so, in addition to treating the leg symptom, we also have to make sure that these patients are being monitored and treated for the presence of coronary artery disease or carotid artery disease that that would take their life in the form of heart attack or stroke. Those patients need to be at appropriate blood pressure control, medication, diabetes control medication, cholesterol control medication, and have to be living an overall healthy lifestyle to the best of their ability to reduce their overall cardiovascular morbidity and mortality. 

    Melanie:  Wow, very well put. Such great information. In just the last minute, give your best advice to people suffering from this claudication, what you really want them to know, and why they should come to the UVA Heart and Vascular Center for their care. 

    Dr. Singh:  Well, I’m very fortunate to work at one of the absolutely best centers in the country, if not the world, for the treatment of patients with lower leg artery disease. And I say that because we have a unique group of surgeons, intervention radiologists, as well as cardiologists, including myself, who take care of this condition holistically and don’t just think of this as a plumbing problem that needs relief. We think of the whole patient who need to have their risk factors modified, their symptoms treated, and their overall health optimized. The patient with claudication needs to recognize that they have this problem to have to talk carefully with their providers about it and make sure that their overall risk profile is minimized. If they’re symptomatic enough that it’s lifestyle limiting—they’re a postal carrier and they can’t get around or do their job, or they’re a line dancer and they can’t get out and dance with their partner—if it’s affecting their lifestyle, then they warrant an intervention, a balloon treatment or a stent treatment or surgery—rarely, but if indicated. For those patients, the primary to think about is getting out of trouble and preventing the downstream complication that leads to limb loss. 

    Melanie:  Thank you so much, Dr. Singh. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Mon, 27 Jul 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/28171-treatment-options-for-critical-limb-ischemia
Muscle Weakness and Rashes in Kids: Could It Be Dermatomyositis? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=28170-muscle-weakness-and-rashes-in-kids-could-it-be-dermatomyositis
The exact cause of dermatomyositis is not known.

It may be an autoimmune disorder. The immune system identifies and attacks viruses and harmful bacteria in your body.

If your child is suffering from muscle weakness and an unexplained rash, dermatomyositis could be the cause.

Learn more about this disease and its symptoms from Dr. Aarat Patel, a UVA Children’s Hospital specialist.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1525vh5a.mp3
  • Location: Null
  • Doctors: Patel, Aarat
  • Featured Speaker: Aarat Patel, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Aarat Patel is a board-certified specialist in pediatric rheumatology, pediatrics and internal medicine.

  • Transcription: Melanie Cole (Host):  If your child is suffering from muscle weakness and an unexplained rash, dermatomiositis could be the cause. My guest today is Dr. Araat Patel. He’s a board certified specialist in Pediatric Rheumatology, Pediatrics in Internal Medicine at UVA Children’s Hospital. Welcome to the show, Dr. Patel. Tell us a little about muscle weakness and unexplained rash and what would send the parent to the doctor. How do you diagnose this? 

    Dr. Araat Patel (Guest):  Thank you for having me on the show. Well, dermatomiositis is an inflammatory disease of the muscle, skin, and blood vessel. The symptoms are very nonspecific, but for someone who’s seen many patients with dermatomiositis, usually an adult rheumatologist or pediatric rheumatologist, it’s fairly easy. But for someone such as a pediatrician who has to see diseases from a vast majority of specialties, it’s a little difficult because of the nonspecific symptoms. Once we see a patient with that classic rash, we usually know what the diagnosis is. 

    Melanie:  So do we know the causes, you know why. Is this an autoimmune disease? 

    Dr. Patel:  Right. So we do not know the cause, but it is an autoimmune disease, meaning your immune system is revved up and attacking parts your body that it should not.  

    Melanie:  So what groups of children are most likely to be affected by that? 

    Dr. Patel:  So all ages of groups, all ethnics groups, but most cases in children occur between ages of 5 and 10 and about twice as often in female. 

    Melanie:  Is it hereditary, Dr. Patel? 

    Dr. Patel:  It is not hereditary, but a lot of the autoimmune diseases, such as lupus, rheumatoid arthritis, dermatomiositis come in batches. So there’ll be a family history of another autoimmune disease, possibly. 

    Melanie:  So how scary for a parent, especially when there’s muscle weakness involved -- a parent’s mind goes in all different directions. Once they’ve come to see you and you have diagnosed this, what treatments are available, and is this something that the child will have to live with now for the rest of their life?  

    Dr. Patel:  So we say that you will have this for the rest of your life, and our goal of treatment is remission. And we can achieve remission fairly quickly. We usually use corticosteroids, which are prednisone, Solu-Medrol. We use that for a brief period of time, and then we use the same medications that we use for rheumatoid arthritis. And one of them is methotrexate, and another medication for those children that are little more sick is something that we give in the hospital through an IV for about 24 hours every month called IVIG. The treatments are really good, and we can control the majority of cases and put them into remission, and they stay on medication for a few years, and then sometimes they come off of medication. So technically they’re cured, but we never say that they’re actually cured, just in case they flare up in the future. 

    Melanie:  What would happen if this is left untreated?  

    Dr. Patel:  Usually the child would get very sick, and it will start affecting the muscles which control breathing and swallowing. So they will end up in some sort of emergency room, urgent care center, or sometimes even in intensive care unit because they can’t breathe or can’t swallow, and their secretion, their spit and their food is going down the wrong tube, into their lungs. So usually they’ll end up sick and someone will figure out the diagnosis.  

    Melanie:  For some children, Dr. Patel, is there a need for physical therapy? What’s their daily life like? And can they mainstream in school, or is this something that’s going to affect their normal living? 

    Dr. Patel:  So it does depend on the severity. Once we diagnose it, we are very aggressive with treatment. We try to get their muscles functioning normal as soon as possible. They may have already suffered some muscle atrophy, so physical therapy is very important. Sometimes we send them to aquatic therapy in a pool; sometimes we send them to physical therapy in an inpatient unit, depending how sick they are. But once we start treating them, they usually will live a normal life with some restrictions, such us the sun. So, where I live in Virginia, it’s pretty sunny, so some of these children have to make sure they apply sun block on every day because that could make their disease flare. The majority them live a normal life as long as we can control the disease. 

    Melanie:  Now you mentioned steroids and the methotrexate. These medications begin to work, and then the parents and the child will see some results. They’ll see them getting better. Do they stay on steroids, and does that have its own side effects? 

    Dr. Patel:  So steroids have a lot of side effects so we try not to use as much steroids as some of the pediatric rheumatologists 20, 30, 40 years ago had to because they didn’t have some of the good medications we have now. So I try to keep patients on steroids for a minimum of one month and a maximum of maybe three months, if anything, depending on how bad their disease is. And then the other medication such us methotrexate, IVIG, Imuran, they sound scary when you read the prescribing information, but in fact they’re very well tolerated and even better tolerated in children compared to adults. 

    Melanie:  Are there any comorbidities that go with this? Is there anything that parents should look out for as the child approaches their teenage years and on? Is this going to put them at risk for other autoimmune diseases—lupus or Crohn’s or MS or any of these others? 

    Dr. Patel:  So once you have one autoimmune disease, you have a higher risk of acquiring another autoimmune disease, such as thyroid disease, psoriasis, lupus. But usually they’ll just have this one disease. The comorbidities come in from the disease severity. So, some of these children, especially teenagers, when they can’t keep up with their peers, there is sometimes depression, sometimes anxiety. Other things are occurring at the same time in their life that should be occurring normally in a child’s life. So, the multidisciplinary approach is usually physical therapy, sometimes psychology, sometimes a counselor just to get them through feeling abnormal because they will probably be the only person with this disease because of how rare it is. 

    Melanie:  So what about dietary needs? If chewing or swallowing or muscular weakness can be an issue, are there certain foods you like to recommend to parents that they feed this child? Is it going to affect their eating habits for a long time? 

    Dr. Patel:  Not for a long time, only in the beginning. If they truly have some problems swallowing, we are aggressive with the steroid dose, and we usually try to fix that in a few days to weeks. So maybe for a few days, you can’t go to a steakhouse and eat some hearty meat that gives you trouble swallowing. But most of the time there are no foods that are going to make this better and there are no foods to really avoid, just the normal foods that everyone should avoid, such as processed food and fast foods, but nothing out of the ordinary. 

    Melanie:  So in just the last few minutes, Dr. Patel, if you would, give your listeners best advice and why they should come to UVA Children’s Hospital for their care. 

    Dr. Patel:  So like I said, unfortunately, dermatomiositis can cause nonspecific lab abnormalities, nonspecific symptoms. So if you are in a position where you’re going from one specialist to another specialist to another specialist, sometimes you have to think about rheumatology—“maybe I should go see a rheumatologist”—especially if there’s fever and rashes, muscle weakness and joint pain and joint swelling. So at UVA, we use a multidisciplinary approach. We are aggressive with our treatments, and we try to get these children back on their feet. We have excellent physical therapy there. We have excellent ancillary services, and most of the families in Virginia are very happy when they come to UVA for their care. 

    Melanie:  Thank you so much. It’s really great information. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Mon, 20 Jul 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/28170-muscle-weakness-and-rashes-in-kids-could-it-be-dermatomyositis
Multiple Sclerosis in Children http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27729-multiple-sclerosis-in-children multiple-sclerosis-in-childrenWhile commonly thought of as a disease that affects adults, multiple sclerosis (MS) also occurs in children.

Learn more about pediatric MS from Dr. Nick Brenton, a UVA pediatric neurologist who specializes in pediatric MS.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1520vh5d.mp3
  • Location: Null
  • Doctors: Brenton, Nick
  • Featured Speaker: Nick Brenton, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Nick Brenton is a board-certified pediatric neurologist who specializes in pediatric multiple sclerosis and pediatric epilepsy.

  • Transcription: Melanie Cole (Host):  Commonly thought of as a disease that affects adult, multiple sclerosis also can occur in children. How would you know that this is what your child is going through? What help is out there for a pediatric multiple sclerosis patient? My guest today is Dr. Nick Brenton. He’s board certified in pediatric neurology who specializes in pediatric multiple sclerosis and pediatric epilepsy. Welcome to the show, Dr. Brenton. Most people think of MS as a disease that affects adults but really how common is it in children?

    Dr. Nick Brenton (Guest): Thank you for having me. MS is actually… it’s very true many pediatricians and pediatric subspecialists are still surprised when I tell them that MS can occur in children. We think about MS all comersto children and adults. The average estimate is about 2.3 million people are affected by MS worldwide, and though we traditionally think of MS as a disorder of young adults and adults, it’s becoming increasingly identified in kids. The estimates now say that up to 10.5 percent of patients have clinical onset of symptoms of multiple sclerosis before the age of 18 years old.

    Melanie:  Wow, what are those symptoms? What would a parent notice or what would a child say to their parents that would spark a little bit of an alert or a red flag? 

    Dr. Brenton:  Absolutely. It’s difficult especially in kids because kids are, in general, not as good as adults about reporting their symptoms. A lot of kids try to ignore them at first and see if they go away. Now, a first attack of MS can manifest in many different ways and it often comes on in a sub-acute nature and I mean that it’s not like it can go like a stroke typically where the symptoms come on like lightning and they stay. It’s more of symptoms gradually come on over the course of several hours and they escalate over the course of one or two days. They don’t tend to fluctuate and they don’t tend to stick around for an hour or two and then leave and then come back five hours later. Examples of first attacks in kids include something called optic neuritis. It’s inflammation of the nerve that sends our visual information to our brain, and so the symptoms can be visual blurring, a child complaining that their vision is blurry and it was perfect five minutes ago. Difficulty noticing colors especially red, they don’t have the color sensitivity as much. They also may complain of pain with eye movements. Other visual abnormalities like double vision or what we doctors call diplopia where they’re seeing two of an object. It shouldn’t be two; it should just be one. Sometimes kids can present with symptoms of what we call transverse myelitis, which is where there’s an attack on their spinal cord and that patient may become progressively weak in their arms or legs or they may have sensory changes, feeling numb or tingling in parts of their body that doesn’t go away. Or they may have bowel or bladder issues, difficulty holding in or difficulty letting out urine or feces. Then another thing that can be seen is balance difficulties. The child has difficulty walking in a straight line. A lot of parents have told me that they noticed their child was walking like they were drunk, running into things. Those are also symptoms that if they persist, it could be concerning for a first attack of multiple sclerosis.

    Melanie:  If they’ve had that first attack and how scary for both the child and the parents, then what do you do? You go see a pediatric neurologist; it gets diagnosed. What are the treatments? What is the outlook like for this child?

    Dr. Brenton:  Absolutely. Depending on how that first attack presents, there are a few treatments to help make the symptoms go away quicker. The natural history is that with their first attack of MS, children are very good about repairing and healing from that event without any treatment usually. Now sometimes if the event is bad enough, and most of the times, there are some things that are worrisome enough that we opt to treat. We can give medicines like IV steroids to help to speed up their recovery. Now the steroids we don’t think makes them better than if they wouldn’t have gotten steroids, but we do think that it speeds us their body’s recovery. Now after they get diagnosed with MS, there are no cures for multiple sclerosis as of right now, but there are treatments to help with the disease and make the disease quieter and not as active. Standard accepted therapies in pediatric MS come in the form of injections. Your injections are either subcutaneous or into the muscle and they can be given as frequently as daily to as infrequently as every other week. These are medicines that we call immunomodulators, meaning that they help turn down the kid’s overactive immune system which is why we think they developed multiple sclerosis. The injections have been available for over 20 years and they’ve proven to be safe, well tolerated, and they have a very good side effect profile. Additionally, their therapeutic benefits have been shown in multiple studies to reduce the attacks of MS on the brain.
    Now as some people may know, there are now three oral medicines out there that have been approved by the FDA to treat adult-onset multiple sclerosis since 2010. Now the problem with these medicines—because as you can imagine, a lot of kids want the oral medicines before the injectables—my problem with that is that we don’t know the safety of these oral medicines in kids yet because they are so new. But it is an exciting time for the pediatric MS community because there are multiple international clinical trials that are currently underway to evaluate the safety and efficacy of these newer emerging therapies for pediatric-onset MS, and UVA plans to be part of this international collaboration in these clinical trials.

    Melanie:  If a child is diagnosed or a teenager with MS—and this is just in your opinion, Dr. Brenton—when you look towards their future life, can you give them hope to say, “Yes, you can manage this and you can go on to get married, have children. This may be not quite the bleak outlook it once was.”

    Dr. Brenton:  Absolutely. I think that’s probably my most important job. When you get a diagnosis of multiple sclerosis, it’s fraught with a stigma that these children are going to be in wheelchairs early on in their life and they’re not going to live a full, long, healthy life. The disease landscape with MS is changing as we get better and better treatment. It’s amazing that we’ve had four, actually five, new treatments approved since 2010 for multiple sclerosis. That is a relief that we’re coming out with therapies in the MS community that has never been seen before. Yes, when I see these kids, I definitely have to encourage them and advise them that I want them to continue with their future just as planned. These kids aren’t like adults because they’re going through a different part of their lives. The psychology behind the diagnosis is so much different in children and adolescents than it is in an adult because they are in school, they may be in college, and they’re at the point in their lives where they’re really looking to just fit in. A chronic disease, like multiple sclerosis, really screws that out. So it’s my job as the pediatric neurologist to make sure that we don’t let MS get in the way of them doing what they want to do as much as possible.

    Melanie:  That’s really great information and great hope. In just the last few minutes, why should families come to UVA for their MS care? 

    Dr. Brenton:  Pediatric MS is rare enough that many child neurologists don’t feel that they see it enough to be absolutely comfortable in treating the disorder. Adult neurologists who see MS much more realize that the differential diagnosis of a child who presents with symptoms of MS is much more different than that of an adult. Given all of these reasons, I’m more excited to bring this especially to UVA so that the children in Virginia and the bordering states don’t have to travel too far to see a pediatric neurologist who specializes in multiple sclerosis. Our clinic is held right now once a week and it features a multidisciplinary team. All of these people are part of this team that is geared specifically for meeting the needs of pediatric and adolescent patients with multiple sclerosis. These team members include physical and occupational therapists. It includes a social worker and also includes a pediatric neuropsychologist. We know that up to one-third of kids with MS can have cognitive impairment towards the onset of the disease, so a pediatric neuropsychologist is a very important piece to having this clinic and then we have the pediatric neurologist who works to treat the disease. So we’re very excited to have this opportunity to offer this to the children of Virginia and very excited to be a part of the UVA community. 

    Melanie:  Thank you so much, Dr. Nick Brenton. You are listening to UVA Health Systems Radio. For more information on the UVA Children’s Hospital and UVA Neurosciences Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Mon, 13 Jul 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27729-multiple-sclerosis-in-children
When Should Patients Get Radiation Therapy for Prostate Cancer? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27728-when-should-patients-get-radiation-therapy-for-prostate-cancer when-should-patients-get-radiation-therapy-for-prostate-cancerCommon practice has been for prostate cancer patients to delay radiation therapy after having their prostate removed.

However, new research from a UVA radiation oncologist is upending this commonly held belief.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1520vh5c.mp3
  • Location: Null
  • Doctors: Showalter, Timothy
  • Featured Speaker: Timothy Showalter, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Timothy Showalter is a board-certified radiation oncologist whose specialties include prostate cancer.

    Learn more about UVA Cancer Center 

     
  • Transcription: Melanie Cole (Host):  Common practice has been for prostate cancer patients to delay radiation therapy after having their prostate removed. However, new research is upending this commonly held belief. My guest today is Dr. Timothy Showalter. He’s board-certified radiation oncologist whose specialties include prostate cancer. Welcome to the show, Dr. Showalter. Tell us a little bit about this. If they’re delaying receiving radiation therapy after having their prostate removed, why is that and what’s changed? 

    Dr. Timothy Showalter (Guest):  Well, first of all, thanks for having me. It’s great to be here. The area of postoperative radiation therapy for prostate cancer is an interesting and very challenging one. There were years ago clinical trials that showed that there was a survival advantage to adding radiation therapy for men with advanced prostate cancer after surgery. Those studies were conducted before we had the PSA blood test, which really changed the way we treat prostate cancer patients. Over time, a lot of clinicians have opted to not offer immediate radiation therapy after prostatectomy with a few goals in mind. One is that some of the patients can be followed with the PSA blood test over time and may end up never having their prostate cancer return. It’s kind of nice to avoid radiation therapy in those patients. The other reason is that there has been a long-held fear in the urology community and in the radiation oncology community that earlier radiation has a higher rate of side effects or complications for urinary function and for sexual function as well compared to delayed radiation. What we found in our recent research is that the latter point about the effect of radiation timing on ultimate complications from radiation therapy just isn’t true. 

    Melanie:  Wow, that’s really good news for men. I mean, because so many men, Dr. Showalter, worry that due to radiation and any other treatments. When they hear prostate cancer, they think of sexual dysfunction, they think of incontinence and these side effects. What do you want them to know about the findings of these studies and what they can look forward to in the future?

    Dr. Showalter:  I think if you’re a man in that situation and your urologist or radiation oncologist has talked to you about the option of doing radiation therapy, I would say first off that if you have more favorable features, for example, a low Gleason score or very low PSA, I think it’s perfectly fine to not rush in to radiation treatment. If, on the other hand, you got a high Gleason score and your urologist has mentioned that you are high risk for progression, I think for those men, it’s pretty clear that timing does matter in terms of cure rate. That earlier radiation therapy is more effective. The recent research is reassuring to men like that, because the research is basically saying, “Hey, if the radiation therapy is offered early when it’s most effective, it’s not going to increase your risk of complications,” because ultimately, these men will need radiation anyways. 

    Melanie:  The question I asked you at the beginning, Dr. Showalter, was for patients receiving radiation therapy, after having their prostate removed. What about those who opt not to have it removed? Is that changing in the landscape of prostate cancer today?

    Dr. Showalter:  Well, the technology has really changed prostate cancer radiation therapy for men with intact prostates who have not opted for surgery. There are a number of new options for those men as well. In the past 15 to 20 years, we’ve seen a number of incremental gains in the way we line patients up and track the prostate gland during radiation treatment and in the way we deliver radiation therapy, and they’ve culminated in giving more focused radiation that’s safer for patients and causes less collateral damage, having better cure rates by giving a higher radiation dose. Then more recently, offering radiation treatment over a shorter time schedule, for instance, a stereotactic body radiation therapy has been one advanced and external beam radiation therapy, where we’re now treating men with radiation schedules as short as five treatments. That’s opposed to the traditional approach of eight to nine weeks of treatment. 

    Melanie:  If patients opt not to have their prostate removed and they do have these radiation treatments, maybe hormone treatments, any of the other treatments out there, how do you keep track for them? How do they know it’s not going to recur? Because having their prostate removed feels like it would be a safer bet but less and less men are choosing that now, so how do you tell them “We’re going to keep track, we’re going to keep a watch”? 

    Dr. Showalter:  Well, first off, it’s helpful to sit down with patients and run through the actual numbers for available clinical trials and, of course, as you know, there’s a ton of prostate cancer research that comes out every day. It’s a herculean task to keep up with all of the new clinical research that comes out each month in the medical journals. The first thing I do is sit down and run the numbers and the reason why the national guidelines recommend either radiation or surgery is that both actually have the same cure rates and similar quality of life outcomes as well. It’s important that the patient realize that it really is a choice. Then in the follow-up period, it takes time to see the full response from radiation and for us to see the PSA blood test go as low as it’s going to go. It often takes a year and a half to two years of just following blood test. The number one way for us to check on patients over time is to continue to follow how their PSA blood test responds. The PSA blood test is a really good marker of radiation response and monitoring patients to make sure the prostate cancer doesn’t return. 

    Melanie:  Give some numbers, Dr. Showalter. What do you want men to know about their PSA numbers? 

    Dr. Showalter:  Well, there’s a lot of uncertainty and lack of clarity for the PSA blood test in the screening situation. In terms of diagnosing them with prostate cancer, there’s a whole lot of literature about what sort of PSA value should prompt the biopsy for example. The PSA test has been recognized to be not a great test in that situation, but it’s quite good in the after-radiation treatment. We generally see the PSA blood test go down to less than one or less than 0.5 within two years after receiving radiation treatment. That’s generally considered a good number and predict the patients will do well long term. For some of our high-dose radiation treatments including when part of our radiation is delivered with implanted radiation like brachytherapy or seed implants, we see PSA values go all the way down to undetectable, so below the sensitivity of the test. It’s just important to follow those numbers over time, keep an eye on the trend, and as we proceed, patients are generally reassured by those numbers.

    Melanie:  That’s great information. In just the last few minutes, give a bit of a summary about the studies that upend these common views we’ve been discussing and why patients with prostate cancer should come to UVA Cancer Center for their care. 

    Dr. Showalter:  First off, for the studies that we looked at, there were actually two reports that we published recently and this was in collaboration with some of my colleagues from Thomas Jefferson University as well. We looked at a total of 10,000 men between the United States and a separate cohort of men in a region of Italy as well and evaluated how men did in terms of major complications from treatment in terms of urinary, sexual, and gastrointestinal function. We did observe, as predicted, some increased risk of complications related to receiving radiation at all. But interestingly, the main hypothesis of the paper is that we did identify that earlier radiation did not increase risk of side effects. It’s highly reassuring for men who are contemplating jumping in with radiation. In fact, for some of the domains, earlier radiation actually had lower risk of complications than delayed radiation. Here at UVA, I think one of the benefits to being at a teaching hospital like the University of Virginia is that we have focused urologists and radiation oncologists who are very familiar with the latest literature and, for example, are aware of a research like this and can counsel patients in a detailed fashion about the latest research that may affect their treatment decisions such as the influence of treatment timing. 

    Melanie:  It’s great information and we applaud you on all of your research studies. Keep up the great work. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 06 Jul 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27728-when-should-patients-get-radiation-therapy-for-prostate-cancer
Stroke Warning Sign: What is a TIA? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27727-stroke-warning-sign-what-is-a-tia stroke-warning-sign-what-is-a-tiaOne of the most serious warning signs of a stroke is a transient ischemic attack, or TIA.

Learn more about the symptoms of a TIA and what to do if you experience one from Dr. Brad Worrall, a UVA stroke specialist

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1520vh5b.mp3
  • Location: Null
  • Doctors: Worrall, Brad
  • Featured Speaker: Brad Worrall, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Brad Worrall is a board-certified neurologist who specializes in stroke care, including transient ischemic attacks.

  • Transcription: Melanie Cole (Host):  One of the most serious warning signs of a stroke is a transient ischemic attack or TIA. What are those symptoms that you should really be aware of so that you can get the help you need as quickly as possible. My guest is Dr. Brad Worrall. He’s a board-certified neurologist who specializes in stroke care including transient ischemic attacks. Welcome to the show, Dr. Worrall. Tell us a little bit about what a TIA is and what are those symptoms that people really need to be aware of?

    Dr. Brad Worrall (Guest): Good morning. Thank you for having me. A TIA should be considered a warning for a stroke and therefore the symptoms of a TIA are exactly the same as what you might expect with a stroke. These symptoms would be weakness, numbness, clumsiness, loss of vision in one eye or on one side, and these symptoms would be things that come on very suddenly like a light switch being thrown. 

    Melanie:  What do you do? People think, oh, they just had too much to drink, their speech is slurred or they’re… people don’t catch these symptoms may be right away. Who would be more likely to catch the symptoms: the persons suffering them or the people they are with? 

    Dr. Worrall:  Actually, it can go either way. A patient experiencing a TIA may be talking and all of a sudden their speech comes out garbled, or they’re trying to prepare a meal and all of a sudden their hand isn’t working. So they may be the first to be aware of it. However, some of the symptoms of stroke and TIA can actually make recognizing that that’s what’s going on difficult, so as you said, somebody slurring their speech may be interpreted as being tired or being drunk or being confused. There is a form of stroke symptom called neglect where you actually are not even aware that there’s anything wrong.

    Melanie:  These are sometimes called mini-strokes, these TIAs. Is it going to lead automatically to a much larger stroke or can they be little warning signs that would build up to that? 

    Dr. Worrall:  Excellent question. I am somebody who does not like the term mini-stroke because mini implies small and these are not necessarily small at all. A TIA may come on with all of the symptoms that would be present in a stroke and the thing that is important is they go away, and that is what distinguishes a TIA from a stroke. We used to think that TIAs were a good thing. “You know, you almost had a stroke, but you didn’t, that’s great,” pat someone on the head and say, “Go home. Come back in a couple of days and we’ll figure out why this happened.” Well, indeed, we found out that TIAs are a very grave warning sign and that the risk of having a stroke or dying in the next two days is greatest and so therefore we most frequently admit people with TIA to the hospital to evaluate them very rapidly to figure out why and try to prevent that threatened stroke. 

    Melanie:  So it sounds like it’s just such a great red flag for physicians to be able to see this and hopefully get at it as opposed to a major stroke that happens with no warning and then you have to treat. How do you treat a TIA and what are you looking for? 

    Dr. Worrall:  Well, if the symptoms are still going on, it’s impossible to know whether the symptoms will be transient or permanent. The initial evaluation is identical to what we might do if somebody is in the midst of having a stroke. Check, make sure the person is stable, blood pressure, breathing, etcetera, and then rapid neurologic examination to determine if there are any lingering problems. As we talked about, the patient themselves may not be aware of everything. They may think everything has gotten better, but perhaps it has not and that would be very important because we do have the clot buster that we can use to try to reverse a stroke that’s in the process of happening. If the symptoms have completely resolved, then it’s still important to get a picture of the brain to see if there has been any permanent damage. Because even if the symptoms go away, there could be damage done to the brain.
    Then the final, crucial part is to look for the mechanism or cause of the TIA. That may be hardening of the arteries, atherosclerosis causing a blockage in the neck. That is one of the more common causes of TIA and potentially a very devastating cause of stroke. It can be caused by atrial fibrillation, an irregular heartbeat that allows a blood clot to form in the heart. It can then break loose and go up and block a blood vessel in the brain. There are other mechanisms of stroke that we would also need to identify and rapidly start medication to try to lower the risk of stroke in that person that’s presented with a TIA. That would include things like aspirin or other medications that make the platelet, little cell fragments in the blood that can stick together and cause a clot from being so sticky; treating risk factors like hypertension, diabetes, high cholesterol; counseling patient to stop smoking which is one of the most modifiable risk factor for stroke. Then if there are one of these specific causes that I mentioned such as hardening of the artery in the neck which would be treated most commonly by either surgery to remove that blockage or using a stent to try to open that blockage up. Or if the patient has been determined to have atrial fibrillation, instead of using antiplatelet agent, a blood thinner such as Coumadin or one of the newer agents to dramatically reduce the risk of stroke in the setting of atrial fibrillation would be of great import. 

    Melanie:  You’ve given us such great information. If you feel that someone is suffering a TIA or you yourself are, is it the same as having a stroke? Do you want them to call 911 and time is brain. Does all of that apply for a TIA? 

    Dr. Worrall:  Absolutely. Again, as I said, because we don’t know whether the symptoms are indeed completely gone or how quickly they might return, I mentioned that the period of greatest risk is actually in the first two days and we think that risk is greater closer to the TIA. The faster you get to the hospital, the better chance you have of catching somebody before they go on to have a stroke. I would absolutely encourage anyone who thinks they might be having a TIA to call 911 and get to the emergency room immediately. It is very important to go to the emergency room. You can call your primary care provider or your neurologist, if you have one, once you get there. Because again if the symptoms come back, you may not be able to communicate any longer and it is of crucial importance that people get to the emergency room. 

    Melanie:  In just the last minute or so, Dr. Worrall, would you please give the listeners your best advice on prevention or recognizing TIA and why patients should come to the UVA Stroke Center for their care. 

    Dr. Worrall:  I’ll take that in three parts. The recognition, as I’ve said, anything that affects particularly one side of the body, particularly coming on suddenly, so weakness, numbness, clumsiness, loss of vision, difficulty speaking or difficulty being understood. Any of those symptoms that come on suddenly without an explanation should be considered stroke symptom and potential TIA and should get to the hospital immediately. Prevention, I talked about some of the risk factors that are important for stroke and TIA. High blood pressure, we know that lowering blood pressure as little as three to five points can substantially lower the risk of having a stroke. Diabetes, high cholesterol, smoking, atrial fibrillation, these are all modifiable risk factors that patients and their doctors can work together to try to lower their stroke risk. At the University of Virginia, we have been providing acute stroke care for decades. It’s a highly specialized team that involves everyone from pre-hospital, ambulance providers, all the way through the inpatient stroke service, the neuro critical care unit, and to our rehab hospital. There is a comprehensive care provided at UVA for stroke patients. Anyone with a TIA or stroke should come to the University of Virginia for rapid evaluation. Time is brain. It is absolutely crucial that we get the opportunity to try to reverse any damage that’s in the process of happening.

    Melanie:  Thank you so much. For more information on the UVA Stroke Center, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Healthy Systems Radio. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Stroke]]>
David Cole Mon, 29 Jun 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27727-stroke-warning-sign-what-is-a-tia
Coping with Seasonal Allergies http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27726-coping-with-seasonal-allergies coping-with-seasonal-allergiesHow do you tell the difference between allergies and a spring cold?

Are there treatments to consider besides over-the-counter allergy medications?

Learn more from Dr. Monica Lawrence, a UVA specialist in seasonal allergies.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1520vh5a.mp3
  • Location: Null
  • Doctors: Lawrence, Monica
  • Featured Speaker: Monica Lawrence, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Monica Lawrence is board certified in internal medicine; her specialties include seasonal allergies.

  • Transcription: Melanie Cole (Host):  How do you tell the difference between allergies and spring cold? Are there some treatments to consider besides all those over-the-counter allergy medications? My guest today is Dr. Monica Lawrence. She’s board certified in internal medicine at UVA and her specialties include seasonal allergies. Welcome to the show, Dr. Lawrence. What are some of the common seasonal allergies people face in the spring and the summer? What do you see the most?

    Dr. Monica Lawrence (Guest):  Hi, good morning. The most common springtime allergies are actually trees and grasses. That yellow coating you see in your car when you come out in the morning is all tree pollen primarily. Right now, we’re in the midst of tree pollen season and heading into grass pollen season. 

    Melanie:  How do people know? When they start to get the sniffles or the itchy eyes—because in the spring and the summer, Dr. Lawrence, colds start coming up, too; we’ve got those wicked spring colds—how do they know that those symptoms are not just the cold, that they are in fact allergies?

    Dr. Lawrence:  That’s a great question, and that’s a question we talk about in the office quite a bit with our patients as it can be really hard to tell the difference between a cold and allergies. There are a few things though that I try to get out with patients that kind of tell them apart. The first thing is if it’s a cold you usually will have a fever and just kind of feel more achy, rundown, and you really shouldn’t get either of those with allergies. With allergies, another big thing that we look for is the eye symptoms. The reason you get itchy, watery eyes is because the pollen is blowing. Because it’s air-borne in the wind, it blows right onto your eyes and that causes that itching and watering. Whereas the colds, it can cause a little bit of watering eyes, but not usually the itchy, red symptoms you get with your allergies.

    Melanie:  These differences are something that would lend someone to think that this is something that maybe they’re going to get every season at this time. Then what do you do about them? First thing people think is to go to the pharmacy and get one of those over-the-counter antihistamines and start using those. What do you recommend we do? 

    Dr. Lawrence:  That’s actually a great place to start. Really, the over-the-counter antihistamines that are available now, drugs like Allegra and Claritin or Zyrtec, all used to be prescription. They are prescription strength and they’re very effective. The other thing that just came over-the-counter in the last year are the nasal steroids, things like Flonase and Nasacort, which also until recently were prescription. Those are really great tools that patients can access themselves without having to come in to see a physician. 

    Melanie:  Do we have a problem with those nasal sprays? Do people kind of overuse them? Can they make that inflammation worse? 

    Dr. Lawrence:  I’m really happy you brought that up. The nasal sprays like Flonase and Nasacort are nasal steroids. When used as directed on the box, there’s really not a problem with those in terms of making things worse. What we do run into trouble is with drugs like Afrin, the decongestant nasal sprays. What can happen with repeated use is that your body can actually become, I use the word, “addicted” to the sprays. In other words, if you try to stop using those sprays after you use them for weeks on end, your symptoms will flare and be worse than when they started. So, the cycle is you go back and use them again. We do see patients in the office who have been on a spray like that for 20 and 30 years and haven’t been able to ever stop. So we really encourage people: Read those package labels. If it says to wean them after a few days, really take that seriously.

    Melanie:  That’s what we look for on the label, the difference between a corticosteroid nasal spray such as Nasacort and the decongestant like Afrin. 

    Dr. Lawrence:  Exactly. Afrin is a great drug but only when used in very brief spurts, no more than five days—it’s what I tell my patients—whereas, Flonase and Nasacort are safe to use year-round.

    Melanie:  What can we do besides medications? Do you like nasal lavage? Do you like one of these kinds of things to kind of clear everything out? What else can we do? 

    Dr. Lawrence:  Nasal lavage which is what we refer to when we rinse our noses with salt water or saline solution is one of the most effective ways to help with your nasal congestion. I liken it to giving your nose a shower. You have all that nasty pollen that’s deposited on the inside of your nose and you really need to rinse that out. The only way to effectively do that is with a nasal lavage. Once you’ve done that, then you’ve got a clean surface and when you use your nasal sprays, they have a much greater chance of actually being able to be effective. Some people find benefit from just using the nasal saline lavage alone. A lot of times I tell people to follow it 30 minutes later by their nasal spray. Again, these are all treatments that are available over-the-counter for patients just at their local drug store. 

    Melanie:  Then what else can we do? You know, triggers, seeing what bothers us the most, and is there any way to work on prevention? 

    Dr. Lawrence:  Absolutely, and that’s where coming in to see an allergist is really important. We can do symptomatic treatment that’s sort of a general symptomatic management by using the stuff that’s available over-the-counter, but very, very often, we’re seeing this especially this season where the pollen levels are very high, that’s not enough. If you come in to an allergist’s office, we offer comprehensive testing for all the environmental allergens that are found indoors and outdoors. Once we know what you, in particular, are allergic to, we can talk to you about how to specifically avoid those allergens because there are some very specific things you can do, for example, for dust mites that are found indoors and there are things that you can do to avoid pollen. We talk to patients about that. If their symptoms aren’t controlled with avoidance strategies and some of the over-the-counter medications, then we often talk about prescription strength medication or doing what we call allergen immunotherapy or, more commonly known, allergy shot. That’s a great tool for patients because it provides a lifetime benefit in the majority of patients who do allergy shots. There are definitely additional tools available for patients if you find that the over-the-counter stuff just isn’t enough. 

    Melanie:  In just the last few minutes, Dr. Lawrence, if you would, give your best advice for people suffering with seasonal allergies, including washing their bedding or watching those pollen counts, and why patients with allergies should come to UVA for their care. 

    Dr. Lawrence:  Sure. This time of year, as I said, tree and grass pollen are our biggest concerns. I would encourage people to keep your windows shut, use the air conditioning if possible. Avoid being outside when people are cutting the grass, or if you’re cutting the grass yourself, wear a mask. When you come in from outside, think about changing clothes and rinsing off in the shower so you’re not bringing that pollen inside your house. Try all the over-the-counter remedies that we discussed, the saline rinses, the nasal sprays. If those aren’t enough, then go in to see your local allergist so that you can be tested and be treated. I think the advantage that a center like the University of Virginia offers is because we really do have comprehensive care. There are many more complex diagnostic tests that we offer that not every practice is going to be able to offer, so it’s sort of a one-stop shopping. The other thing I think that’s really a huge advantage is that we have researchers that are doing cutting-edge research in all of the areas of allergy and food allergy and chronic sinusitis and aspirin allergy and asthma and viral triggers of asthma. We really have a lot of folks with very specific expertise, and when you come in to see one of our doctors, you benefit from that doctor being able to collaborate and talk about the latest in research from here at UVA. It’s a really fantastic experience for patients to be able to come in and not have to be referred elsewhere.

    Melanie:  Thank you so much, Dr. Lawrence, what great information. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Allergies]]>
David Cole Mon, 22 Jun 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27726-coping-with-seasonal-allergies
Helping Patients Recover from a Heart Attack http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27408-helping-patients-recover-from-a-heart-attack helping-patients-recover-from-a-heart-attackWhat care will help patients speed their recovery from a heart attack?

Learn more from Dr. Ellen Keeley, a UVA specialist in helping patients recover following a heart attack.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1516vh5e.mp3
  • Location: Null
  • Doctors: Keeley, Ellen
  • Featured Speaker: Ellen Keeley, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Ellen Keeley is board-certified in cardiovascular medicine and interventional cardiology; her specialties include helping patients with their post-heart attack recovery.

    Learn more about UVA Heart & Vascular Center
  • Transcription: Melanie Cole (Host):  If you or a loved one suffered a heart attack, what can help you speed your recovery? What things do you need to do so that you can get back to living a normal high quality form of life? My guest today is Dr. Helen Keeley. She’s an interventional cardiologist. Her specialties include helping patients with their post heart attack recovery. Welcome to the show Dr. Keeley. So once someone suffers a heart attack, what is the typical timetable for recovery? When can they get back to normal life?

    Dr. Helen Keeley (Guest):  It usually takes several weeks. It depends, of course, on the type of heart attack and the severity of the heart attack. But in general it takes about two to three weeks for them to really start feeling back to their normal self, and then depending on the pumping function of their heart and how they’re doing in general, it might take another couple of weeks before they really feel as though they can get back into, say for instance, their exercise program.

    Melanie:  Dr. Keely, back in the day, if someone would have a heart attack, they’d be in bed for three weeks. Now with the cardiac rehab and phase one, you’re really getting people up pretty quickly, aren’t you?

    Dr. Keeley:  That’s right, exactly. In fact, even with some of our large heart attacks, the patient is up and around within about two days and on the floor out of the unit around that time. We encourage them to walk around with the physical therapist, and usually by day three or four, at least by day three or four, they’re discharged from the hospital, even with some of our larger heart attacks. Most of the recovery actually does happen at home and that’s why it’s still important, we believe, to really have a program set for patients when they do go home because this when all the hard work really starts for them.

    Melanie:  So speak about that multidisciplinary approach for as, if you would. What are some of the key elements of that post heart attack care that your healthcare team provides?

    Dr. Keeley:  Well, what we realized is that, again, a lot of the work for the patient and the patient’s family starts after discharge. We thought that maybe if we were to develop a clinic that where we would see the patient very early after discharge, within about a week to 10 days after discharge, that we would be able to really answer any questions that they had that they weren’t able to ask during the hospitalization or that they were unclear about during hospitalization. We are able to check their medications, make sure they’re on the correct medication and really get them referred properly to cardiac rehab, help them with their smoking cessation and do all this early on, because we find that when patients run into trouble after heart attack and they get readmitted to the hospital, this actually does occur, the majority of it, within about the first two weeks. So we feel though if we’re able to see them quickly after discharge, we’ll be able to catch anything that might be brewing and kind of nip it in the bud so that they do not get readmitted to the hospital.

    Melanie:  Tell us a little bit about the new clinic that you’ve helped establish for patients recovering from heart attacks.

    Dr. Keeley:  Well, we’re really excited about this. It is a multidisciplinary clinic. In our clinic we have an exercise physiologist, we also have a dietician and we have a pharmacist who not only specializes in arranging the patient’s medications so it’s easy to take and affordable but who also is very interested in helping patients stop smoking, and then myself. So we’re able to really, in one clinic, answer a lot of questions for the patients and, more importantly, make sure that their medications are correct, answer questions according to their medication problems that they may be having, and then also get them referred to cardiac rehab that’s close to their home. And if they, for whatever reason, cannot go to cardiac rehab which we feel though is extremely important, we try to arrange a bit of an exercise program for them to get started at least at home.

    Melanie:  And how do you engage them in that lifestyle management, behavioral changes that are so important after a heart attack so that hopefully to prevent another one?

    Dr. Keeley:  The last several weeks in the clinic, we have found that patients are really enjoying the clinic. A lot of them have brought their family members, they have lots of questions, they’re very motivated at this stage of the game to make some changes in their lifestyle, whether it be smoking cessation, starting an exercise program, and also monitoring their diet more closely to a heart healthy diet. They seem to be very motivated because they were just discharged from the hospital and, you know, it’s a scary thing to have a heart attack and a lot of things happen during the hospitalization. So when they come in, they’re a little bit more relaxed they’re able to focus on themselves, we give them personalized attention because each patient is obviously different and their needs are different, and we found that we’ve been able to really hopefully make some changes early on. The patients seem to be more motivated and more relaxed than when you’re trying to discuss these types of things while they’re still in the hospital.

    Melanie:  What nutritional advice do you like to give them? Is there any dietary restriction or are there things that you want them to learn about nutrition after heart attack?

    Dr. Keeley:  Well, our dietician Carter Buxbaum, who works with us in the clinic, is really fantastic and she has a handout about healthy heart diet. She also goes over portion control with the patients; she goes into lots of details about their specific issue. Say, for example, if someone has hypertension and she feels as though that they have too much sodium intake, she teaches them how to read the labels about the amount of sodium in their food. So truly, it’s very personalized. Some patients she recommends the Mediterranean diet for, other patients she feels as though they’re doing the right thing but gives them some little tips here and there. So in general we do teach them a heart healthy diet, but you will see that a lot of them are doing some things correctly, some things maybe not so correctly, and she monitors that and adjust it accordingly to each patient.

    Melanie:  And what about exercising on their own, walking, getting a bike in their home, doing any of that sort of thing? Do you encourage that or do you like them at least at the beginning to be monitored?

    Dr. Keeley:  We very much like them to be monitored at the beginning. We’re very much a pro-cardiac rehab. The problem is that not all patients are able to attend to cardiac rehab because it is something that you have to go several times a week and the reality of it is that some patients are not able to do it, even though we very much encourage it and any patient who can we certainly enroll them into a cardiac rehab program close to their home.
    But short of that, we have found that our exercise physiologist Mitchell Adams and Courtney Connors are able to sit down with the patients and at least get them started. They have several handouts showing how to exercise safely in the first couple of weeks after a heart attack, and safety tips of exercise. They also have some very interesting applications that can be used on smartphones to help people be motivated to try to start an exercise program.
    So in general, yes, we do like them to be monitored and we do advocate them to be enrolled in a cardiac rehab program. The reality is it’s not always possible, and when is not possible, then Courtney and Mitchell do their very best to start them on an exercise program that they can do at home.

    Melanie:  When generally can people return to work and some of those activities? What about lifting and strength training?

    Dr. Keeley:  Usually we ask them to wait ideally until after cardiac rehab is finished because during cardiac rehab the exercise physiologist is really able to see how they’re doing in general, especially in patients who, for example, has had a large heart attack and the pumping function of the heart is not normal any more. So we would really encourage patients to be monitored while they’re exercising, kind of do what the exercise physiologist sets out for them to do. In terms of people who have had smaller heart attacks and kind of activities of daily living, usually within the first couple of weeks, again, we advocate that patient can start walking and usually start lifting at that point probably no more than 10 pounds or so. A big exercise program involving weight probably would be something we would defer for probably a month to six weeks, again depending on the size and severity of the heart attack.

    Melanie:  Dr. Keeley, in just last minute if you would, give listeners your best advice about those who have just had a heart attack or whose loved one has just had a heart attack and what you really want them to know and why they should come to UVA for their heart care.

    Dr. Keeley:  Well, I think UVA provides just topnotch health care. Especially in our division, cardiology division, we advocate patients to come early whenever they have a sign or symptom of anything consistent with a heart attack. And remember, it’s not always classic chest pain; it can be any symptom. If the patient is concerned about it, they need to to call 911 and come early. So the earlier someone comes to the hospital, the earlier we’re able to take them to the cardiac cath lab, the quicker we’re able to open up the artery and establish normal blood flow and the smaller the heart attack will be. So the key is to come early. Once it happens and the patient does have a heart attack, then the next important thing is to modify any risk factor possible that the patient may have, including smoking cessation, control of their diabetes if they have diabetes, control of their cholesterol if they have high cholesterol, and control of their blood pressure, staying on a heart healthy diet and starting an exercise program. These are all extremely important things. So, the first thing is to come early and have the heart attack stopped as quickly as possible. The next important thing is to make important changes to decrease the chance of you having a second heart attack.

    Melanie:  Thank you so much for great information. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Disease]]>
David Cole Mon, 15 Jun 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27408-helping-patients-recover-from-a-heart-attack
Enhanced Recovery After Surgery http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27407-enhanced-recovery-after-surgery enhanced-recovery-after-surgeryA new recovery program for surgical patients at the University of Virginia Health System is helping patients go home sooner while making them more comfortable both before and after surgery.

Learn more from Dr. Traci Hedrick, a UVA surgeon who helped put the new procedure in place.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1516vh5d.mp3
  • Location: Null
  • Doctors: Hedrick, Traci
  • Featured Speaker: Traci Hedrick, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Traci Hedrick is a colorectal surgeon who specializes in caring for patients with colorectal cancer and other colorectal conditions with minimally invasive surgery.

    Learn more about UVA Cancer Center
  • Transcription: Melanie Cole (Host):  A new recovery program for surgical patients at the University of Virginia Health System is helping patients to go home sooner while making them more comfortable both before and after surgery. My guest today is Dr. Tracy Hedrick. She is a colorectal surgeon who specializes in caring for patients with colorectal cancer and other colorectal conditions with minimally invasive surgery. Welcome to the show, Dr. Hedrick. So tell us a little bit about some of the typical challenges that are faced by patients when they are recovering from colorectal surgery.

    Dr. Tracy Hedrick (Guest):  Yes, thank you. So, colorectal surgery itself can be quite complex and patients typically after surgery, you know, as from any surgery, can have pain after surgery but also can have problems with their bowel becoming awake after surgery, so it’s oftentimes that patients are in the hospital four to five days waiting for their bowel function to return. What enhanced recovery does is allow that process occur much more quickly.

    Melanie:  Wow. So what can people expect? I know you doctors, you want the bowels to return, you want to make sure that they are passing gas and having a bowel movement, whatever it is that they have had done, before you let them even think about leaving the hospital. When do they get up and start moving around? Does that help speed the process?

    Dr. Hedrick:  Yes, absolutely. So, with this new protocol, in fact, we get them up and moving around in the recovery room because we know that that stimulates the bowel to function. So we get them up in the recovery room and then once they get to the hospital ward, we get them up again and we get them up two and three times on the day after surgery. That is very important.

    Melanie:  What about eating? Do they start eating solid food pretty quick? Do they have to take laxatives, stool softeners for quite a while afterward, or is this just initially?

    Dr. Hedrick:  Before, we used to wait until the patients were passing gas to actually feed them, but with the new protocol they get liquids the night of surgery, jello and that type of thing, and then the next day they are started on solid food. You know, patients are very good at regulating themselves. Since they are nauseated, they don’t take the food but most patients are able to tolerate soft food the day after surgery.

    Melanie:  You’ve helped pioneer some of the changes in the recovery process for abdominal surgeries. Can you explain how the enhanced recovery after surgery process works a little bit for us?

    Dr. Hedrick:  Yes. You know, each protocol is a bit different at each institution, but it’s basically based on several tenets,and that is, one is avoiding the use of opioids such as morphine which can slow the bowel down after surgery, so we use different types of pain medicines to control pain such as ibuprofen and Tylenol and gabapentin and things like that. It’s also based on avoiding giving the patients a lot of intravenous fluids, saline, through their veins, so we let the patients drink up until two hours prior to surgery and then we allow them to drink in the recovery room to keep themselves hydrated. It’s also based on, as we discussed, getting up and walking right after surgery and also eating right after surgery. Finally, it’s really based on allowing the patients and their family to be an active participant in their care, so we tell them exactly what is going to happen, we give them a checklist so that they know what is going to happen, and they help us to remind the nurses to get them up after surgery, and really make them the star player of their care.

    Melanie:  What are some of the benefits for the patients of this enhanced recovery process? Does it help them to go home quicker? Does it help their families care for them post-surgery?

    Dr. Hedrick:  Yes. So it helps them, on average, go home two days sooner; it helps them be prepared to go home sooner. It actually controls their pain better and it allows them really to get back to their normal selves much quicker.

    Melanie:  What do their families and loved ones need to know about post-surgical care and taking their loved one home? Are their certain things you like to teach them about their incisions or about things they should be looking for, red flags?

    Dr. Hedrick:  Yes. So, you know, a lot of times families want to keep their loved ones in bed and do everything for them. I personally think it’s better for the patient to be up and active as much as possible after surgery. There are red flags: We want to know anytime the patients have a fever, anytime they start to develop flu-like symptoms, things like that. But outside of that, we want them to be up and active, taking walks and doing the likes, because that really does speed up the recovery process.

    Melanie:  And so if they have these red flags, obviously they call you right away. Are there certain candidates, certain patients that you have that have surgery that are not candidates for this enhanced recovery program?

    Dr. Hedrick:  No. Really we do put everybody on the protocol, even the sickest of patients that have certain medical conditions. We monitor them very closely; we don’t send them home before they are ready. The key is not to discharge patients before they are ready. It’s to get them to the process where they feel like being discharged sooner than before, and so if they are not quite ready, we don’t send them home. But, you know, the key is standardizing the care process and we do it for the young 19-year-old patients to the 90-year-old patient. We do customize it to each individual person that everyone benefits from the protocol.

    Melanie:  So tell us in just the last few minutes your best advice for people that are considering having surgery, what to expect afterward and why patients should come to UVA for their surgical care.

    Dr. Hedrick:  Well, I think we pride on ourselves on providing the most up-to-date quality care. You know, this protocol has been proven to be effective, in not only reducing the link to stay but also reducing complications, and we are becoming a center now for teaching other institutions how to do this protocol. I think for all those reasons, patients should choose UVA for their health care needs.

    Melanie:  Thank you so much, what great information. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Sugar]]>
David Cole Mon, 08 Jun 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27407-enhanced-recovery-after-surgery
Repetitive Stress Injuries in Athletes http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27406-repetitive-stress-injuries-in-athletes repetitive-stress-injuries-in-athletesRepeatedly performing the same athletic task – such as throwing a baseball – can lead to injuries.

Learn what steps athletes can take to reduce their risk for these repetitive stress injuries – as well as what treatments are available – from Dr. Stephen Brockmeier, a UVA specialist in sports medicine.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1516vh5c.mp3
  • Location: Null
  • Doctors: Brockmeier, Stephen
  • Featured Speaker: Stephen Brockmeier, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Stephen Brockmeier is a board-certified orthopedic surgeon who specializes in sports medicine and shoulder surgery.

    Learn more about UVA Orthopedics
  • Transcription: Melanie Cole (Host):    Repeatedly performing the same athletic task, such as throwing a baseball, can lead to injuries. What steps can athletes take to reduce their risk for these repetitive stress injuries? My guest today is Dr. Stephen Brockmeier. He is a board-certified orthopedic surgeon who specializes in sports medicine and shoulder surgery at UVA. Welcome to the show, Dr. Brockmeier. So tell us a little about some of the more common stress injuries that you see.

    Dr. Stephen BrockMeier (Guest):  Thanks, Melanie. Thanks for having me. So each sport kind of has its own subset of repetitive or we like to call overuse injuries. The ones that we see most commonly or certainly get the most attention are associated with the overhead athletes, as you mentioned in the introduction of this topic, something you hear very commonly associated with either baseball players or racket sport players like tennis, where you have some overuse injuries that are pretty common involving the elbow and the shoulder, and these are pretty common things that we see.

    Melanie:  So in sports, in our little athletes, in our high school and collegiate athletes, and I'm sure in professional sports, Dr. Brockmeier, they have you know throwing limits. There are people that put it out there that, you know, can't have your little athlete out there for more than a few innings. So what are they doing to hopefully reduce this?

    Dr. BrockMeier:  Yeah, so there is a lot of research going on in this area, specifically the baseball player population. And really what they are looking at is, is there a pitch count and is there a better pitch count given the age of the athlete? There is a subset of this that we see in youth athletes that really can be very problematic. And so you are either looking at pitch counts. I think one of the major mistakes that are made, especially with those of us who are parents with our children, is underestimating the rest that these children will need. So it's not only pitch counts in one given outing but it's also sometime for the arm to kind of rest and recover from a repetitive stress type sport. So oftentimes these kids will pitch and then they will go and play in the outfield or go play in a different position and there is really not a lot of down time to let the arm accommodate it. That's I think one of the common mistakes that we see.

    Melanie:  With all sports and even with, you know, exercisers running and people that do certain exercises repetitively, these overuse injuries are becoming more and more common. Do you recommend cross training? What do you recommend as a way to sort of prevent some of these overuse injuries?

    Dr. BrockMeier:  Yeah. I mean I think you mentioned one of the key areas of prevention is a good healthy conditioning. You know, I preach moderation to my patients. I think youth sports in particular have directed over to being kind of a specialist. So a kid is a baseball player or a soccer player or a basketball player. It used to be back when I was a child that, you know, the three-sport athletes were the true athletes. I think some of the better athletes you’ll see are the ones who really develop their athleticism through a lot of different sports. And so one of the traps obviously is doing the same sport repetitively. If that’s something that you are doing, I think it's really critical to train in different ways to improve on your endurance and your muscle memory and all those various things without doing the same exact thing over and over and over again.

    Melanie:  What do you do if you do start to suffer an overuse injury or a repetitive stress injury? Do you like your patients to ice, elevate, rest, wrap? What is it you want people to do to give this some relief?

    Dr. BrockMeier:  Yeah. I mean the good news is with a lot of these injuries, the majority of times, this is something that gets better without any type of intervention, And the key component almost always is going to be rest, meaning that the athlete needs to take a period of time, and normally it's not just a day or two, away from their sport to let their body try to recover. You know, the majority of these can get better if you just give your body a chance to help. So icing can be helpful; rest is critical. There are certain rehabilitation exercises that are specific to each type of injury that we will often institute. Things of that nature are the initial steps that we’ll take, and that normally gets this better in the majority of athletes.

    Melanie:  And what about those people that are just your exercisers? I mean, they don't want to stop running, right, Dr. Brockmeier? They don't want to stop going to the gym doing the things that they are doing. How do you get those people to settle down a little bit, cross train, do some other things?

    Dr. BrockMeier:  Yeah. I think to really answer that question, you may want to have a psychotherapist on the line here because this is really a way of life. I mean, you know, people don't generally get these types of injuries sitting on the couch. And so it's really hard for some of these people to take a break. So what I tend to try to do is I try to find a different area that they can maintain some of the stress relief and some of the other aspects of sports or of fitness that these people really use this for and focus them on that area while they are letting their body recover. So if it's a runner, for example, maybe they try swimming or other type of cross training type activities. You know if it’s a baseball player if it's somebody playing a specific sport, maybe you focus on some of the training aspects of things. And sometimes these people actually really get into the rehab portion of the treatment for these types of injuries. So you can kind of try and focus their energy and their attention and, you know, kind of their obsessions, so to speak, on rehabilitating from the injury. And they tend to be pretty dedicated to that.

    Melanie:  Dr. Brockmeier, what we are seeing now something sort of new in the sports medicine field, and it's not even necessarily in sports medicine now, are occupational repetitive stress injuries, I mean everything from using a computer to texting, these things, these overuse injuries. Are you seeing that now?

    Dr. BrockMeier:  Yeah, you do. You know, occupational injuries account for a good percentage of the patients that we see for a variety of things, both overuse injuries as well as structural things that may require surgery. This is something that can be particularly challenging because it's not like this is a hobby or kind of a recreational pursuit. This is how somebody makes their living so that's a real challenging thing because oftentimes it requires at least a period of time to allow the body to recover from whatever the treatment’s going to be and it can have major impact and ramification for this individual as far as how they make a living.

    Melanie:  Are you looking at ergonomics? Are you helping them to decide different positional ways that maybe whatever it is they are doing can, you know, not cause some of these repetitive injuries that you might be seeing?

    Dr. BrockMeier:  Yeah, certainly ergonomics from the standpoint of the elbow and wrist type of injuries that we see commonly, very important. Low back, you know, is something that obviously all of us will get from time to time. But the way that you lift for those that do labor is really critical. And then some of the stuff that I see in the shoulder or in the knee, a lot of these things are related to repetitive stress as well, so maybe limiting overhead positioning of the arm to kind of let the shoulder maybe not be quite as symptomatic or positional things with relation to the lower extremity. All of these things are really things that you have to consider to try to get these people healthy and pain-free and to be able to continue to do their job.

    Melanie:  So really, you know, a burgeoning field and a burgeoning topic, this occupational frozen shoulder, from your desk, being at improper height and such, so what do you tell people when they've got this kind of situation? Do you ask them to assess their work situation and then go from there?

    Dr. BrockMeier:  You know, it's funny; a lot of people have already done that. People are always looking for why “it shouldn't be that all of a sudden my shoulder starts hurting,” so what happened? And sometimes it is something related to either repetitive things that thy are doing at work that initially they don't seem to pick up on but then do, and other times they are just trying to find a reason. Some things we see will come on just with age-related changes or just with use over time. But these are questions that we'll often ask when we are first meeting a patient: How did this happen? What are some things that may be contributing? How can we address those things to try to minimize symptoms for you? So, yeah, all of these things are very critical.

    Melanie:  In just the last few minutes, Dr. Brockmeier, if you would, give listeners your very best advice, and those that may be suffering from sports-related repetitive stress injuries, overuse injuries, and why they should come to UVA Orthopedics for their sports medicine care.

    Dr. BrockMeier:  Sure. Well, I think what I would tell them is obviously this is something that is really common, so you are very much not alone. And a lot of times it can be managed very efficiently just by recognizing what the problem is and taking some simple steps to try to address it and correct it. The body can correct a lot of these problems if just given the opportunity to do so. Our group, we really have a multi specialty group. I have four partners who are board certified and some specialty trained orthopedic surgeons for those patients who do require more specialized care. But we have primary care sports medicine doctors, specialists in running athletes and other conditioning type sports, exercise physiologists, things of that nature, and all of us work together to treat kind of the entire spectrum essentially of bone and joint problems and try to get people to be active and to be healthy and fit and enjoy their lives and their jobs and their other pursuits.

    Melanie:  Thank you so much for being with us. Absolutely great information. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic]]>
David Cole Mon, 01 Jun 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27406-repetitive-stress-injuries-in-athletes
The Latest Research on Brain Tumor Treatments http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27405-the-latest-research-on-brain-tumor-treatments the-latest-research-on-brain-tumor-treatmentsRecent media coverage has focused on possible new treatments for brain tumors.

Learn about the latest developments from Dr. Benjamin Purow, a UVA specialist in neuro-oncology.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1516vh5b.mp3
  • Location: Null
  • Doctors: Purow, Benjamin
  • Featured Speaker: Benjamin Purow, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Benjamin Purow is a neurologist who specializes in researching new brain tumor treatments and caring for patients with brain tumors.

  • Transcription: Melanie Cole (Host):  Recent media coverage has focused on possible new treatments for brain tumors. My guest today is Dr. Benjamin Purow. He is a neurologist who specializes in researching new brain tumor treatments and caring for patients with brain tumors. Welcome to the show, Dr. Purow. So there has been some coverage recently about new potential treatments for brain tumor, so talk about some of those recent developments.

    Dr. Benjamin Purow (Guest):  Certainly, certainly, and thank you for having me. You know, there is really growing excitement in this field, as I would say, there is a cross oncology, but there is lot of it focused in neuro-oncology and brain tumors. We had a big brain tumor meeting back in November several months back and there were few exciting developments there which, you know, I have to say is all too unusual at this meeting.
    You know, one of these was combining very unusual new treatment which actually involves electrical currents to the skull to the region of the brain tumor, combining that electrical treatment with radiation and a chemotherapy we use a lot called temozolomide and this combination for patients that had recently been diagnosed with glioblastoma, the most common and aggressive brain cancer that’s out there, led to some exciting results in the clinical trial.
    There was another positive clinical trial that was announced at this meeting, which combined in immunotherapy essentially a vaccine against a mutation only found in about a third of glioblastoma patients but only in those cells in the body, that particular mutation combining that vaccine with a drug called avastin which attacks the blood supply but may also have some good effects on the immune system which prompted that clinical trial which again had positive results which is also super. You know, there is a bit of other positive results announced at this trial using this avastin medication in a subset of patients with glioblastoma, but a lot of enthusiasm at the meeting was focused on new immunotherapy treatments that rev up the immune response against the cancer, and there are different ways to do this. A couple of exciting presentations with the meeting involved a polio virus treatment which is being pioneered at Duke University. They use polio, basically a weakened and attenuated polio virus, and inject it right into a piece of a location of recurrent glioblastoma cancer. Another couple of things: they’re trying to directly kill the cancer cells there in the brain but it also seems to attract the immune system’s attention because of the polio virus infection. An immune system then turns around and attacks the tumor. They have a couple of patients who have done great for a long time with this treatment. There was another viral therapy being pioneered at MD Anderson Cancer Center in Texas that also looks very promising, but there are a number of other immunotherapy that are looking great now too. There are some other cancer vaccines which are starting to show some exciting results. On top of that, there are some therapies that are already out there and FDA-approved for melanoma that people are increasingly excited about for glioblastoma, other brain tumors and cancers across the board. These are treatments that can be given IV every couple of weeks and they rev up the immune system, somewhat nonspecific so there are some risks to these drugs like autoimmune diseases. But they seem to be a great way to get the immune system engaged in fighting the cancer, and everyone is awfully excited about these drugs and some of the combinations that we’ll be doing. 

    Melanie:  So most of these immunotherapies and vaccines and really exciting new treatments that you are describing, they are in clinical trial phase. When do you, in your opinion, see some of these coming to the forefront where they might actually benefit some patients?

    Dr. Purow:  Sure, sure. So for some other cancers, as I said, for melanoma and actually one of these for lung cancer are already FDA approved. Insurance won’t cover this but a few patients are trying to get some doses of this paid for out of pocket. So a few patients are already accessing this immune system boosters we call check point inhibitors and drugs like nivolumab or [pembrolizumab] but the trials I think will move fairly fast, and [recurring] patients certainly fast too, so it may just be a matter of couple of years, few years, before there is evidence of the fact and FDA approval will hopefully come pretty quickly, especially since these are drugs where they are already FDA-approved for certain settings, patients with melanoma, or already lung cancer has been added to melanoma.

    Melanie:  Now patients with glioblastoma, you mentioned earlier electrical fields and I know your colleague Dr. David Schiff was involved in this wearable device, tell us a little bit about that trial.

    Dr. Purow:  Sure, sure. So, you know, the great results from that trial I have to say came as a bit of a surprise to the field in a way. It stems from, you know, this is a very unusual treatment, as I started mentioning before. It essentially involves putting electrode patches up on the skull in the region roughly over where the brain tumor is. These electrode patches are wired to a battery pack you carry around that applies alternating electrical current to that region of the head. We have some good research that led into this, mostly out of Israel, that show that these electrical currents can actually lead to killing of glioblastoma cells especially if the current hits the dividing cell, dividing cancer cell, at the right orientation. There had been trials of these electrical treatments in patients that had recurrent glioblastoma when the cancer came back again, and this actually prompted FDA approval of the device in this setting, although the effectiveness of this in that setting, you know, glioblastoma coming back wasn’t traumatic. But, you know, there is a hint that it was about as much as some chemotherapies we use that can have some marginal benefit but very safe; it only seems to cause a little bit of skin irritation. But in this new trial, this was combined with the upfront radiation and chemotherapy that we use, a drug called temozolomide, and then the effects seem much more dramatic. You know, it really led to a significant lengthening of people’s lives. This sort of hit like a bit of a bombshell and there may be an extension of the FDA indication for two patients who, you know, were recently diagnosed and just got the radiation and using this alongside the upfront chemotherapy. So, you know, this another exciting new development in the field. 

    Melanie:  Dr. Purow, I know you are very excited about the immunotherapies and all of these trials, since we last talked you’ve been on the show with us before, what are some new areas of research that you are focused on?

    Dr. Purow:  Sure, sure. So I spend about a quarter of my time seeing patients and then three-quarters of the time in my laboratory and we are trying to figure out some new and creative ways to attack these diseases. We focus mostly on glioblastoma in the laboratory and we are attacking glioblastoma at multiple levels. We are also finding the several of our projects seem to have potential for other cancers as well. One of the things we’ve been doing is repurposing existing drugs or recycling some abandoned drugs, you know, not only to block an exciting new target called DGK Alpha or diacylglycerol kinase alpha. You know, it’s one that we think hits the cancer at multiple levels, directly killing cancer cells, attacking the blood supply, but there is also potential to rev up the immune system against the cancer. So I think this may be a great combination with some of these hot new immunotherapies.
    You know, we are also repurposing existing drugs to suppress some promising known targets. There are drugs out there that are in light use that have some anti-cancer properties that haven’t even been really figured out. We think we are nailing down the important effects for at least one of these drug classes out there. We’re also looking at some new projects where we think we figured out new vulnerability of subtypes of glioblastoma and other cancers.
    There are some subgroups within glioblastoma that you see similar general types in other cancers as well, so we are trying to figure out some Achilles’ heels for those and have some new ideas there. You know, we are also trying ways to maximize the effects from existing drugs, combinations and ways to sensitize to some of the existing armamentarium against cancer. Some of those things are starting to look promising as well.

    Melanie:  It’s absolutely fascinating, Dr. Purow. You can hear the passion in your voice. What an amazing doctor you are! In just the last minute, why should families come to the UVA Neuro-oncology Center for their care?

    Dr. Purow:  Sure. You know, we hope that we can provide a lot of reasons for patients to come here. We’re not only giving patients state-of-the-art care including a number of exciting clinical trials that are ongoing, but we add to that compassion and also 24/7 access to our doctors on our team. We also have wonderful other members of the team. Our nurses, physician assistant, even our administrators, you know, are just a terrific group and I think we all come to mean a lot to the patients hopefully. This entire team approach and all the members of the team really bring a lot to our patients and giving them this great access. We really try to treat every patient uniquely as we would our own family member or loved one. We emphasize not only length of life that we really fight to extend as much as possible but also quality of life. So, you know, hopefully we just bring all of that to the patients in a unique way.

    Melanie:  Thank you so much for joining us today. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Brain & Nervous System]]>
David Cole Mon, 25 May 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27405-the-latest-research-on-brain-tumor-treatments
Concussions Outside the Playing Field http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27404-concussions-outside-the-playing-field concussions-outside-the-playing-fieldWhile concussions are most commonly associated with sports, they can happen in a variety of settings.

Learn more about where concussions can occur – and when parents should take a child with a concussion to see a doctor – from Dr. Kristen Heinan, a UVA specialist in concussions.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1516vh5a.mp3
  • Location: Null
  • Doctors: Heinan, Kristen
  • Featured Speaker: Kristen Heinan, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Kristen Heinan is a pediatric neurologist who specializes in caring for children with concussions.

    Learn more about UVA Neurosciences
  • Transcription: Melanie Cole. (Host):  While concussions are most commonly associated with sports, they can happen in a variety of other settings. My guest today is Dr. Kristen Heinan. She’s a pediatric neurologist who specializes in caring for children with concussions. Welcome to the show, Dr. Heinan. So tell us a little bit about concussions. They are most commonly associated with sports but there are other settings; I mean kids can bump their head in a variety of ways.

    Dr. Heinan (Guest):  Yes, absolutely. We see a lot of different mechanisms for concussion in the clinic. For some of the older teenagers, car accidents are quite common, cars versus trees, or rollovers. For the younger kids, playground accidents, or this winter, a lot of flooding mishaps were causes of concussion that brought people in.

    Melanie:  You know, these are things you don’t always really realize and think about, but now that you say that sliding playgrounds, kids fall off of the equipment, what’s a parent to do? You know, in sports we are looking to the helmets, to teams, to coaches to help us with this. What do you do on the playground or the sliding hill?

    Dr. Heinan:  We have this conversation with parents a lot particularly if they’ve had a child with one concussion. They are especially sensitive to the risks and are hoping to prevent future injuries. You can’t wrap your kids in bubblewrap, you have to let them go out into the world, but common sense things, if you are sliding on a hill, probably a well-travelled hill not in the forest but a bunch of trees on the playground with a good soft surface and again parental or teacher supervision. But accidents and things will happen. And that’s what we are here for if something does.

    Melanie:  So what are some signs that a child has gotten a concussion? If we see them fall off the monkey bars, or bump into a table, what are some signs we might notice?

    Dr. Heinan:  Sure. So a lot of times, sometimes kids are afraid to say that they have gotten hurt practising gymnastics in their room without permission. So, a parent, or teachers even, might notice that the child seems more fatigued. A lot of times they might be grumpier; appetite can be decreased. They may not directly complain of a headache but you can notice changes like not being as active as usual, being more quiet, not wanting to do all the fun things that they usually want to do. And sometimes obviously they’ll say, “My head hurts, it hurts for me to read, I don’t want to play the video games or watch the TV.” Parents are just really good at picking up when their child just doesn’t seem right, and so those are kind of the big key features of concern.

    Melanie:  Dr. Heinan, when children, little babies, are learning to walk, we worry about them falling and hitting things. Can little babies get concussions too?

    Dr. Heinan:  They can. It helps that toddlers are closer to the ground. Usually you hear the thump and they end up with a bruise on the outside that looks terrible but they are typically okay. They sure can though; I mean we’ve seen young kids who have fallen or been involved in car accidents and they’ll do the same thing. They’ll be sleepier, they might be fussier, not wanting to eat as much; they seem out of sort just like they are getting sick almost.

    Melanie:  If you do suspect that your child has a concussion, should you always take them to the doctor? Do you go to the emergency room? What do you do?

    Dr. Heinan:  Nobody would ever fault a parent for bringing their child to the doctor or the emergency room if they were concerned. A lot of times what we do is offer reassurance that, yes, this is a concussion and it’s going to be uncomfortable and nerve-wracking for a while but then the child will be fine. It’s difficult to tell the severity of a concussion oftentimes, but certainly you should definitely seek medical attention if there is loss of consciousness involved, if the child is not making a lot of sense when they return, when they wake up. If there is any weakness on one side of the body or both sides, if they are complaining of really excruciating headache, if there is a lot of confusion, those are some major warning signs. Also a lot of vomiting, some is okay, some is pretty common but we can worry about more severe head injuries if there is a lot of vomiting or if there is any physical abnormalities that are going along with the concussion like weakness or…

    Melanie:  And what do you do for a concussion? Is there anything for a parent to do or you as a physician? What about things like, you know, for the headache or symptom management, Tylenol? Are any of these things okay, ice? What do we even do?

    Dr. Heinan:  Yeah, we are still working on that one. Unfortunately, there is no silver bullet for how to make the brain heal faster at this point aside from rest. It is very okay to treat the headache. Oftentimes there is associated neck pain too. If you think about hitting your head, your neck is attached, so they can have head and neck pain.
    Tylenol is fine. Typically recommendations are, for the first 48 hours or so, to give Tylenol rather than ibuprofen or naproxen which is Aleve, because it has less of a chance of contributing to bleeding, in case there is a more significant injury. But after the first couple of days, your pain medication of choice is fine. We caution people to not rely on that so heavily after the first couple of weeks but initially that’s fine. And then the brain really just needs to rest. For the first 24, 48 hours, even three days, we say treat it like you have the flu. You are not going to feel good, let them rest; it’s kind of very symptom-guided, it’s very patient-specific. So whatever they indicate that they are up to doing, they should be allowed to do, but rest is key for those first couple of days.

    Melanie:  Is there any truth to the video game, television, reading, to keep them out of those things for that first day or so, to allow your brain not to, you know, work so hard?

    Dr. Heinan:  That’s a great question. We get that question a lot. There is nothing magic about the TV, video games, and reading. It is, as you said, just a cognitive exercise, if you will, that those things tend to require; that is the problem. So, if they are feeling well enough to want to email a friend and say, you know, “Hey, I have a concussion, I’m resting but I’m doing okay,” that’s fine. A lot of times the bright light of the computer screen or the TV screen are really exacerbating and the kids really don’t want to do that anyway. So there is, you know, there is no magic in what you can or cannot do; it’s just whatever symptoms tend to be exacerbated. The noise, the light, is what they should avoid. And the reading is great if your child loves to be read to; sometimes that’s easier. There is a lot of visual symptoms that go along with concussion that conversionsinsufficiency, difficulty sort of coordinating the eyes, and reading can sometimes be really annoying. So, if they try it for a little bit and it’s okay, no problem; if they try it for a little bit and they just feel terrible, then stop.

    Melanie:  So in just the last minute, Dr. Heinan, why should families come to UVA brain injury and sports concussion clinic for their care?

    Dr. Heinan:  It’s a really great clinic. It’s very interdisciplinary. So we have physicians that are there, we have occupational therapy who does a lot of work with the visual symptoms, there is physical therapy, education no consultants, are available and then we can set people up with neurocognitive testing or neuropsychiatric testing if they are having trouble with school, memory, things like that. So it’s a really great, very whole-person-oriented, family-oriented, inclusive clinic.

    Melanie:  Thank you so muh for joining us today. You are listening to UVA Health Systems radio. For more information, you can go to uvahealth.com; that’s uvahealth.com. This is Melanie Cole, thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic, Brain & Nervous System]]>
David Cole Mon, 18 May 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27404-concussions-outside-the-playing-field
Genetic Counseling for Cancer http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27094-genetic-counseling-for-cancer genetic-counseling-for-cancerWhich patients should consider genetic counseling to gauge their risk for cancer?

What can you expect when you meet with a genetic counselor?

Learn more from Martha Thomas, a genetic counselor with the UVA Cancer Center.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1512vh5c.mp3
  • Location: Null
  • Doctors: Thomas, Martha
  • Featured Speaker: Martha Thomas
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Martha Thomas is a genetic counselor at the UVA Cancer Center who meets with patients to discuss their family history of cancer and determine their level of risk.

    UVA Cancer Center
  • Transcription: Melanie Cole (Host):  Which patients should consider genetic counseling to gauge their risk for cancer and what can you expect when you meet with a genetic counselor? My guest today is Martha Thomas. She’s a genetic counselor at the UVA Cancer Center who meets with patients to discuss their family history of cancer and determine their level of risk. Welcome to the show, Martha. When should patients or anybody consider receiving genetic counseling to measure their cancer risk? That’s the biggest question.

    Martha Thomas (Guest):  Sure. I think there are really two categories of patients that I tend to see. The first are patients that have actually been diagnosed with cancer, and when they first meet with the doctor to get that diagnosis, they say, “Gosh! There’s a lot of other cancers in the family. Could my cancer be caused by an underlying genetic reason?” Also, when individuals are diagnosed with cancers at young ages, we don’t expect to see colon cancers and breast cancers when people are in their 30s and 40s. That can raise a red flag as well. The other are healthy individuals that might come to me and say, “My grandma had breast cancer, my mom had breast cancer, and my sister just got diagnosed with breast cancer. Am I myself at increased risk of developing breast cancer?” Those are really the two categories of patients that I tend to see the most of.  

    Melanie:  You’ve mentioned colon cancer and breast cancer. Are there other particular cancers that you can identify with genetic counseling their risk? 

    Martha:  Really, any type of cancer can be connected to an underlying genetic predisposition. Breast cancer, colon cancer, ovarian cancer, and uterine cancers tend to be the big ones. Pancreatic cancers, I also see a lot of those. A lot of times, people don’t realize that certain cancers can actually be connected. For instance, a family history of pancreatic cancer and then having a woman diagnosed with breast cancer does raise some suspicions in my mind for a genetic predisposition, where a lot of people might not realize that breast cancer and pancreatic cancer can be connected. 

    Melanie:  I didn’t realize that either. Now, people hear about genetic counseling. They get scared. We’ll talk about what you do with the information that you get, but what do you do for testing? If we’re testing, we hear about the BRCA gene for breast cancer. What is the test like itself? 

    Martha:  Sure. Doing genetic testing is actually very straightforward. It’s just a blood draw. Testing actually radically changed in June 2013 after a Supreme Court decision that de-patented genes. There’s also been brand new technology that’s come out called next-generation sequencing, and this allows us, instead of just looking at one or two genes at a time, we can look at 10, 20, 100 genes all at the same time and get those results back within a month or so. Testing has really now moved from just one or two genes to looking at larger panels of genes to get a broader idea of what might be going on in an individual.

    Melanie:  What kind of questions do you get from patients during a meeting? If they’ve already had the test or they’re considering it and you’re doing the family history evaluation, what are they asking you?

    Martha:  A lot of people want to know what their risk of developing cancer is, particularly if they haven’t had a cancer. That’s a big question and sometimes we can’t answer that to the point that people are satisfied, just because that information doesn’t always exist. People also want information on how to interpret their results. A negative result is not always a clinically negative result. Sometimes walking through those fine details of “what was your result and was does this mean to you in your particular situation” can be really helpful for people.

    Melanie:  Now, the big question, Martha, what do they do with the information? If they get that you have a genetic risk for breast cancer and we found the BRCA gene, how do you counsel them on making this really difficult decision on what to do with it? I don’t know that I’d want to know. Or can you change the outcome if you do have a positive result by prevention and other means?

    Martha:  Sure. That’s the million-dollar question really. I do always emphasize that genetic counseling is not the same as genetic testing. If you want to come for genetic counseling just to learn about your risks and the options that are available for you but decide that ultimately you’re not interested in testing, that’s a completely fine decision. You don’t have to get testing just because you’ve come for the counseling. In terms of what to do with the information, we’re really in an exciting period in genetics that our knowledge is growing extremely rapidly, but we don’t have all the information that, again, a lot of people want. Yes, we can tell individuals that they are at increased risk of developing cancer, but a lot of times outside of surgeries or increased surveillance, there’s not much that we can do to really reduce the risks of developing cancer. There are some interesting trials going on with using aspirin and how it reduces the risk of developing colon cancer and there are some certain drugs that can be used to reduce a woman’s risk of developing breast cancer, but a lot of it is just giving people the information so that they can be more diligent about their screening and asking their doctors questions and making sure that they’re getting the preventative care that is really appropriate for them. 

    Melanie:  There’s been some news in the media recently about preventive surgeries, prophylactic mastectomies and things along those lines. What do you tell people when they ask you, “Well, now if I’ve got this BRCA gene, should I have a double mastectomy?”

    Martha:  Those are 100-percent personal decisions, and that’s actually what I think makes my job so interesting is I could have two different patients who tested positive for the exact same mutation in a gene and one patient might get her results and say, “Great! What’s the next opening in the OR? I want to do surgery this afternoon if I can.” Another patient might say, “Okay, that’s fine. I’m not ready to act on this yet,” or, “I’m not ready to act on this ever.” Those are really individualized decisions and I always emphasize, there is no wrong decision. As long as the patient has all of the information that they need to make the right decision for themselves, whatever decision they make is the right decision.

    Melanie:  Do you involve the families in that counseling session? Do you want the spouses to sit there and listen to these results? I know that it could be individual and personal, but you as a counselor, do you want the family to hear all these things? 

    Martha:  When it comes to genetics, I always say the more, the merrier. Genetics is unlike any other area in medicine because a person’s result doesn’t just affect them. It’s not like getting a cholesterol level or a CBC. Your genetic testing results have implications for your children, for your siblings, for your parents, so on and so forth. The more ears that can hear this information and the more open families are about sharing this information, I think the better. With spouses being involved when talking to their children or something like that, I do encourage that as much as people are comfortable with, because you do walk that fine line. We still obviously observe HIPAA and it’s not like if a patient’s sister calls me and says, “Well, what was my sister’s genetic testing result?” I can’t give that out to them, even though it could potentially have implications for their own health. It’s a really interesting ethical area to work in. 

    Melanie:  In just the last minute or so, Martha, give the listeners your best advice for those considering genetic counseling and maybe even genetic testing, and why should patients come to UVA Cancer Center for their genetic counseling?

    Martha:  The number one thing that I tell people before appointments is to get as much information as possible. A lot of times, there’s the “Oh, grandma died of some cancer in her stomach.” If we can really pinpoint what that cancer is, or even what treatment she had, sometimes that can be helpful for me. Gathering as much information as you can about the family history is really my number one advice. UVA is just such a cutting-edge institution. We really are on the forefront of doing testing on tumors that can give us indications for genetic predisposition syndrome. We are looking at new drugs and therapies that can potentially reduce individual’s risks of developing cancer. It’s just such an exciting innovating place to come, and with genetics, you want to be at an exciting innovating place because this stuff changes truly on a daily basis.

    Melanie:  Thank you so much, Martha. It’s absolutely fascinating. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Genetics, Cancer]]>
David Cole Mon, 27 Apr 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27094-genetic-counseling-for-cancer
Advances in Vascular Surgery http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27093-advances-in-vascular-surgery advances-in-vascular-surgeryLearn about the latest treatment advances for vascular conditions from Dr. Margaret Tracci, a UVA specialist in vascular surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1512vh5b.mp3
  • Location: Null
  • Doctors: Tracci, Margaret
  • Featured Speaker: Margaret Tracci, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Margaret Tracci is a board-certified vascular surgeon and president of Virginia Vascular Society who provides comprehensive treatment and care for a range of vascular conditions.

    UVA Heart & Vascular Center
  • Transcription: Melanie Cole (Host):  The vascular system is a complex system in the body, but certain things can go wrong with it. My guest today is Dr. Margaret Tracci. She’s a board-certified vascular surgeon and president of Virginia Vascular Society who provides comprehensive treatment and care for a range of vascular conditions. Welcome to the show, Dr. Tracci. What are some of the most common vascular conditions that you encounter?

    Dr. Margaret Tracci (Guest):  Thank you for having me. The most common disorders that we treat are disorders of both the arteries and the veins. In the arterial system, really much of our practice is centered around the treatment of atherosclerosis. This is very closely related to coronary artery disease. What we most commonly see is atherosclerosis of the carotid arteries which can be associated with stroke, and atherosclerosis of the arteries of the legs which can be associated with a range of symptoms from cramping of the legs with exercise to failure to heal ulcers, longstanding persistent sores in the legs, to even loss of limb. 

    Melanie:  Dr. Tracci, people are always worried about symptoms of vascular disease, peripheral vascular disease, heart disease. They’re always looking for those red flags to give them a better sort of chance. When you mentioned the legs, hot feeling, blood clots, tell us some symptoms that we might come up with for any of these vascular conditions that people really need to be aware of when they’re exercising and when they’re at rest. 

    Dr. Tracci:  Absolutely. As I said, the most commonly treated condition for us in the legs is atherosclerotic disease. What people notice is essentially the symptoms of angina in the legs. When they exercise, the muscles demand more oxygen, the body is not able to deliver that, and they feel a cramping or “Charley horse” sensation in the leg with exercise. People will tell you, “I get 50 yards and my legs cramp up on me.” In more severe cases, people will find that they have ulcers that won’t heal or constant pain in their feet and those can both be associated with bad atherosclerotic disease of the legs. We also get inquiries about venous disease. People will see varicose veins or notice that they have swelling or bulging of veins in their legs. We then screen them for either occlusive disease which would be blood clot, or what we call reflux disease which is badly functioning valves in the vein.  

    Melanie:  If people are experiencing this claudication or pain in their legs when they’re exercising or any of these other conditions, do you recommend vascular screening? Who should be screened? 

    Dr. Tracci:  We absolutely do. There are a number of different screening tests available and each one of them has slightly different criteria. I think one of the most important screening initiatives that vascular surgery has supported is screening for abdominal aortic aneurysms. Unlike all of the other conditions that we’ve described, aneurysms are really insidious because they don’t come with symptoms typically. People will sometimes have a family history of aneurysm, but more often not. So we do recommend that people have a simple ultrasound screening for men over the age of 65, or 55 if they have any family history of aneurysm; and for all women over the age of 65 who have either a family history of aneurysm or a smoker. For peripheral arterial disease, anybody who has got significant atherosclerotic disease in other areas, known coronary artery disease, known carotid artery disease, ought to be screened. Certainly anybody who is having symptoms potentially of claudication or noticing that they’re having sores on their feet that won’t heal. With regard to carotid artery disease, again, this tends to be a condition that’s insidious. It’s not symptomatic until somebody has a stroke. Again, we do tend to recommend that people undergo simple ultrasound screening for this if they have other significant atherosclerotic disease, either coronary artery disease or known peripheral artery disease. 

    Melanie:  Now tell us some of the latest advances in the treatment of some of these common vascular conditions.  

    Dr. Tracci:  Sure. Vascular surgery has been one of the most exciting areas in medicine over the last 10 or 15 years, primarily in the area of minimally invasive treatment of each of these categories of disease. With regard to arterial aneurysms, particularly aortic aneurysm, virtually all of these can be treated with stents now rather than open surgery. We’re just becoming more able to treat aneurysms of the mid-portion of the aorta, the branch portion of the aorta, with stents. This was an area that historically we hadn’t had the technology to manage this one. It’s incredibly exciting. In the area of peripheral artery disease, new technology such as drug-eluting stents or balloons that actually chemically treat the lesions while we’re ballooning them or stenting them seem to be effective in reducing the rate of re-narrowing over time. We’re very excited about this as well. Finally, in a similar fashion, endovascular or minimally invasive catheter-based treatment has revolutionized the treatment of venous disease. A lot of people remember the old-fashioned vein stripping, which could be fairly extensive surgery and painful. For the vast majority of patients, that’s been transformed into in-and-out day procedure that essentially requires a single Band-Aid for a dressing. 

    Melanie:  That’s fascinating. Can you give the listeners some of your best advice on prevention of vascular disease so maybe they don’t need any of these treatments? 

    Dr. Tracci:  Absolutely. And thanks for asking. That’s a wonderful question. Part of the reason that we’re so supportive of screening is that the most important thing about identifying vascular disease, particularly atherosclerotic disease, is that early management with exercise, aspirin, cholesterol management, blood pressure management, and in the case of those who are diabetic, blood sugar management, not only can slow or reverse the progression of disease, but ultimately the most significant impact is on the rate of heart attacks and strokes. They really have an opportunity to impact not just the symptoms from this particular manifestation of the problem, but actually extends people’s life times and quality of life. 

    Melanie:  Why should patients come to UVA for their vascular care? 

    Dr. Tracci:  We’ve got a wonderful group of fellowship-trained, board-certified vascular surgeons who are national and international experts in all areas of vascular surgery, and these are folks who are writing the textbooks and traveling nationally and internationally to teach other people about this. As a result, we really do have access to the latest techniques and technology, including access to technologies that are really only available through clinical trials. At this point, we’re a part of a number of large trials sponsored by the NIH, sponsored by industry, and have quite a bit to offer. We also have a great multidisciplinary team and we really view this as a cardiovascular center of excellence that involves having a certified top-quality vascular lab with technicians and equipment to do the best diagnostics, and a wonderful interdisciplinary relationship with cardiology, cardiovascular medicine, interventional radiology, cardiac surgery, endocrinology, and other specialties that really need to be involved in the 360-degree treatment of vascular disease. We also have an absolutely wonderful team of nurse practitioners and physician assistants who are specifically trained in vascular disease and incredibly dedicated to the care of our patients.

    Melanie:  In just the last minute, Dr. Tracci, if you would, give your best advice for people that might already be suffering with vascular disease, peripheral vascular disease, and just really give them your best advice about things that they can do, lifestyle management. 

    Dr. Tracci:  Absolutely. I think that it absolutely makes sense to approach your physician about treating and managing peripheral arterial disease. Like all atherosclerotic disease, the management depends on exercise, which encourages your body to build up its own collateral system or other branch vessels to relieve symptoms. In management of atherosclerosis, really the mainstays of that are: medication such as aspirin, frequently statins in the management of high cholesterol, and the management of hypertension or high blood pressure and blood glucose or blood sugar in diabetic patients. All of these things are routine portion of that and absolutely things that can typically be managed by your regular primary care physician. It makes sense to involve a vascular surgeon, a cardiovascular expert because we can actually quantify the disease and in most instances, we can actually help get you feeling better. There are treatments for this. There are options for this. We can all work together to make sure that we’re doing absolutely everything we can do to offer you the longest, healthiest, most symptom-free life that we can, and all of that depends on really early lifestyle changes and, again, a 360-degree approach to this. 

    Melanie:  Thank you so much. What great information! You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Sugar]]>
David Cole Mon, 20 Apr 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27093-advances-in-vascular-surgery
The Changing Face of Stroke Care http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=27092-the-changing-face-of-stroke-care the-changing-face-of-stroke-careWith recent studies confirming the benefits of some newer stroke treatments, how is the field of stroke care changing?

What does it mean for stroke patients?

Learn more from Dr. Avery Evans, a UVA interventional neuroradiologist who specializes in stroke care.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1512vh5a.mp3
  • Location: Null
  • Doctors: Evans, Avery
  • Featured Speaker: Avery Evans, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Avery Evans is a board-certified radiologist who specializes in interventional neuroradiology procedures to treat strokes, cerebral aneurysms and arteriovenous malformations.

  • Transcription: Melanie Cole (Host):  With recent studies confirming the benefits of some newer stroke treatments, how is the field of stroke care changing? My guest today is Dr. Avery Evans. He’s a board-certified radiologist who specializes in interventional neuroradiology procedures to treat strokes, cerebral aneurysms and arterial venous malformations. Welcome to the show, Dr. Evans. Tell us a little bit about some of the major developments in stroke care recently and describe them for the listeners. 

    Dr. Avery Evans (Guest):  Well, as you mentioned, there have been some very exciting recent changes in stroke care. For a few years, we’ve had the ability to go in and treat some of the most devastating kinds of stroke, which is the ability to go in and remove a blood clot from a blood vessel in the patient’s brain. But up to now, we haven’t really been sure that this is the best thing for the patient, but four trials have recently come out that showed that unequivocally, this is a benefit to patients and more patients will get better if we do this than if we don’t. 

    Melanie:  So that’s what it means for patients. Tell us a little bit about who could benefit from these developments. 

    Dr. Evans:  Well, anyone can develop a stroke. It’s generally a disease of older patients, but it can happen in younger patients as well, but anybody can develop a stroke. The people who will benefit from this most are people who are having what we call ischemic strokes. This is a stroke that occurs because there has been blockage of a blood vessel in the brain.

    Melanie:  Tell us a little bit about ischemic stroke and what you’re doing. Is there a revascularization? Are we talking about first responder, what’s happening in the emergency room? Kind of go through it for us.

    Dr. Evans:  Well, one of the things I want to do is frame this for the people who are listening. Stroke is an incredibly important disease. Most people don’t realize that. It is the third leading cause of death in this country and it is the leading cause of disability. I think it’s sort of underappreciated by the general public. It’s a very important disease. What happens is a patient has signs and symptoms of a stroke and we can talk about what they are, and if we must, we’ll talk about them now. If you or a loved one is having weakness or numbness on one side of the body, if you’re having difficulty speaking or understanding speech, if you’re having a facial droop or difficulty seeing or blindness in one eye or the other or both, these are all very common symptoms with stroke, and the most important thing is that if you or a family member or a friend is having any of those symptoms, it’s incredibly important that you immediately call 911 or get that patient to the nearest emergency room because we have a saying among those of us who treat this disease, and that is, “Time is brain.” The longer you wait, the less likely it is that you’ll be able to have a good outcome if you’re having that kind of stroke. So it’s imperative that patients get to the hospital immediately. It’s the kind of thing, I think, because it doesn’t hurt—everybody understands if you have chest pain, you need to get to the emergency room—but stroke is not painful, and so I think because it doesn’t hurt, people think, “Well, Grandma doesn’t look exactly right. She’s a little weak, but we’ll just let her sleep it off.” That’s the wrong thing to do. If people are having signs and symptoms of stroke that I described, they need to get to the emergency room immediately. That’s the most important thing people listening to this need to hear. 

    Melanie:  When we think about identifying it then, so time is brain, they spot some of these red flags you’ve described, they get to the emergency room, what do those people do to identify rapidly and accurately that it is a stroke and how fast can they start treating it?

    Dr. Evans:  We can start treating it very quickly. One of the great things about being here at the UVA is that we have all the pieces of the puzzle to make this happen properly. Make no mistake: it takes a team of people to make this happen. First off, you have to have the complex imaging equipment that it takes to diagnose the disease. Then you have to have people like me and some of my colleagues who have the ability to go in and remove the blood clot from the brain. Most importantly, it takes a team of specialized stroke neurologists which we have here at University of Virginia. We have a team of stroke neurologists who are on call 24/7/365. The minute the patient like this comes to the hospital, they jump into action and make the diagnosis. What happens is the patient comes in, the ER doctor identifies that the patient is having a stroke. The stroke neurology team jumps into action; they go and examine the patient. The patient very quickly is taken to the CT scanner. We do imaging of the brain and we’re looking to make sure that there is not already a completed stroke. We have to make sure that the damage hasn’t already been done. We also make sure that there hasn’t been bleeding because some kinds of stroke can present with bleeding. Then the stroke neurologist makes the determination whether they are going to give a clot-busting drug through the IV, that’s a clot-busting drug called tPA, so frequently they’ll give that. Then at that time, or before or after, we’ll do a specialized imaging study to find out if one of the large blood vessels in the brain is being blocked by a blood clot. If we determine that that large blood vessel is being blocked by a blood clot, then we can go in with some specialized tools, some catheter, some very long plastic tubes and some other specialized tools. With a high degree of success, we can remove the blood clot that’s blocking the blood vessel and restore flowing blood to the brain and hopefully prevent further damage. In a nutshell, that’s how it works, but it starts with a team. You’ve got to have a team of people who are experts in how to do this. No one physician group has all the expertise that it takes to do this.

    Melanie:  That’s absolutely fascinating. In addition to acting fast and your ability to go in there and get these blood clots and the medications, what are you seeing as outcomes and what can we do to prevent stroke in the first place? 

    Dr. Evans:  Well, the outcomes from stroke with this new technique are better than they have ever been. The particular kind of stroke that we’re targeting with this is what we call a large vessel occlusion stroke. These are the strokes of large blood vessels of the brain that lead patients most to devastated. These are the kinds of strokes that just really totally devastate the patient. Now, sort of for the first time – well, we’ve been able to do it as I said for several years – but for the first time, we have absolute proof that it helps a lot of people, a lot more than we could have. It’s very exciting in that sense. It’s the biggest development we’ve had in stroke care in 20 years, it’s easy to say. As far as prevention is concerned, prevention mainly has to do with good medical care. You need to have a relationship with your primary care doctor. You need to make sure that if you need blood pressure medicine, that you’re taking it appropriately. You need to make sure that if you have high cholesterol that you’re treating that either through diet or through meds. So stroke care begins with patients taking good care of themselves, and that has to do with making sure that you get your annual checkups with your primary care doctor.

    Melanie:  Tell us in just the last minute your best advice for people listening who are worried about stroke, and what are the benefits of coming to UVA for their stroke care? 

    Dr. Evans:  Well, as I said earlier, it takes a team to do this and we have all the pieces of the puzzle right here. Not very many hospitals in the country have all of that and we have it. We’ve got excellent primary care doctors. As I said, we’ve got a team of absolutely fantastic stroke neurologists on call 24/7 who will be there immediately the patient needs them, and we have a complex imaging equipment and also doctors like me who, if needed, can go in and remove these blood clots if they’re present. We have it all here. But it all begins with patients taking care of themselves, getting their annual checkups and making sure that they reduce their stroke risk factors as best they can. 

    Melanie:  It’s great information. Thank you so much. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Stroke]]>
David Cole Mon, 13 Apr 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/27092-the-changing-face-of-stroke-care
Protecting Against Common Sinus Conditions http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=26894-protecting-against-common-sinus-conditions protecting-against-common-sinus-conditionsSinus conditions can occur at any time of year.

Learn how you can reduce your risk for sinus infections and other sinus conditions – as well as the treatments available – from Dr. Jose Gurrola, a UVA expert in sinus health.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1508vh5d.mp3
  • Location: Null
  • Doctors: Gurrola, Jose
  • Featured Speaker: Jose Gurrola, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Jose Gurrola is a fellowship-trained otolaryngologist – head and neck surgeon whose specialties include endoscopic sinus surgery.

  • Transcription: Melanie Cole (Host):  Sinus conditions can occur any time of the year. How can you reduce your risk for sinus infections and other sinus conditions as well as how do you treat them if they do occur? My guest is Dr. Jose Gurrola. He’s a fellowship trained otolaryngologist, head and neck surgeon whose specialties include endoscopic sinus surgery at UVA. Welcome to the show, Dr. Gurrola. We hear a lot about the sinuses. What do they actually do? And that pain that we sometimes feel on the bridge of our nose, what is that? 

    Dr. Jose Gurrola (Guest):  Thanks, Melanie. There are a number of different theories as to what the sinuses are, why they actually exist, and what they do for us. That includes moisturization of the air as it moves through our bodies, improving the sound and our perception of our voice, as well as protective mechanisms for our brain and other important structures in our head. We don’t clearly know exactly what they’re there for, which makes my job all the more interesting because I like to optimize the health and the normal function of the sinuses for all of our patients. In regard to the various pains, that is a more complex question because it can be a number of different things that are causing a patient’s perception that may or may not actually be related to the sinuses. 

    Melanie:  What are some of the most common conditions that you see? 

    Dr. Gurrola:  On a typical day, we see a number of different people who have what most people would call a running nose but could be related to either allergies; some other non-allergic forms of rhinitis, as we would call it; a lot of upper respiratory infections; and then we see patients with a number of different complexities of sinusitis, which can be both infectiously related; and also a chronic sinusitis, which can be more of an inflammatory condition.  

    Melanie:  People hear about sinus infections, Dr. Gurrola, and they say if you’ve got green goo coming out of your nose, you definitely have a sinus infection. Or if you smell that bad smell into your own mouth, what is that? Does that mean that you’ve got a sinus infection? And how do you treat them? Why are they sometimes so difficult to treat? 

    Dr. Gurrola:  It’s hard to answer that in a blanket statement, but what’s most important isn’t necessarily the initial colors or whether or not the smell is going on, but it’s more the duration. A lot of people will reflexively think that if they have these types of symptoms, they need to be on antibiotics as soon as possible. What we have found out through research over the years is that a good number of patients will in fact have an upper respiratory infection related to viral infection—meaning a virus is causing it—in which case, antibiotics are going to be less effective. Whether or not a patient is on antibiotics, over the course of the first five to seven days, by the end of that time, the patient will typically be better. What this then leads us to is optimizing the treatment of that patient during that time with non-antibiotic related measures. That would include improved nasal hygiene, including saline rinses, saline irrigation, and from my perspective, having them evaluated at the end of that five- to seven-day period. In our office, we typically use an endoscope, which is a small scope that’s attached to a camera and allows us to see inside. If we need to, we are able to take cultures and grow out whatever may be in there to see whether antibiotics are warranted or not.  

    Melanie:  Now, what can people proactively do to keep their sinuses clear? Do you like nasal lavage, neti pots? What about some of these nasal decongestant sprays, antihistamine? People tend to use those things ad nauseam. Sometimes they use them all the time. 

    Dr. Gurrola:  That can be an issue, and it’s one of the things we like to do in our practice is to educate the patient that while they may have an immediate relief from some of these over-the-counter decongestants, long term they can lead to more problems, and they may be masking things that can otherwise be dealt with either through medications, sometimes in-office procedures, and other times, in certain patients, they may need to have an actual surgery where we go to the OR. It’s important to get evaluated if you do find yourself relying more and more on over-the-counter medications or the need for things beyond just nasal saline irrigations. I’m a big proponent of saline lavages or the irrigations and also the nasal saline sprays, and we’re talking just a typical saltwater, not the more medicated treatments that are going to actually have an immediate relief or typically will make a person feel decongested in the short term. The irrigations and the normal sprays that we’re talking about with normal saline are going to help to improve your circulation, going to help to moisturize, particularly during this time of the year, when it’s winter out and you have a heater going on, or even during the summer when it’s hot out and you have a lot of cool air that’s going to be dry. We’re going to like to optimize what you have going on at baseline and, if we need to, intervene and help improve that for you. 

    Melanie:  If someone suffers from allergies or asthma, is there a good relationship there between the sinuses, sinusitis? Does it mean that they’re getting more sinus infections or more sinus problems if they have allergies or asthma? 

    Dr. Gurrola:  The allergies is interesting because in fact, if you are suffering from repeated allergy infection or allergy exposure and exacerbations of that, that can chronically lead to more issues for you, whereby which you may have an increased number of sinus infections. The key to that and just your overall sense of well-being and quality of life is going to be to ensure that you’re doing things to avoid those allergic triggers if there is something that’s going on. In some cases, you may need to actually have further testing done to see what is causing these issues for you. But if you know what your triggers are, if you know it’s going to be early spring when this happens, then towards the end of the winter, it’s a good time to start getting your nasal hygiene improved and talk to your doctor about possible preventative treatments, whether that be nasal steroid sprays or use of oral antihistamines and the patient taking a proactive approach to that. In addition, you could do things like the hypoallergenic beddings. Some of the air filters and whatnot may be of use for some people. And of course, we always recommend avoidance of exposure to smoke or other environmental allergens or irritants that may be causing issues for people. 

    Melanie:  Dr. Gurrola, is there ever time when surgical intervention is considered? 

    Dr. Gurrola:  There absolutely is, but that’s going to be based more on the patient’s history. We take a strong effort to make sure that our patients are medically optimized before we go off to surgery, and in terms of medical optimization, that includes a thorough clinical evaluation, including the endoscopy that I mentioned to you. Where necessary, we will get a CT scan to both evaluate for what’s going on. And if we need to take a patient to the OR, that CT scan can be of use intraoperatively as well. Now, it is worth noting that there are in fact some patients in whom some in-office procedures may be reasonable approaches to treatment with. That doesn’t work for everybody, but there are some patients who may be able to be treated with in-office procedures. 

    Melanie:  In just the last minute or so, Dr. Gurrola, why should patients come to UVA for their treatment of sinus conditions? 

    Dr. Gurrola:  At UVA, we offer evidence-based medicine by fellowship-trained physicians. We are patient oriented and we are interested in ensuring that the patients get an optimal medical assessment, treatment, and experience no matter what time of year, what time of day, or the circumstances notwithstanding. We look forward to seeing any and all patients that we’re able to, and we like to do so with a smile. 

    Melanie:  That is great information. What a nice man you are. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Sinus Issues]]>
David Cole Mon, 06 Apr 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/26894-protecting-against-common-sinus-conditions
Treating Pulmonary Hypertension http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=26584-treating-pulmonary-hypertension treating-pulmonary-hypertensionWhat is pulmonary hypertension, and how is it linked to heart failure?

Learn more from Dr. Sula Mazimba, a UVA specialist in pulmonary hypertension.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1508vh5c.mp3
  • Location: Null
  • Doctors: Mazimba, Sula
  • Featured Speaker: Sula Mazimba, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Sula Mazimba is board certified in internal medicine and cardiovascular disease and specializes in caring for patients with pulmonary hypertension and heart failure.

  • Transcription: Melanie Cole (Host):  What is pulmonary hypertension and how is it linked to heart failure? My guest today is Dr. Sula Mazimba. He is board certified in internal medicine and cardiovascular disease and he specializes in caring for patients with pulmonary hypertension and heart failure. Welcome to the show, Dr. Mazimba. Tell us a little bit about pulmonary hypertension. What is it and how does it differ from hypertension that we might have heard about? 

    Dr. Sula Mazimba (Guest):  Thank you so much for having me on the show. Pulmonary hypertension is a type of blood pressure that affects the arteries in the lungs and ultimately the right side of the heart. In order to be able to sort of understand the disease, it’s important to understand that we have two sides of the heart, the circulation. There is the left side and the right side. In order for blood to pump around the body, it has to pump from the left side which has a higher pressure to the rest of the body and ultimately to the right side which takes blood to the lungs. The right side of the heart has fairly low pressure. It’s a low pressure system. In some situations where you start having elevation in blood pressure in their right side of the heart or the lungs, what happens is that the circulation is impaired, meaning that the blood going to the lungs is not able to adequately get oxygenated, and so it affects the circulation around the heart. That’s kind of, in a nutshell, what pulmonary hypertension really is. 

    Melanie:  What symptoms might somebody experience if they think that they might have this? 

    Dr. Mazimba:  The symptoms for pulmonary hypertension are actually very nonspecific, and because of this, sometimes patients present very late. Typical symptoms include shortness of breath, which as you know is very nonspecific. Patients really just feel short of breath and very tired, dizzy, occasionally they may have some chest pains or racing heart, and so they tend to be very nonspecific. 

    Melanie:  Okay, so what would send somebody in to see you to even get tested for pulmonary hypertension? Would it have anything to do with if they have been suffering from regular hypertension before or if they have a family history of this situation? 

    Dr. Mazimba:  In some cases, patients do have family history of pulmonary hypertension, and sometimes they come testing for the disease, but those are very few situations. Oftentimes, patients who have presented at their primary care physician, they may have been trying to find out why they are very short of breath and very tired. Ultimately, an echocardiogram is ordered and that kind of shows that the pressures on the right side of the heart are high and that’s how they end up oftentimes coming to see us. 

    Melanie:  If you diagnosed someone with pulmonary hypertension, then what do you do for them? 

    Dr. Mazimba:  Well, in some cases, pulmonary hypertension is related to other disease conditions, and so when we are treating pulmonary hypertension, we often treat also the underlying disease condition. The treatments are often very complex. The medications, they are sometimes very complex, and so we oftentimes have to make combination therapies. There are also what we call supportive therapies, where we essentially, not necessarily, altering the disease process, but we are kind of helping patients deal with the symptoms, like for instance, giving them some diuretics, oxygen, blood thinners. In some situations, we resort to surgery. We may have to sometimes recommend lung transplant or heart and lung transplant, depending on the situation. 

    Melanie:  What are some of the complications that could happen if… they can go into heart failure if this isn’t treated? How long can it go on before those complications might start to set in? 

    Dr. Mazimba:  That’s a very good question. Pulmonary hypertension is, like I said, associated with other disease conditions, and so it depends on the company it keeps. There are some situations where, for instance, it may be connected with rheumatoid arthritis or other connective tissue disease, and so depending on the company it keeps, the prognosis also varies according to the type of pulmonary hypertension. There are various types. We often categorize pulmonary hypertension in five major groups. Each of those groups may have different prognostic type over the long haul. In general, without treatment, pulmonary hypertension can be very fatal and so this is why it’s critically important for patients to present early so that we can institute some of these medical advances including therapy treatments and sometimes surgeries. 

    Melanie:  Dr. Mazimba, how does your expertise in hypertension relate to your work with heart failure patients? 

    Dr. Mazimba:  As you know, when pulmonary hypertension is severe enough, it impairs the contractility of the right ventricle, meaning that the right ventricle will have to struggle to push blood to the lungs. Ultimately, heart failure is the leading cause of death in patients with severe pulmonary hypertension. There is that link between pulmonary hypertension and advanced heart failure. 

    Melanie:  Wow, it’s really very interesting. Tell the listeners why should someone come to UVA for heart failure and pulmonary hypertension care and give your best advice for people that might be suffering some of these nonspecific symptoms and what you would tell them. 

    Dr. Mazimba:  One of the reasons why patients should really look at UVA as a place where they need to seek their care is that pulmonary hypertension and heart failure are very complex disease conditions, especially heart failure when it’s advanced. They are best served in medical teams that specialize in these disorders. At UVA, we see patients from within the state and outside the state. We have a lot of experience when we’re talking about pulmonary hypertension and advanced heart failure. That is one of the strong points, advantages of care at UVA. It’s multidisciplinary and we see a lot of very complex patients. One of the things I advise patients who are having these nonspecific symptoms is, of course, talk to your doctor about this and don’t blow away the symptoms and say, “Well, it’s maybe I’m just tired.” Indeed, you may be tired, but if the symptoms persist, it’s important to seek medical advice. 

    Melanie:  That’s very good information. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health, Heart Disease]]>
David Cole Mon, 30 Mar 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/26584-treating-pulmonary-hypertension
New Studies Highlight Breakthrough Stroke Treatment http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=26583-new-studies-highlight-breakthrough-stroke-treatment new-studies-highlight-breakthrough-stroke-treatmentAn innovative method of removing blood clots significantly reduces stroke patients' chances of being disabled, new studies suggest.

Doctors at UVA expect the findings will fundamentally change how stroke patients are cared for.

Learn more from Dr. John Gaughen, a UVA specialist in this procedure.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1508vh5b.mp3
  • Location: Null
  • Doctors: Gaughen, John
  • Featured Speaker: Dr. John Gaughen
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. John Gaughen is a board-certified radiologist who specializes in interventional neuroradiology procedures to treat strokes and other brain conditions.

    Learn more about UVA Neurosciences
  • Transcription: Melanie Cole (Host):  An innovative method of removing blood clots significantly reduces stroke patient’s chances of being disabled, new studies suggest. My guest today is Dr. John Gaughen. He’s a board-certified radiologist who specializes in interventional neuroradiology procedures to treat strokes and other brain conditions at UVA Health Systems. Welcome to the show, Dr. Gaughen. Tell us a little bit about these studies, the recently published studies that examined the type of stroke treatment. What is this treatment?

    Dr. John Gaughen (Guest):  Well, Melanie, first of all, thank you for having me on. I’m very excited to be here. Yes, last week, at the International Stroke Conference in Nashville, Tennessee, there were two—really three studies—two that have already been published that has demonstrated very exciting news for the stroke world. Many of the listeners may know there has been a treatment around for about a decade now to help treating certain patients with stroke called mechanical thrombectomy. Simply, what that is, is taking the tube into the blood vessels of the brain, finding the blood clot in the blood vessel of the brain that is causing the stroke and mechanically pulling that blood clot out and restoring blood flow to that part of the brain. Now, we’ve always known that this is a very time-sensitive treatment and only works for patients that have brains that have not completely stroke, so within the first several hours after the stroke onset. It doesn’t apply to all patients. But one of the things that we’ve had a very difficult time in the past doing is demonstrating that this approach to stroke treatment actually provided benefit to patient. What these studies last week showed is they basically confirmed another study that came out over the last fall that showed that in certain patients that have clots in large blood vessels of their brain removed in a timely fashion, those patients showed a much lower rate of disability, a much lower rate of death, than patients treated with our typical conservative treatments, which are blood clot medicines through the vein and other conservative measures. Basically, in a nut shell, what these pieces of literature have done is overnight, made a gigantic paradigm shift in how we’re going to approach strokes in this patient population, which is patients that come in with stroke symptoms that have large clots in large blood vessels of the brain. It is going to change, I think, the way that patients are evaluated and the way patients are treated once they get to the emergency room when they do have an acute stroke. So it’s very exciting information. 

    Melanie:  It is very exciting information. Dr. Gaughen, when a patient is admitted and they’re evaluated for stroke situation, how fast can this procedure be evaluated for and then done? 

    Dr. Gaughen:  Well, the interesting thing, all of these different studies looked at this disease process in a little bit different way. One study was done in Netherlands, one study was done in Australia, and two of the studies are multinational studies and they all had a little bit different criteria for how they evaluated these patients and determine who was eligible for the treatment. But one thing that they all found was that the faster these patients were identified and the faster they got on to the operating room table to have the clot removed, the better they did. One of the big focuses in the coming months and years are going to be to standardize ways to streamline patients who come to the emergency room to get this treatment as quickly as possible. 

    Melanie:  Streamlining that would make it so because with stroke, we know that time is brain and the speed at which you’re cared for really determines that amount of disability you could possibly suffer. As an interventional neuroradiologist, would you be one of the first people in line to see this person and say, “Let’s get them up. Let’s do the mechanical stent.” How does that process work? 

    Dr. Gaughen:  Well, the process starts with the first responders. One of the things that we have been doing and we will continue to do is to educate the EMS, Emergency Medical Services, the population in general, that when you identify the symptoms of a stroke, that that is a very time-sensitive issue. When a patient comes in the emergency room, either from family members themselves or from the EMS, we want to know right away if we think that that patient is having a stroke. Typically, at the University of Virginia, we have a stroke neurology service that’s in-house 24 hours a day, seven days a week, and as soon as anybody in the hospital, whether they’re admitted to the hospital or showed up in the emergency department with stroke symptoms, a pathway is begun where the stroke neurologist sees that patient immediately to determine whether they truly think that patient is having a stroke and how bad that stroke is, and how long they’ve been having the symptoms. Once we determine that, we can determine what type of treatment we think that patient is eligible for. If they’re eligible for this type of treatment, meaning they have been having the symptoms for less than eight hours, their stroke symptoms are bad enough that we think that a large blood vessel is blocked and that’s causing the symptoms, that patient will go immediately to the CAT scanner where we do some imaging tests, a CAT scan and a CT angiogram, to look at the brain to make sure that there isn’t something that’s causing the stroke that’s different than what we think, like a big brain bleed or tumor or something that can mimic a blood clot. Then we’d do the CT angiogram which looks at the blood vessels of the brain to see if there is a clot in the location that we can remove. That imaging takes no more than a couple of minutes. Once that patient has got that imaging, we have already, as interventionalists and as radiologists, have already been alerted that there is a patient that potentially has this blood clot. We are looking at those images as they are being processed immediately after they’re taken to make the decision about whether or not that patient is a candidate. If that patient is a candidate, the goal is to get that patient directly from the CAT scanner to the angiography table, where we can place the patient on the table and remove the clot. It is a very time-sensitive procedure, and there are a lot of moving parts between the emergency room physicians, the first responders, the neurologists, the radiologists, and the interventionalists and it takes a very coordinated effort to get that system as streamlined as possible to help patients. What we see is that if you can do that in a quick fashion, we see very good outcomes. We see patients that have significantly reduced mortality and significantly improved functional outcomes when they recover from strokes. It is something that we’re going to see dramatically change, I think, the face of stroke as we know it today. 

    Melanie:  Now, in just the last few minutes, Dr. Gaughen, tell us about the risk of this type of thrombectomy and why patients should come to UVA for their stroke care. 

    Dr. Gaughen:  Well, like I just said, having a multidisciplinary approach, having physicians that are available in the hospital 24 hours a day, seven days a week, having dedicated critical care team members that are specifically trained in neurological disorders, are all very, very important because the speed with which we treat this disease and the expertise with which we have to treat this disease is very important in this very complex disease process. UVA has all of these. UVA has one of the most experienced stroke neurology services and one of the most acclaimed neuro intensive care units in the state, if not the country. As neuro interventionalists, we have over 50 years of experience in treating all sorts of complex neurovascular diseases and a great degree of expertise in the ischemic and hemorrhagic stroke. What was the first part of the question? 

    Melanie:  I just wanted you to tell the listeners how safe this procedure is and really how exciting. What’s on the horizon for this now? 

    Dr. Gaughen:  What these studies have done actually is very interesting. The disease itself is a very bad disease. Stroke is the third or fourth, depending on what you read, the third or fourth leading cause of death in America and the number one cause of adult disability in the United States. The major complication with the treatment is bleeding. When we remove that clot and the blood gets back to the brain, if the brain has already been damaged, it may not be able to accommodate that blood or deal with that blood and that causes bleeding into that area. The interesting thing about this study is that in the time frames that these studies were able to get blood clot out, which is quicker than older studies, we find that that risk of bleeding is very low. In a couple of these studies, that risk of bleeding is even lower than the risk of bleeding when we give the clot buster medicine through the vein. It turns out that it is a very safe procedure compared to what we have historically seen with stroke treatment and very effective. We’re very excited about it. I think this is only going to lead to a better understanding of our ability to treat this disease in the future and I think we’re going to continue to see improved outcomes with this treatment modality. This is certainly not the end. I think it’s the beginning of a wonderful road ahead that’s going to give us a lot of information on ways to treat a disease that has been a very difficult disease to treat in the past. 

    Melanie:  Thank you so much, Dr. John Gaughen, absolutely fascinating information. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Stroke]]>
David Cole Mon, 23 Mar 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/26583-new-studies-highlight-breakthrough-stroke-treatment
When Should Your Child See a Pediatric Geneticist? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=26582-when-should-your-child-see-a-pediatric-geneticist when-should-your-child-see-a-pediatric-geneticistWhen should families consider bringing their child to see a medical geneticist?

Learn more from Dr. William Wilson, a UVA specialist in pediatric genetics.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1508vh5a.mp3
  • Location: Null
  • Doctors: Wilson, William
  • Featured Speaker: William Wilson, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. William Wilson is board certified in pediatrics and medical genetics and specializes in caring for children with genetic conditions.

  • Transcription: Melanie Cole (Host):  Fortunately, most children are born healthy with no medical problems or birth defects. However, there are some instances where your family might consider bringing their child to see a medical geneticist. When might that occur? My guest is Dr. William Wilson. He’s board certified in pediatrics and medical genetics and specializes in caring for children with genetic conditions. Welcome to the show Dr. Wilson. Tell us a little bit about what a pediatric geneticist does.

    Dr. William Wilson (Guest):  Pediatric geneticists see a wide range of patients. Actually, most geneticists are in fact pediatricians, but we also see adults because our training is both in genetic conditions in children and in adults. We diagnose patients. We see patients who are referred because of family histories, because of findings of biochemical disorders, or newborn screening or in subsequent testing. Frequently we see patients whose families just have questions about what is going on with their children, what the diagnosis might be, what they might expect and what this might imply for other family members and potentially future children. 

    Melanie:  Tell us, Dr. Wilson, what types of conditions do you help evaluate? 

    Dr. Wilson:  We see a wide range of children and adults. Again, we see primarily children, but we also see adults, as medical geneticists are trained in both pediatric and adult genetics. We see children with birth defects, growth issues, sometimes learning issues, problems like autism, suspected biochemical disorders, abnormalities on newborn screening test that all children in Virginia get. We also see adults with similar sorts of issues or with positive family histories or findings that might suggest a genetic disease that may have some more specific diagnostic testing available. 

    Melanie:  What would make somebody decide to come to see you for this evaluation? In some of the things that you’re talking about, yes, testing, that sort of thing with a child, we go to our pediatrician and then they say, “Well, you might want to go see a pediatric geneticist.” When an adult would see you, what would make them decide that “this is time, I need this evaluation”? 

    Dr. Wilson:  One of the problems with genetics is that the knowledge base is expanding so rapidly right now. It’s very difficult for excellent primary care physicians and even excellent specialists who aren’t specifically geneticists to keep abreast of the changes in diagnosis and testing availability. We see about half of our patients who are referred by other physicians, either their primary care physician or other medical specialists, and about half come from initial family referrals because of something that they’ve heard about other family members, something they have read in the newspaper, seen on the Internet or television, and we are here primarily to make diagnosis and to share information with families. 

    Melanie:  What do they do with the information that you then give them after an evaluation? 

    Dr. Wilson:  Well, it depends on what the specific situation is. Sometimes, we make diagnosis of conditions that have some complicated medical implications or perhaps involving other organ systems that may not have been considered, and somehow, if we can help with case management, we can help the primary physicians in terms of other specialty referrals that might be appropriate. We’re primarily involved in making diagnosis and giving the information. What we don’t is usually tell people what to do, because sometimes these are very difficult situations in terms of deciding who gets tested, what people want to do with the information, if in fact, they don’t what to have that information, and so we try not to force anything on our patients, but really give them information and try to help them make informed decisions. 

    Melanie:  Dr. Wilson, as you stated earlier, the field of genetics is exploding right now. It is huge. People are looking for genetic markers and everything from family risk of breast cancer and congenital heart disease, hypercholesterolemia, all of these things with genetic markers. What do you tell people about that decision to even see a geneticist, to even find out what they might possibly be at risk for? As you say, some people don’t know if they even want that information. What do you say to people questioning this? 

    Dr. Wilson:  Sometimes, before we do the testing, we actually discuss the test results before they come out, before we even start the testing process actually, and talk about the implications. Many tests are not perfect. Most tests are not perfect. There are certainly genetic conditions for which we do not have a reliable genetic marker, and then there are other genetic conditions where we have genetic markers and yet the implication of finding that particular change may vary from one patient or even one family member to another. We try to give people a notion of what they’re getting in for, in terms of information and what kinds of issues, even having the testing information right there for them.  

    Melanie:  Is the testing information public? If somebody gets some kind of genetic information, is that now something that insurance companies can look up and find out? 

    Dr. Wilson:  You’ve asked a very good question. There is a federal law called the Genetics Information Nondiscrimination Act that is supposed to protect the patient’s use of genetic testing information. Genetic testing information is part of the medical record, like any other physical finding or any other piece of laboratory information. Thus far, I’m not aware of patients who have problems with having the genetic information per se, but it is a concern that sometimes having that piece of information might be disadvantageous to certain individuals in certain situations. 

    Melanie:  What else would you like to tell families, in just the last few minutes, Dr. Wilson, about genetic testing and specifically, pediatric genetics, if their children have some issue that they would like to get tested for, and why should families come to UVA for evaluation of pediatric genetic conditions? 

    Dr. Wilson:  I think the most important thing is to discuss the possibility of seeing a geneticist with your primary care physician because sometimes that physician can provide us with some information in pediatric cases, like growth charts or medical information, etcetera, that might help us in seeing the patient and make the visit more efficient for the family and make the use of the patient’s time much more productive. Some families see us primarily without referral from physicians because of family history and concerns, and I think it’s important to try to get as much family information before you come because then that’s more going to be helpful for us in trying to figure out if there’s a pattern in the family, if there are clues that might lead us to a specific diagnosis or might help guide us in what we might suggest to the family for testing. Why come to UVA? One of the great things I like about being at UVA, and I’ve been here for over 35 years, is we work together very well. We have excellent pediatric and adult specialists and subspecialists and we really work in a collaborative, cooperative fashion. I think this really makes the care of patients much more efficient, much more streamlined, and much more effective for the families. 

    Melanie:  Thank you so much. It’s an absolutely fascinating field of study and field of medicine. Thank you so much for being with us today. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Genetics, Children's Health]]>
David Cole Mon, 16 Mar 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/26582-when-should-your-child-see-a-pediatric-geneticist
New Prospects for Treating Brain Cancers http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=25726-new-prospects-for-treating-brain-cancers new-prospects-for-treating-brain-cancersSince primary brain tumors account for only 1-2% of all cancers, most doctors aren’t very familiar with brain tumors.

At UVA, our neuro-oncology doctors only see patients with neuro-oncologic disorders, and they’re up to date on standard and experimental treatments.

Listen in to Dr. Benjamin Purow, UVA specialist and researcher in neuro-oncology, to learn about some new potential treatments for patients with brain tumors.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1503vh5d.mp3
  • Location: Null
  • Doctors: Purow, Benjamin
  • Featured Speaker: Benjamin Purow, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Benjamin Purow is a neurologist who specializes in researching new brain tumor treatments and caring for patients with brain tumors.

    Learn more about UVA Neuro-Oncology
  • Transcription: Melanie Cole (Host):  If you are someone who has been diagnosed with a brain tumor, what are the potential treatments for patients and what can you expect as an outcome? My guest is Dr. Benjamin Purow. He is a neurologist who specializes in researching new brain tumor treatments and caring for patients with brain tumors. Welcome to the show, Dr. Purow. Tell us a little bit about brain tumors and some of the challenges of developing treatments for patients with brain cancer.

    Dr. Benjamin Purow (Guest):  Sure. I am happy to. Brain tumors can present in lots of different ways. That is something that people are often curious about, that they worry about. It can present as something like a severe headache, but in most cases by far, headaches are due to other things. Seizures are very common presenting symptom. Those can be much more diverse than people expect. Those can be the grand mal seizure that people are used to hearing about, but also much more subtle things that are very brief, difficulty with speech or numbness or tingling somewhere, sometimes difficulty, weakness somewhere or balance. There really are a plethora of symptoms and it is always good to consult with your doctor. There are a number of challenges once you have diagnosed a brain tumor and typically that happens after patients present with some of the symptoms I have described or one of the symptoms I have described. It usually leads to an MRI, scan of the brain, and these are extremely sensitive scans that can show us these brain tumors. From there, we typically need a neurosurgical colleague to take some of this tissue and we will go on to some of the existing treatments such as initial surgery, radiation, chemotherapy. Unfortunately, for some of these brain cancers, and I will mention one in particular called glioblastoma or GBM for short, that is the most common and most aggressive kind of brain cancer we see in adults and we can see it in children as well. Some of the challenges for that cancer, as well as for some of the other brain tumors that are out there, include invasiveness into critical structures of brain. If they stay as a discrete lump, very often the neurosurgeons can just take that lump out. Unfortunately, glioblastoma and other brain cancers invade elsewhere into the brain. They are fairly resistant to existing treatments such as chemotherapy and radiation. There are a fairly diverse group of tumors. They can be heterogeneous and, worst of all, very adaptable to a lot, if not all, of the existing treatments that we have. They can always evolve and find a way around these treatments. There is also something called the blood-brain barrier, which makes it hard to get some of the treatments that we give intravenously get them into the brain. There is kind of a tight barrier between our blood and our brain itself, where these tumors are lurking.

    Melanie:  Describe for us some of the research that you are working on right now. 

    Dr. Purow:  Sure. We are excited about a number of things that we are doing in the laboratory right now. I mentioned the adaptability of this cancer. One of the things that we and others in the field are trying to do is tackle these cancers on multiple fronts all at once with one or two therapies at a time. We really need good multi-targeted therapies. We have some work in the lab focusing on what is essentially a genetic approach using very small molecules called microRNAs. There are actually lots and lots of these found normally in our self, but cancers such as glioblastoma and other brain cancers tend to suppress or increase expression of some of these, and some of these microRNAs that are down-regulated in the cancers are actually pretty toxic to cancers if we can go back and deliver them to glioblastoma and other cancers. One of the things we focus on in the lab is exploring these microRNAs, their biology, but also trying to use their delivery as therapy for brain cancers, given that each of these microRNAs can target multiple pathways at once. They tend to suppress their targets and a given microRNA can hit lots of these pathways that are very important in these cancers. We also have another big project in the lab, looking at a fairly new target in glioblastoma, brain cancers, and actually cancer in general. It is a protein called diacylglycerol kinase alpha or DGK-alpha. We think it is a very nice signaling hub in these cancers, such that when we inhibit this, we can actually attack multiple cancer pathways all at once. It got some other exciting aspects that seem to directly kill the cancer cells when we inhibit these. It also attacks their blood supply, may also boost the immune system, so exciting at multiple levels. We also have some new projects in the lab, basically a personalized medicine approach. We are trying to move forward where we can target subsets or subtypes of glioblastoma and other brain cancers. We are also exploring what we hope are some smarter, more rational combinations of some of the existing drugs that are out there.

    Melanie:  Wow! How exciting is this research you’re doing now. Tell us a little bit about how long some of these things when you talk about the DGK-alpha and these microRNAs, what can patients expect? When are you going to know if these can be used on patients and how long? What is the future of brain cancer care? 

    Dr. Purow:  Sure, that’s a great question. With some of these research fronts that we are working on, it will probably take years to develop. The microRNAs, in particular, there is a major delivery hurdle and we and others are working on overcoming this. There’s some [treading] progress being made there. The DGK-alpha project, it may actually not be that long because we found that there is an old drug that was being used for a different purpose in some clinical trials, not yet FDA-approved, but were safe in clinical trials being used for something else. We find that we can repurpose that drug as an inhibitor of DGK-alpha. We think that is going to really speed up clinical trial of this approach in the not-so-distant future in the next year or two with inhibition of DGK-alpha. With some of our other projects, we are actually using existing drugs that already are being used for cancer or repurposing existing drugs in new ways to use them against brain tumors and other cancers and that’s going to let us go to the clinic much faster. Truly an exciting time more broadly with lots of great new developments for cancer in general and that really extends also to neural oncology to brain cancers. I think we will for a long time be using chemotherapy, although hopefully more gentle ways than is typically thought of, and radiation as well. I think we are getting toward better use of targeted agents. Some of these are more sophisticated, personalized medicine or re-matching the drugs better to the patients who are out there. We will also be doing, I think, better combinations of existing drugs. One of the most exciting areas out there is with immunotherapy, boosting the immune system against cancer, including brain cancer. We used to think that it might not apply to brain tumors, but they really seem to be applicable to glioblastomas and these other awful brain tumors. There was a recent meeting in November in our field, the biggest brain cancer meeting there is, and there were some very exciting new clinical trial results with one immunotherapy. There are some other immunotherapies that looked great. These are kind of nice because they are not very toxic often and they really use your own immune system to fight the cancer. This meeting was also exciting because there were positive results with the really quite an interesting alternative approach to fighting cancer, applying electrical currents to the head against the tumor and that had positive results. So there are lots and lots of exciting things going on right now in this field and throughout oncology actually.

    Melanie:  Wow, Dr. Purow. Why should patients come to UVA for brain cancer care, if anything else, than just to see you and hear your enthusiasm for the subject? 

    Dr. Purow:  I think there are lots of reasons why I would encourage patients to see us. We see very many patients who have brain tumors. We have broad experience. We give everyone that we see really the state-of-the-art care, but then we go beyond and really try to go the extra mile. We give compassion to all the patients that we see. We really treat every patient the way that we would want ourselves or a family member to be treated. It is a frequent question from patients. What would you do? How will you want to be treated at this point? I really give the same answer, which is just “I already was talking to you about exactly what I would want to do.” I think we really apply the golden rule or, if you will, the platinum rule, to do for people what we would want for ourselves and our loved ones. We also have here a number of clinical trials in any given point and that is applying, trying things that are in the pipeline to our patients with these brain tumors, glioblastoma, and other brain tumors. Even outside of the clinical trials, though, we have the willingness to, as I said, do the standard of care and beyond, really look for combinations of standard of care with other existing agents that might give a little boost to the therapy, if we have to add on a blood pressure medicine or a seizure medicine for a patient. We are always thinking about medicines that will not only do that function that we need, but pick one that may also give a little boost against the brain cancer. Some of our patients want cocktails, state-of-the-art and other things, and we are very happy to fight as best we can and make those cocktails for our patients. We emphasize not just length of life but also quality of life, and that is really paramount in something that we are always thinking about. 

    Melanie:  Thank you so very much. Really, really great information and very exciting research. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 09 Mar 2015 17:00:00 +0000 http://radiomd.com/uvhs/item/25726-new-prospects-for-treating-brain-cancers
Treatment Options for Early-Onset Scoliosis http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=25725-treatment-options-for-early-onset-scoliosis treatment-options-for-early-onset-scoliosisWhat options are available for patients with early-onset scoliosis?

Scoliosis is an abnormal curvature of the spine, or backbone.

Instead of a straight vertical line from the neck to the buttocks, the spine has a C- or S-shape.

Listen in as Dr. Anuj Singla, a UVA spine surgeon who specializes in scoliosis, discusses available treatments for this condition.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1503vh5c.mp3
  • Location: Null
  • Doctors: Singla, Anuj
  • Featured Speaker: Anuj Singla, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Anuj Singla is a fellowship-trained orthopedic spine surgeon whose specialties include caring for patients with scoliosis.

  • Transcription: Melanie Cole (Host):  If you suspect that your child might have a curvature of the spine, what options are available for patients with early onset scoliosis. My guest today is Dr. Anuj Singla. He is a fellowship trained orthopedic spine surgeon whose specialties include caring for patients with scoliosis at UVA. Welcome to the show, Dr. Singla. What is early onset scoliosis and what are the symptoms that parents might recognize in their children that would even send them to the doctor to begin with.

    Dr. Anuj Singla (Guest):  Good morning, Melanie. Thanks for having me. Scoliosis is a lateral or sideways curve of the spine. Normally, a spine is straight upright, but when the spine starts growing sideways in the shape of a C of S, it is what we call scoliosis and early onset scoliosis is when the scoliosis starts early on, say, less than 10 years of age. That is early onset scoliosis. The most important remarkable symptom of a scoliosis is asymmetry or unevenness. Normally, our spine—and for that matter, the whole of our body—is very symmetrical, very even on both sides, the right side and the left side of the body. But if you notice that there is some unevenness in the kid’s body with regard to spine or adjacent to the spine, like tilted or uneven shoulder, one shoulder blade protruding more than the other or prominence of ribs on one side or uneven baseline or uneven pelvis, one hip higher than the other, or overall, kid leaning onto one side, these are the things that should give you the early clue that the kid might have scoliosis and you should see a specialist.

    Melanie:  Is this something in a pediatrician’s office during their well visit that might be caught by the pediatrician when they are just doing their normal well visit? 

    Dr. Singla:  Yeah. Actually, most of the time, parents has features of unevenness like I just mentioned, but sometimes, the findings are so subtle, it is so minor difference between the right side and the left side overall asymmetry, that the parents do not notice that and the pediatricians are very good at finding that out and we get a lot of referred patients from the pediatricians all over the region where the pediatrician or the primary care doctor find out about the scoliosis and the patients get referred over to us.

    Melanie:  Are there certain groups of patients, Dr. Singla, that are at higher risk than others? 

    Dr. Singla:  Yeah, there are certain groups of patients. Early onset scoliosis, we broadly say there’s a neuromuscular type of early onset scoliosis, which is imbalance of the nerve and the muscle function, like in cerebral palsy, CP, spinal muscular atrophy, muscular dystrophies, or paraplegia or a traumatic spinal cord. If the nerve and the muscle band go haywire, then they can get scoliosis. Some kids who have some syndromes in the body like Marfan syndrome or neurofibromatosis or dwarfism, they also have higher chances of getting scoliosis. Some kids who have abnormal bone in the spine, which is present since the birth, what you call as congenital scoliosis, they can also have a big scoliosis deformity early on in their life. At the same time, the biggest chunk of our patient is a group of patients who are otherwise completely normal, no problem with any other system in the body. They just have scoliosis. There is no reason for them to have scoliosis, but they end up having scoliosis.

    Melanie:  What a scary diagnosis, I would assume, for parents. What treatment options are available and what can they look toward for the future of this child? Are they going to be standing upright after these treatments? What are the options out there and what are the outcomes? 

    Dr. Singla:  Melanie, this is a very interesting question. Because treatment options for scoliosis and especially early onset scoliosis has to be customized for every child’s need, there is no one single answer for all the patients. The treatment has to be individualized. There are broadly three categories of treatment, three steps of treatment. First is observation, where we just look at the child and see if it is progressing, if the curve is getting worse over time or not. We take images of the spine. We take MRI or a CT scan to make sure we understand the problem and we take the consultation with some of the other specialists to make sure there is no other problem in any other part of the body. That is observation. The second step is doing a non-surgical treatment. Non-surgical treatment, we use bracing and casting for that. That is really very effective. That is one of the mainstream treatments for scoliosis especially early on. The third category of treatment is doing a surgery. For the surgery, I would like to mention that there have been some tremendous advances in the treatment of scoliosis and early onset scoliosis in last five to ten years. Earlier, the treatment option for early onset scoliosis and scoliosis used to be only fusing the spine. We used to fuse the spine so the spine does not grow any more crooked or any more curved than it is now. Or we used to correct the spine and then fuse it. That was the problem, especially for early onset, because if you fuse the spine, that also fuses the chest cavity or the thorax. If the chest does not grow, say in a five or six-year-old, the space available for the lungs for breathing gets very compromised or very jeopardized and that has a far-reaching effect and the lungs cannot actually grow to the normal extent for the rest of their lives. But with the newer advances of non-fusing technologies, we can really overcome. It is still early on for the non-fusing technologies for spine, but I guess we have made some groundbreaking achievements in the last five to 10 years. Now we have the groin rods, we have the dissection B system; we have the magic rod system. We don’t have to fuse the spine with the tethering and stapling. So there are a couple of options, which we can customize as per the kid’s age, kid’s growing potential, the flexibility of the curve, and the severity of the curve.

    Melanie:  Dr. Singla, when you speak about bracing and casting and traction, back in the day, we would see people, young kids walking around in those really severe braces with their heads up. It was something that really restricted that child’s movement, and in school kind of set them aside from the other children. What is it like now if a child has to go through bracing or casting or traction?

    Dr. Singla:  The principle behind the bracing is we have to push on certain segment of the spine on the convexity or the rounding side so that the spine grows straight. The brace, obviously, has to be worn for quite a significant amount of time, we say, about 16 to 18 hours a day. But that bracing material has changed a lot in the last five to ten years, and people do not notice. If you are wearing a brace underneath your clothing, people do not notice. Kids do not have any major restriction with the brace on. For the kids’ playtime and activity time, we encourage them to take the brace off, say after the school period. We encourage them to take the brace a couple of hours so the kids have time to do all the fun activities as well. 

    Melanie:  That is really great information that gives hope to parents. Dr. Singla. Why should patients come to UVA for their care? 

    Dr. Singla:  That’s an interesting question. I am fellowship trained and I have the training in the latest and cutting-edge technologies like the non-fusing methods I was just mentioning. If you combine that with the extensive experience of my mentor, Dr. Abel, over here, it makes up a great pediatric spine surgical team. Spine and scoliosis treatment is not just pediatric spine surgeon; it is a big team effort. It involves pediatric surgeons, team of intensive care intensivists, ICU nurses, anesthetists, therapists, orthotists who work with the braces, neurologists. I feel we have a great team taking care of kids with scoliosis over here at UVA. We also have low-dose imaging modalities. Because, like I mentioned, these kids need frequent and repeated imaging of the spine, and over a long period, the radiation amount in the body can have impact on the overall growth potential on all the glands and on the reproductive function later on. If we can cut down on the radiation dose, it can significantly impact the overall growth of the kid. We also have a one-stop solution to the problem over here. We have the imaging, our clinic, and our bracing shop all under one roof in our clinic setup. 

    Melanie:  Thank you so much. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Bone Health]]>
David Cole Mon, 02 Mar 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/25725-treatment-options-for-early-onset-scoliosis
Is Bariatric Surgery Right for You? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=25724-is-bariatric-surgery-right-for-you is-bariatric-surgery-right-for-youConsidering bariatric surgery?

Obesity can cause a number of conditions, including diabetes, high blood pressure, sleep apnea and joint problems.

Weight-loss surgery, combined with exercise and a sensible diet, has controlled obesity and its effects for thousands.

Learn from Dr. Peter Hallowell, the director of UVA’s bariatric surgery program, who may be a candidate for the weight-loss surgery as well as some of the potential benefits.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1503vh5b.mp3
  • Location: Null
  • Doctors: Hallowell, Peter
  • Featured Speaker: Peter Hallowell, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Peter Hallowell is a board-certified surgeon and director of bariatric surgery at UVA Health System.

  • Transcription: Melanie Cole (Host):  Are you severely overweight? Have you ever considered bariatric surgery? Who is really a candidate for this weight loss surgery and what does it involve? My guest today is Dr. Peter Hallowell. He is a board certified surgeon and Director of Bariatric Surgery at the UVA Health System. Welcome to the show, Dr. Hallowell. Tell us a little bit about bariatric surgery. What does it involve? 

    Dr. Peter Hallowell (Guest):  Bariatric surgery involves an operation on the patient and it describes a field of surgery where there are multiple different procedures that we do, all with the goal to help the patient lose a significant amount of weight and to improve the medical problems that are associated with carrying a significant amount of weight. 

    Melanie:  What are the different kinds of bariatric surgery out there now? Some of them are permanent and some of them are not, correct? 

    Dr. Hallowell:  Yes. In a general sense, what we found is that even the procedures that are somewhat temporary, once that procedure is withdrawn, there is a tendency to regain weight. So there tends to need to be a procedure, in effect, to maintain this weight loss. The procedures that are commonly done in the United States include the gastric bypass, the sleeve gastrectomy, and the lap-band, as far as common surgical procedures. 

    Melanie:  Who are candidates? Who really should be considering any of these types of bariatric surgery? 

    Dr. Hallowell:  Excellent question. Patients who are severely overweight and in medical terms, we measure that by a tool called the body mass index. This is essentially a ratio of your height and weight, so that taller people can carry a lot more weight. Think of a person like Shaquille O’Neal, who is nearly 7 feet tall versus somebody who is 5’ 4”. Shaquille O’Neal can carry a lot more weight on his frame and not be unhealthy. The body mass index is something that you can easily calculate in your head. Most places have a calculator on a website and we use that in our own clinic. What we are looking to see is if your body mass index is greater than 40, you would be a candidate for surgery, or if your body mass index was greater than 35 and you have a significant medical problem like hypertension, diabetes, obstructive sleep apnea. The body mass index in those ranges translates to roughly 80 to 100 pounds over your ideal weight. 

    Melanie:  Dr. Hallowell, explain a little bit about these types of surgeries. People think of a stomach getting smaller and limiting the amount of solid food, but does that also make it like malabsorptive? Does it make it so that you cannot retain that food? Explain a little bit about it. 

    Dr. Hallowell:  Each of the main procedures that we do works in a slightly different way. I’ll take them kind of each in and of itself. In a gastric bypass, we will take the upper part of your stomach and staple that off and make it into what we call a small pouch. It is generally about the size of an egg or smaller and holds pretty much up to about an ounce to an ounce-and-a-half of food or fluid. We then take part of your small intestine and attach it to that pouch. The food you eat will go into the stomach and then into a part of the small intestine that is usually further down. Then we make another connection, even farther down the small bowel, where the rest of the body’s juices from the liver and pancreas, and the rest of the stomach come in to help you digest. In a traditional sense, we think of that operation as sometimes limiting the amount of food that you can eat because of the size of the pouch and also inducing a little bit of malabsorption because of where the digestive enzymes come into the system and shortening your intestines a little bit. Some of the newer research into bariatric surgery indicates that some of the effects that we are having may be more hormonal or biochemical than pure restriction of food or malabsorption, and that while it hasn’t been fully fleshed out, it’s one of the most interesting areas in the field. The next procedure that is commonly done in the United States and, in fact, the most common operation performed these days, is called the sleeve gastrectomy. Simply put, that is taking the stomach and turning it into a thin tube, about the size of your esophagus. If you think of your stomach as a big reservoir that can stretch out, especially around Thanksgiving time when you may overindulge in food and it becomes a big reservoir, the sleeve gastrectomy turns that into a much smaller reservoir, much smaller tube, and you cannot hold as much food. Then the last procedure that is commonly done in the United States, the lap band, we take basically a plastic belt with a balloon on the inside and put that around the upper part of the stomach, right by the entrance to the stomach, and by inflating the balloon, we cause that area to narrow down and allow patients to feel hungry earlier than they would when eating food, so it gives a lot more restriction.  

    Melanie: What questions would you advise patients to ask their doctors when they are considering these types of surgery? 

    Dr. Hallowell: They need to ask their doctor, if they are considering this surgery, which operation may be best for them. They should ask their doctor how much experience have they had in the various operations that they propose. It would be very prudent to ask what the risks of the surgery that they are thinking about entail, what the potential benefits for them are, and if the surgeon is a member of an organization that specializes in bariatric surgery, if the hospital and center they are going to is recognized as the center that performs this and a high volume with good outcomes. 

    Melanie: Tell us a little bit about the recovery. We don’t have much time left, but what can patients expect afterward? 

    Dr. Hallowell:  Again, it depends on the procedure that they have, but in general, it is about a two-day hospital stay. Most of the procedures in the United States are performed in a minimally invasive surgery fashion or what we call laparoscopic surgery. There will be multiple small incisions on the patient’s abdomen. This allows it to have a lot less pain than a traditional open surgical incision. The patients will generally recover pretty quickly from the surgical side of the equation. However, they begin losing weight, especially with the gastric bypass or sleeve, sometimes up to a pound a day, so they may feel a lot of fatigue up until six weeks after surgery. Those should be some of the expectations going in that they may be out of work for a week or two after the surgery and then they may feel tired for up to a month to a month and a half. 

    Melanie:  Dr. Hallowell, why should patients come to UVA for their bariatric surgery? 

    Dr. Hallowell:  UVA has been doing bariatric surgery for the longest period of time in Central Virginia and we have the most experienced team taking care of our patients. We are a recognized center of excellence for bariatric surgery and we’ve held that designation since the beginning of the program to designate hospitals as centers of excellence. It is really our experience, our knowledge, and our skill at doing these operations that should drive patients to come and see us.

    Melanie:  Thank you so much. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Weight Loss]]>
David Cole Mon, 23 Feb 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/25724-is-bariatric-surgery-right-for-you
How Clinical Trials Improve Cancer Care http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=25723-how-clinical-trials-improve-cancer-care how-clinical-trials-improve-cancer-careA key to improving cancer care is clinical trials.

Clinical trials are prospective biomedical or behavioral research studies on human subjects that are designed to answer specific questions about biomedical or behavioral interventions.

Some examples are novel vaccines, drugs, treatments, functional foods, dietary supplements, devices or new ways of using known interventions.

Learn from Dr. Robert Dreicer how they benefit cancer care, how they work and how patients can volunteer to participate from a research specialist at UVA Cancer Center.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1503vh5a.mp3
  • Location: Null
  • Doctors: Dreicer, Robert
  • Featured Speaker: Robert Dreicer, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Robert Dreicer is director of clinical research and deputy director of the UVA Cancer Center.

    Learn more about UVA Cancer Center
  • Transcription: Melanie Cole (Host):  A key to improving cancer care is clinical trials, but how do they benefit cancer care? How do they work and how can you get involved in a clinical trial? My guest today is Dr. Robert Dreicer. He is director of clinical research and the deputy director of the UVA Cancer Center. Welcome to the show, Dr. Dreicer. Tell us a little bit about clinical trials. What are they and how are they run? 

    Dr. Robert Dreicer (Guest):  I think the best way to define a clinical trial is to use the definition that the National Institutes of Health use. It’s basically research studies explore whether medical strategies, treatments, medical devices are safe and effective for patients and they may show whether medical approaches work best for certain illnesses or groups of people. That’s a nice sort of all-encompassing definition. 

    Melanie:  Why have they been so important to advancing cancer care? What are clinical trials doing for us? 

    Dr. Dreicer:  I think they have been absolutely critical to the really dramatic progress that’s been made over the last 10 to 15 years in managing a variety of the major cancers that we take care of. Because what it does is it gets us out of one doctor treating one patient with a certain treatment and seeing whether or not it works. That’s an anecdote. We don’t learn by anecdotes. We learn by carefully structuring trials to address the question about a drug or a device to say whether this is effective in patients and then ultimately, whether it works better than what we’ve done in the past. That’s actually been critical in making progress. 

    Melanie:  If patients are considering participating in a trial, I think that this could make somebody nervous that maybe they’re not getting the standard of care or the care that they should be getting especially where cancer is concerned. How do you explain to them that a clinical trial might be the best option? 

    Dr. Dreicer:  That’s a great question. Obviously, it depends very much on the circumstances that the patient is facing and there are different types of trials. Some that’s very early and those trials may be more appropriate for patients who have been heavily treated and have limited additional treatment options. As we begin to develop better therapies, trials that compare the standard treatment to a treatment that probably or maybe better is a different kind of study. For each patient, it’s really important to understand the kinds of trial that is being presented, what the standard of care is. Part of a physician’s responsibility is to make sure that patients understand these issues as they begin to contemplate participating in a trial. 

    Melanie:  What protections are in place for those patients? What if they say, for example, “Well, this didn’t work for me and I wasted all this time when I could have been being treated”? 

    Dr. Dreicer:  That’s clearly an understandable issue. The protection for patients in our system in the United States is extensive. There’s something called an Institutional Review Board and basically, what that is, it is a group of physicians, scientists, lay people, ethicists, whose sole goal – and this is a federal mandate – is to review what the clinical trial is, how it is being explained to patients to make sure that the risk/benefit ratio makes sense for patients. That happens before a trial is ever opened and before a patient ever is approached.

    Melanie:  If somebody wants to look into clinical trials, how do they decide if a clinical trial is right for them? What things do you want them to look at and questions do you want them to ask? 

    Dr. Dreicer:  I think the first question should be: What is the standard of care and why might my participation in this particular trial that I am being offered be rational compared to being treated by a standard treatment? Now, in some instances, there may not be a standard treatment, but that is still a legitimate question. What rationale is it for me to participate in this trial? What should I expect in terms of the time that I am committing to this, the side effects that I might expect from this therapy? And then contrast that with the side effects that I might get from a standard treatment. What’s the potential upside? Is it something that’s going to potentially cure me, might I live longer, or is this a trial just to see whether or not this drug is going to potentially make me feel a bit better, but not likely do more than that? Those are very important questions which, frankly, should be some questions that the patient doesn’t really need to ask. This is being presented to them as information.

    Melanie:  Is there ever a time, Dr. Dreicer, when a placebo is what’s administered to a patient? Because, I think, that especially where medication is concerned and the effects of medication, that’s what patients seem to be afraid of, that they are going to end up in the placebo group and not get the help that they need. 

    Dr. Dreicer:  That’s obviously a very important issue. I just would remind our audience that many trials are not comparative trials. Meaning, there are trials that are called phase one or phase two trials, in which patients all get treatment. That there are no randomizations, so there is no chance of not getting treated. In some phase three trials, these are comparative trials. Occasionally, there is no standard of care and a placebo, meaning no treatment, is actually what normally would be offered to patients. In fact, giving somebody treatment might be, in fact, the investigation arm. The critical nature of having the study rationale explained, taking some time to work through this, the one thing I would advise folks who are looking at trials is to remind themselves that they are not going into used car dealership. This isn’t about pressure tactics. This is about careful consideration, being thoughtful, and making sure that one has all the information you need and to be comfortable to make that decision. 

    Melanie:  What a great answer! You mentioned the phase portion of the trial. Please explain that phase and what do you hope to achieve as you go through those phases? Is there some end goal with these clinical trials? 

    Dr. Dreicer:  Briefly, we think about sort of three major phases of trials. Phase one, first thing human or finding the safe dose that can be further tested in a phase two trial. Phase two trial, a specific disease, say colon cancer, a specific drug or drugs. Does this drug or drugs have benefit to these patients with this disease? Phase three is comparing a new treatment or perhaps an older treatment to what is considered the standard, to understand whether or not one is the same or better than the other. 

    Melanie:  Really, what would be your best advice? What are the benefits to patients coming to an NCI-designated cancer center like UVA Cancer Center? 

    Dr. Dreicer:  Participation through the National Cancer Institute suggests a certain level of interdisciplinary management of patients, the kinds of expertise that is sort of clustered in major academic centers, the ability to sort of call upon our colleagues in basic science and translational science to bring the best, newest things into the clinic. Participation in a clinical trial also has a regimentation, meaning that the oversight from the institutional level, from the federal level, is extreme and, therefore, patients in that setting are getting basically the best therapies that we have across the world. 

    Melanie:  Now, just one last question, if you would, Dr. Dreicer, when someone is considering a clinical trial, your kind of recap for us if you would please, what you want them to know about clinical trials and what you think the most important questions they should ask when they are exploring this. 

    Dr. Dreicer:  Back in the day, patients who participated in clinical trials did it almost always for altruistic reasons, to help the next generation. Increasingly, with the developments of the therapies that we have, it is much more common for a patient to actually, not only help additional generations, but potentially achieve benefit for themselves. Patients need to be comfortable with the rationale of the trial. Why are we doing this? What are we trying to learn? What is in it for me? What are the risks for me? What is my time commitment going to be to this? Those are obviously pretty critical questions and I do not want to oversimplify this, but if you start there, and remember that there is no guarantee you have to make a decision. Sometimes, you need a little bit more time. I would rather have a patient be comfortable with a decision than to second-guess their judgment.  

    Melanie:  Really great information, Dr. Dreicer. Thank you so much for being with us. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 16 Feb 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/25723-how-clinical-trials-improve-cancer-care
Minimally Invasive Spine Surgery http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=24909-minimally-invasive-spine-surgery minimally-invasive-spine-surgeryFor some patients with spine conditions, minimally invasive surgery may be an option.

Learn more about which patients may be candidates for minimally invasive surgery from a UVA specialist in spine surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1451vh5d.mp3
  • Location: Null
  • Doctors: Hassanzadeh, Hamid
  • Featured Speaker: Dr. Hamid Hassanzadeh
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Hamid Hassanzadeh is an orthopaedic surgeon whose specialties include minimally invasive spine surgery and complex spinal deformities.

    Learn more about UVA Spine Center
  • Transcription: Melanie Cole (Host):  For some patients with spine conditions, minimally invasive surgery may just be an option. My guest today is Dr. Hamid Hassanzadeh. He’s an orthopedic surgeon whose specialties include minimally invasive spine surgery at UVA. Welcome to the show, Dr. Hassanzadeh. Tell us a little bit about the difference between minimally invasive surgery and traditional spinal surgeries. 

    Dr. Hamid Hassanzadeh (Guest):  Thanks very much for having me. Minimally invasive surgery is a newer technique which has been promoted or been evolved over the last decade. The benefit over classic open surgeries is that you don’t need to get cut through the muscle, so it’s a muscle-sparing procedure. By just dilating the muscle, we get an area we want to work and we perform the work we want to do without creating new damage to the muscle and the soft tissue down the spine. You have to know that a lot of related complications of the spine is related to the soft tissue coverage of the spine. We try to minimize that complication with approaching the spine through minimally invasive, not only skin incision, also muscle-sparing procedure. 

    Melanie:  As back problems and spinal pain are such a huge problem in this country, what patients might be candidates for this type of minimally invasive surgery to help them with their problems? 

    Dr. Hassanzadeh:  This is a very good question. Unfortunately about 80 percent of the population will have experienced some type of back pain in their lives. Not every back pain requires surgery. That’s a good thing. The first line of treatment for every back pain is actually non-operative management, but in a patient who has stenosis, disc degeneration or some stability, minimally invasive procedures are very good approach or technique to address the problem, and usually the recovery is a little bit faster, actually much faster. They don’t need that much rehabilitation to return back to work and to activities of daily living. 

    Melanie:  How do you determine whether somebody is a candidate? When they do have this pain, it’s not really working to use anti-inflammatories or whatever else that they’ve tried, then what’s the next step? 

    Dr. Hassanzadeh:  The indication for a spine surgery, few things have to speak the same language. The clinical presentation, the complaints you have, should show the same problem in the imaging of spine in MRI and so on. Once we have the same problem and we know we can help it with a surgical procedure, then it’s usually surgery indicated. In a case where we exactly know we would do this, then the patient will improve significantly, 90 percent chance or higher than 90 percent chance. The first line of treatment is always activity modification. We try to do it non-operative and anti-inflammatory medication and also core muscle strengthening is a huge part of prevention and also treatment of the spine problem. There’s also a point that non-operative management just aren’t enough to provide enough relief, then the next step is obviously after having the appropriate imaging to perform the appropriate surgery. 

    Melanie:  With minimally invasive spinal surgery, how long usually is somebody in the hospital and then what is it like afterward? How soon can they return to activity? 

    Dr. Hassanzadeh:  All this will depend on the extent of the surgery. For just the decompressive surgery for stenosis or discectomy, patient leaves the same day. Patients are able to leave the same day. Eighty percent of all my decompression or discectomy patients will leave the same day and they’re back to work within the week if they’re having just light duty job. In cases of heavy duty job, then it takes about six weeks to return to work. 

    Melanie:  Then how soon should they see results? I know it depends on the type of surgery and what their problem was to begin with, but generally, how soon can people feel a reduction in pain or the shooting pains that go down their legs or whatever reason that they came in to see you? 

    Dr. Hassanzadeh:  This is a very good question. It’s a question asked a lot by my patients. As you said, the pathology differs in outcome. In terms of acute disc herniation and having a disc problem, compression on a nerve, it’s immediately. This is really the patient wakes up and they have no pain really. It’s a very gratifying moment for us as physician to see the patient being pain-free and so very grateful for that. There are some other pathology that would take time. Usually you see the majority of benefits first six weeks to three months, and a complete recovery is about six months. In larger cases, the deformity cases where multilevel fusions are involved and very long surgery, then recovery could take up to a year. 

    Melanie:  Is there physical therapy needed after this type of surgery? 

    Dr. Hassanzadeh:  Again, it depends on the type of surgery and it depends on the patient’s activity levels. When patients are very active to start with, yes, especially after fusion surgery we send them back to rebuild their core muscles to prevent further problems in the future. 

    Melanie:  Let’s talk about some of that prevention and strengthening. You’ve mentioned the core. What do you like people do to keep a really good, strong spine? 

    Dr. Hassanzadeh:  I think working out is very important. It’s not only the back muscles. It’s abdominal muscles, chest muscles, hip muscles, they’re all important to keep a stable core. What I mean by that is you can divide. There’s so much pressure we have when we walk, when we run, when we do things. You can drive the entire pressure to the spine and will have back pain or you can divide the pressure through your muscles and spine. By having a very strong core muscles, then the muscle will take a lot of that pressure or force away from the spine, so it’s a divided work, so you will see less pain as a result. Also as to degeneration, you can decrease the rate of degeneration of the facets, joints, and discs, and so on. 

    Melanie:  Dr. Hassanzadeh, tell us about what’s going on in the horizon picture for minimally invasive spine surgery. What’s really exciting that you’re doing there at UVA? 

    Dr. Hassanzadeh:  I think the beauty of the spine surgery is that we can transfer this to other fields. One of the major advances we have here by collaborating with other teams, not only within orthopedics but also outside the orthopedics department, we start treating some of the complex factors through minimally invasive techniques, and that’s a huge advantage we are currently studying and could affect bio-mechanic study to prove that it’s really as stable as a local procedure. We’re convinced that it’s going to be the future. I think the future will be less soft tissue damage, more precise surgery through small incision. Having the technology behind us, it makes our work much easier. This is the exciting part, to be in UVA, it’s a great place because of the resources that UVA has as a lead institution. Also, people are around… medicine is always a multidisciplinary teamwork. If you have the right people in the right positions, the work is easy and patients benefit the most. 

    Melanie:  Great information. Thank you so much. For more information on the UVA Spine Center, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Sugar]]>
David Cole Mon, 09 Feb 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/24909-minimally-invasive-spine-surgery
When To Consider Genetic Testing for Your Heart http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=24908-when-to-consider-genetic-testing-for-your-heart when-to-consider-genetic-testing-for-your-heartHeart conditions run in some families, and genetic testing may help family members better understand their risk for a hereditary heart condition.

Learn more about genetic testing for heart conditions from a UVA genetics counselor.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1451vh5c.mp3
  • Location: Null
  • Doctors: Thomas, Matthew
  • Featured Speaker: Mr. Matthew Thomas
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Matthew Thomas is a genetics counselor at UVA’s Cardiovascular Genetics Clinic and at UVA Children’s Hospital.

  • Transcription: Melanie Cole (Host):  Heart conditions run in some families and genetic testing may help family members better understand their risk for hereditary heart conditions. My guest today is Matthew Thomas. He’s a genetics counselor at UVA Cardiovascular Genetics Clinic. Welcome to the show, Matthew. Let’s talk about genetics and heart disease. How would someone know if they are at risk for an inherited heart disease? 

    Matthew Thomas (Guest):  Melanie, thank you for having me. Someone would know if they’re at risk for an inherited heart disease if there is a pattern of the disease in their family. What you tend to see with heart conditions that are genetic are people that get diagnosed with certain heart problems, like enlarged hearts or cardiomyopathies or heart rhythm disorders, arrhythmia at younger ages than you would expect. The thing that stands out about inherited heart disease is these are caused by genes that are faulty, that you’re just born with and that maybe running in your family for generations. It’s not the result of poor diet or lack of exercise. It’s a genetic predisposition that you have. Some clues that you would see aside from an early age of diagnosis are someone in the family passing away suddenly and unexpectedly at an age younger than would be expected, say, less than 50 years old. Those are a couple of things that stand out.  

    Melanie:  What would somebody do if they find out that their family members, immediate family members, have had heart disease problems before? What would you advise be the first thing that they should do? 

    Matthew:  The patient or person out there who’s concerned that they may have an inherited heart condition in their family, the most useful thing that they can do is just gather their family history, talking with siblings or parents, grandparents, aunts, uncles to find out if there was somebody who passed away suddenly at a young age. What were the circumstances behind that? Was there ever a diagnosis? One thing I commonly see when I meet with patients is that people commonly refer to any death that happens suddenly as a heart attack and what it turns out is oftentimes that heart attack may have actually been a typical heart attack that many people can have, but there are also heart issues, cardiac arrests, that can be caused by an electrical problem with the heart or structural problem that has nothing to do with a typical risk that you would get again from diet and exercise or related concern. Collecting the family history would be step one, and then if the patient has a concern, sharing that information with their primary care doctor. You can even directly call a cardiovascular genetics provider to find out, “Okay, is this a good reason to come in for a concern? Is there something that you might be able to help me with?”

    Melanie:  What can someone expect when they’re getting a genetic test for heart conditions and does the genetic test tell you anything about their lifestyle risk for heart disease? 

    Matthew:  Genetic testing has some good value for people that are concerned about their risk for having a heart condition that’s running in their family. Occasionally, we are able to find a test result that explains exactly why somebody has a given heart condition. For example, if somebody comes to our clinic with a genetic heart condition called hypertrophic cardiomyopathy where a portion of the heart is thicker and it can lead to certain problems with how the heart pumps and send the electrical signals in the heart, we can do a very cutting edge state-of-the-art genetic test on a blood sample to find the gene that’s responsible for that patient’s heart problem. Then, that test can then be used for other people in the family, like if a mother comes to see me when she has children that are about to start playing sports in high school and she wants to know, “I have hypertrophic cardiomyopathy, are my children at risk? Is it safe for them to play sports?” By finding the gene in the mom, we would have the ability to then know whether the children may carry the gene or not and that would determine what their risk is for having that disease. If we find the gene in one of her children, then they may receive some restrictions in their exercise actually. For some people, it’s not safe to be in competitive sports when you have this heart condition because it puts you at risk. On the other hand, if they’re negative for the gene, that means that they’re going to likely be cleared to play with no restrictions whatsoever, and that’s pretty reassuring to the athlete and the family. 

    Melanie:  Besides blood tests, Matthew, what other type of tests do you do for genetic counseling? 

    Matthew:  I work as a part of a team here, and what we typically do is a combination of genetic testing when indicated and cardiology screening. If genetic testing doesn’t provide any answer but we still believe a patient has an inherited heart condition, then we rely on cardiology testing, and that would be things like an echocardiogram or an ultrasound of the heart or an EKG which is looking at the heart rhythm. Sometimes, we do exercise testing and other sorts of heart studies that are not invasive, but they give us a good picture of the heart and its health and that gives us reassurance when you know there is a pattern of disease in the family when you examine somebody with good cardiology testing and interpreted by a cardiologist to determine if there is a current risk and whether that needs to be repeated again as the person gets older. 

    Melanie:  What’s your role within the cardiovascular genetics clinic? 

    Matthew:  I’m a genetic counselor. I work exclusively with cardiovascular disorders, and my role is to do two things. One is to identify patients that are at high risk for or have an inherited heart condition and offer them genetic testing that’s indicated based on their condition. The second thing is to get the word out to family. Even though I may be meeting with one patient in an afternoon, one patient per half hour, hour slot, I help reach the family members that aren’t in the room to make sure they know that they could be at risk for the same thing and they can get protected by close cardiology screening. So I basically work with them to offer genetic testing and then get the word out to family.

    Melanie:  If someone gets a positive test result, Matthew, does that mean they’re a ticking time bomb? Does that mean that they will necessarily have one of these types of genetic heart disease or are there things they can do to change the outcome? 

    Matthew:  Fortunately, inherited heart conditions are very responsive to treatment. We may not be able to prevent problems from happening in some people, but we can certainly prevent actually the more serious complications like a cardiac arrest. That requires early identification of the disease and that’s what’s critical with this conditions. What we want to avoid is somebody who is at risk for a serious inherited heart condition that predisposes to cardiac arrests from not being aware of it, not receiving necessary medicine or receiving necessary surveillance to make sure that if they needed to have a procedure done to protect them that they don’t miss that opportunity. Fortunately, we feel very positive when we can diagnose the patient with the positive result that we can take good care of them to protect them from serious complications. Each disorder is very unique in the way that it affects somebody, but we are in general very positive about our ability to make sure that we can prevent really serious events from happening in someone.  

    Melanie:  Why should patients come to UVA to address their concerns about inherited heart disease, Matthew? 

    Matthew:  At the University of Virginia, we have a multidisciplinary team. I am a member of that team as the genetic counselor. We have cardiologists that specialize in electrophysiology or heart rhythm, congenital heart diseases, sports cardiology. We have specialists that emphasize heart failure, enlargement of the heart or cardiomyopathy. Whatever the individual condition is that’s running in the family, we have the expertise here to take good care. We all work together to help both patients and their family members who have these conditions, and as a team to make sure that we’re providing the optimal service for the entire family who comes here. This doesn’t happen in a vacuum. You mentioned the idea of this being for some people, when is the next you’re going to drop, what could happen next? We provide as much support as necessary to make sure that when we make these diagnoses, the patients feel that they get the support they need to live the most fulfilling and active life that they possibly can.

    Melanie:  Thank you so much, Matthew. For more information on the genetics clinic at UVA, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Have a great day.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Genetics, Heart Health]]>
David Cole Mon, 02 Feb 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/24908-when-to-consider-genetic-testing-for-your-heart
How to Prepare Your Child for Surgery http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=25398-how-to-prepare-your-child-for-surgery how-to-prepare-your-child-for-surgeryGetting your child ready for surgery doesn’t have to be a scary experience.

A good start is to help your child understand what is going to happen and try to bring it to a level they can understand.

Dr. Jeffrey Gander,a UVA pediatric surgeon, is here to discuss and give some tips on how to prepare your child – and yourself – for this big event.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1451vh5e.mp3
  • Location: Null
  • Doctors: Gander, Jeffrey
  • Featured Speaker: Jeffrey Gander, MD
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Jeffrey Gander is an Assistant Professor of Surgery specializing in pediatric surgery.

    Learn more about Dr. Jeffrey Gander

    Learn more about UVA Children’s Hospital
  • Transcription: Melanie Cole (Host):  Getting your child ready for surgery doesn’t have to be such a scary experience, and we’re offering you today some tips on how to prepare your child and yourself from UVA pediatric surgeon, Dr. Jeffrey Gander. Welcome to the show today, Dr. Gander. Tell us a little bit about what are some of the most concerns you hear from families before they have to have surgery for their child.

    Dr. Jeffrey Gander (Guest):  Hi, Melanie. How are you? Thank you very much for having me on. Happy New Year to you. That’s a great question. I hear a lot of concerns from families before surgery. One is, how is their child going to cope with being separated from them, often for a couple of hours at a time? That’s one thing they worry about, having to say goodbye to their child when the child’s taken off to the operating room. Another thing they ask often is because with surgery, there is incision and opening of other skin in some part of their body and they are worried about are they going to have pain during the surgery and are they going to have pain after the surgery? Another thing we get asked a lot is about anesthesia. What kind of anesthesia, what are the side effects of the anesthesia, things like that? It’s certainly understandable. I have a couple of young ones myself. I understand them well to be concerned when your child is going to have an operation. 

    Melanie:  As a parent myself, Dr. Gander, I have been there. Both my children have had to have surgery at some point. How do you address those concerns, like, for example, I was worried about anesthesia myself, how a child tolerates that anesthesia and what’s going to happen afterwards, how lethargic will they be for that day following. I know it’s individual for each child, but how do you answer those questions that you listed?

    Dr. Gander:  Well, a lot of times I reassure the families and I’d say that the anesthesiologist we have here at UVA that are going to be taking care of their children are all fellowship trained in just taking care of children. They have a lot of experience. They’re just some of the best doctors we have in the hospital. They are very used to taking care of premature babies who are less than a pound at birth to adolescents and even to early 20s. They are very used to taking care of children. That’s a good thing, is that they have a lot of experience. What they do, what helps also, is that they often get a little medicine to help them to get into the operating room. I know the anesthesiology team – because a lot of families and a lot of children are very anxious – will even give a little bit of something to sedate them a little bit so they can come into the operating room and be a little bit more comfortable and not be as nervous. The reason I bring that up is because often when a child is less nervous, they often need less anesthesia, so that actually helps them to go to sleep a little bit easier and then actually wake up and not be quite as groggy after the operation. That goes with the families, too. Children as you know read off the emotions of their parents, very much so. If a family or a parent is anxious, then the child is going to be anxious as well. Like I said, that even sometimes makes them have to have more of the anesthesia and even sometimes, more medicine. There’s a lot of different types of anesthesia and depending on what type of the operation is, sometimes, it can happen under just a local anesthetic where we give some medicine into the surgical incision so that they don’t feel anything, so it numbs the area. The anesthesiologist will give just give them a little bit of medicine to make them nice and comfortable so they won’t know what’s going on. Along those lines, what I often tell families is the child is going to have no pain and they are going to have no memory of the operation whatsoever because they’re given a little something before that makes them nice and comfortable. They go to sleep, have their operation, and oftentimes, they wake up and say, “Oh, I didn’t even realize that surgery was done already.” I think that’s certainly a common concern is about the anesthesia, but I can certainly say that here, they are well taken care of. Those children are very well taken care of. 

    Melanie:  As far as that medication to help calm the children down, Dr. Gander, I would think the parents need that even more so than the child. What do you tell these nervous, freaked out parents? I give you so much credit working with parents as a pediatric surgeon, Dr. Gander. What do you tell the parents that they should be doing before, during, and after their child goes in for surgery?  

    Dr. Gander:  Right. Before surgery, I tell them just to ask me as many questions as they can. Because like I said, people are well informed. There’s a lot of information. People will often come in with some of their own concerns and their own anxieties about their child having operation. I do sit down with them and spend most of the visits just going over that. What are your questions about the operation? What are your concerns? I do my best as well as the nurses I work with very closely. Here at UVA, we do our best to answer those questions to kind of make them a little bit less anxious. That morning of the surgery, I just tell them, go through their normal routine. We can talk about it later, but the child is not allowed to eat anything, but how the family makes sure that they eat some breakfast, make sure they got a good night’s rest because they need to be there for the child the next day. During the operation, what I often tell people is go out, grab a cup of coffee, go get something to eat and read the newspaper. Oftentimes, they won’t be able to do that because they’d be so nervous. Just try not to think about it for a period of time. Then for after the operation, I’ll always confine them and just go over everything and often, what I’ll do, as in before, I’ll tell them, give them a rough estimate how long the operation’s going to be because then they can sort of say, “Oh, well, they told me it’s going to take two hours, so I won’t be worried because it’s only been an hour-and-a-half.” At least you give them some period, something to anticipate so that they know that there’s a period of time they may be in during the operation and they can expect to hear from us around that time. Then for after the surgery, what I tell families is that their child will have some pain afterwards, some discomfort, and depending on what type of surgery it is, whether it’s a general abdominal or operation or something on the leg or bones, the pain will be different with each procedure. I assure them that our team, the surgery team as well as the anesthesia team in the recovery room, will do our best to alleviate that pain and help control that pain. I think with hearing all those things and just speaking with the families, it often helps out a lot for them. 

    Melanie:  In just the last few minutes, Dr. Gander, what could parents do or say to their children? Based on a child level of understanding of what’s going to happen to them, what do we tell our children to put them at ease from all those lights and the scary people in white coats and then why should families come to UVA Children’s Hospital for their care?

    Dr. Gander:  Right. Children are very smart and they understand something is going on. Try to explain to them as best we can what is going on and why they need to have the procedure. What we do in our preoperative visit and as well as sometimes we ask the families to do is we have certain dolls and teddy bears that have devices. If they’re having a feeding tube placed or a Port-A-Cath we call, something that goes underneath the skin to help them get the medicine infused, we show them what these things look like and show them on a doll or a mannequin so that they can at least be used to what’s happening or give them an idea about that. We have a child life specialist who works with them before the operation to try to get them used to a mask sometimes that the anesthesiologist will put on for them. Then, like I said, the medicine that they give beforehand sometimes makes them nice and relaxed for when they go back to the operating room. I always ask them what kind of music they like to listen to, so I will try to put a little bit of music on at the beginning of the operation, anything—I like all kinds of music and I know all the nurses do, too—anything they want to listen to, just to make them nice and calm. We all introduce ourselves beforehand, not only to the families, but there’s typically at least six people in the operating rooms, two surgeons, two anesthesiologists, and two nurses, and we all introduce ourselves by our first name and then once they come back into the operating room, we re-introduce ourselves again. Say, “Remember me? I have a mask on, but we’re going to help and take care of you.” I think all those things really often help out these children. As far as coming to UVA, I think, the nice thing about here is everyone works as a team. The kind of olden days of the surgeon as the captain of the ship are gone, and it’s really everybody works together. Like I mentioned, there’s usually at least six people in the operating room, if not sometimes more than that, all working to take care of children. We all communicate pretty well. If someone has a concern, they bring it up to the group and we try to do our best to do that because our ultimate goal is for the child to be safe during the operation and have the operation be successful so that whatever was wrong with them can be fixed.

    Melanie:  Thank you so much, Dr. Jeffrey Gander. It’s really great information. You’re listening to UVA Health Systems Radio and for more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Sugar, Children's Health]]>
David Cole Mon, 26 Jan 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/25398-how-to-prepare-your-child-for-surgery
Treatment Options for Esophageal Cancer http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=24907-treatment-options-for-esophageal-cancer treatment-options-for-esophageal-cancerLearn about the latest treatment options for esophageal cancer from a UVA surgeon who specializes in treating esophageal cancer.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1451vh5b.mp3
  • Location: Null
  • Doctors: Kozower, Benjamin
  • Featured Speaker: Dr. Benjamin Kozower
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Benjamin Kozower is a board-certified surgeon whose specialties include esophageal cancer and lung cancer.

    Learn more about UVA Cancer Center
  • Transcription: Melanie Cole (Host):  If you found that you’ve had difficulty swallowing or weight loss without trying, you might want to see your doctor because you do need to be checked for esophageal cancer. My guest today is Dr. Benjamin Kozower. He’s a board-certified surgeon whose specialties include esophageal cancer and lung cancer at UVA. Welcome to the show, Dr. Kozower. Tell us a little bit about esophageal cancer and who is at risk for this?

    Dr. Benjamin Kozower (Guest):  Sure. Well, there are really two main types of esophageal cancer. First type is called squamous cell and the two main risk factors for that are really smoking and then use of alcohol. In the US, that’s actually not as common now, although it previously was the most common form. Now, the most common form occurs at the bottom of the esophagus close to where the esophagus meets the stomach. That is dramatically increasing in the US. In fact, that’s one of the only two cancers that’s actually increasing in frequency. The cause for that is heartburn. The reflux that we have of contents coming from the stomach and actually moving up into the esophagus is really not good for the lining of the esophagus and that’s what predisposes patients to then have changes in their esophagus that ultimately can go on to cancer.  

    Melanie:  Because we’re experiencing more heartburn, do you advise that people kind of keep an eye on that or get checked for Barrett’s esophagus, things that might increase their risk? 

    Dr. Kozower:  Absolutely. That’s really the key to this whole thing. Unfortunately, as our population continues to kind of grow in weight, that puts us at increased risk for heartburn and for reflux, and then you mentioned that term, Barrett’s esophagus. So patients who have reflux who know they have heartburn, it’s not just enough to take something over-the-counter, and now some of the stronger medications can actually be purchased over the counter. They’re really good at helping with symptoms, but what patients don’t understand is that they decrease the amount of acid in the stomach. That helps patients feel better, but they don’t stop the contents from the stomach from going up into the esophagus. Even though you’re feeling better, you could still potentially have a lot going on that you’re not aware of. So, for patients who really need to be on this medications long term, it’s really important to get checked by their physicians, to have an endoscopy performed which is where a scope can get put in through the mouth and you can actually look at the esophagus. If you find something that shouldn’t be there, then you could actually take a sample of that. Then you can find out exactly what’s going on. 

    Melanie:  Dr. Kozower, does endoscopy, like colonoscopy, if you find something or polyps in there or something and you remove them, does that then reduce your risk as it would in a colonoscopy? 

    Dr. Kozower:  Yeah, it’s very different. You don’t really get polyps in your esophagus like you do in colorectal cancer, so they’re not really analogous. But what you can do is you can identify patients who have Barrett’s esophagus or who potentially have a very early stage esophageal cancer that could be cured. 

    Melanie:  What are some treatment options if you do find that they have early stage esophageal cancer? 

    Dr. Kozower:  Yeah, the most exciting treatment option is now to treat it endoscopically. In this kind of injury that takes place to the esophagus, you first develop Barrett’s esophagus and then you go on to something called dysplasia, and you can get as complicated as you want, but just keeping things fairly simple, then dysplasia goes on to cancer. The most exciting treatments now are treatments that are endoscopic. The first thing for patients who have bad dysplasia, which is a strong risk factor for cancer, is you can actually ablate that endoscopically using radio frequency ablation. That dramatically reduces the risk for cancer. The other exciting thing is, for patients with a very early cancer or very small nodule you actually can take it out endoscopically. That combination of treatments is quite effective. Unfortunately, most patients are not identified that early. For the majority of patients, the primary treatment is surgery; you have to remove the esophagus. It is a big operation so patients have to be fairly healthy, but we can do that in all different ages. Then the other treatments are chemotherapy and radiation therapy. One of the things we’ve learned over the last 10 years is for the majority of patients who present with symptoms – when you started this segment, you said for patients having trouble swallowing or patients who have lost weight. Unfortunately, when you get those symptoms, it’s typically not an early stage cancer, meaning, that the cancer has kind of gone through the wall of the esophagus and also involves some lymph nodes close by. The best treatment for those patients is combine therapy using essentially all three of those treatments. Radiation and chemotherapy first, followed by surgery. It’s a lot of treatment for patients, but fortunately, we’re having more and more success with it. 

    Melanie:  If somebody does have to have a portion of their esophagus removed, tell us how that affects their daily life because this is a scary type of cancer and so people don’t know what to expect if they had to go through this type of treatments. 

    Dr. Kozower:  It’s a great question. When patients heal, they ultimately can eat anything they want. What they can’t do is they can’t eat the same quantity of food. Typically, we have patients eating six smaller meals a day instead of having three large meals. Unfortunately, with Christmas coming up, you’re probably never going to have a huge plate of food like you used to, but ultimately when everything heals, you can eat all types of foods. The other problem is that everybody gets some reflux. We talked about reflux being the cause for esophageal cancer, but we actually when you take the esophagus out, you make a tube out of the stomach and you bring that tube up and you’d reconnect it with the esophagus. You really have to have patients sleeping with their head of the bed elevated. You don’t want to eat right before bed. Those lifestyle changes along with smaller and more frequent meals are things that we have patients do for the rest of their lives. 

    Melanie:  Tell us about some of the really exciting advances in esophageal cancer today and things you’re doing at UVA. 

    Dr. Kozower:  I think the most exciting treatment is really the endoscopic resection. That’s when you can identify these patients at an earlier stage. That’s why it’s so important for patients with symptoms of heartburn who need to be on medicines, whether it’s the proton pump inhibitors that most people take and there’s many different names for them now, it’s really important to get that endoscopy early and make sure that there’s nothing bad going on. The most exciting treatment is instead of the big surgery that I was talking about is to treat it from the inside. From a surgical standpoint, we now do at UVA about a third of our surgeries in a minimally invasive fashion, and so we’re able to accomplish the same results but with a lot less pain and decreased time in the hospital. The third major change is this use of kind of multimodality therapy or the combination of the therapies. It’s a lot easier for patients to get the chemotherapy before surgery than it is after. That’s really important. God forbid any cancer cells are out of the esophagus in the blood stream. The purpose of the chemotherapy is to be able to attack those early. 

    Melanie:  In just the last minute, Dr. Kozower, tell the listeners why patients should come to UVA cancer center for their care. 

    Dr. Kozower:  At the University of Virginia, we really do have the latest in multidisciplinary care, so we have a dedicated team of gastroenterologists and they’re the ones who handle the endoscopic side, doing things with the scopes. Then we have three dedicated thoracic surgeons who do all, what we call, general thoracic surgery. So we don’t do heart surgery, we don’t do general surgery, we just do thoracic surgery, and our outcomes even compared with national benchmarks are quite good. Then we have a dedicated team of both medical and radiation oncologists who are used to taking care of patients who unfortunately have esophageal cancer. I think that’s part of the main advantage that we can offer is that we have a team including our nurse coordinators, who can really help guide patients through this whole process. When I meet people the first time, I tell them that it’s a long journey. It’s not a sprint. You really have to kind of understand that you’re buying into this, and in the end, you’re going to have a pretty good quality of life, but it does take some work to get there. 

    Melanie:  Thank you so much. For more information on the UVA Cancer Center, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole. Have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 26 Jan 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/24907-treatment-options-for-esophageal-cancer
Common Injuries for Skiers http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=24906-common-injuries-for-skiers common-injuries-for-skiersAs winter begins, skiers will take to the slopes for ski season.

What are some of the most common injuries they will face?

Learn more about these common injuries and the latest treatments from a UVA specialist in sports medicine.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1451vh5a.mp3
  • Location: Null
  • Doctors: Miller, Mark
  • Featured Speaker: Dr. Mark Miller
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Mark Miller is board certified in orthopaedic surgery and sports medicine. He specializes in treating sports injuries, including injuries suffered by skiers.

    Learn more about UVA Orthopaedics
  • Transcription: Melanie Cole (Host):  As winter begins, skiers are going to take to the slopes for the ski season. What are some of the most common injuries that they will face and how do you prevent those injuries in the first place? My guest is Dr. Mark Miller. He’s board certified in orthopedic surgery and sports medicine at UVA. Welcome to the show, Dr. Miller. What are some of the most common injuries you see with skiers?

    Dr. Mark Miller (Guest):  Thank you, Melanie. Yes, there’s a variety of injuries we see with skiers, ranging from knee injuries to hand and wrist injuries to simple overuse injuries. Prevention really is a matter of conditioning yourself ahead of time and taking lessons so that you’re a qualified skier and ski under control at all times.

    Melanie:  That’s great advice, certainly advice that I’m hoping that even snowboarders will take from you, Dr. Miller. Let’s just start with can we prevent injuries by having proper fitting boots, binding skis, as you said ski in control and take lessons if you need to, but does the base of support have anything to do with our injury prevention?

    Dr. Miller:  Absolutely. Bindings have gone through quite an evolution in even my ski lifetime. Used to be you just strap on whatever bindings happen to come on that particular ski, but nowadays, there’s a lot of technology in bindings. You should caution people not to set their bindings so tight that they won’t come out of the bindings. That’s the whole idea, to come out of those bindings when you have a significant injury. Otherwise, you can very likely get an ACL tear in your knee, for example. That’s how the bindings are designed, so you shouldn’t over-tension them, thinking that you’re a better skier than you really are.

    Melanie:  What about maintaining a certain level of fitness or pre-training if you’re going to start skiing? Just hitting the slopes can predispose someone to injury, too, can’t it?

    Dr. Miller:  Absolutely. There’s something to the fact that most of these injuries occur late in the day. That’s because at that point, your quads are tired and you’re really kind of not in control as you’d like to be and therefore, conditioning is critical. Also, take breaks and quit early if you’re tired. Never ski tired. You’re at risk for injury.

    Melanie:  Do you happen to have some advice on how they’ll know if they’re tired? Because it is certain, I’m right there with you and I’m always stopping my kids and saying and they say, “No, we’re not done yet.” What do you think are some signs that you might be fatigued and that’s the time to stop skiing?

    Dr. Miller:  Well, I like to call it quad burning. When you’re doing the bump for even just making a lot of turns and your quadriceps in your thighs start burning, that’s a pretty good sign that you’re getting pretty tired. That’s a good warning sign also if you’re having to stop frequently to catch your breath. Mountain altitude is sort of part of that issue. All of these come into play. If you’re tired, take a break.

    Melanie:  Now, suppose you do get injury, whether it’s ACL injury or lower back or really anything, quad pulls, what treatments are available for skiing injuries?

    Dr. Miller:  Well, it depends upon the individual injury, but obviously, if you tear your ACL, no matter what sport you tear your ACL, then you’re out for the season and then you need to have an ACL reconstruction. If you have a back strain, then that requires just some rest and time, more than anything else. It’s simply a matter of taking care of whatever problem there is and there’s experts available in every area to do that for you.

    Melanie:  Where do you stand on braces, Dr. Miller? If somebody has previous knee, maybe instability, or just they had had a previous injury, do you advise wearing a brace when they ski?

    Dr. Miller:  That’s an interesting question, and actually this is the one area in all of orthopedics that this has been shown to be effective, that is in preventing recurrent ACL injuries after ACL reconstruction in skiers, and so this has been proven that there is some benefits to that. It’s also beneficial to wear a brace just for proprioception feedback in people that need that. Braces are a very reasonable thing to wear in skiers.

    Melanie:  What about icing afterward? Do you advise using ice after you’ve hit the slopes or is the hot tub the better place to go?

    Dr. Miller:  I always tell people heat before and ice after. Ice is a very reasonable option after your skiing, particularly if your knee or your joint swells because this is a very effective modality after your activity. So, it’s “heat before, ice after.”

    Melanie:  Now, what about things like just meniscus problems or really anything that may not be something that require surgery? How long if you have one of these injuries can you wait before you get back on the slopes?

    Dr. Miller:  Well, I think it’s a matter of returning gradually, and I tell my patients this all the time. It’s wise to just kind of take things incrementally. Try some conditioning. Try some cross-training. Try elliptical trainer and then increase a little bit. Try to do more things or do some activities or you change direction, and as you progress, then you can progress accordingly. The first day you go back, maybe ski just a few hours, take a break, assess how you’re really doing and then gradually get back. Start on the easier slopes and then work your way back. Once you have an injury, you gradually work your back to the level you were before. It doesn’t happen immediately.

    Melanie:  What about stretching before you ski? Do you stop mid-skiing halfway through the day and stretch out your muscles? Where do you stand on that?

    Dr. Miller:  Stretching is somewhat of an individual thing. Some people get tremendous benefit from that and they’ve done that as part of their exercise regimen all along. Those people should continue to do that. Other people don’t require it as much. In general, it’s a good idea to stretch before you do exertional activities.

    Melanie:  What about things like plantar fasciitis? If you’re somebody who suffers from this, Dr. Miller, you step into those boots in the morning and it’s pretty painful for the first, maybe, hour. Do you have some advice for people?

    Dr. Miller:  Sure. For some reasons technology really hasn’t caught up with ski boots. They are uncomfortable no matter what for everybody. I think it might be reasonable for people who have suffered from foot injuries to maybe have their own custom boots and it’s maybe worth the investment for those people. You can also use inserts just like you use in your ordinary shoes. Try to not skinchon the boots and get more comfortable boots.

    Melanie:  You mentioned cross training, which is so really important to avoid those overuse injuries. What other types of activities would help you become strong for skiing?

    Dr. Miller:  Yeah, I think more than anything else, it’s aerobic conditioning, so it depends upon the status of your knees and your hips. If you’re a jogger, then I think that’s a good thing to do for conditioning. It’s more a matter of building up your endurance and your aerobic capacity. Because when you’re skiing at an altitude, it’s more difficult to catch your breath and stay fit.

    Melanie:  It absolutely is. In just the last few minutes, if you would, Dr. Miller, please give your very best advice for preventing ski injuries and also why should patients come to UVA for treatment of their sports-related injuries.

    Dr. Miller:  Sure. We can prevent ski injuries by being prepared – the old Boy Scout motto. In other words, be fit. Get your aerobics fitness together. Get your equipment together. Don’t skinch  on safety items. Ski under control. When you get tired, rest.
    As far as UVA, we offer a whole variety of orthopedic treatment options for people from nine to 90 and we have all certified and specially trained orthopedic surgeons to take care of every need you have. In our sports division, we have surgeons that cover the entire gamut of sports medicine, from hip arthroscopy to multiple ligament knee injuries to complex shoulder problems. We’ve got it all covered with experts in their field and nationally and internationally known surgeons, so come to UVA.

    Melanie:  That is absolutely great information. Thank you so much, Dr. Mark Miller. For more information about UVA Orthopedics, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole. Have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic]]>
David Cole Mon, 19 Jan 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/24906-common-injuries-for-skiers
How a Pediatric Neuropsychologist Can Help Your Child http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=24538-how-a-pediatric-neuropsychologist-can-help-your-child how-a-pediatric-neuropsychologist-can-help-your-childIn select cases, a neuropsychological evaluation can help families learn how to support their child’s healthy development into adults.

Listen in as Dr. Laurie Brenner discusses more about these evaluations from a UVA expert in pediatric neuropsychology

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1447vh5e.mp3
  • Location: Null
  • Doctors: Brenner, Laurie
  • Featured Speaker: Dr. Laurie Brenner
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Laurie Brenner is a pediatric neuropsychologist who specializes in assessments of neurological conditions such as epilepsy, traumatic brain injury, stroke, central nervous system tumors, and genetic disorders.

  • Transcription: Melanie Cole (Host):  In select cases, a neuropsychological evaluation can help families learn how to support their child’s healthy development into adults. My guest today is Dr. Laurie Brenner. She is a pediatric neuropsychologist who specializes in assessments of neurological conditions such as epilepsy, traumatic brain injury, stroke at the UVA Health Systems. Welcome to the show, Dr. Brenner. When would a child benefit from a neuropsychological evaluation and what does that even entail?

    Dr. Laurie Brenner (Guest):  Hi. Thank you for having me. The neuropsychological evaluation helps us understand how the medical condition is affecting the child’s ability to process information, learn new skills, and use the skills he or she has. When we have a better understanding of the child’s strengths and weaknesses, we can now plan for the child’s future and also identify services that might be helpful for the child. In some cases, that also helps the child’s doctors to make more informed decisions about treatment.

    Melanie:  What’s involved during a neuropsychological evaluation? Is this an easy thing for the child? Or is it harder for the parents?

    Dr. Brenner:  Good question. Some children actually enjoy it because the tests that I do are more like puzzles or games oftentimes, as well as an interview with the parents and the child. I ask a lot of detailed questions so that I have a good understanding of the child’s history and how they’re currently doing and what’s happened up until this point in time. I ask a lot of questions to make sure that I understand what the parents’ concerns are, and then I spend between four and five hours with the child and that’s when we do assessment of attention and memory and problem solving and language and visual spatial skills, executive functioning to really get a sense for how this child thinks and learns and feels. Then the family comes back for a feedback and that’s when I construct a coherent summary for the family so that they really understand what their child’s strengths and weaknesses are and what they can do to help their child.

    Melanie:  Dr. Brenner, do you get any pushback from parents when you say maybe that your child has a little aggression or that they had a little problem solving issue? And do parents ever not want to hear that kind of information, because you have a delicate situation there when you are telling parents about attention and intellectual capabilities of their child?

    Dr. Brenner:  Sure. It’s very much a discussion. Oftentimes, the parents know that there are concerns and that’s usually why they’ve come to me. This is really helping them to understand the nature of the child’s difficulties. Sometimes, it can be hard for parents to hear, but because we’re working together to identify the problem and then figure out how to fix it, it’s much more of a constructive approach, so most families leave their feedback, feeling hopeful that they now know what they can do.

    Melanie:  What do they take away from these evaluations and what are the next steps based on your findings?

    Dr. Brenner:  They oftentimes will report feelings that are clarity. They have a plan for the future. They have a better understanding of their child and how their child thinks and learns and interacts with the world and what will be helpful for their child going forward. It’s like providing a blueprint for them so they know where to devote time and energy to optimize their child’s development, and this oftentimes does include concrete steps that they can take to address their child’s needs, whether that be services in the community, a revised education plan, or changes in the medical treatment.

    Melanie:  This can be an ongoing thing, such as early intervention might drop off at three. What are the general ages that the parents would bring their child in for a neuropsychological evaluation?

    Dr. Brenner:  It really depends and it can be helpful to have this evaluation at points of transition in the child’s education and in their development. Because oftentimes, we see the medical condition affecting the child differently depending on what the environmental demands are and the changing expectations for the child, so usually we recommend reevaluation every two to three years. I see ages all the way down to age two up to 18, early 20s. It really depends on the referral question.

    Melanie:  Then what? How is this evaluation going to help them? Do the parents tell the school what happened? Do you work with the school to help the child work on some of these situations in the school environment? How does it all tie together for the child?

    Dr. Brenner:  A comprehensive report is generated as a result of the visit. I write up all of the findings so that they have with them a written document that they can share with other providers, certainly with the school, and then the school works with the family to develop an appropriate treatment plan for the child or intervention plan for the child. In some cases, yes, I would talk to the teachers and talk to the school to help make sure that they are interpreting my findings accurately and providing the child what they need.

    Melanie:  That’s where I was going with that, to match those specific strengths and weaknesses to what the school can give them. Now, what if what you’ve identified, Dr. Brenner, the school cannot provide that level of care? Do you then provide that extra care? Do you recommend them to somebody else to help work on maybe anxiety, depression management, any of the other things that you might have found?

    Dr. Brenner:  Yeah. Oftentimes, the treatment plan or the intervention plan is really comprehensive in the sense that it takes community services, and that may include therapy. It may include a visit to a psychiatrist in addition to detailed school plan. It usually is a combination of different resources and I help put the family in touch with the resources that would be beneficial for them.

    Melanie:  Then do you keep an ongoing record and see how the child is progressing when they’ve been seeing another specialist?

    Dr. Brenner:  The evaluation is usually only every two to three years, but I am certainly available for consultation. If the family is having trouble translating my recommendations into the reality of the services available in their community, I certainly am available to help problem solve and figure out what might be helpful.

    Melanie:  Give your last bit of advice to parents, Dr. Brenner, on if they think that their child might be having issues and why they would come see a pediatric neuropsychologist and why families should come to UVA for their evaluation.

    Dr. Brenner:  Yeah. The first step would be to talk to your doctor, or if you have a neurologist, definitely speak to the neurologist. Then in terms of why come to UVA, I think the main thing is the collaborative nature of care here. There are a lot of experts here who work well as a team, a lot of resources at their fingertips, and we can really be committed to each child and their individual needs.

    Melanie:  Thank you so much, Dr. Laurie Brenner. You’re listening to UVA Health Systems Radio. For more information on UVA Neurosciences, Brain, and Spine Care and on pediatric neuropsychological evaluation for your child, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Mon, 12 Jan 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/24538-how-a-pediatric-neuropsychologist-can-help-your-child
Advances in Heart Imaging http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=24537-advances-in-heart-imaging advances-in-heart-imagingRadiologists and heart specialists are developing new ways to identify heart disease through imaging.

Listen in as Dr. Christopher Kramer, a UVA specialist, talks about the latest advances in radiology and cardiovascular disease.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1447vh5d.mp3
  • Location: Null
  • Doctors: Kramer, Christopher
  • Featured Speaker: Dr. Christopher Kramer
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Christopher Kramer is board certified in internal medicine and cardiovascular diseases and serves as director of UVA’s Cardiovascular Imaging Center.

  • Transcription: Melanie Cole (Host):  Radiologists and heart specialists are developing new ways to identify heart disease through imaging. My guest today is Dr. Christopher Kramer. He is board certified in internal medicine and cardiovascular diseases at the UVA Health System. Welcome to the show, Dr. Kramer. Speak about, what imaging tests are used to diagnose certain heart conditions and how easy is this process?

    Dr. Christopher Kramer (Guest):  Thank you for having me, Melanie. There are actually five different tests that we use on a daily basis to evaluate heart conditions, and they all have their individual strengths and applications that we use them for. We can discuss each of them in turn. The most commonly used heart test is echocardiography or ultrasound to image the heart. It is frequently used to assess the function of the heart muscle as well as the function of the heart valves. It is frequently used to screen patients for the first time who may present with shortness of breath and to look for reasons why they may be short of breath, whether there is a problem with the heart function, cardiomyopathy, or problem with a heart valve, either it’s blocked or leaky. That’s the most frequently used reason for echocardiography or ultrasound of the heart. Another commonly used heart imaging test is SPECT, which stands for single-photon emission computed tomography. It is a nuclear technique that involves taking images of the heart and looking at blood flow to the heart muscle. This is very commonly used to again assess blood flow in a stress test. Typically, a patient will walk on a treadmill until they’re exhausted and can get no farther and we will image the patient with SPECT at rest and after stress to look for problems with blood flow to detect blockages in the heart arteries that might lead to reductions in blood flow. That’s a very commonly used cardiac imaging test. A relative of SPECT is a test called PET or positron emission tomography. It is somewhat less used. It is, in a sense, a better version of SPECT, but it is more costly and less available. It is used to again detect abnormalities in blood flow, but is much more quantitative than SPECT. It’s particularly used in certain types of patients, especially those who are on the obese side. Another commonly used cardiac imaging test is MRI of the heart. MRI is a newer test that’s only been available the last 10 or 15 years in heart patients and it is used both for stress testing, but not with an exercise treadmill. For this, we’d use an infusion of a medication that simulates the effect of exercise on the heart and we measure blood flow. In addition, MRI is often used in patients who have reduced heart muscle function or cardiomyopathy, because its best indication is really to understand what has caused the heart muscle to decline in function. That’s a very common use of MRI in 2014. Lastly, a very exciting cardiac imaging test is computed tomography or cardiac computed tomography or CT. CT is an anatomic test. Many of the other tests we’re talking about assess the function of blood flow. CT is really best at imaging the anatomy of the coronary arteries. It gives us a three-dimensional snapshot of the coronary arteries and it enables us to look at any blockages in the heart arteries. CT is best used as a test to exclude coronary artery disease in patients who are at low or maybe intermediate risk of having heart blockages because its best use is to show when those arteries are completely normal.

    Melanie:  Does somebody, Dr. Kramer, have to be symptomatic to get some of these imaging tests or are any of them sort of a yearly or an every five-year screening process?

    Dr. Kramer:  We have something called appropriate use criteria in cardiovascular imaging and we assess whether tests are appropriate to use as screening test. Most of the tests I’ve talked about are really reserved for patients who are symptomatic, either having chest pain or shortness of breath or some symptom that points to an abnormality in their cardiac condition. There are a couple of these tests that can be used for screening. I mentioned CT. There is a test called CT coronary calcium scoring, which is a test that doesn’t use dye. It just looks at the heart with a little bit of radiation, but no dye, and looks for calcium in the heart arteries. It turns out that calcium is a marker for the amount of atherosclerotic plaque in the heart arteries. This test is useful for screening in patients who are at intermediate risk of heart disease and asymptomatic. Because if they have a very high calcium score, that points to the need for very aggressive risk factor modification, and if one has a very low or zero calcium, then one can be less aggressive about risk factor modification. Overall, among those tests, in terms of screening asymptomatic patient, calcium scoring is the one that is best used.

    Melanie:  Speak about your research into improving cardiac imaging and how that’s leading to better diagnosis for patients.

    Dr. Kramer:  Sure. We’re very fortunate at University of Virginia to have a very strong team in cardiovascular imaging research with individuals in cardiology, radiology and medical imaging, and biomedical engineering, working together to improve cardiac imaging, make it more patient friendly, faster, safer, with improved diagnostic accuracy. One of our major areas of research is in improving cardiovascular MRI, especially stress testing MRI, making it more quantitative, more accurate, and faster and safer. Another area that UVA has worked on over many years is improving nuclear cardiac imaging, in particular, SPECT and PET. That’s an area that we’ve had strong efforts for decades here at the University of Virginia.

    Melanie:  Tell the listeners why someone should come to UVA for their heart imaging and heart care, and also really your best advice for people who might suspect that they might have heart disease and what they can do about it.

    Dr. Kramer:  Yeah, as I mentioned, we have a very strong team in cardiology, radiology and medical imaging, not only in making the correct diagnosis using these imaging tests that I’ve described, but taking outstanding care of the patient once heart disease is diagnosed. I think in addition to having excellent care, we also have the latest imaging equipment in all of the imaging modalities that I mentioned: echo, SPECT, PET, MRI, and CT. We have the very latest in technology, and our physicists and engineers are improving the technology on a daily basis to make it even better at making the diagnosis. If a patient has symptoms that they think might be or their primary care doctor thinks it might be a problem with their heart, the best is for their primary care doctor either to refer them to a cardiologist at UVA or may primarily refer them for a test to evaluate their heart, which, if the patient is presenting with chest pain, some sort of stress test either with SPECT or echocardiography or MRI might be indicated. If the patient is short of breath, then perhaps a screening echocardiogram may be the first test that is ordered to look for problems with the heart muscle function or the valves of the heart.

    Melanie:  Thank you so much. It’s very exciting information. You’re listening to UVA Health Systems Radio. For more information on the UVA Heart and Vascular Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Mon, 05 Jan 2015 19:00:00 +0000 http://radiomd.com/uvhs/item/24537-advances-in-heart-imaging
Helping Kids with Type 1 Diabetes http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=24536-helping-kids-with-type-1-diabetes helping-kids-with-type-1-diabetesAs many as 3 million Americans have type 1 diabetes, according to the JDRF, and it is frequently diagnosed in children.

Listen in as Dr. David Repaske discusses what causes type 1 diabetes, how it differs from type 2 diabetes and about available treatments from a UVA expert in pediatric endocrinology.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1447vh5c.mp3
  • Location: Null
  • Doctors: Repaske, David
  • Featured Speaker: Dr. David Repaske
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. David Repaske is board certified in pediatric endocrinology whose specialties including caring for children with diabetes.

    Learn more about UVA Children’s Hospital
  • Transcription: Melanie Cole (Host):  As many as three million Americans have Type 1 diabetes, according to the JDRF, and it’s frequently diagnosed in children. What causes it and how does it differ from Type 2 diabetes? That’s what we’re talking about today. My guest is Dr. David Repaske. He’s board certified pediatric endocrinologist at UVA Health Systems. Welcome to the show, Dr. Repaske. Tell us, what is Type 1 diabetes and how is it different from what we’ve been hearing a lot about Type 2 diabetes?

    Dr. David Repaske (Guest):  Hello, glad to be here. The hormone insulin moves sugar or glucose from the blood into the cells of the body where it’s burned for energy. In diabetes, there is not enough insulin to move the glucose. In fact, the definition of diabetes is a fasting blood sugar greater than 126 mg/dL. Now, in Type 1 diabetes, the problem is the body’s ability to make insulin decreases. That’s different than Type 2 diabetes where you can make lots and lots of insulin, but the body becomes very insensitive to insulin and you need more and more and more until you can’t make it enough to supply the needs.

    Melanie:  What symptoms would a parent notice in their child that would send them to a pediatric endocrinologist to get checked and have their blood sugars checked?

    Dr. Repaske:  Well, Type 1 diabetes can kind of be a masquerader. It can look like flu, but the things that set it apart are: lots of urine, so the child is going to the bathroom much more frequently than normal; a child can also be tired, lethargic, can be losing weight which is sort of unusual for a growing child. I think those are the highlights you can look out for.

    Melanie:  Then, when they take them in, how do you check for diabetes? What’s the first line of treatment when you discover that this is what a child has?

    Dr. Repaske:  Well, it’s really that blood sugar level. If the child comes in and has the symptoms of peeing a lot and drinking a lot and losing weight, we’ll check the blood sugar and find that it’s exceedingly high, that pretty much makes the diagnosis. The treatment is giving insulin. There’s an insulin deficiency. Really the only treatment is replacing what’s missing, giving insulin back.

    Melanie:  What does that involve? Is this something that children eventually learn to do by themselves? We’ve heard about kids carrying their needles around and parents having to show them how to do it. Speak about this insulin that they have to have and now it becomes a lifelong thing, correct?

    Dr. Repaske:  That’s right. At least at this moment, there is no real cure. You can just replace the insulin that the body is no longer making. It’s complicated because you need to match the amount of insulin to what the child is eating, the exercise level, and during other illness, you also need more insulin. It’s a very fine game of providing just the right amount of insulin. If you give too much, then the blood sugar will drop. If you don’t give enough, then the blood sugar rises and both of those are dangerous.

    Melanie:  Doctor, because exercise has an insulin-like effect, we encourage our children to be active and run around in gym and recess and such, do you have to be a type A personality as a family to really get this, as you say, this delicate balance? How do we work with kids that way?

    Dr. Repaske:  Unfortunately, it is a delicate balance. With time, every family learns the amount of insulin and the amount of glucose that a child needs to prevent highs and lows and we work with the family to customize the dose and to come up with strategies to keep the blood sugar normal during exercise. In some children, it may require giving a little less insulin. In some, it may require giving some extra carbohydrate or glucose, some form of sugar to keep the blood sugar from dropping during exercise. That’s the role of the pediatric endocrinologist, to work with the family to overcome these challenges.

    Melanie:  What about nutritionally, Dr. Repaske? Are there any limits to what a child can eat as they grow? And as they go into teen and adulthood, are there things you want them to really steer clear off that could exacerbate their Type 1 diabetes?

    Dr. Repaske:  You know, in the old days, we had many, many limits on what a child with Type 1 diabetes can eat. These days, you have to be reasonable. Eating a pound of sugar wouldn’t be such a great idea, but within reasonable limits and eating a relatively healthy diet, we can pretty much give the amount of insulin that anybody would need. Basically, you don’t really have to change your diet. We’re at a point where we have fancy insulin – some work quickly, some work slowly – that can match just about anything in the diet. I don’t want to give the wrong impression. A healthy diet is important for everybody, but especially for somebody with Type 1 diabetes.

    Melanie:  Talk about the horizon a little bit. What’s on the horizon for curative or treatments for Type 1 diabetes?

    Dr. Repaske:  Well, I think the thing that’s coming closer and closer and is quite exciting is an artificial pancreas. We have currently insulin pumps that deliver insulin under the skin continuously and then we also have continuous glucose sensors which check your blood sugar almost continuously. If the two of those could work together so that the blood sugar is constantly being checked, then that controls the pumps. If the blood sugar is rising, it signals the pump to deliver a little bit more insulin and decrease the blood sugar down to a normal level. Or if the blood sugar drops, then the sensor would tell the pump to back off in the amount of insulin that’s being given at that moment. That is what the pancreas does. That would be artificial pancreas, but then you wouldn’t have to worry so much about trying to match the insulin to what you’re eating and exercising; it would happen automatically. I think that is really coming pretty close, and here at University of Virginia, we are involved with designing those artificial pancreas instruments. I think another thing that’s coming along is islet cell transplantation where you put back the islets that have been destroyed by the immune system in Type 1 diabetes. A problem there that still has to get overcome is that the new islets are also going to be attacked by the immune system, and so we’ve got to regulate the immune system so it doesn’t pick on those new cells. Ultimately, there’ll be a cure. It’s hard to predict when it’s going to happen, but I think the cure is likely to involve a new mechanism for turning off the immune system so it stops picking on those beta cells, and if they can regenerate themselves and the immune system isn’t attacking them as they do so, then perhaps the beta cells will come back and be able to produce insulin again.

    Melanie:  In just the last minute, doctor, why should children with Type 1 diabetes receive their care at UVA Children’s Hospital?

    Dr. Repaske:  Well, our program has really dramatically expanded in the recent past. We now have six physicians and four nurse practitioners and we’re very shortly going to extend our clinic from two days a week to five days per week. We have all the latest technology, the pumps and the sensors that I have been talking about. We are involved in cutting edge research and offer patients an opportunity to participate. Last but not least, we have moved our diabetes clinic into that beautiful, new children’s hospital building on the UVA campus. We are really enthusiastic to welcome new patients into our practice and we promise to take excellent care of the whole family that’s affected by diabetes.

    Melanie:  Thank you so much. That’s wonderful information. For more information on UVA Children’s Hospital, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health, Diabetes]]>
David Cole Mon, 29 Dec 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/24536-helping-kids-with-type-1-diabetes
Expanding Access to Stem Cell and Bone Marrow Transplants http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=24535-expanding-access-to-stem-cell-and-bone-marrow-transplants expanding-access-to-stem-cell-and-bone-marrow-transplantsFor patients with immune disorders and blood cancers, such as leukemia, multiple myeloma and lymphoma, stem cell or bone marrow transplants can offer potential cures.

Listen in as Dr. Leonid Volodin, a UVA expert in these transplants, how a new designation earned by the UVA Cancer Center’s Bone Marrow and Stem Cell Transplant Program will help patients access these vital treatments.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1447vh5b.mp3
  • Location: Null
  • Doctors: Volodin, Leonid
  • Featured Speaker: Dr. Leonid Volodin
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Leonid Volodin is board certified in hematology and medical oncology and specializes in working with patients who need bone marrow or stem cell transplants.

  • Transcription: Melanie Cole (Host):  For patients with immune disorders and blood cancer such as leukemia and multiple myeloma and lymphoma, stem cell or bone marrow transplants can offer potential cures. My guest today is Dr. Leonid Volodin. He is board certified in hematology and medical oncology at UVA Health Systems. Welcome to the show, Dr. Volodin. Speak first about when would somebody need a bone marrow or stem cell transplant? When would this be considered for a patient?

    Dr. Leonid Volodin (Guest):  Thank you, Melanie. Thank you for inviting me to the show. Bone marrow transplant can be lifesaving for patients with hematological cancers, as you mentioned, conditions such as leukemia and lymphoma. For example, in case of leukemia, many of the non-transplant treatments can achieve cures but the cure rate is still relatively low for some of the high-risk leukemias. We’re talking only 20 to 30 percent of people being cured with non-transplant treatment. Transplant offers a more effective treatment for those types of patients, usually achieving a cure rate of 50 to 60 percent. This is one example for conditions such as refractory lymphomas or multiple myeloma. Transplant can also achieve cures or prolong remission rate. It is important to distinguish two types of stem cell or bone marrow transplants. One is autologous, when cells are taken from the patient him or herself, then after high-dose chemotherapy, re-infused back into the patient to recover their blood counts faster. The other one is allogeneic when a donor is needed. Donor cells are given to the patient after, once again, high-dose chemotherapy. In the case of allogeneic transplant, apart from getting the benefit of high-dose chemotherapy, the patient also benefits from the donor cells which often fight the disease directly in what’s called the graft versus leukemia or versus lymphoma effect.

    Melanie:  Let’s talk about the allogeneic. How are donors found? Is there a database like there is for other kinds of organ donation? Or does it have to be somebody you know? Speak about donation a little bit.

    Dr. Volodin:  Sure. As opposed to solid organ transplant, when one sometimes look at blood group, for example, and donor has to match in the blood. With allogeneic transplants, donor has to achieve an HLA match. HLA is a group of genes that’s located on chromosome 6 that are responsible for how our immune system interacts with the rest of our body, how it sees other molecules and distinguishes self from non-self, for example, eliminating viruses from our body. So if we transplant from a donor that’s not HLA-matched, the transplant is very likely to fail. The first source where we go to, to find a donor are siblings of the patients because we inherit half of our genes from one parent and half from the other parent. There’s a one-in-four chance that any one of our siblings may be a donor and be HLA-matched. However, if there are no siblings, or siblings are not in adequate state of health to donate, then we would go to an unrelated donor. There is this, as you mentioned, the NMDP or data match program that attracts volunteers from U.S., North America, and also around the world and currently has more than 15 million people who volunteered to donate for unrelated people or patients who need this donation. If there are no siblings, we go to the database and compare the patient’s HLA type to those of the donors available in the database and hopefully find a donor that way.

    Melanie:  UVA was recently designated as a National Marrow Donor Program and be the Match Transplant Center. Speak about how that really benefits the patients that come to UVA for bone marrow or stem cell transplants.

    Dr. Volodin:  Obviously, if before we had access to our related donors, we could only find donors among the siblings and so we had limited number of potential donors. Especially in small families where there may be only one sibling, the chances, as I mentioned, are only 25 percent. In the average American family, you would probably have a chance of 30 percent of having one of the siblings being a match. This significantly extends the number of donors that we have access to. Potentially if a patient previously could not have transplant because of lack of a donor, now we are able to find a donor and proceed to transplant and avoid any delays. Previously, patient might have had to go to another center that’s farther away. Now, he or she can come closer to where they live and have a transplant offered to them. Also, being part of NMDP is an attestation to our ability to provide comprehensive care. We had to match a certain requirement, show that we are able to provide comprehensive care for our patients who have 24-hour access to care post-transplant, able to rapidly access our system, be treated for complications, and also that our program follows certain standard operating procedures that enable us to provide the treatment in a reliable way and matching a certain quality. It’s all attestations of the level of quality of our programs. Both of those ways are beneficial to our patients.

    Melanie:  Dr. Volodin, why should patients who need a bone marrow or stem cell transplant come to UVA for their care?

    Dr. Volodin:  As I mentioned, those who do need transplant often receive their hematological care at UVA already by regionally and nationally recognized hematologists, and so us getting the transplant part to the options that they have at UVA allows for them to stay at UVA and continue their care. We closely communicate to non-transplant hematologists, and so this facilitates us providing the care in an efficient way and this allows us to minimize delays in providing the care. As I mentioned, being part of NMDP attests to the quality of care and the standards that our program has met so far. I think as perhaps somewhat smaller program compared to some of the big programs, we are able to provide more personable care where our patients get well-[acclimated] with various members of our team who work well together in close communication. The transplant is a procedure that’s performed by a team rather than an individual and so we have many dedicated doctors, nurses, transplant coordinators, cell processing, laboratory team, apheresis team and many other professionals, more than 20 people on our team who provide care to our patients.

    Melanie:  In just the last minute, people get a little bit afraid of donating bone marrow. Does it hurt? How is it for the donor itself? We only have about a minute left.

    Dr. Volodin:  Sure. As opposed to perhaps previously or older days when bone marrow donation was done through actually doing a surgical procedure, 95 percent of donations are done by extracting cells from peripheral blood. A person gets connected to an apheresis machine which is like a dialysis machine that centrifuges the blood, separating it into layers of cells, and the layer that’s rich in stem cells gets extracted while the rest of the blood gets re-circulated. It’s a relatively painless procedure and people from the ages of 18 to 45 are very much encouraged to join NMDP program. There’s probably one-in-500 chance of one actually being a donor during their lifetime, but it’s a very worthy cause especially for people of non-white ethnic groups where there is very much a need for more donors.

    Melanie:  Thank you so much. You’re listening to UVA Health Systems Radio. For more information on the UVA Cancer Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 22 Dec 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/24535-expanding-access-to-stem-cell-and-bone-marrow-transplants
Options for Treating Rotator Cuff Injuries http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=24534-options-for-treating-rotator-cuff-injuries options-for-treating-rotator-cuff-injuriesIt’s most commonly linked with pitchers, but athletes aren’t the group of people most likely to suffer rotator cuff injuries.

Listen in as Dr. Winston Gwathmey, a UVA specialist in orthopedic surgery and sports medicine, discusses rotator cuff injuries and it's treatments.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1447vh5a.mp3
  • Location: Null
  • Doctors: Gwathmey, Winston
  • Featured Speaker: Dr. Winston Gwathmey
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Winston Gwathmey is is a board-certified orthopedic surgeon whose specialties include sports-related injuries to the hip, shoulder, knee, foot and ankle, including rotator cuff tears.

  • Transcription: Melanie Cole (Host):  Rotator cuff injuries are most commonly linked with pitchers, but athletes aren’t the group of people most likely to suffer rotator cuff injuries. My guest today is Dr. Winston Gwathmey. He is a board certified orthopedic surgeon whose specialties include sports-related injuries to hip, shoulder, knee, foot, and ankle at the University of Virginia Health System. Welcome to the show, Dr. Gwathmey. Tell the listeners, what is the rotator cuff and what does it do?

    Dr. Winston Gwathmey (Guest):  Thanks, Melanie. The shoulder is a very complex joint that has the highest range of motion in the joints of the body, and so intrinsically there’s very little bone stability. The bone socket of the shoulder joint isn’t really held together by much in the way of bones and ligaments. The rotator cuff is a complex group of muscles that wraps around the bone socket and holds the ball positioned within the socket so that you have the entire arc of motion without having any… or compromise the mechanics of the bone socket joint.

    Melanie:  This is a very movable joint and also more complicated to treat if it’s injured, but easily injured. So, we hear a lot about rotator cuff injuries. How do they occur and what exactly is a rotator cuff tear? We hear so much about that, Dr. Gwathmey.

    Dr. Gwathmey:  It’s actually a continuum of injuries. The rotator cuff is actually a pretty robust structure within the body, but as we sort of get older, a lot of things are breaking down the body and the rotator cuff, in particular, gets a lot of miles over the course of your lifetime. So, as people enter their 40s and 50s and 60s, just that motion that’s been going on there for so long can cause some breakdown when the pocket of the rotator cuff is… there’s a continuum and it starts with some tendonitis or some impingement type symptoms on the top of your shoulder, which is basically just shoulder pain, and as that tendon starts to become attenuated, it’s more prone to tearing. Sometimes, it might be something as little as overuse or sometimes it requires a more dramatic injury like a fall or something like that for that rotator cuff structure to be injured, but it can be quite debilitating when it does occur.

    Melanie:  Tell us some of the symptoms because I know that when people say, “Oh, it hurts to roll over on my side at night or put a jacket on.” Tell people what they might experience that would send them to see you to look and see if it’s some rotator cuff problem.

    Dr. Gwathmey:  Of course. I think most people, as they get older and they have shoulder pain they assume is the rotator cuff, it’s because it’s on the tip of their tongue whenever they’re thinking about shoulder pain. The most common symptoms of rotator cuff pathology is typically pain from the top or the front of the shoulder, worse with overhead activity like lifting a milk jug onto the top of the refrigerator or something like that or trying to put your clothes on. A lot of times, there’s pain at night. As the disease process progresses, sometimes it can also be associated with weakness in the same position for the same movement. Normally, you could easily put the milk jug on the top of the refrigerator and as the rotator cuff becomes more pathologic, it’s more difficult to do that. There’s pain as you try to lift your arm above the level of your shoulder.

    Melanie:  If you’re diagnosed with having some sort of a rotator cuff injury, what treatments are available? Speak about non-surgical treatments first and then if it becomes bad enough, they have to deal with surgery.

    Dr. Gwathmey:  I think the algorithm is there’s no question the first approach to a rotator cuff injury is going to be non-operative treatment. For the most part, there’s a lot of redundancy around the shoulder as far as function and even full-thickness rotator cuff tears can be treated non-operatively initially. There’s actually been studies showing in the average active population, almost a quarter of people in the age of 60 and almost half of people in the age of 80 actually have full-thickness rotator cuff tears and may not even know it. The initial goal of treatment is going to be to try and make that tear asymptomatic, which is simply possible with a good treatment algorithm. Normally, it requires some degree of either physical therapy exercises or activity modification to try to get the other muscles around the shoulder to activate and to fire so they can accommodate for the fact that one of the muscles up there has an injury. For the most part, the patient sees me with a rotator cuff type pain, which I try to get an idea of the degree of pathology and then normally, even if someone ends up having surgery, therapy or some sort of exercises are always helpful to optimize mechanics from the shoulder before we even get started on anything else.

    Melanie:  What about cortisone shots? I know people, Dr. Gwathmey, that have had five, six, seven of them. How many can you get? And does a rotator cuff ever, if it’s a tear, does it ever really, truly go away on its own or that really just doesn’t happen?

    Dr. Gwathmey:  Well, most of the natural history studies of rotator cuff pathology show that once a rotator cuff is torn, it will never actually heal. In fact, most of the time, it has some degree of progression. The speed of that progression is really what defines what treatments can end up being. Of course, I think it’s really helpful for a couple of reasons. One, I think in some of these acute inflammatory situations, you can actually take a tendon that is inflamed and swollen and causing more pinching of the shoulder. I use the analogy of the fat lip. When you have injury like that to your lip, you bite itover and over again until the swelling goes away. Sometimes with the rotator cuff, when you’re trying to get your arm above your head, the fact you’re sort of pinching that swollen tendon can propagate or perpetuate the symptoms. I do use cortisone periodically for people to try to see if I can get [rid of] that inflammation on the shoulder to get them a more pain-free range of motion so that they may make more progress with therapy and perhaps they can render this tear asymptomatic, which ultimately is the goal for all of these. To be honest, the tendon is not going to heal back down to the bone, but in a lot of cases, can actually make patients asymptomatic. I think  the goal is to get them back to what they wanted to do.

    Melanie:  When does surgery come in to play?

    Dr. Gwathmey:  I think when people have failed in all those concerted treatment strategies. If they’ve done therapy, they’ve done a cortisone shot or two, even taking anti-inflammatories, and really they’ll not be able to do what they want to do, pain at night, pain with routine activities, weakness so they can’t get their arm over their head, that’s really when we start talking about surgery for this. I always tell my patients this is not a very fun experience to go through, rotator cuff surgery. You’re going to be in a sling for six weeks, get the rehab pretty extensively for three to four months. That’s why we try to get people better without surgery, but if they do go to surgery, it’s fairly straightforward. We just take the tendon that’s torn and we repair it back down to the bone where it ripped from and once that process occurs, once the healing occurs, typically the symptoms get much better after surgery.

    Melanie:  You mentioned that as we age, many people have rotator cuff injuries that they may not even be aware of. What about prevention and keeping that good strong shoulder?

    Dr. Gwathmey:  Of course, prevention is the key to everything. As we get older, our bodies are going to have some degree of mileage that’s going to be put upon them. The goal of aging effectively is to optimize, stay healthy, exercise, those kinds of those things within the shoulder in particular. It’s always good to keep all the muscles on the shoulder fairly active and fairly strong so that you can tolerate this sort of wear-and-tear kind of stuff. A lot of people who are very firm, it just fit people who have rotator cuff tear they may or may not even know because there is so much extra muscle around the shoulder that can help out. It’s hard to prevent things that happen naturally with aging. I guess just trying to figure out how to live with the symptoms and how to improve the symptoms through exercise is probably the best thing.

    Melanie:  Dr. Gwathmey, in just the last minute or two, why should patients come to UVA Orthopedics when they suffer a rotator cuff injury?

    Dr. Gwathmey:  Well, we treat the entire spectrum of shoulder pathology. A lot of people come in with their primary care doctors if they have a rotator cuff problem, but really we’re pretty comfortable treating the entire spectrum of injury. Sometimes it’s not just the rotator cuff. There could be an element of biceps or labral pathology as well. There could be an element of arthritis as well. What we can do here – I have four partners and myself, all of them treat shoulder injuries – is we can take the entire natural history of their shoulder and provide basic care across all spectrums of shoulder injury, from shoulder instability, meaning shoulders that dislocate or shoulders that have arthritis or shoulders that need just some direction as far as why it hurts and how to make it feel better. Also, we have – the five of us – all of us do arthroscopic surgery for the shoulder to repair these things. It’s minimally invasive and we get people back to their activities as quickly as possible.

    Melanie:  Thank you so much and for more information on UVA Orthopedics, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic]]>
David Cole Mon, 15 Dec 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/24534-options-for-treating-rotator-cuff-injuries
What Causes Swallowing Problems? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=23861-what-causes-swallowing-problems what-causes-swallowing-problemsWhat are the most common causes of swallowing problems, and what treatments are available to help.

Learn more from a UVA otolaryngologist who specializes in treating swallowing problems

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1442vh5e.mp3
  • Location: Null
  • Doctors: Daniero, James
  • Featured Speaker: Dr. James Daniero
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. James Daniero is a board-certified otolaryngologist – head and neck surgeon who specializes in caring for patients with voice and swallowing conditions.

    UVA Otolaryngology – Head & Neck Surgery
  • Transcription: Melanie Cole (Host):  Swallowing is complex, and a number of conditions can interfere with this process. What are the most common causes of swallowing problems, and what treatments are available to help? My guest today is Dr. James Daniero. He is a board certified otolaryngologist, head and neck surgeon, who specializes in caring for patients with voice and swallowing conditions. Welcome to the show, Dr. Daniero. What are the most common causes of swallowing problems? 

    Dr. James Daniero (Guest):  First of all, thank you, Melanie, for having me on the show. The most common cause of swallowing problems typically happen to the elderly population, and that involves stroke, neurodegenerative diseases such as Parkinson disease, dementia, and ALS or Lou Gehrig’s disease. That can be also a consequence of radiation for treatment of other disorders, primarily head and neck cancer, as well as neck surgery or neck trauma. 

    Melanie:  Okay. So these things that are happening in the elderly and because of diseases, you have explained to us the people that are most likely to be affected. How do swallowing problems affect the quality of life, and what might signal that this is actually happening? Because sometimes we all feel, Dr. Daniero, a little lump in our throat or we have trouble getting something down. What distinguishes this to something that would say, “Okay, you need to see the doctor about this”? 

    Dr. Daniero:  Sure. Quality of life is a huge issue for patients with swallowing disorders, and the particular signs that this is becoming a more significant problem that needs evaluation by someone who treats swallowing disorders would be weight loss or recurrent pneumonia. Those type of things are really the most severe consequences of swallowing disorders. Now, it is very common for patients to complain of difficulty swallowing with a lump in their throat, and if that’s persistent, if that is a recurrent problem, then that would also warrant evaluation. 

    Melanie:  How is this diagnosed? What do you do to diagnose a swallowing problem? 

    Dr. Daniero:  I think the primary thing, the best thing I have to look at swallowing problems is talking with the patient. It’s just getting a good -- what we call a history, the onset and the type of symptoms. When I talk with patients, I ask them what kind of foods are they having trouble with and what particular situations do they describe that they’re having trouble swallowing in. That really narrows me, and primarily there’s two different types of swallowing disorders. One is swallowing disorders related to liquids, and that’s a whole different set of problems than those related to solid food, such as meats or bread that people will complain of difficulty with. 

    Melanie:  If you’ve diagnosed somebody with one of these swallowing problems, what treatments are available out there? 

    Dr. Daniero:  There is a number of different causes for the swallowing problems, but treatments can be broken down into a couple of main categories. One is a medical and therapy treatment, and that is why I actually work along with a speech pathologist in clinic, and we can often provide some of that treatment right in the same day as the visit. And working with the speech pathologist, there can be different maneuvers as far as swallowing that can assist them in their swallowing trouble as well as modifying the diet to different consistencies—thickened liquids or softer, pureed type food, and different conservative things. The other category, the main category and what I am typically involved in, when the speech pathologist isn’t able to make the adjustment for a safe swallow, then it becomes a surgical option. I perform endoscopic surgeries, and that’s all through the mouth without incisions in the neck and usually a faster recovery. If they’re not candidates for the endoscopic approach, then I also perform an open surgery with the incision through the neck to address some of the swallowing disorders. 

    Melanie:  What is that surgery like? People would hear about swallow surgery and get very nervous, get scared. It sounds very scary because this is your ability to eat and to talk, and so it’s really a sensitive area. Tell us a little bit about the surgery. 

    Dr. Daniero:  The newer approaches—and what I am actually a specialist in—is the endoscopic approaches. This is within the past 20 years, we really revolutionized the way we treat swallowing disorders and now have incision-less surgery, a minimally invasive approach. For patients, it typically involves coming into the hospital, spending a night over in the hospital, but going home the next morning, and then, generally with almost immediate relief. It’s relatively limited pain. Most patients complain they have a sore throat, like they had a strep throat or something. Then they are back on to swallowing with usually impressive results. 

    Melanie:  Wow! Is this something that is likely to reoccur? What is the outcome from this type of surgery? 

    Dr. Daniero:  Well, there are certain types of surgery that tend to require more interventions, and those are things such as stretching the esophagus. And many people come in saying that they have had gastroenteritis or other doctor that performed the stretching of their swallowing tube. That often will require repeated dilations, if you will, or repeated stretching in order to have a long-lasting benefit. The surgeries that I particularly specialize in are where I use a laser and I actually cut muscle fibers that produce the swallowing dysfunction tends to be a permanent result. 

    Melanie:  Wow! That’s incredible. Now, what is then the eating outcome? Do they have to be on those thickened liquids for the rest of their life? Is there a possibility of needing a feeding tube? Or, can they resume eating certain foods and solids? 

    Dr. Daniero:  Well, depending on the problem, the people that are generally surgical candidates from the procedure that I was talking about typically have trouble with the solid food. They’re in that category primarily. Those patients can mostly resume a normal diet, and those are my favorite patients to see after surgery because they come in and they are just so happy that they can resume a normal life. They can go out to eat again with their family members for Thanksgiving and other holidays. They now can enjoy the social interaction. And this is an at-risk population for depression, too. They are usually 65 and older. Half of this age group, half of Americans 65 and older will have swallowing trouble. Therefore, when we can restore the ability to eat, it restores a lot of their ability to have social interactions, and they are at risk for depression as a result of socialized isolation. We can cure that. 

    Melanie:  That’s amazing. In just the last minute or so, Dr. Daniero, why should patients come to UVA for treatment of their swallowing problems? 

    Dr. Daniero:  Well, one thing for patients to look for when they’re evaluating a place for possible treatment of their swallowing problem is to look for someone who is a fellowship-trained laryngologist. That’s some of the training that I received. That is an otolaryngologist or ear, nose, and throat doctor that specializes in voice and swallowing and has special training regarding that. There’s only a handful of providers in the state of Virginia that provides this service and have this designation, of which UVA is one of them. We also have a team approach to swallowing disorders, and I have a voice and swallowing specialized clinic, at which I work with a speech and language pathologist. We can perform some of the swallowing evaluation right in clinic on the same day. We can even perform in-office surgeries for swallowing disorders, where the patient doesn’t have to be admitted to the hospital and they can come in and out without -- they can even drive themselves to their own appointment to have these procedures because there’s no sedation or anesthesia other than just numbing the throat. 

    Melanie:  Wow! Thank you so much, Dr. James Daniero. For more information, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Digestion Problems]]>
David Cole Mon, 08 Dec 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/23861-what-causes-swallowing-problems
Surgical Options for Stroke Patients http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=23860-surgical-options-for-stroke-patients surgical-options-for-stroke-patientsFor select stroke patients, surgical procedures may aid in their treatment and recovery.

Learn who may benefit from a UVA neurosurgeon who specializes in caring for stroke patients.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1442vh5d.mp3
  • Location: Null
  • Doctors: Crowley, Webster
  • Featured Speaker: Dr. Webster Crowley
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Webster Crowley is a neurosurgeon whose specialties include endovascular and cerebrovascular surgical procedures for conditions such as stroke.

  • Transcription: Melanie Cole (Host):  If you or a loved one has suffered a stroke, for select patients, surgical procedures may aid in treatment and recovery. Who can benefit from these procedures? My guest is Dr. Webster Crowley. He is a neurosurgeon whose specialties include endovascular and cerebrovascular surgical procedures for conditions such as stroke. Welcome to the show, Dr. Crowley. First, can you briefly describe what is a stroke? 

    Dr. Webster Crowley (Guest):  Sure thing. There are two types of stroke that most people think of, and the first one is something called an ischemic stroke, which is essentially a cut-off of the blood supply to a portion of the brain. That tends to be what most people think of. And then there’s also something called a hemorrhagic stroke, which effectively does the same thing, but it’s a bleed in the brain rather than a cut-off of blood to the brain. These can manifest as a number of symptoms, and it really depends on where the stroke is. So it’s difficult to determine when someone is having symptoms whether it’s a stroke caused by a cut-off of blood or by a bleed itself. 

    Melanie:  What are the most common symptoms? Because stroke, time is absolutely essential in treatment and management of this disease. What are the main symptoms that somebody might notice that would really send them to the hospital as quickly as possible? 

    Dr. Crowley:  The main symptoms tend to be focal neurologic deficits, such as weakness on one side of the body or speech difficulties. And again, that will depend on where it is. You also can occasionally have people with severe headache, particularly for the hemorrhagic type of stroke, and again, you can have anything you can imagine really be a symptom. But the main ones are the weakness and the speech difficulties, and sometimes someone becomes less conscious and not alert. 

    Melanie:  Why is it so important to get to the hospital that quickly if you feel or if a loved one is suffering a stroke? 

    Dr. Crowley:  Well, there are a number of reasons. First, for the ischemic type of stroke—again, the one where there is a cut-off of the blood vessel—time is really of the essence because we have medications that we can give intravenously, but those are only typically available within four and a half hours of the time of the symptom onset. For the surgical options that we have for the ischemic stroke, typically we need to get to it within eight hours to be able to operate safely. For the hemorrhagic stroke—again, where there’s a bleed, it could be a large bleed that needs to be evacuated surgically. It could be an aneurysm that is ruptured that needs to be treated before it re-ruptures. And so, again, a patient sitting there with thesymptoms isn’t going to know which type of stroke it is, and therefore, the sooner you get in, the more likely it is that we can treat it and hopefully reverse some of the symptoms, if not prevent new ones from occurring. 

    Melanie:  Dr. Crowley, are there particular groups of stroke patients who may benefit from surgery? 

    Dr. Crowley:  There are, in fact. The patients who had the cut-off of the blood vessel but usually by a clot that is clogging off the vessel. The main ones we think about are the patients that are ineligible for the intravenous treatments, which means that they are sometime between the four and a half and eight hour time window after the time of symptoms. Or, if they have another contraindication to the TPA, the tissue plasminogen activator, which is the medicine that you can give IV, those contraindications would be a recent major kind of hemorrhage or often a brain surgery, or perhaps they’re on different blood thinners, which makes giving IV tPA more risky. In those patients, certainly, the endovascular or the surgical treatment for the stroke are an option. For the other types of strokes, the hemorrhagic stroke, the things that we look for is their ability to recover in general from as large of a stroke as it is. The patients who are able to tolerate anesthesia that might need to undergo in order to get the aneurysm treated, or the blood clot removed, certainly. But in general, anyone who comes in with a head bleed is a candidate for treatment. Anyone who comes in with an ischemic stroke, one of these cut-off, is a candidate for surgical treatment if they don’t meet the qualifications for tPA, and occasionally, if they do, if the clot is quite large. 

    Melanie:  Can you describe a little bit about the surgery that a stroke patient might undergo? What can they expect? We’ve heard a lot about heart disease and cardiac surgery. Tell us a little bit about stroke surgery. 

    Dr. Crowley:  Yes, ma’am. When the clot is there present in the blood vessel in the brain -- again traditionally, the medicine that has been the only hope in this is try to break up the clot. We now have a number of what we call endovascular devices where we can go in through an artery in the leg and pass little tiny catheters up and try to remove the clot. Again, that typically needs to be done within eight hours of the time of onset. We are now with the newest devices. There’s one device which is essentially a stent that we open up within the clot and then capture the clot and bring it back, and we suction as well to try to bring the clot back. The latest data suggests that we can get that open between 85 and 90 percent of the time in patients if we get to it in time.  Then, of course, there are going to be a small subset of patients that we’re not able to remove that clot. That will cause a stroke or complete the stroke and can cause some swelling in the brain. In that case, as a neurosurgeon, we may have to remove a large piece of the bone in order to accommodate the swelling so that someone can survive their stroke. Lastly, for the hemorrhagic stroke, there are a number of different causes. Again, it can be an aneurysm. It could be something called an AVM, which is an arteriovenous malformation and those have treatments, both endovascularly, where you go into the groin and you either treat an AVM with glue-like material or treat an aneurysm with coils or stents. And surgically, we can remove an AVM or we can put a clip across the neck of an aneurysm. There are a number of options, but again, it depends on what it was that caused the stroke, obviously. 

    Melanie:  What is the recovery period following a surgery to treat a stroke? What are the outcomes? After they’ve had something, whether it’s stenting or something, do they have a risk of reoccurrence of a stroke then? Are they at a higher risk? What’s the recovery like? 

    Dr. Crowley:  They often do have a higher risk. The patients who have the blood clot that is within the blood vessel, there is often something that sent that clot to clog up the blood vessel, and often it’s a narrowing in the artery in the neck. It could be narrowing in the artery of the brain. So treating the stroke itself—meaning, getting that clot out—it doesn’t often end the chance of it happening again. For those patients, they may need, again, either stents in the neck to open up the narrowing which has caused the stroke, or sometimes a surgery called a carotid endarterectomy. The aneurysm ones, recovery from a bleed hemorrhagic stroke tends to be longer because the blood itself irritates the brain. Again, if we are able to successfully remove the clot within the blood vessel, you can see a pretty rapid return of function. Some people go home within a matter of two or three days. For the patients who have a completed stroke, it’s a longer course, certainly, that often needs a rehab. Again, for an aneurysm that’s ruptured, the recovery -- we often keep patients in the hospital for two weeks just to manage other possible sequelae that they run into. 

    Melanie:  Dr. Crowley, why should patients come to UVA for their stroke care? 

    Dr. Crowley:  Why? I think the University of Virginia has excellent experts in pretty much anything that you can think of, and I hope that you gathered from the things I was talking about that a stroke can be caused by a number of different things. There are a number of hospitals that may have the medicine to give the tPA in order to break up a clot, but they may not have the ability to operate on aneurysm or ability to operate on a large hemorrhage. Other places may have some but not the other. At University of Virginia, we have everything possible. My medical and surgical colleague, Dr. Kenneth Liu, and I are both neurosurgeons that do both endovascular and cerebrovascular, meaning that we can do the stent or we can do the surgery, either the endarterectomy or the clipping of the aneurysm. And the old adage that if the only thing you have is a hammer, everything looks like a nail, I think being able to do both of those or all of those eliminates a great amount of bias. And at University of Virginia, we have a number of people who are trained in a lot of these different things, and so we can tailor the treatments. We have a number of radiologists, we have a number of cardiothoracic surgeons, cardiovascular surgeons, neurosurgeons, that all treat different aspects of stroke. We have a great neurology team. Again, there are other centers in the country, certainly, that have everything. There are a lot of centers that don’t. I think when you’re looking to find -- like I said, when a patient has a stroke or has symptoms of a stroke, they can’t determine whether it’s a blood clot in the artery or a large hemorrhage on the brain. They just know their symptoms, and so I think it’s best to go to a place that has a capability of treating every single one of those, no matter what it turns out to be. 

    Melanie:  Thank you so much, Dr. Webster Crowley. For more information on UVA neurosciences, brain, and spine care, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. You are listening to UVA Health System Radio. Thanks so much for listening, and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Sugar, Stroke]]>
David Cole Mon, 01 Dec 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/23860-surgical-options-for-stroke-patients
Head and Neck Cancer http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=23859-head-and-neck-cancer head-and-neck-cancerWhat are the most common forms of head and neck cancer, and what treatment options are available.

Get the facts from a UVA expert in head and neck surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1442vh5c.mp3
  • Location: Null
  • Doctors: Jameson, Mark
  • Featured Speaker: Dr. Mark Jameson
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Mark Jameson is an otolaryngologist – head and neck surgeon whose specialties include head and neck cancer.

  • Transcription: Melanie Cole (Host):  This year, more than 55,000 Americans will develop cancer of the head and neck. Which are the most common forms of head and neck cancer and what treatment options are out there? My guest is Dr. Mark Jameson. He is an otolaryngologist, head and neck surgeon, whose specialties include head and neck cancer. Welcome to the show, Dr. Jameson. What are the most common head and neck cancers that you see? 

    Dr. Mark Jameson (Guest):  Well, the term “head and neck cancer” is actually a very broad term. We use it to refer to all of the cancers that occur in the head and neck with the exception of brain and eye cancers. That includes cancers of the skin, salivary gland, the thyroid gland, sinuses, and the team at UVA manages all of these types of cancers. But the most common brand of head and neck cancer that we see is the squamous cell carcinoma that occurs in the mouth, that we refer to as the oral cavity, the throat or the pharynx, and the voice box or larynx. As you said, that’s a relatively small number of cancers in the United States every year, but in our practice, because it’s dedicated to head and neck cancer, that’s what we see predominantly. 

    Melanie:  What most commonly causes these cancers, and are any of them preventable? 

    Dr. Jameson:  Well, the biggest risk factor for head and neck squamous cell carcinoma is tobacco use. That’s been well established for a long time. That includes smoking and also chewing tobacco. And we know as well that excessive alcohol use is also a risk factor. While alcohol is not as big a risk factor as smoking, when the two are used together, they’re more than additive, so there’s a synergistic effect between those two things. Classically, our head and neck cancer patient has been a longtime smoker and someone who has used alcohol frequently. However, in the last decade, we have seen the emergence of a new form of throat cancer that is caused by the human papilloma virus or HPV, and most folks are becoming aware of this. The virus is often acquired early in adulthood and then often resides in the tonsil tissue for a long period of time, sometimes decades, before it causes cancer. What’s interesting is that while the incidence of smoking-related head and neck cancers is declining over time, actually, the incidence of HPV-related head and neck cancer is rising steadily. So we’re seeing that change in our practice. 

    Melanie:  Dr. Jameson—because I think this is one of the scarier cancers for people because they think of their ability to talk and to eat, to swallow—what are some symptoms that might scare somebody or send them in to see you? 

    Dr. Jameson:  You’re right. It is a scary cancer. It affects very important parts of our day-to-day life. There are a variety of symptoms, but they tend to depend on where cancer occurs. The cancer usually develops as a mass at what we call the primary site, and that mass sometimes has an ulcer or an erosion that’s very painful. Often, the presentation is, for instance, with an ulcer in the mouth that isn’t going away. Sometimes folks present with a painful or loose tooth that is sort of out of the ordinary for them. If these cancers arise in the throat, the voice box, then often, folks don’t see or feel a mass because they can’t look there. But they might notice pain when they swallow or difficulty swallowing, not being able to eat things that they could eat before. Or they might notice a change in their voice, and sometimes even difficulty breathing or shortness of breath with exertion, more so than their baseline. Cancers in the throat, interestingly, often cause ear pain just on one side because of the nerve wiring in our head and neck. There’s nothing wrong with the ear, but it’s referred pain to the ear. Sometimes we see folks that have ear pain just on one side. Then, as these cancers begin to spread, they will grow in lymph nodes in the neck. Sometimes patients just present with a lump in the neck or something. Maybe they notice when they’re shaving or doing their daily routine that there’s a lump there. Often, it doesn’t hurt, but sometimes it does. Really, any of those symptoms that linger for more than a couple of weeks are concerning to us, and those need to be evaluated. 

    Melanie:  How is it diagnosed, Dr. Jameson? 

    Dr. Jameson:  We diagnose by obtaining a tissue biopsy, and the way we start when they’re just concerned for a lump or a bump or some pain is we do a full physical exam. We look in the mouth and the throat. We feel the neck. And then in our clinic, we’re able to actually, with the patient awake and comfortable, pass a small camera through the nose and down into the throat so we can get an extra look around at the back of the tongue, the throat, the voice box. That allows us to see something that might be of concern. If there’s something of concern in the mouth, often in clinic, we can get a small piece of that tissue. Or if there is a lump in the neck, we can put a tiny needle into that, just with the patient awake in our clinic—a little bit of pain, but not too bad—and we can send that tissue to the pathologist and they can answer the question for us. If it’s something farther back or they’re in the voice box, then we usually have to put folks to sleep in the operating room and do a procedure where we look back there, examine everything, and also get a piece of that tissue to send to the pathologist. 

    Melanie:  If they test positive for one of the head and neck cancers, then what treatments are available? Because again, as scary as these are, there are really innovative treatments out there that can help live this normal quality of life. 

    Dr. Jameson:  In general, as with other cancers, there are really three big options, and those are surgery, radiation, and chemotherapy or medication. Occasionally, we can use just a surgery or just a radiation, but many of these cancers need to be treated with a combination of the two. So often we’ll do an operation to remove the cancer and follow that with some radiation or use radiation and chemotherapy together. Occasionally, we need to use all three for the more difficult cancers. We really work to provide that treatment that not only provides the best chance of a cure but also provides the best chance of preserving function, as you mentioned. Since we breathe, talk, and eat with the mouth, throat, and voice box, we really need to think about how our treatment will impact those functions. We’re really trying to optimize how a patient will function after their treatment. Now, for cancers in the mouth, the treatment of choice usually is to remove those, and often that can involve removing part of the tongue or part of the jawbone, which can be very debilitating. We have developed ways to transfer tissue from other parts of the body to reconstruct those areas. We can take bone from the leg to reconstruct the jawbone or tissue from the forearm to reconstruct the tongue and return a lot of the native function to those folks. Cancers in the throat have usually been treated in the past with radiation and chemotherapy, but a lot of these now, because of HPV, are occurring in younger folks, and radiation and chemotherapy has some downsides in terms of long-term impact on swallowing, risk of secondary cancers, and some other risks. We’re now trying to operate on these if we can. We’re using the da Vinci robot to operate through patients’ mouths and remove these surgically so that we can usually eliminate their need for chemotherapy and often reduce the dose of radiation and reduce the related side effects. For cancers in the voice box, obviously folks want to maintain their voice if they can. We try to use radiation and chemotherapy for those in very creative ways so that folks can keep their voice box, if possible. But sometimes we do have to remove the voice box, and when we do that, we have special valves that we can put in after the voice box is gone to help folks restore their voice. Part of our team specializes in restoring voice and helping folks get back their communication skills if that’s what has to happen. None of these are really a perfect scenario, but what we work at is developing an opportunity to get the patient as much back to normal as we possibly can. 

    Melanie:  Dr. Jameson, in just the last minute or so, why should patients come to UVA Cancer Center for head and neck cancer care? 

    Dr. Jameson:  Well, I think there’s a few big reasons. First of all, this is a fairly uncommon cancer, and yet it’s really what we spend our time doing. So we have a great experience with this illness. We have a team of experts that works in a multidisciplinary way, and we’re able to provide very complete care. We offer a comprehensive array of treatments and surgery, radiation, chemotherapy, as we mentioned, and we have all the folks that are needed to get that done in addition to surgeons and radiation oncologists and medical oncologists. We need speech and language specialists. We need dental specialists, eye care. We need nutrition and pain management, physical therapists, all those things. We have them all here and committed to caring for these patients. As we talked about, we have some exciting advanced treatment options. We have specialty reconstructive skills that really return people to great function. We have an opportunity for minimally invasive robotic surgery, and we have brand new concepts in radiation oncology that are helping us reduce side effects in addition to some new drug trials in the chemotherapy area. Lots of opportunities for folks to get the very most advanced care in the field. Then, I think finally this entire team that takes care of these patients, I know them all well. And while being some of the best docs in the country, they are also committed to a very compassionate, patient-centered care, and I’m very proud of the care that we provide to patients here. 

    Melanie:  Thank you so much, Dr. Mark Jameson. For more information, you can go to uvahealth.com. That’s uvahealth.com for more information on the UVA Cancer Center. You’re listening to UVA Health System Radio. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 24 Nov 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/23859-head-and-neck-cancer
Minimally Invasive Valve Surgery http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=23857-minimally-invasive-valve-surgery minimally-invasive-valve-surgeryUVA is among the few hospitals in the region offering mini valve replacement surgery.

Which patients with heart valve disease could benefit from this minimally invasive surgery?

Learn more from a UVA expert in heart valve surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1442vh5b.mp3
  • Location: Null
  • Doctors: Ailawadi, Gorav
  • Featured Speaker: Dr. Gorav Ailawadi
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Gorav Ailawadi is a board-certified surgeon whose specialties include heart valve disease.

  • Transcription: Melanie Cole (Host):  UVA is among the few hospitals in the region offering mini valve surgery. What patients with heart valve disease could benefit from this minimally invasive surgery? My guest today is Dr. Gorav Ailawadi. He is a board certified surgeon whose specialties include heart valve disease. Welcome to the show, Dr. Ailawadi. What is cardiac valve disease? 

    Dr. Gorav Ailawadi (Guest):  Thank you for having me. Well, our heart has four main valves. Their job is to open without restriction and close completely without leaking to allow blood to really move forward between the different chambers of the heart out to the lungs and to the body. When a valve is tight, we call it stenotic, and what it does is it restricts blood flow out of the heart. When a heart valve leaks, we call it regurgitant, and then blood ends up going backwards. Either way, when a valve doesn’t work properly, it can lead to symptoms that cause congestive heart failure, which includes things like shortness of breath, fatigue, chest pains. People can feel pretty bad. Valve disease can really span a lot of different types of causes and things like that. 

    Melanie:  What are some of the causes of valve disease, and who is at most risk? 

    Dr. Ailawadi:  Well, really, anybody can get valve disease. It’s not related to things that we consider to cause other heart disease, like smoking and diet. Those don’t actually lead to valve disease as much as they lead to other diseases of the heart. But there are many different ways that the valve can have problems. We probably ought to think about the two most common valves that are affected because there are four valves. The two most common valves are the aortic valve and the mitral valve. The aortic valve is the main valve between the main pumping chamber of the heart called the left ventricle and the body. This valve most commonly gets stenotic or tight, more so than leaking. When this valve gets tight, again, it restricts blood flow out of the heart to the body. There are few general disorders, such as disorders that people are born with that put people at higher risk for aortic stenosis, and those are people that have a bicuspid aortic valve. That’s where the valves have two parts in the valve instead of three. These patients have a higher risk to get aortic valve problems early on in their life. The other causes of aortic stenosis really are not genetic. It’s really more just related to other things that happen in their life. For example, rheumatic valve disease can occur when someone has had rheumatic fever, typically as a child. That can lead to aortic stenosis later on in life. The most common cause for aortic valve disease is really aging and wear and tear on the heart. Just like our back and our knees that have issues as we get older, so does the aortic valve. We get calcium buildup, and that leads to the valve getting tight. The other common valve that is affected is the mitral valve, and that more commonly leaks than gets tight. The mitral valve is a very complex structure. It actually looks like two parachutes side-by-side with little cords. There can be multiple reasons that cause the mitral valve to leak, like an old heart attack or stretching of the valve or cord itself—that’s called mitral valve prolapse. Rheumatic fever can also cause the mitral valve to leak or become tight. There’s a lot of different reasons. There are few genetic reasons, but most of them, a little bit of bad luck, I’d say, and/or wear and tear on the valve. 

    Melanie:  Dr. Ailawadi, I understand there are a number of innovative treatment options. Can you tell us about minimally invasive surgical option, and how does it differ from traditional open heart surgery people might have had to have to get these leaky valves fixed and/or replaced? 

    Dr. Ailawadi:  Okay. Well, I want to emphasize the goal with any surgery is to do the right thing for the valve, whether it’s to repair or replace it. The second thing we think about is how best to get to the heart. The way we fix the valve depends on what’s their issue. When a valve is stenotic or tight, we usually replace the valve with an artificial valve, whether it’s mechanical or bioprosthetic, which is a tissue or a cow or pig valve. When the valve is leaking, it’s common to try to repair the valve. That typically is a better option, particularly for the mitral valve. Minimally invasive surgeries are really doing the same operation that we do through full incision through the entire breast bone without breaking the breast bone. For example, we could fix the aortic valve through a small or partial opening in the breast bone or adjacent to the breast bone on the right side, while the mitral valve is fixed through a small incision in between the ribs on the right side of the chest without breaking any bones. Again, it really doesn’t matter if we’re repairing or replacing. We can really do both options through either incision. 

    Melanie:  Who is eligible for this minimally invasive approach, and who might not be a candidate? 

    Dr. Ailawadi:  It really takes thoughtful consideration for every individual patient, but anybody who has an isolated valve problem—that means they only have one valve that needs to be fixed, they don’t have a second valve or they don’t have a bypass surgery that needs to be done—we consider for a minimally invasive approach as the first option. We start looking at any unusual things that may suggest that traditional open heart surgery may be better for them. For example, they have a lot of calcium buildup around the heart, around the valve, around the aorta that might make minimally invasive surgery more risky. If they’ve had certain types of heart surgery before, it may be safer to do through a traditional incision. But I’d say by and large, the majority of patients that have an isolated valve problem that is just one valve that’s the issue; we’re offering a minimally invasive approach. 

    Melanie:  If you’ve had to repair the mitral valve, for example, what is recovery like and what is the outcome? Are they going to have it re-repaired or possibly replaced later on in life? Can they still go into congestive heart failure if you’ve repaired a leak? What’s the outcome like? 

    Dr. Ailawadi:  It depends a little bit on how it’s leaking. We’re learning more and more about the mitral valve. There have been large recent studies for what we call ischemic mitral valve regurgitation, when a valve is leaking to a very weak heart. And we’re learning that it might be actually better or at least as safe to replace that valve so that the valve leak should not come back. When we’re talking about mitral valve prolapse, by and large, those valves can be repaired with very good longevity without a need for repeat operation. It’s not to say it never happens, but it’s pretty unlikely and we have data up to 15 years that the valves still work very well once we repair when it’s a mitral valve prolapse. In terms of recovery and the benefits, what we see is there’s a shorter stay in the hospital, like a return to activity and driving. For young patients, that means they can get back to work sooner. In older patients, it means they can get more mobile with fewer restrictions. They don’t need as much help with rehab. I think there is certainly recovery benefits. Regardless of the incision, the outcome and longevity really should be the same. The valve should be repaired with the same efficacy. 

    Melanie:  Is there anything you can tell listeners about prevention, or is there anything they can do to kind of keep their valves healthy? As you said, it’s not necessarily lifestyle management, but is there anything else that we should know? 

    Dr. Ailawadi:  Again, since it’s not related to really our lifestyle, I wouldn’t say there is any modifications. What I would suggest is if you’ve ever been told you have a murmur -- or certainly ask your doctor when they listen to your heart, “Do you hear anything?” If there’s ever a murmur or you have any history of valve disease, the easiest thing to do is to ask your doctor to get an echocardiogram. That’s an ultrasound on the chest of the heart. That would be a great screening to see do you have any valve disease or not. The other part of it is to really pay attention to your symptoms. When you have valve disease in which you can feel short of breath, particularly when you start exerting yourself or going uphill, that’s usually the earliest sign. And what we find is a lot of patients modify their lifestyle so they don’t do as much, and it’s been very subtle and you ask them and they say, “I do everything I can. I don’t have any issues.” Really, they changed their lifestyle over the last few years. The other thing we hear is palpitations when people feel their heart racing. Those are the things that should tip off your family doctor or other doctor to start thinking about—could it be valve disease, let me listen to the heart, and maybe even push for an echocardiogram. 

    Melanie:  Dr. Ailawadi, in just the last minute or so, why should someone come to UVA Heart and Vascular Center for valve disease treatment? 

    Dr. Ailawadi:  Well, UVA is really one of the few places, really, in the country that has all the options to treat valve disease. For example, for the aortic valve, we have more than, say, seven different ways to fix the aortic valve from simply ballooning the valve open to a transcatheter valve replacement, which we didn’t talk about. But we can replace the aortic valve in the right patient without an incision by going through the groin, or even through a small incision on the chest without stopping the heart, minimally invasive valve repair, minimally invasive valve replacement, a traditional incision valve repair or replacement. For the mitral valve, we have at least five ways to fix the mitral valve, including a percutaneous mitral valve repair with mitraclip device, minimally invasive mitral valve repair, minimally invasive replacement, traditional valve repair or replacement. We have a lot of different options, and we’re one of the few places that really can offer the full spectrum of what’s available. Choosing the best option for each patient involve our whole valve team, a really multidisciplinary approach with experts, really, from all disciplines working together to provide the best outcome for each individual patient. I think the care is very individualized. Really, finally, our excellent outcomes and reputation, I really think, are world-renowned, and that allows us to get access to, really, the newest techniques and devices that are not available to other institutions. We’ve got some of the newest valves, newest devices that we use to help aid in minimally invasive surgery, and we really have leaders in the field who love to do their job and they love to do it with a smile. 

    Melanie:  Thank you so much. And for more information on the UVA Heart and Vascular Center, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health System Radio. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Sugar]]>
David Cole Mon, 17 Nov 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/23857-minimally-invasive-valve-surgery
Enterovirus in Children http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=23856-enterovirus-in-children enterovirus-in-childrenEnterovirus D68 has received a great deal of recent news coverage – what signs and symptoms should parents look out for?

Learn more from a UVA specialist in pediatric infectious diseases.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1442vh5a.mp3
  • Location: Null
  • Doctors: Turner, Ron
  • Featured Speaker: Dr. Ron Turner
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Ron Turner is a board-certified specialist in pediatric infectious diseases.

  • Transcription: Melanie Cole (Host):  Every year, millions of children in the United States catch enteroviruses that can cause coughing, sneezing, and fever. This year, the enterovirus that is most commonly causing respiratory illness in children across the country is enterovirus D68. My guest today is Dr. Ron Turner. He is a board certified specialist in pediatric infectious diseases. Welcome to the show, Dr. Turner. What is enterovirus, and what conditions is it most similar to? 

    Dr. Ron Turner (Guest):  Well, enterovirus is a very common virus of children that causes a whole spectrum of different diseases. The most common diseases that it’s associated with are summertime fevers and rashes. Hand-foot-mouth disease is a commonly known variant of this. That’s one of the syndromes that it causes. The enteroviruses are cousins, if you will, to another group of viruses called rhinoviruses, which are more commonly associated with common colds and asthma attack. The interest in enterovirus 68 is because it has some features of the standard enteroviruses but also has some features of the rhinoviruses, and so, it’s this year causing a fair amount of respiratory disease. 

    Melanie:  What are the most common symptoms, and are children at higher risk for EV-68? 

    Dr. Turner:  Well, it certainly seems that this virus is preferentially attacking children, and that would be consistent with what we know about both enteroviruses and the rhinoviruses, that that’s where these infections tend to occur. The symptoms that the virus is causing are basically common cold symptoms. They are more likely to be associated with a fever than the typical or common colds, but other than that, they are a fairly typical common cold. The thing that seems to be a little bit atypical this year for this virus is that there seemed to be more asthma attacks associated with this infection than there maybe have been in the past. 

    Melanie:  If a child has enterovirus-like symptoms, when does a parent say, “Okay, this may not be just the flu or a cold or seasonal allergies”? When do they take them to the doctor? 

    Dr. Turner:  Well, I think the best advice for parents is really to not focus so much on the enterovirus story, but most parents whose children have asthma or have had asthma attacks in the past are pretty familiar with the symptoms of those illnesses. There’s no real reason to see a physician for this infection if all your child has is common colds. There’s no treatment. There’s nothing that anybody is going to do to intervene, and it will resolve on its own. On the other hand, if your child has asthma and begins to develop symptoms associated with their asthma attack, and you have routine medications that you use at home for that and those don’t seem to be working, obviously, that’s the time to take your child to a physician. 

    Melanie:  If there are no treatments, Dr. Turner, for this EV-68, what about the symptoms? Is there symptom management that parents can do? Should they be using acetaminophen or ibuprofen to get the fever down? Is there anything they can do for coughs and the sneezing and just the overall general ill feelings the kids get? 

    Dr. Turner:  Well, I think parents can manage this infection the way they would typically manage a cold in their child. Of course, as you know, the American Academy of Pediatrics has recommended against the use of common cold medicines in children under the age of six. We wouldn’t recommend that, but certainly for fevers, to use treatments like Tylenol or ibuprofen to bring the fever down as it is appropriate. Other treatments are, bless you, but parents can manage this just the way they would any other common cold illness. 

    Melanie:  Is there a way to protect our families from EV-68? 

    Dr. Turner:  Well, I think it’s always reasonable to suggest good hand washing, good hand hygiene. There seems to be evidence that these enteroviruses are spread by hand contact, and so that certainly helps. Obviously, when there’s this much disease in the community, the risk that you’re going to become infected goes up regardless of those types of intervention. In spite of meticulous hand washing, it’s still possible to become ill. 

    Melanie:  Now, what about school, Dr. Turner? Because that’s every parent’s sort of quandary. As the specialist that you are, when would you say, “Yes, you must keep your child home from school during this if they’re coughing or fever,” or if it’s just the coughing and sneezing without a fever? When can they go back to school? 

    Dr. Turner:  Well, the typical guidelines for when children can be in school, certainly, if they have fever, they should be excluded from school. That’s a relatively easy line to recognize. The other criteria for when a child can go to school really involve when they can actively participate in the class and productively participate in their class instead of if a child had so much cough going on or so much… if there’s a will that they would not be able to participate in class, then obviously, they should not be in school. There is no recommendation that children be kept out of school for mild symptoms. 

    Melanie:  The newest flu vaccine, does that have any effect on the immune system to help fight this enterovirus, Dr. Turner? And why are we seeing so many cases of it now? 

    Dr. Turner:  Well, the flu vaccine, obviously everybody should get their flu vaccine. There’s no question about that. But the flu vaccine won’t have any effect on this virus. They’re different viruses. The mechanism of the vaccine is such that it won’t have any impact on this infection. I think the question about the number of infections we’re seeing, first of all, I think it is unusual, but these infection -- particularly that they came so early. They started in August, which is atypical. They do seem to be on the wane now, and we would expect that in early November, these will kind of go away. The reason why this year enterovirus 68 was the virus that popped up as the major virus, that’s not really known. 

    Melanie:  Really, why should families come to UVA Children’s Hospital for treatment of enterovirus and other similar conditions? 

    Dr. Turner:  Well, I think it is important to have your child cared for in a facility that has a specialist for pediatrics. These children can be taken care of by a variety of different specialists as needed. We, of course, have all of that here at the University, and so I think that makes us a reasonable place to come. 

    Melanie:  Thank you so much, Dr. Ron Turner. For more information about the enterovirus and whether you and your family should get seen, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening, and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Mon, 10 Nov 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/23856-enterovirus-in-children
Lung Cancer http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=23275-lung-cancer lung-cancerIs smoking the only way to get lung cancer?

Learn more about this disease and the available treatment options from a UVA surgeon who specializes in lung cancer.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1438vh5d.mp3
  • Location: Null
  • Doctors: Lau, Christine
  • Featured Speaker: Dr. Christine Lau
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Christine Lau is a board-certified thoracic surgeon who specializes in treating lung and esophageal cancer.

  • Transcription: Melanie Cole (Host): Is smoking the only way to get lung cancer? Learning more about this disease and the available treatment options will help you get the answers that you need. My guest is Dr. Christine Lau. She’s board-certified thoracic surgeon who specializes in treating lung and esophageal cancers at UVA Cancer Center. Welcome to the show, Dr. Lau. Most people associate lung cancer with smoking. Is that the only cause of lung cancer? Are there other causes?

    Christine Lau: It’s really great to be on the show. Smoking is by far the leading risk factor for lung cancer. In the early 20th century, lung cancer was much less common than it is today, because of the manufacturing of cigarettes. At least 80% of lung cancer deaths are thought to be a result of smoking. But other things can cause lung cancer. Cigar smoking, pipe smoking – that’s obvious. That’s very similar to cigarette smoking. Second-hand exposure smoke can cause lung cancer. Radon which is in very small levels outdoors, but inside, higher levels of radon have been associated with lung cancer. Asbestos exposure in the workplace has been associated with lung cancer, and other types including mesothelioma with asbestos aren’t just the standard types of lung cancer that we see. There are other things that are more, you know, rare. Diesel exhaust has also been somewhat associated with it. Radioactive ores, such as uranium, other types of chemicals and minerals have been associated with it. More commonly now, we’re seeing cities with air pollution have higher risks of lung cancer. People who have been exposed to radiation to their lungs, and then a personal or family history of lung cancer have a higher risk of developing a second lung cancer, or developing lung cancer.

    Melanie: So what are some of the best steps? You mentioned smoking as one of the main causes, but what are some of the best other steps that we can do to prevent lung cancer? Exercise, for example, Dr. Lau, does that help to reverse some of the effects that smoking or radon or any of these other pollutants might have had on our systems? Are there ways to actually prevent it?

    Christine Lau: There have been a couple of studies looking at various minerals and vitamins to prevent lung cancer. None of them have panned out. Exercise and a healthy kind of lifestyle is always good for any person, but really the big thing is to avoid smoking and then to get your health tested for radon. Asbestos is much less common in the workforce today, but we still see it in patients who were exposed to it even 30 or 40 years ago. So, there really isn’t good prevention other than avoidance of the risk factors.

    Melanie: So what are some of the common symptoms? People always think of the coughing and they vision people with oxygen. What are some symptoms that might send someone to the doctor to even get that lung cancer found?

    Christine Lau: That’s a great question. Usually, symptoms of lung cancer don’t appear until the disease is quite advanced and usually non-curable by the time patients present with symptoms. Symptoms such as weight loss, even hemoptysis, bone pain – these can be signs that the tumor is quite advanced. Even something like an infection, where they come in, they have had a chronic infection, they may have a lung cancer that’s actually been the cause of that. It’s unfortunate, but those patients are often quite advanced by the time they present. When we see cancer that’s curable, it’s often found by just a routine chest X-ray for another reason. They come in for a hernia surgery and they get a chest X-ray. There is new evidence that lung cancer screening in patients who meet very specific criteria that does help detect it early. I think the best thing to do is, if you have smoked or you are currently smoking, that you let your doctor know and you talk with them about lung cancer screening, because that’s relatively new. It’s a CT scan and it’s relatively new on the horizon. I think it has been shown to decrease deaths from lung cancer.

    Melanie: What’s involved in the screening?

    Christine Lau: The screening is done in most centers. UVA has a lung cancer screening program. You basically call our number and if you fit in a certain criteria, they will get you in for a CT, a low-dose CT scan. That scan will scan your lungs and look for any small nodule. So patients who have smoked for 30 packs a year and they’re over 55, they still smoke or has smoked, they should really be contacting their primary care doctor to arrange to get a lung cancer screening study.

    Melanie: That’s really great advice, because if you’ve been a smoker, even if you’re a reformed smoker, it’s something to ask your doctor about getting lung cancer screening, because it could help you to find it early enough. You mentioned the word “cure,” Dr. Lau. At what point and stage, if lung cancer is found early enough, can it be treated successfully?

    Christine Lau: It sure can. I mean that’s the goal, if we can find lung cancer as early. There are four stages of lung cancer. Stage four is the most advanced. It is considered not really curable but we can palliate patients with stage four lung cancer. Stage 1, 2 and some 3, we can still go after cures for the patient. And if it’s found early, if it’s a very small nodule, with no lymph nodes spread and no other spread, we often will be able to treat them with surgery.

    Melanie: Wow. That’s amazing. So tell us some of the treatment options you mentioned. Surgery – does this usually also involve chemotherapy radiation? When it’s the lungs, people, you know, get a little bit more wary of these types of treatments. Tell us how these treatments affect the lungs.

    Christine Lau: Well, there are several options for patients who are diagnosed with lung cancer, and that’s the big thing. I always tell my patients, “The first thing we need to figure out is: What are we dealing with? How advanced is it?” And then, we can really sit down and go through all the options that they have. I know it’s very hard to hear. I’ve had my own family members diagnosed with cancer and the first thing you hear is that word and it’s really hard to focus on anything else. The best thing you can do when you get a diagnosis is to really figure out, where do you fit in and what are your treatment options? There are several options for patients with lung cancer. Surgery is for relatively early stage lung cancer: Stage 1, stage 2 and some stage 3-A lung cancers. There are other new options: the radiofrequency ablation, also called stereotactic radiation. It’s a type of very focused beam radiation treatment, and that’s been very successful and is relatively new in the armamentarium of what we can use to treat lung cancer with. There’s also standard radiation and chemotherapy. Then finally, there’s targeted therapies that are very specific for the type of cancer you have. I think the big thing is to get in with a group that’s multidisciplinary and can really approach you based on what is the best plan, individualized plan for you if you have lung cancer, because it can really vary based on: 1) what you want; 2) what your health is, how good your health is; and 3) what options are available at the institution that you’re being seen at.

    Melanie: Give us a little advice about some of the lifestyle things if somebody is diagnosed with lung cancer, Dr. Lau. Coping with some of the symptoms, like shortness of breath, can be very scary. Give us some of your best advice on dealing with some of those things at home.

    Christine Lau: Yeah. I think that is really hard. It’s a very difficult time and often they are still smokers and then everyone tells them, “You know, you really need to quit smoking.” It’s a very stressful time. I will tell you that my own father smoked until the day he died, and I’m a thoracic surgeon. So I do understand what a habit and how addictive tobacco is to my patients and to people, in general. I think the first thing is to recognize a lot of these patients are already short of breath and some of them are on oxygen. But to really just take a step back and know that it’s not always that this lung cancer stuff is causing additional symptoms. It’s really just the stress of knowing you have this diagnosis and how it’s going to be treated. So, the thing I really tell patients is it’s going to take some time to put together your treatment plan and we need to just be very thoughtful about that.

    Melanie: So, in just the last minute, tell the listeners why patients should choose UVA for their lung cancer treatment.

    Christine Lau: Well, I think UVA has a lot of options that other places also do have, but they’re a fairly unique one. We are a big multidisciplinary group. There are three thoracic surgeons at University of Virginia, which is a very large group of thoracic surgeons, and we all communicate with each other. We discuss cases together. We have conferences where we meet and discuss various options. What would you do? How would you handle this? We also have three thoracic oncologists, that all they do is thoracic surgery. That’s the only type of chemotherapy that they actually provide. They’re experts specifically in lung and esophageal cancer. We also have a radiation oncology program that is very specific to lung cancer. We have nurses that all they work on are patients who have lung cancer. And so, I think the thing that we have that’s very unique is that we have a multidisciplinary group. I actually go over to Augusta. We also have collaborations with the community hospitals, as well. So we have the option to do some things over at Augusta Hospital and also over at UVA. I think we have an outreach, a pretty big, broad group or area that we can cover. I think the biggest thing is that we’re also affiliated with a major cancer center and so we all the resources that are offered from the cancer center. So, big clinical trials – there’s a lot of clinical trials that are coming out that we can offer, that other centers just don’t have the ability to, because we are affiliated with such a topnotch cancer center.

    Melanie: Thank you so much, Dr. Christine Lau. For more information, you can go to uvahealth.com. That’s uveahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 03 Nov 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/23275-lung-cancer
How is Heart Disease Different for Women? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=23274-how-is-heart-disease-different-for-women how-is-heart-disease-different-for-womenHeart disease isn't just a "man's disease," but heart disease symptoms are often different for women. Learn how from a UVA specialist in women's heart health.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1438vh5c.mp3
  • Location: Null
  • Doctors: Patterson, Brandy
  • Featured Speaker: Dr. Brandy Patterson
  • Guest Name: Null
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  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Brandy Patterson is board-certified in internal medicine and cardiovascular disease; her specialties include women’s heart health and general cardiology.

    UVA Heart and Vascular Center
  • Transcription: Melanie Cole (Host): Heart disease isn’t just a man’s disease. But heart disease symptoms are often different for women. Would you know the signs and symptoms of heart disease when they happen?My guest today is Dr. Brandy Patterson. She’s board certified in internal medicine and cardiovascular disease. Her specialties include women’s heart health and general cardiology. Welcome to the show, Dr. Patterson.Let’s start with heart disease in women: number one killer. Tell us about heart disease in women and why it’s so different than it is in man?

    Dr. Brandy Patterson: Well, every minute in the United States, somebody’s wife, mother, daughter or sister dies from heart disease, stroke or another form of cardiovascular disease. Every year, more than 400,000 women in the United States die from heart disease. It is the leading cause of death in women and kills six times more women than breast cancer alone. Right now, more than one in three women is living with some form of cardiovascular disease, including nearly half of all African-American women. Although heart disease death rates among men have declined steadily over the last 25 years, rates among women have fallen at a much lower rate. There are many potential reasons for this. However, women may not always recognize that they are having a problem with their heart because their symptoms may be much more subtle.

    Melanie: Speak about the symptoms, because, really, Dr. Patterson, we, women, are always taking care of everybody else in our lives and we get our men to go to the doctors and we take our children and we do everything for everybody. But, you know, we can’t take care of everybody else. I always say, we have to put our own mask on before we put the other kids’ masks on. We have to know these symptoms. They’re so important but we don’t recognize them for what they are. We usually dismiss them as something related to stress or tension. Tell us these symptoms that differ in women.

    Dr. Patterson: That’s right. All of us have seen the movie scenes, where a man gasps, clutches his chest and falls to the ground, and it’s always a man. But in reality, the heart attack victim could easily be a woman, but the scene may not be that dramatic. Instead, women may experience symptoms of dizziness, sometimes cold sweat, lightheadedness, sometimes just shortness of breath, pressure pain in the lower chest or upper abdomen that they may think is reflux. They may have caught a GI, a virus going around with some nausea and abdominal pain, sometimes upper back pressure, or pain in one arm or both arms, in the jaw, or just extreme fatigue. And so, as I said, women may attribute these symptoms to reflux and upper respiratory infection, GI virus going around, or just getting older. The signs and symptoms can be subtle but the consequences are deadly, especially if the victim doesn’t get help right away. So it is very important for women to understand what their risk for coronary artery disease and for heart disease in general is. They need to learn what their personal risk is for heart disease.

    Melanie: What are some steps that women can take to protect themselves and things that we can do to prevent heart disease?

    Dr. Patterson: That’s a good point. Heart disease is preventable. There are a few non-modifiable risk factors, meaning, risk factors we can’t change. Number one, that’s our age. We don’t have a choice. We’re getting older and as we get older, plaque does build up in the coronary arteries and we’re more likely to have a heart disease as we get older. We can’t change that. We can’t change our gender. We can’t change our family history. We are born with the genes that we have. If you do have family members that have had heart disease, you are more likely to have it yourself, especially if they had it at a younger age.
    The risk factors that you can change, that you can modify, are those reasons why heart disease is largely preventable:
    1. Smoking. Smoking really makes the plaque progression much more rapid in the coronary arteries. So don’t even start smoking, and if you are smoking, quit. After quitting for just about a year or so, you really cut your risk by about half of having plaque progression that is accelerated.
    2. Your blood pressure. Control blood pressure. Know what your numbers are.
    3. Your weight. Obese patients—or obese women in general—tend to have accelerated plaque progression.
    4. Your cholesterol. Know your cholesterol.
    5. If you have diabetes, try and control it as best as you can. Get out and start an exercise program. Just walking at least 30 minutes a day, five days a week, at moderate intensity can lower your risk for heart attack and stroke.
    6. Modify your family diet if needed. Follow a heart-healthy Mediterranean diet.
    So, as you can see, there are a number of risk factors for heart disease that are modifiable, and women do have the ability to adopt positive lifestyle habits. And as you mentioned, women tend to take care of everybody else in the family, so if women tend to adopt the positive lifestyle habits in their life, they’re more likely to have their significant others as well as their children adopt those positive healthy lifestyle habits, as well.

    Melanie: Absolutely great information, so well put, Dr. Patterson. What is Club Red? And how can someone get involved?

    Dr. Patterson: Club Red is a UVA Heart and Vascular Center initiative that is designed to help women understand and manage their risk factors for heart disease. It’s free and it’s an online program, and it inspires women to live a heart-healthy lifestyle by providing them with health tips and recipes, as well as fun community events throughout the year. You can go online at clubreduva.com to learn more information.

    Melanie: Give us really some of your best advice about women who may already have heart disease. So we spoke a little bit about prevention. But now, if they’ve already come up with it, whether it’s genetic or just something that they’ve had, what can they do to treat it? What do you do for them?

    Dr. Patterson: I’m a firm believer in regular healthcare provider appointments to ensure that the blood pressure, heart rate, cholesterol, diabetes are well-controlled. And again, I can reinforce it enough, walking, exercising, anything that you can do to get up and active, will help prevent the progression of coronary artery disease, as well as eating a healthy Mediterranean diet. In general, for women that have already had the diagnosis of coronary artery disease, whether it’s obstructive or non-obstructive, we prescribe the same regimen: controlling blood pressure, cholesterol, diabetes, exercising, living a healthy lifestyle by eating a Mediterranean diet, and not smoking. The things that we do to prevent heart disease are the same things that we do to help control progression as well. Of course, once women are diagnosed with non-obstructive or obstructive coronary artery disease, there may be more medications involved in treating and helping to prevent the progression, as if you did not have any coronary artery disease. But it’s something, again, that the healthcare provider follow-up on a regular basis can keep track of and tailor your medication according to your situation.

    Melanie: Dr. Patterson, in just the last minute or so, give us your best advice for women and heart disease and why someone should come to UVA for their heart care.

    Dr. Patterson: Well, UVA provides wellness and health for all women, whether or not they have coronary disease or are just looking to find ways to prevent coronary artery disease and heart disease. Their standards of care are amongst the best in the nation and it truly is a wonderful place to come to for the best healthcare in the country.

    Melanie: Thank you so much. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thank you so much for listening and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Women’s Health, Heart Disease]]>
David Cole Mon, 27 Oct 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/23274-how-is-heart-disease-different-for-women
Learning More About Neurofibromatosis Type 1 http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=23273-learning-more-about-neurofibromatosis-type-1 learning-more-about-neurofibromatosis-type-1Neurofibromatosis type 1 is a genetic disorder that affects 1 in every 3,000 to 4,000 Americans, according to the National Institute of Neurological Disorders and Stroke.

Learn more about the symptoms spotted during childhood and treatment options from a UVA specialist in neurocutaneous disorders.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1438vh5b.mp3
  • Location: Null
  • Doctors: Dhamija, Radhika
  • Featured Speaker: Dr. Radhika Dhamija
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Radhika Dhamija is a board-certified neurologist – with a special qualification in child neurology – whose specializes in neurocutaneous disorders such as neurofibromatosis.

    UVA Neurosciences: Brain & Spine Care
  • Transcription: Melanie Cole (Host): Neurofibromatosis type 1 is a genetic disorder that affects one in every 3,000 to 4,000 Americans, according to the National Institute of Neurological Disorders and Stroke. My guest today is Dr. Radhika Dhamija. She’s board-certified neurologist, with special qualification in child neurology, who specializes in neurocutaneous disorder, such as neurofibromatosis. Welcome to the show, Dr. Dhamija. Tell us, what is neurofibromatosis type I?

    Dr. Radhika Dhamija (Guest): Thank you for having me on this show. I’d love to tell you about neurofibromatosis. neurofibromatosis type 1 is a genetic, neurologic disorder and it is caused by mutations in a particular gene that we call neurofibromin. The normal function of this gene is to suppress tumor growth or help normal cell growth. And when this gene is not functioning, then we see abnormal cell growth in the form of tumors. So that is, in summary, what a neurofibromatosis type 1 is.

    Melanie: Who does it most typically affect?

    Dr. Dhamija: It can affect really anybody. It affects children. It affects adults. It affects people of all races. It doesn’t have any sex predilection. It affects females and males equally. As I said, it’s a genetic disorder, and oftentimes, in at least half of the individuals, we can trace it to other members of the family; it is inherited from their mom or dad. But probably in about half of the patients, it is caused by new mutations, so we are not able to find a family history and that individual is the only affected member in the family.

    Melanie: What are some of the most common signs and symptoms that would either signal a parent to take their child to see you or that someone might notice?

    Dr. Dhamija: Oftentimes, a common cause of referral is café au lait macules. They are brown spots on the skin. They start developing in the first few months of life and keep increasing in number as a child is growing. The other common symptoms are neurofibromas. Neurofibromas are benign tumors of the nerve. Nerves are present really anywhere in our body. They’re present in the skin, under the skin, the nerves, except the spinal cord. So once those neurofibromas or tumors form around those nerves or in the nerve, they cause symptoms such as pain or weakness in a limb. Those would be common signs and symptoms that a patient can present with. These neurofibromas can also be found under the skin, so they can be of some cosmetic issues depending on where in the body they are. The other symptom that we worry about in this disease is this disease, as I said, is caused by mutation in a tumor-suppressor gene, so it increases the chance of an individual to develop other kinds of tumors. One particular tumor we worry about especially in children is called optic glioma. It’s a brain tumor and it affects the optic nerve or the eye nerve that goes to the brain and its pathway. We do recommend that all patients with neurofibromatosis type 1 see an eye doctor annually so that we don’t miss it. We also worry about blood pressure issues, because there’s a specific kind of tumor that can happen in this disease. It’s called pheochromocytoma that releases hormones that can increase one’s blood pressure. Those are, I guess, the common things that we worry about in this disease.

    Melanie: As you’re facing these medical challenges that this disease can cause, do you treat each of these things as they come up, Dr. Dhamija? Or do you treat this as a whole disease in the child? Or do you take each one of these challenges and deal with them as they come?

    Dr. Dhamija: We try to look for those things in an individual whether they have it or not, and as the challenges come, we offer specific therapy for them. I recommend that anybody with neurofibromatosis type 1 to see a physician who’s very familiar with this disease every year, because even within the same family, if they have the same mutation, the manifestations of this disease are very different. Some individuals can have really minor signs and symptoms, like only skin changes and fibromas under or over their skin; however, other individuals can develop more serious kinds of problems, like tumors, and so would probably need different management. So it really depends on what manifestations or what sign and symptoms an individual develops, and then we try to manage those. Annual follow-up in a neurogenetics clinic with somebody who’s familiar with this disease would be the key, and then the other things sort of follow it.

    Melanie: So speak about the treatment options that are available now for neurofibromatosis type 1. As you’re dealing with the high blood pressure and the optic nerve tumors and any of these things, what treatments are out there?

    Dr. Dhamija: Sure. Optic glioma – we can start with that. Optic glioma is very unique in neurofibromatosis type 1. It can actually be present in up to 25% of kids with this disease, especially under the age of 8 years. This is very different from optic glioma in an individual who does not have neurofibromatosis type 1. Typically in this disease, we think that it regresses actually, and may not even need chemotherapy or radiation therapy. And so we oftentimes follow them very closely with a serial MRI scans of the brain, do their vision assessment, and only treat if it’s really rapidly going or it’s affecting their vision to a certain extent. As I said, it can often regress, but behaves very differently, and so they would rarely need a physician who knows about optic glioma in this particular disease, versus if it occurred without neurofibromatosis type 1. Coming to blood pressure issues, it is more about detecting high blood pressure in an early stage so that we can look for that one kind of tumor that I talked about, pheochromocytoma, and that would be managed like any other pheochromocytoma. If the blood pressure is unrelated to pheochromocytoma, again, the management would be similar to hypertension, otherwise. The neurofibromas can be removed oftentimes easily especially if they’re over the skin or in the dermis. However, there is a particular kind of neurofibromas that can happen in this disease, called flexi-form neurofibroma, which is a very complex neurofibroma involving multiple nerves. Oftentimes, the skin over that neurofibroma is discolored, has a patch of hair, and so we get an idea that there might be a flexi-form neurofibroma underneath. So those neurofibromas are somewhat challenging to manage because if you cannot do surgery and take the whole tumor out, as they are large, in about 10% of the time, those flexi-form neurofibromas can turn malignant or turn into neurosarcomas. Unfortunately, we don’t have very good therapies for those kinds of cancers yet. However, as I said, they’re very rare and most of the time, 90% of the time, the neurofibromas are benign and the symptoms that really come out of it are because of the location of them and are more related to pain and cosmetic issues, and worrying that they’ll turn into cancer.

    Melanie: And doctor, in just the last couple of minutes, please give the listeners your very best advice about kids that have neurofibromatosis type 1 and the outcome for the rest of their life and why should patients come to UVA for their care.

    Dr. Dhamija: I should tell the listeners that most patients of neurofibromatosis type 1 have mild to moderate challenges in their life. Their longevity, for most part, is not affected because, as I said, cancers in this are not malignant. They’re benign. I think UVA is uniquely positioned. We offer a multidisciplinary care. We have neurologists, geneticists, neurosurgeons, plastic surgeons, oncologists, genetic counselors who work very closely with both adults and kids, and we have a dedicated neurocutaneous clinic and a neurofibromatosis type 1 clinic. And so, all the physicians who are involved in this multidisciplinary clinic are very familiar with the latest research, the latest technology, and just the latest knowledge of neurofibromatosis type 1.

    Melanie: Thank you so much. For more information, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole. Have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Brain & Nervous System]]>
David Cole Mon, 20 Oct 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/23273-learning-more-about-neurofibromatosis-type-1
Caring for Mother and Baby http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=23272-caring-for-mother-and-baby caring-for-mother-and-babyExpectant and new parents are full of questions.

Get some answers to those common questions – and learn how parents can get ready for a newborn – from a UVA specialist in maternal-fetal medicine.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1438vh5a.mp3
  • Location: Null
  • Doctors: Dudley, Donald
  • Featured Speaker: Dr. Donald Dudley
  • Guest Name: Null
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  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Donald Dudley is board-certified in both obsetrics and gynecology and maternal-fetal medicine; he is director of UVA’s Division of Maternal-Fetal Medicine.

    UVA Children’s Hospital
  • Transcription: Melanie Cole (Host): Expectant and new parents are full of questions. Here to answer some of those common questions is Dr. Donald Dudley. He’s board certified in both obstetrics and gynecology and maternal-fetal medicine and he’s the director of UVA’s Division of Maternal-Fetal Medicine at UVA Children’s Hospital. Welcome to the show, Dr. Dudley. What are some of the most common questions that you get from parents and new parents?

    Dr. Donald Dudley (Guest): Well, thank you and thank you for having me on this show. I’d say some of the more common questions that I receive are questions about the labor process and what they can expect in labor. Especially for first-time moms, it can be quite a time of anxiety because they just don’t know what it’s like and what’s going to be happening and they’re concerned about dealing with pain issues and all about just the practical things, like ‘what’s the hospital like,’ and the like. They often ask how long they have to stay in the hospital. Another common question is ‘when is the baby going to come,’ which is a hard question for us. We never really know. In some cases, we actually are able to schedule labor inductions, but we usually reserve that for obstetric or medical problems that require delivery at a scheduled time. So, new patients often come in with many questions on many topics, and our role really is to help educate patients about what they can expect during their pregnancy.

    Melanie: Dr. Dudley, [what do you] tell them about the pain that they can expect? I’ve had two babies. I loved labor and delivery. I did. I loved it. But what do you tell them about the pain threshold that they can expect.

    Dr. Dudley: Well, I actually really very much encourage that they undergo some form of labor education at our hospital, and really all hospitals where they have delivery services usually offer prenatal classes to teach ways to manage pain. Pain is a very subjective feeling. It’s the same pain, and yet there’s a wide range of responses to the pain. But for the most part, women tolerate this very well. There are options for pain control, for example, epidural analgesia, which a majority of our women tend to have. And I encourage, if they’re not able to cope with the pain, that there’s no reason to suffer through this much pain later in their labor process. And so, we have a number of options available to help manage this, but we really much prefer patients who can come in and manage the pain on their own.

    Melanie: What are some of the most important things a new parent can do to get their newborns off to a great start in life?

    Dr. Dudley: Well, I think the most important thing first is to eat a healthy diet. There are new weight gain recommendations during pregnancy that we try to follow as best as we can, but certainly eating a healthy diet. Avoiding any unnecessary medications or exposure during pregnancy is also important for the developing baby. There are some medicines that need to be taken during pregnancy and our role as obstetricians is to try to provide safe medication for the mother and for the baby. Also, avoid unnecessary exposures to things like pesticides and cleaning agents and things such as that that potentially can be toxic. It’s amazing how many chemicals are in the world that we just don’t know if they’re safe during pregnancy. I like my ladies to have the chance to exercise and, more importantly, to be aware of changes in their body and look for warning signs of problems such as preterm labor or high blood pressure. We spend quite a deal of time educating patients about the warning signs for these conditions.

    Melanie: So what are some of the most challenging things that a new mother is going to face after giving birth?

    Dr. Dudley: Well, in my experience in seeing patients soon after they deliver, probably one of the most challenging things is finding enough time for sleep. Fatigue is a very common problem early in the newborn period for the mother. I always ask my patients to be sure to sleep when the baby sleeps, which is easy to say and awfully hard to do sometimes. So, I’ll often see patients in after two weeks and ask them how much sleep they’re getting, and they’re getting maybe three to four hours of sleep in a 24-hour time period, which is really not enough for a healthy start for a new baby. So we work out strategies to try to help them improve their sleep. There are common challenges with nursing. We very much encourage women to breastfeed. Especially here at UVA, we have a very active program to try to help women learn all the tools for breastfeeding. Sometimes, that can be a challenge too, with getting a new mom and new baby to learn how to breastfeed together. Another common challenge is kind of the baby blues. It’s very common for women after having a baby to have some mood swings early after taking the baby home, where they’ll just be standing the sink, crying for no clear reason. And typically, this clears after about a week or two, and our patient’s moods get better. But in a substantial proportion of patients, they will develop a postpartum depression, and that’s something that we’re very much aware of and very often we will screen for all of our postpartum women about a couple of weeks to six weeks after their delivery to make sure that they’re not suffering from a post-partum depression.

    Melanie: Dr. Dudley, what’s your best advice for new parents to be prepared to welcome their newborn home? Are there things that they should do before they go into labor to get ready to bring that little baby home?

    Dr. Dudley: Yes. I think one of the most important things is to create an environment that’s safe for the baby and also safe for the mother. One of the most common problems that occur after they take the new baby home that can be devastating is this Sudden Infant Death Syndrome, and they often occur because of unsafe sleep practices in the home. It’s really important for parents to work with their pediatricians and their obstetricians to create a safe environment in the home and to emphasize safe sleeping habits for the baby. Another issue is to be sure to try to have as much help as they can get at the home the first few weeks, whether or not it’s their mother or mother-in-law, for the new mom, her mom, or her mother-in-law or sister, someone to help out around the house. I think it’s really important just so they can get some of that sleep that they need after they take the baby home.

    Melanie: Now, what about things like car seats and getting that kind of thing ready and organized? You have to have a car seat before you can even leave the hospital, correct?

    Dr. Dudley: Correct. If they can get their own car seat, that would be great. If they cannot afford one or cannot get one, most hospitals have a car seat program. You certainly have to have a car seat to take the baby home. Again, that’s the whole issue of safety, providing a safe environment for that baby. We need to take the baby home and that the baby be safe in all aspects from the minute you leave the hospital to the minute you get to the house and really for the rest of their lives.

    Melanie: Dr. Dudley, we have about two minutes left. If you would, just tell the listeners your very best advice for new mom, new baby, bringing a newborn home, and then why parents should choose UVA for their care.

    Dr. Dudley: Well, my very best advice is to keep a healthy lifestyle and to be very aware of what’s going on with their body and to really emphasize both the mother’s and the baby’s safety as they get started off with a new family. We really emphasize this at the University of Virginia. We have a “Be Safe” initiative throughout the hospital for we truly work to provide the safest environment for patients when they come in to the hospital. As many of the listeners may know, patient safety is of paramount importance and the healthcare system can sometimes, in the past, have not been emphasized as much as now. So we really do go the extra mile to provide a safe environment for mothers when they’re in labor and for their new babies. At University of Virginia, we have a very patient-friendly center. We’re a baby-friendly hospital. We emphasize skin-to-skin contact, rooming in. We’re going to be beginning a midwifery service in recognition that we not only provide outstanding care for mothers with high-risk conditions, but also that we’re a fabulous place to deliver for a low-risk baby, for completely normal pregnancy where there are no problems. We’re going to be embarking on a remodeling project to provide a much more patient-friendly atmosphere here at UVA. We anticipate that all these changes that we’re going to be doing are going to be providing what the patients need and what they want in order to have a wonderful start to having a new family.

    Melanie: Thank you so much. It’s such an exciting time for the whole family. For more information on UVA Children’s Hospital, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health, Women’s Health]]>
David Cole Mon, 13 Oct 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/23272-caring-for-mother-and-baby
Understanding Muscular Dystrophy http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=22597-understanding-muscular-dystrophy understanding-muscular-dystrophyMuscular dystrophy is a genetic condition that weakens muscles and in many cases can require patients to use a wheelchair.

Learn more about the causes, symptoms and treatment options from a UVA specialist in developmental pediatrics.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1433vh5d.mp3
  • Location: Null
  • Doctors: Scharf, Rebecca
  • Featured Speaker: Dr. Rebecca Scharf
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Rebecca Scharf is a board-certified pediatrician who specializes in developmental and behavioral pediatrics.

  • Transcription: Melanie Cole (Host): Muscular dystrophy is a genetic condition that can weaken muscles and in many cases can require patients the use a wheelchair. However, there are treatment options available for patients and their families. My guest is Dr. Rebecca Scharf. She’s a board certified pediatrician who specializes in developmental and behavioral pediatrics at UVA Children’s Hospital. Welcome to the show, Dr. Scharf. Tell us a little bit, what’s muscular dystrophy?

    Dr. Rebecca Scharf (Guest): Thank you, Melanie. Muscular dystrophy is a genetic disorder that involves progressive degeneration and weakening of the muscles. We often see children with Duchenne muscular dystrophy in our clinic, which is one of the most common types that we see, one of the nine types of muscular dystrophy. This disorder involves particularly the muscles but can involve cells throughout the whole body and tends to lead to weakness over time.

    Melanie: Do doctors know what even causes it? Is it something that’s present right at birth?

    Dr. Scharf: Yes, we do know what causes it. Duchenne muscular dystrophy is caused by an absence of a protein in the muscle which is called dystrophin. Dystrophin is a large protein in the body encoded by a large gene in the genome, and we know that absence of that gene or dysfunction of that gene lead to less or altered dystrophin in the muscles. Dystrophin is the protein that helps keep the muscles intact and helps the muscles to contract and be used. When a patient has muscular dystrophy, that dystrophin protein is missing or altered, so the protein in the muscle and throughout the body are missing or altered, and this leads to the progressive weakness or muscle degeneration that we see.

    Melanie: In Duchenne’s, what might parents notice at the beginning? Is this something that, as I said, comes with birth or is it something you notice once you start noticing developmental or motor delays?

    Dr. Scharf: Right, great question. Yes, the muscular dystrophy present at birth is part of the genetic makeup of the child and so it has been there all along. However, oftentimes, it is not picked up until early childhood. The more common story that I see is a little boy who’s brought into the office with a history of falling frequently or being a clumsy child, or having delayed walking, all those types of symptoms that oftentimes will present in our office – being a little bit weaker, having low muscle tone, and this onset of weakness is usually noticed somewhere between two and five years of age. Sometimes, families will notice even earlier and sometimes children don’t present to my office until six, seven years of age. The most common, I would say, is somewhere between two and five years of age. This disease affects primarily boys, but it can be seen in girls in rare cases. Children usually have muscle weakness that first affects the proximal muscles, meaning the muscles that are closest to the body of the trunk. These would be the hips, the pelvis, the thighs, and the shoulders. Calf muscles are usually enlarged and so sometimes someone will pick up on that in the child. Again, these children will be the ones who have difficulty climbing stairs, difficulty with strength involving their legs and arms. By the teenage years, the heart and the respiratory muscles are often affected, and so sometimes children will then present with difficulty with breathing or difficulty with endurance due to their heart muscle. 

    Melanie: Now when somebody is diagnosed with muscular dystrophy, and the parents are probably quite scared at that point and picturing the worst outcomes, tell us a little bit about treatment options. What do you do for the patients? Do you manage the symptoms? Do you deal with the chronic complications that might end up? What do you do for them?

    Dr. Scharf: Currently, we do a lot of treating the symptoms of muscular dystrophy to the best of our ability. We manage muscular dystrophy through a variety of specialties. The first line is therapy. Children benefit from physical therapy to keep their muscles in use, to keep them active, to keep stretching their joints so they don’t get contractures. They also benefit from occupational therapy which helps with adaptive and daily living skills. It can allow them to continue to move around, to get in and out of their bed, to get through the house in order to feed themselves. All those things are things that an occupational therapist would work on with the child. Children with muscular dystrophy also sometimes have delays in their language or their cognitive ability, and so speech and language therapy can be very helpful in helping with communication, as well as in terms of feeding. We certainly benefit from having them in our team. Pulmonary specialists are also very important in treating muscular dystrophy. They help monitor the children’s lung functions and to keep their lungs functioning at best possible. The children will have pulmonary function test at each clinic visit to keep an eye on how their lungs are functioning, and sometimes we’ll give medications or different lung exercises to keep the lungs as healthy as we can. Next, children see cardiologist to monitor their heart function. This dystrophin is a protein that’s also found in the heart muscle, and so we keep a close eye on the children’s heart functions and then are able to provide treatments as needed, if there’s any difficulty with the function of the heart. Next, children will see the orthopedic team, and that’s very important to assess for things like scoliosis, contractures in the ankle joints, fractures, and they will provide treatment when necessary. Currently, the medication that we use for muscular dystrophy is prednisone. It’s a medication that has been shown in many, many studies to allow boys to walk longer, use muscles for several years longer. So it really has shown to be a life-sustaining medication that allows for functions for several more years in many boys. The Muscular Dystrophy Association and other groups are actively involved in research and development for new drugs to treat muscular dystrophy. I’m really excited about that. I’m thankful to the Muscular Dystrophy Association and the NIH and everyone else who funds research in muscle disorders. I think it’s so important and it’s so needed. We need many more medications to help treat children with muscular dystrophy.

    Melanie: Tell us how these children grow. What happens as they grow – the changes that parents can look toward? And while you’re speaking about that—you mentioned the Muscular Dystrophy Association—tell us what research is going on out there.

    Dr. Scharf: Sure. Over time, we follow children in our clinic and we keep an eye on many things including how they’re growing and developing and learning and thriving. Are they able to do everything they’re supposed to do throughout their day, the things that kids do? Are they able to play and go to school, or be part of their families? We monitor things closely to see if we can provide any help or any assistance to allow those things to happen on a daily basis. A lot of times, we’ll see that children will continue to make good developmental progress through those first two years of childhood. Sometimes, often around five, six, seven, we’ll see a little bit of plateau in skills where children aren’t able to continue to learn new motor skills and sometimes begin to lose some skills. Usually, somehow around that time is when some things become harder like running, jumping, walking, and so that’s often when we treat this prednisone, if we haven’t been already, to try to prolong some of the muscle function that we have. And then, we often do need some aids for mobility. Sometimes, children need to use crutches or walkers or wheelchairs to enable mobility, and those can be really helpful things. I think using a wheelchair to enable a child to go out and be in the park and go to school is really great. It allows them to participate in the community so much better, and I think those things are very important. We try to keep an eye on what equipment would be most helpful for each child and how we can help them function to their fullest. The Muscular Dystrophy Association is doing new research into different types of medication that can be used in order to treat muscular dystrophy. Some of these target the gene particularly. Some target the dystrophin protein, seeing if they can make that stronger or replace that within the muscle. And some come about trying to make other parts of the muscle function better, so that it can account for that lack of dystrophin in the muscle. And all of these things, I think, have some promise in terms of what will be able to be helped. There are trials going on for some early-phase medication, which I’m very hopeful will soon to be somewhat effective for this children, because we certainly need a lot more medication options than we currently have for children with muscular dystrophy. So I encourage everybody to support the Muscular Dystrophy Association, or just medical research in general. I think it’s very needed.

    Melanie: Thank you so much. And, Dr. Rebecca Scharf, tell us why patients and families should come to UVA Children’s Hospital for their care.

    Dr. Scharf: Sure. Here at UVA, we have a multidisciplinary clinic to help care for children who have muscle disorders. We have recently opened the new UVA Children’s Battle Building, and that’s where our clinic is located. So when children come for their appointment to the Battle Building, they’re able to see first the developmental pediatrician and we’re the ones who take responsibility for overseeing the medical care as well as to be sure that children are receiving the therapies and the services that they need in their communities. We’re the ones who monitor the children’s developmental progress. We monitor their growth to make sure that’s going well, and we keep an eye on their learning over time to see if they’re receiving all that they possibly can in school. At UVA’s Battle Building, the children are also able to see physical therapists, occupational therapists, speech-language pathologists, and our therapy area has a gym, which are a fun way for children to connect with our therapist and sometimes develop plans for therapies back in their neighborhoods or schools, as well. We also have evaluations for the equipment needs that children have and they can come to equipment clinic and try out various pieces of equipment to see which would be best for them. We also have orthopedic surgery in that clinic and Dr. [Evan] did a wonderful job of caring for our children’s orthopedic needs. We’re very thankful to have that all-in-one place. When children come to clinic, they are also able to get their pulmonary function test done at that visit, so we can keep an eye on their lung function, and pulmonology as well cardiology are also in our Battle Building. Therefore, children could see those specialists if needed on the same day and monitor their heart and their lung function.
    In addition, we have nutritionists in the clinic. They often help us with monitoring growth and providing some good input for healthy diet and exercise for our children. We also have endocrinology and a fitness clinic, which is a wonderful resource to have for children. Oftentimes, one side effect of prednisone is weight gain, so children can be monitored with our fitness clinic and our nutritionist to see how well they’re doing them. We also have teachers in this clinic who help us with education and interfacing with the children’s schools so we can make sure that they’re receiving the appropriate services in school and so we can communicate with schools about how this is going on, like is there anything we can do to support this child being able to participate fully in school, which has been wonderful. And we also have members from our Department of Neurology who come to this clinic and have been helping manage some of the other neurological symptoms that children may have, such as headaches or seizures, which not all children with muscular dystrophy have, but when they do, it’s nice to be able to have neurology there. Some of them are neuromuscular specialists who have been coming, which has been wonderful. We work together and care as best as we can for these children. So, I find the UVA Children’s Hospital Battle Building to be a great place to work as a team and be able to care for a child in a very multidisciplinary setting, which has been helpful for me and helpful for, more importantly, the patients to be able to receive a more comprehensive care.

    Melanie: Thank you so much, Dr. Scharf. What a wonderful approach for patients with muscular dystrophy and their families. You’re listening to UVA Health System Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thank you so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Genetics]]>
David Cole Mon, 06 Oct 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/22597-understanding-muscular-dystrophy
What is an EMG? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=22596-what-is-an-emg what-is-an-emgAn electromyography, or EMG test, is often used to better diagnose and detect a wide range of neuromuscular disorders.

Learn more about EMG tests and what to expect from a UVA specialist in neurology.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1433vh5c.mp3
  • Location: Null
  • Doctors: Jones, Sarah
  • Featured Speaker: Dr. Sarah Jones
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Sarah Jones is a board-certified neurologist whose specialties include clinical neurophysiology and EMG testing.

  • Transcription: Melanie Cole (Host):  Electromyography or EMG test is often used to better diagnose and detect a wide range of neuromuscular disorders. My guest today is Dr. Sarah Jones. She’s a board certified neurologist whose specialties include clinical neurophysiology and EMG testing. Welcome to the show, Dr. Jones. Tell us, what is an EMG? 

    Dr. Sarah Jones (Guest):  Hi, thanks for having me. An EMG is a test called electromyography which can be primarily used to help evaluate the health of the nerves and muscles. It’s also used to ascertain nerve dysfunction or muscle dysfunction and also disorders of communication between the nerves and muscle. 

    Melanie:  Why would you use an EMG? 

    Dr. Jones:  Well, there are several reasons why an EMG could be used. Most of our patients come to us because they're having symptoms of tingling or numbness and possible muscle weakness, muscle pain, cramping, or sometimes, neck or back pain. And so, an EMG can be used to figure out, are these symptoms a sign of some kind of dysfunction of the neuromuscular system? Physicians use the test to help support a diagnosis or rule out a diagnosis. So for example, somebody has tingling in their hand, there’s a few different nerves that can cause that. It can be caused by carpal tunnel syndrome, for example, or it could be caused by a pinched nerve in the neck. An EMG is a very useful test to help distinguish those two things. 

    Melanie:  Are there any risks to this test? Does it hurt at all? 

    Dr. Jones:  That’s a very good question. That’s probably one of the biggest questions that our patients ask us. So before I go into the risks and does it hurt, I want to talk a little bit about what an EMG is, what a patient would experience. There are two different parts to the EMG test. The first part is something called nerve conduction studies. With that first part of the test, what we’re looking for is how the large sensory and motor nerves are transmitting electrical impulses, because your nerves actually act like wires. So during this part of the test, an electrical impulse is applied with tiny electrodes at one part of the nerve, and then it's recorded at the other part of the nerve. This is just done with electrodes that stick on to the skin. The specialist is measuring how quickly those impulses travel, how strong they are, and whether there’s any distortion of the impulse’ signal. The second part of the test is called the needle EMG, and, yes, unfortunately it does involve a needle. But what is really interesting is most people, when they're going through this test, they're pretty amazed to see how their muscles are working, because you can see it in real time. So, what happens is your motor nerves are transmitting electrical signals to the muscles, and what we’re doing is recording it with a tiny needle. The needle is placed into the skin and into the muscle. What we’re doing is ascertaining what the muscles are doing while they're relaxed and also what they're doing when you activate the muscle. The EMG machine is translating these signals into graphs and sounds and numerical values that the electromyographer then interprets to determine, is it healthy or unhealthy? So in regards to does it hurt, that’s a very good question, and most people would say, yeah, probably getting electric shocks and needles is not a walk in the park. It’s not something you want to do every day. But we actually did a very brief evaluation in our neurological EMG lab last year. We asked everybody who came through the lab to document at the end of the test how bad was it on a scale of 1 to 10, what exactly was their experience and which part was worst for them. It was actually pretty split as far as which part was worse. I would say 50 percent said that the first part, the nerve conduction, was worse with the shocks, and then about the other half said the needle part was worse. But surprisingly, most people rated that as far as how bad the pain was, it was really only a 3 out of 10. So most patients’ experience was that, yeah, it's not comfortable, but it's not too awful compared to what their anticipation, what their anxieties about the test were. In regards to risks, there are very few risks involved in this test. Complications for this test are pretty rare. There is a small risk of bleeding and infection because, of course, we use needles. It would be very important for you to tell the person doing the test if you take any kind of blood thinners, because we would want to avoid any deep muscle on our evaluation. We do the test with folks who have pacemakers, and there is no risk to doing the test when we’re studying the arms and legs. If a person has a pacemaker, it's not going to necessarily disrupt the pacemaker. Or if they have an ICD, it's not necessarily going to discharge it. But doing studies around the neck, that would be something that we would take with a little bit more caution and just make sure that we have any kind of additional precautions available if we’re going to go ahead and do any of those more proximal neck or arm studies.

    Melanie:  Dr. Jones, who does this test, where is it performed, and are there other tests that can be used instead? 

    Dr. Jones:  The test can be performed by a variety of different doctors at UVA. We have the physiatry team over at the Fontaine location who performs the EMG, and then we also have the neurological team. At this time, we’re performing the test at three different locations: at the main hospital, the primary care center, and the neurology clinic there, also the neurology clinic at Fontaine and the neurology clinic at Zion Crossroads. The team who performs this test includes a technician who has been trained specifically to do the nerve conduction studies, and this is completely supervised by a board certified neurologist at any one of these locations. And then the needle EMG is performed by a variety of neurologists. At UVA, we have EMGs that are performed by the attending physicians and also by our neurophysiology fellows, and that is then supervised by the attending physician. 

    Melanie:  So why should patients with neurological conditions come to UVA? 

    Dr. Jones:  That’s an excellent question. EMGs are something that you certainly can train over a weekend and learn how to do or you could do a year-long fellowship. At UVA, everybody who is participating in the EMG has been specifically trained for this purpose. Our technicians are very skilled, and the physicians supervising are all board certified and have trained for over a year or more for this specific procedure. We feel that the neurology department is able to take the EMG and use it along with the other team members in a multidisciplinary kind of approach and apply it to help clarify the diagnosis to allow the patients to have the best care possible.

    Melanie:  Dr. Jones, we have just a few minutes left. Tell us a little bit about what patients can expect from the results. How long does it take to get results? Do they get them immediately, right there in the room with the doctor conducting the test? Do they wait a few days? And what do the results tell them? 

    Dr. Jones:  That’s a great question. Depending on the EMG and how complicated the test is, most often, the patients will have some kind of preliminary results when they're there in the clinic. But oftentimes, we will have to go through the numbers, go through the patient’s evaluation if they were seen in the clinic, or go through their history and compute the data before knowing exactly what the final results are. That report though, we generate the same day and send it to their doctor. So although they don't necessarily have the finalized results while they're still here in the clinic, they will have a finalized report sent to their doctor within 24 hours. 

    Melanie:  And then you can help them understand what it is that the results even showed. 

    Dr. Jones:  Right, right. It certainly is something that can be used to help guide additional treatment. Of course, when we’re seeing patients in the clinic just for the EMG test, we don't necessarily have the full context. So oftentimes, we may not have our MRI results or necessarily know all about their family history and so on, so it really oftentimes will take a full clinic evaluation to really be able to use the EMG results in the clinical context to give an accurate diagnosis and develop an accurate treatment plan. 

    Melanie:  Thank you so much, Dr. Sarah Jones. You’re listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
]]>
David Cole Mon, 29 Sep 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/22596-what-is-an-emg
Reducing Stroke Risk in Patients with Atrial Fibrillation http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=22595-reducing-stroke-risk-in-patients-with-atrial-fibrillation reducing-stroke-risk-in-patients-with-atrial-fibrillationA common heart rhythm disorder, atrial fibrillation also increases patients’ risk of stroke.

Learn more about the options available for atrial fibrillation patients to reduce their stroke risk from a UVA specialist in heart rhythm disorders.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1433vh5b.mp3
  • Location: Null
  • Doctors: Malhotra, Rohit
  • Featured Speaker: Dr. Rohit Malhotra
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Rohit Malhotra is board-certified in internal medicine and cardiovascular diseases; his specialties include caring for patients with heart rhythm disorders.

  • Transcription: Melanie Cole (Host):  A common heart rhythm disorder, atrial fibrillation, also increases patients’ risk of stroke. My guest today is Dr. Rohit Malhotra. He’s board certified in internal medicine and cardiovascular diseases. His specialties include caring for patients with heart rhythm disorders at UVA Heart and Vascular Center. Welcome to the show, Dr. Malhotra. Tell the listeners, what is atrial fibrillation? 

    Dr. Rohit Malhotra (Guest):  Thanks for having me. Atrial fibrillation is an abnormal rhythm in the heart. Essentially, the heart beats because of electrical signals that arise from the top chamber of the heart and travel down to the bottom chamber. In some people, abnormal signals can arise so that the heart, instead of beating regularly and changing in rate depending upon need, such as exercise, will beat fast and irregular at times when it shouldn't be—sometimes during sleep, sometimes during activity. These can lead to symptoms of shortness of breath, chest pain. In essence, what ends up happening is that many people end up feeling very fatigued and are unable to do their normal daily activities. This can be detected quite easily by checking your pulse, or often the blood pressure cuff, for example, will demonstrate that the heart rate is fast and irregular. Unfortunately, this abnormal rhythm can lead to an increased risk for stroke. The reason that happens is because most chambers in the heart actually have an inlet and an outlet where blood will come in and blood will go out. But there is a chamber on the left side of the heart called the appendage. It’s sort of like the appendix of the heart, where blood can only come in and out through one doorway, for example. The problem is, when the heart starts beating fast and irregularly, the blood doesn't pump out of that chamber appropriately, and that can actually lead to clot formation, and those clots can then break off and cause stroke or blood clots in the arm or the leg. 

    Melanie:  So that is really why patients with atrial fibrillation are at higher risk for stroke. So how is stroke risk for a-fib typically managed in patients? 

    Dr. Malhotra:  Well, the two big risk factors that we think about with atrial fibrillation are stroke, as you mentioned, as well as potentially heart failure, where the heart starts going really fast for long periods of time. So in general, what we want to do is prevent clot formation in the atrial appendage in that top chamber of the heart. Predominantly, the way that this has been done historically over years has been using medication. Predominantly, one medication has been available up until the last two or three years, and that’s been Warfarin, or Coumadin. This is a medication that will thin the blood and help prevent clots from forming. Unfortunately, Warfarin can be quite cumbersome for patients to take. It involves alterations in the diet and monitoring of blood levels in order to make sure that the blood is not too thin but also that an effective dose has been consumed by the patient. Now, in the recent past, in the last three years or so, there have been newer medications that have come to market that allow for either once-daily or twice-daily dosing. The blood is thin, clots don't form, and the risk of stroke is reduced. These medications don't involve changes to diet. They don't involve checking blood levels. Now, one of the issues that has arisen is that we’ve had many years’ worth of experience of using Warfarin, so we know how, in general, to make people’s blood clot, should they have a problem. If somebody needs emergency surgery or falls and bumps their head and starts bleeding, we need to manage that. With some of the newer medications, we don't have quite as much experience and so don't have great agents to reverse the effect. With time, the medications will filter out of the system, but sometimes we need to accelerate time, if you will. 

    Melanie:  Dr. Malhotra, what are some innovative treatment options and research that UVA is offering? Tell us a little bit about the procedures that people can have to treat their atrial fibrillation and decrease their stroke risk. 

    Dr. Malhotra:  There are two different approaches to that. In the recent past, we were involved in a trial. I talked about the appendage and its contribution to stroke risk in atrial fibrillation. One question that arose several years ago was what happens if we actually close off the appendage in one way or another and thus prevent blood from going into this chamber, and thus hopefully limiting the risk of clot formation? It appears to be quite effective, and there are a number of different approaches for actually closing off the atrial appendage. One is to place a device either inside the heart, in the appendage, and close that off. We’ve recently been conducting part of a national trial of one of the devices available for this, and the FDA’s currently reviewing that. And so, we’re not continuing. Their nationwide study has been closed for now and may re-open in the future, or the device itself may be approved. There is another procedure that involves actually placing a suture in a relatively non-invasive way where we put catheters around the heart as well as within the heart and close off the appendage from the outside. And that involves no use of blood thinners after the procedure, and that’s been thus far in our experience very effective. There are a number of institutions in the country participating in that type of work. There is a newer study that’s opened that involves a surgical procedure. It actually involves using two or three keyhole incisions, thereabout, a centimeter to two centimeters long in the chest, and we’re actually able to place what almost looks like a hairclip over the appendage from the outside, and that closes off the appendage and makes sure that no blood can get in or out. During this procedure, while it is a surgical procedure, the heart remains beating, and in general, patients have been doing very well with that. That hairclip style device has been used in surgery, cardiac surgery, for a long time, but we’re part of a trial looking at doing this procedure by itself without doing any cardiac surgery other than just putting this clip on. Beyond that, there really is a lot of debate as to whether reducing the total amount of atrial fibrillation actually has an impact on stroke risk. So, one approach that people take to managing atrial fibrillation and stroke risk is to potentially try to reduce the amount of atrial fibrillation, and for that we do a variety of different rhythm-related procedures to try and help people stay in rhythm. In general, we do that predominantly for symptoms but there may be some benefit in terms of stroke risk reduction. With that, we have catheter-based techniques where we place catheters into the heart and modify the electrical system, either by heating up the tissue or in fact using a newer technique using a balloon that will freeze some of the tissue and leaves normal tissue function but changes the electrical properties of the heart and may limit the risk of atrial fibrillation. There also are some surgical techniques that are used as well.

    Melanie:  Dr. Malhotra, in just the last minute that we have, why should patients come to UVA for treatment of their heart rhythm disorders? 

    Dr. Malhotra:  I think we have a wide number of people that are actually intimately involved in doing these procedures, we have about 10 years’ worth of experience, and the advantage ends up being that we offer people a wide variety of different techniques. There are multiple approaches to doing these types of procedures in order to close off the appendage or limit the amount of atrial fibrillation, and we have a wealth of experience with all of those techniques, I think more so than most hospitals in the country, in fact. So, I think we offer perspectives that are really unique, and we tailor all of our therapies specifically to the patients that we treat on a daily basis. 

    Melanie:  Thank you so much. You’re listening to UVA Health System Radio. For more information about UVA Heart and Vascular Center, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health, Stroke]]>
David Cole Mon, 22 Sep 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/22595-reducing-stroke-risk-in-patients-with-atrial-fibrillation
Surgical Options for Breast Cancer http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=22594-surgical-options-for-breast-cancer surgical-options-for-breast-cancerPatients with breast cancer have an increasing number of surgical options to treat their disease.

Learn more about these options – including breast conserving surgery – from a UVA specialist in breast cancer surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1433vh5a.mp3
  • Location: Null
  • Doctors: Showalter, Shayna
  • Featured Speaker: Dr. Shayna Showalter
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Shayna Showalter is a board-certified surgeon who specializes in treating breast cancer and diseases of the breast.

  • Transcription: Melanie Cole (Host):  Receiving a diagnosis of breast cancer can be devastating, but patients with breast cancer have an increasing number of surgical options to treat their disease. My guest is Dr. Shayna Showalter. She’s a board certified surgeon who specializes in treating breast cancer and diseases of the breast at UVA Cancer Center. Welcome to the show, Dr. Showalter. Tell us, what are the most common surgical options available for breast cancer patients?

    Dr. Shayna Showalter (Guest):  Good morning, and thank you for having me. What makes breast cancer interesting is that the treatment, especially the surgical options, are actually not defined before you even meet a patient. A lot of what ultimately makes the surgical plan for breast cancer patients is the patient’s preference. The two most common surgical treatments for breast cancer are what we call breast-conserving surgery and also a mastectomy. And so, it's my job as a breast surgical oncologist to sit with a patient, to describe the options in detail the risks and benefits of both of them, and ultimately, the surgical choice is typically up to the patient and their family. 

    Melanie:  What factors determine the available surgical options for a breast cancer patient? 

    Dr. Showalter:  Well, like I said, a lot of it, the number one factor is patient choice. And then a lot of it has to do with the particular cancer that the patient has. So we look at things like the size of the tumor, the stage of the tumor, meaning, whether or not it has spread to the lymph nodes underneath the arm, whether or not it involves the skin of the breast. We look at things like the patient’s age, their ability to potentially undergo radiation therapy. So a lot of that, those are the main things that factor into the patient’s choice and ultimately choose what type of surgical treatment. One thing that is hard for patients to understand is that the surgical treatment and the options that they choose in terms of surgery for their breast cancer is actually not at all related to whether or not they're going to need chemotherapy or hormonal therapy. So once we explain that to patients, they seem a little bit more free to really choose what works best for them.  

    Melanie:  That’s an excellent way of explaining it, Dr. Showalter. Describe a little bit about what breast-conserving surgery is and who might be a candidate for it. 

    Dr. Showalter:  Sure. Breast-conserving surgery is a word that implies removing the cancer from the breast. We typically also remove a small rim of normal tissue around that cancer to ensure that there’s no cancer cells left in the breast. But ultimately, the majority of the breast is left intact. There are some newer techniques that we use called oncoplastic surgery that we do at the time of breast-conserving surgery to help basically move some of the remaining breast tissue around to create a great cosmetic result for patients. Oftentimes, patients even with fairly large tumors won’t even realize that they’ve had breast tissue removed at the time of surgery. So breast-conserving surgery, which is also oftentimes called a lumpectomy or a partial mastectomy, it all means the same thing, and it basically means removing the breast cancer and leaving the remainder of the breast intact. Breast-conserving surgery is often basically always followed by the recommendation to undergo radiation therapy.

    Melanie:  And patients who have breast-conserving surgery, do they also have some lymph nodes under the arm removed as well, or is that not a part of this? 

    Dr. Showalter:  Yes, that is a part of it. So regardless of whether you choose to have a mastectomy or breast-conserving surgery, either as a separate surgery beforehand or at the same time, we do what we call a sentinel lymph node biopsy. That involves removing one or two of the main lymph nodes underneath the arm in order to check to see if cancer has spread to those lymph nodes. Depending on the results of that surgery, that information helps actually all of us on the team in order to guide the rest of the treatment. Sometimes that implies that the patient will then need what we call a complete axillar node dissection, which means removing the remainder of the lymph nodes. But more and more, we’re actually not even doing that. Sometimes having positive lymph nodes will mean that the patient is going to be recommended to undergo additional treatments, including radiation therapy or potentially even chemotherapy. 

    Melanie:  Dr. Showalter, after a patient has breast-conserving surgery, then you mentioned that those don't necessarily intertwine with chemotherapy or radiation. How long might they have to wait after surgery to start those other treatments? Is there any interaction there? 

    Dr. Showalter:  Yeah. So typically, after breast-conserving surgery, it takes about five days for our final pathology report to come in, which we need to ensure that we have all of the cancer out. Again, that tells us if there’s cancer involved in the lymph nodes. And then, once we have the clear report that all the cancer’s out, the patient will typically meet with some medical oncologists to discuss the risks and benefits of chemotherapy. Then, like I said in the beginning, every time somebody has breast-conserving surgery, the recommendation is always to follow that with radiation. Fortunately, we’ve made a lot of advances in radiation treatment recently and able to shorten the course to make that part of the treatment a little bit more palatable for most patients.

    Melanie:  What questions should patients ask their surgeons when considering their options for breast cancer surgery? 

    Dr. Showalter:  Well, I think it's very important for patients to really understand the difference between breast-conserving surgery and a mastectomy not just in what that surgery entails -- because of course, that’s a very important question asking about recovery time. Especially with a mastectomy, we oftentimes work with a plastic surgeon, and we’ll do what we call immediate reconstruction. But the patients really need to understand their different options in terms of their plastic surgery options, in terms of their recovery, in terms of the length of time they're in the hospital, but what I think is the most important thing that patients need to understand is that it's the job of the surgeon to explain what these choices mean in terms of patient’s overall survival. What we’ve learned from studying breast cancer patients for decades is that whether or not you choose breast-conserving surgery or a mastectomy, the overall survival is the exact same. I think that’s very hard sometimes for patients to understand because they assume that a bigger surgery will lead to a longer survival, so I really make a point of explaining that to patients. The difference between the two surgeries is that there’s a slightly increased chance of a recurrence, meaning, the breast cancer coming back again, when you’ve left some of the breast tissue intact. But most importantly, the overall survival between breast-conserving surgery and a mastectomy is the exact same. 

    Melanie:  What about recovery time between those two surgeries? 

    Dr. Showalter:  Well, that, I always say, very much depends on the type of plastic surgery that the patients that are opting for a mastectomy end up choosing. When you have breast-conserving surgery, that is outpatient surgery, so we typically will do the breast surgery and the lymph nodes biopsy at the same time. Patients come in and go home on the same day, and they typically are feeling pretty well within just a couple of days, although I always tell them to take it easy for much longer than that. A mastectomy requires one to five nights in the hospital, which is completely dependent based upon the type of plastic surgery for reconstruction. So for both of them, the recovery is fairly quick. Women typically say that they're up and about probably faster than they should be but feel pretty well very quickly after surgery. 

    Melanie:  Dr. Showalter, why should patients come to UVA for their breast cancer care? 

    Dr. Showalter:  Well, of course, I’m biased but I think that at UVA, what we very much excel in is our multidisciplinary approach to the treatment of breast cancer. So not only are there breast surgical oncologists, myself and my two partners, but we have a great team of radiologists that are all fellowship-trained. They help us in the screening, the diagnosis, and the staging of breast cancer. We have wonderful radiation oncologists, pathologists, and plastic surgeons, and we all work together as a team to really come up with an individualized treatment plan for our patients. One of the things that I love about working at UVA is that we have things to offer for patients with early and late stage disease. For our late-stage patients, we have a lot of clinical trials, especially with the medical oncologists. And like I mentioned earlier, for the patients with early-stage disease, we have a lot of exciting options for shorter courses of radiation as well as interesting surgical techniques that really help us ultimately enhance the cosmetic outcome of our surgery.

    Melanie:  Thank you so much, Dr. Shayna Showalter. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Sugar, Cancer, Women’s Health]]>
David Cole Mon, 15 Sep 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/22594-surgical-options-for-breast-cancer
How to Determine the Best Knee Replacement Option http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=22156-how-to-determine-the-best-knee-replacement-option how-to-determine-the-best-knee-replacement-optionPatients considering knee replacements are faced with a steadily increasing number of treatment options.

Which one is best for you?

Learn what to consider when thinking about a knee replacement from a UVA specialist in knee replacement surgery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1425vh5e.mp3
  • Location: Null
  • Doctors: Browne, James
  • Featured Speaker: Dr. James Browne
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. James Browne is a fellowship-trained orthopedic surgeon who specializes in knee and hip replacements.

  • Transcription: Melanie Cole (Host): Patients considering knee replacements are faced with a steadily increasing number of treatment options. Which one is best for you? Today, we’re speaking with Dr. James Browne. He’s a fellowship-trained orthopedic surgeon who specializes in knee and hip replacements. Welcome to the show, Dr. Browne. So what are some conditions which would prompt or warrant someone to even consider getting a new knee or a knee replacement?

    Dr. James Browne (Guest): Sure. Well, first of all, thank you Melanie, for having me on the show. I appreciate the invitation. Knee replacement surgery is really an option for patients who have advanced arthritis of the knee, so advance wear-and-tear of the knee joint and have failed non-operative treatment. Non-operative treatment is always the first line of treatment for knee arthritis, and knee replacement may be an option for those patients who have failed those treatment options.

    Melanie: What are some questions that people should ask the surgeon when they’re considering to have a knee replacement?

    Dr. Browne: Well, I think the first and probably the most important question that the patient should ask their doctor is whether or not they’re a good candidate for surgery. As I mentioned, knee replacement surgery is an option for some patients with advanced arthritis who have failed non-operative treatment, but certainly not all patients with knee pain need surgery. I think, furthermore, for some patients with advanced medical problems, knee replacement surgery may not be a safe option, so it’s important to really dive into these questions with your surgeon. It’s also a very important to discuss appropriate expectations in terms of outcome with your surgeon before you decide to proceed with knee replacement surgery. I think probably the most common question that I get from my patients is whether or not the time is right for them to have surgery. There are many factors that are important to think about when it comes to planning a knee replacement surgery: patient’s general health, their time away from work, some family commitments, the time it takes to get better afterwards. These are things that I think patients want to discuss with their surgeon. I think most people decide the time that’s right for them when their hip or knee pain prevents them from living comfortably and that interferes with their daily activities. But at the end of the day, it’s really up to the individual patient to make the decision about whether or not surgery is right for them and if the time is right to proceed.

    Melanie: What conditions might preclude somebody from getting knee surgery? I mean if they are a heart patient or if they have diabetes, is there anything that really makes somebody not a candidate?

    Dr. Browne: Certainly, medical conditions such as you list there are our concerns. What we try to do is address any modifiable risk factors patients may have for a poor outcome. Some factors that patients come into the office with are already optimized, we can’t do anything about it, and then we discuss the risk of surgery. But there are a lot of factors such as diabetes, as you mentioned, and patient weight, for example, smoking, that we know are risk factors to poor outcome and are areas we can potentially intervene ahead of surgery to improve the chances of a good outcome.

    Melanie: Dr. Browne, are there some non-surgical options available?

    Dr. Browne: Yeah, absolutely. So as I mentioned earlier, the treatment of arthritis really starts without surgery. Pain relievers are often the first choice of therapy for osteoarthritis of the knee. Simple pain reliever such as over-the-counter Tylenol and non-steroidal anti-inflammatory such as Motrin, which is Ibuprofen or Aleve can reduce pain and swelling in the joint. There are more potent types of pain reliever that are prescription strength, non-steroidal anti-inflammatories, and those can be discussed with your doctor as well. Exercise and physical therapy can help strengthen the muscles around the knee and this can lead to reduced pain, swelling and stiffness. Braces can also be a helpful treatment option for certain types of arthritis. Many people with osteoarthritis, particularly of the knee, are overweight. We know that simple weight loss can reduce the stress on weight-bearing joints, such as the knee, and that given the physics of the hip and knee joints, you end up putting about three to five times your body weight across these joints throughout the day, so even the loss of a relatively modest amount of weight, say, 10 pounds or so, can really reduce the stress that the joints see substantially. About 10 pounds of weight loss can result in about 50 pounds of weight reduction on the knees, so losing weight, I think, is really key for certain patients. Then finally, there are some other treatment interventions that we have such as injections, they can also help. Steroid injections in particular have been shown to be very effective at providing pain relief and reducing inflammation.

    Melanie: Tell us about some of the major differences and outcomes between different surgical approaches. Mention what the surgical approaches that you use in somebody getting a knee replacement.

    Dr. Browne: Sure. There are number of different minimally invasive techniques and various technologies that have been developed, such as computer navigation, custom cutting guides and robotics that have been implemented in knee replacement. I would say that today, there appears to be both pros and cons to each of these technologies but I think really more research is required to determine what advantage, if any, these may offer. We offer these approaches for certain select patients and in certain situations, but we really can’t claim any major long-term differences in outcomes at the moment. I think if there are benefits between these different techniques, they’re likely to be relatively small and not dramatic in most cases. I think probably the major improvements that we have seen in the past decade or so really have been in the areas of anesthesia and pain management. The advances we’ve seen in these areas have really led to a rapidly improved recovery and quicker return to function.

    Melanie: Tell us a little bit about the knee implants themselves, Dr. Browne. Are they going to set off alarms at the airport? Are people expecting full range of motion once you’ve done this? Once they’ve gotten a new knee and you’ve replaced all the ligaments, re-attached all the ligaments and gotten everything back in working order, what can they expect from those implants?

    Dr. Browne: Sure. Well, to answer your first question about setting off metal detectors, most patients with hip or knee replacements will set off metal detectors. There’s no security card that patients need to carry with them, although we do provide a card for them, if they’d like, and patient should expect to set off metal detectors. The newer type detectors are less of a problem, but certainly the older metal detectors in many of the smaller airports remain an issue for folks with artificial joints. There are so many people now in the United States that do have artificial joints that this has become fairly routine for screening at airports and so on. The other issue about what to expect after surgery is a good one, and I would tell you that each patient is different. We know that the best predictor of post-operative range of motion is pre-operative range of motion. What that means is that patients who go into surgery with really compromised function, with a very stiff knee, have lack of flexion, well, they may have some improvements in those categories, tend to still have some limitations. The patients who go into surgery with functioning at very high level, who have good range of motion, tend to preserve the range of motion after surgery as well. The ultimate goal of knee replacement is to reduce pain and improve function, and the goal of knee replacement surgery in many cases is not solely to improve range of motion.

    Melanie: What about after that? How long does a new knee last? Is this something that they can expect they’re never going to have to worry about again? Can you still get pain in the knee that’s had a replacement?

    Dr. Browne: Certainly. In terms of the life expectancy of knee replacement, we know that a knee replacement is mechanical device, just like your television, your microwave, your car, and like any mechanical device, parts can wear out, they can break, and they can fail. The failure rate of knee replacement is about 1% per year. What that means is that patients have about a 90% chance of getting a good 10-year result with their knee replacement. That number drops down to about 75 to 80% at 20 years, so about 75 to 80% of our patients, we expect to get 20 years more out of their knee replacement. A lot of knee replacements do start wearing out between your 20 and your 30 and that’s often where we see re-do surgeries come into play. So, patients should expect that if they live long enough, they may need further surgery on their knee.

    Melanie: Dr. Browne, in just the last two minutes or so, give your best advice about people considering a knee replacement and why patients should come to UVA for their knee replacement.

    Dr. Browne: Sure. Knee replacement is an excellent operation. It’s very successful in most patients. Most patients are very satisfied they had the procedure. It is important though to know to make sure that you’re a good candidate, and I think this requires good, thoughtful discussion with both yourself as well as with your family, your loved ones, and your surgeon as well. You certainly want to try all non-operative measures before jumping in the knee replacement surgery, and it is important to have a good expectation about what knee replacement surgery can offer for you, so it’s a very individual decision that each patients needs to make for themselves. Here at UVA, we are unique in that we’re the only Joint Commission Certified Joint Replacement Program in the area. We’re awarded the States and Nations by the Joint Commission for our commitment to quality and our use of evidence-based clinical practice guidelines. We have a comprehensive Joint Replacement Program here at UVA that includes a dedicated team of nurse coordinators, outpatient and inpatient nurses and physical therapies, and I think importantly, all of our surgeons are fellowship-trained in joint replacement; what that means is that we have expert training and we’re really true specialists in knee replacement. Those of us doing knee replacement and hip replacement only do joint replacement surgery here at UVA. I think, as with many things in life, volume matters and we are one of the highest volume centers in Virginia. Finally, at UVA, we’re involved in a number of innovative endeavors and pioneering research that’s been recognized nationally. I think we have a very special place here and a very special team to get the patients through the operation successfully.

    Melanie: Thank you so much, Dr. James Browne, fellowship-trained orthopedic surgeon with the UVA Health Systems. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic]]>
David Cole Mon, 08 Sep 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/22156-how-to-determine-the-best-knee-replacement-option
Having Brain Tumor Symptoms Without a Tumor http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=22026-having-brain-tumor-symptoms-without-a-tumor having-brain-tumor-symptoms-without-a-tumorPseudotumor cerebri can cause symptoms that resemble a brain tumor.

Learn the differences between the two conditions, the symptoms and the treatment options from a UVA neurosurgeon who specializes in pseudotumor cerebri.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1429vh5e.mp3
  • Location: Null
  • Doctors: Liu, Kenneth
  • Featured Speaker: Dr. Kenneth Liu
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Kenneth Liu is a fellowship-trained neurointerventional surgeon who specializes in caring for patients with aneurysms and stroke as well as brain and spinal vascular malformations.

  • Transcription: Melanie Cole (Host): Pseudotumor cerebri can cause symptom that resemble a brain tumor but is different from that. My guest is Dr. Kenneth Liu. He’s a fellowship-trained neurointerventional surgeon who specializes in caring for patients with aneurysm and stroke, as well as brain and spinal vascular malformations at UVA Neuroscience: Brain & Spine Care. Welcome to the show, Dr. Liu.

    Dr. Kenneth Liu (Guest): Thank you, Melanie.

    Melanie: So tell us a little bit about pseudotumor cerebri.

    Dr. Liu: Pseudotumor is a condition that no one really knows a lot about it. What it basically is is a patient will present with increased pressures in their brain and can develop symptoms of severe headache. They can develop visual loss, and they can have a ringing in their ears. But it can be a fairly debilitating condition.

    Melanie: People are going to have some of these symptoms, and right away they’re going to think that they have a brain tumor. It can be very scary. What red flags would people have that would send them to see you?

    Dr. Liu: I think typically these patients first go to either their family physician. And with someone who’s demonstrating symptoms of increased pressures in their brain, such as headaches and maybe visual loss, the doctor will usually have them see an ophthalmologist and also undergo some non-invasive brain imaging. Typically, the brain imaging will be fairly normal—no tumors, no aneurysms, nothing scary, anything like that. And when the eye doctor looks into the patient’s eyes, they’ll see pressure behind the eyes or fluid built up behind the eyes. In those sorts of situations, you can almost diagnose the patient with pseudotumor at that time. Typically, I’ll get involved at that point.

    Melanie: What are some risk factors for pseudotumor?

    Dr. Liu: Now, that’s a really great question. I don’t think anyone really knows the answer to that question. A lot of patients with pseudotumor tend to be young female patients from about age 20 to 35, 40 years old. They do tend to be overweight. But I do see patients with pseudotumor that are the complete opposite of that. They’re male, they’re older. So I think that there does tend to be a population of patients who can get this, but it really can affect everyone. Some people think that if you take too much of Vitamin A, you can get pseudotumor, but I don’t know that that’s really been proven.

    Melanie: So, Dr. Liu, is pseudotumor an emergent condition? If people would come to see you, you would diagnose this. Is this something emergent that you have to do something about very quickly? Can it predispose someone to stroke or other problems?

    Dr. Liu: Generally, it’s not an emergency condition, but it’s a condition I think a lot of physicians can be fooled by it because it appears benign. The result of imaging is normal and there’s no tumor, there’s nothing to worry about, but the reality is that these patients do indeed have high pressures inside their skull, high pressures inside their brain, which can lead to permanent visual loss. So it is something that should be investigated in a fairly aggressive process. And there have been patients, I’ve had patients who do present in a very emerging fashion who do need to go under treatment right away to decrease the pressures in their head and to save their vision.

    Melanie: Tell us about treatments, Dr. Liu. What treatment options are available?

    Dr. Liu: A lot of the more traditional treatment options for pseudotumor are aimed at trying to get the pressures in the head to come down. Traditionally, there haven’t been a lot of great ways to do that. Typically, patients will often experience relief when spinal fluid is drained from their brains, so either they undergo a spinal tap or have some kind of drain placed and some fluid is taken off. Typically, that will give them some temporary relief. A lot of times, when patients get relief from that, neurosurgeons such as myself, will put in something that’s called a shunt, which is basically a permanent drainage system that drains spinal fluid from the brain to another spot in your body, such as the abdomen. While these shunts can be helpful, it’s really not treating the underlying condition, and about 5, 10 years ago, some of us realized that some of that there’s a subset of these pseudotumor patients that actually have narrowing in the veins that drain blood from the brain. What that narrowing of the veins does is it essentially causes a traffic jam in the brain and causes blood to back up, and that’s why the pressures go up. You can sort of imagine it similar to a clogged toilet. So a shunt, if you were to use that analogy, a shunt is something like if your toilet’s clogged, you kind of use a bucket or a cup to drain the toilet, which doesn’t really fix the underlying issue. One of the latest treatments that we’ve been pioneering here at UVA is using a balloon and a stent to minimally invasively open up these areas of narrowing. What that does is that improves the drainage of blood from the brain, decreases the traffic jam, gets rid of the blood backing up, and these patients will actually, their pressures will actually return to normal. A lot of times, their vision will improve and their headaches will get better as well.

    Melanie: What about medications? Is there something in lifestyle changes, anything you want the listeners to know? And what kind of medications might they go on after this treatment?

    Dr. Liu: There probably aren’t a whole lot of lifestyle changes that a patient can make. A lot of us will recommend trying weight loss initially, but I know that can be very difficult, and the results are variable with that approach. Some physicians will try to, before any kind of invasive treatments, some physicians will try a medicine called Diamox to try to decrease the amount of spinal fluid that’s produced. Again, that doesn’t really treat the underlying issue of potentially having veins that are narrowed veins or blocked veins that are causing the pressures to build up, and a lot of patients don’t really tolerate Diamox that well. It makes them feel very funny. As far as medications that someone might be on, after a stent is placed, anytime a stent is put in the body, whether it’s in your heart or your brain or your leg or anywhere else, a stent -- stents are made out of metal, and so, patients will typically need to be on a short course of blood thinners to kind of keep the blood lubricated while the stent heals into the blood vessel. And that’s the same thing that happens when you have a stent placed in a vein in your brain. You will need to -- typically, we have patients on two blood thinners. One is an Aspirin. The other one is a medicine called Pladex, which I’m sure that everyone has seen TV commercials for it. But typically, patients are on these for maybe three to six months after the procedure, and then we kind of start tapering them off at that point.

    Melanie: Dr. Liu, why should patients choose UVA to receive treatment for brain conditions?

    Dr. Liu: Well, I think the great thing about UVA is that I think you have a tremendous number of very smart, very bright people here that are leaders in their field, not only in neurosurgery but in areas such as radiology and endrocrinology, and almost every specialty there has… I know there are tremendously bright people there, and they are considered national experts. For something like pseudotumor, you have neurosurgeons, myself and my partner, Dr.Crowley, who are both trained, and we’re sort of the 21st century neurosurgeons. We’re trained in both open techniques and minimally invasive techniques and we’re able to tailor patients treatments to what we think is the safest and most effective treatment option. Then I have colleagues in interventional neuroradiology who also have a lot of experience placing stents in the brain. And so actually, I think here at UVA, not only do we have lot of bright people, but there’s a tremendous amount of collaboration, and I think we’re all very excited about figuring out things that we can do to push the field forward and give and provide what we think is the best care for patients.

    Melanie: Thank you so much, Dr. Kenneth Liu. You are listening to UVA Health Systems Radio. You can get more information at uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Brain & Nervous System]]>
David Cole Mon, 01 Sep 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/22026-having-brain-tumor-symptoms-without-a-tumor
When to Consider a Hip Replacement http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=22025-when-to-consider-a-hip-replacement when-to-consider-a-hip-replacementWhat symptoms should lead you to consider a hip replacement?

What is the surgery and recovery process like?

Learn more from a UVA orthopedic surgeon who specializes in hip replacements.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1429vh5d.mp3
  • Location: Null
  • Doctors: Brown, Thomas
  • Featured Speaker: Dr. Thomas Brown
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Thomas Brown is a board-certified orthopedic surgeon who specializes in hip and knee replacements.

  • Transcription: Melanie Cole (Host): What symptoms would lead you to consider a hip replacement? What is the surgery and recovery process like? My guest is Dr. Thomas Brown. He’s a board certified orthopedic surgeon with UVA Orthopedics, and he specializes in hip and knee replacements. Welcome to the show, Dr. Brown. What are some symptoms that people would feel pain? What are some of the most common symptoms that would lead patients to even consider a hip replacement?

    Dr. Thomas Brown (Guest): Good morning, Melanie. I think the most common symptom is pain that you experience in the front of the hip that may radiate down towards the knee. Sometimes the hip pain can be confused for back pain, but that’s really more on the backside, where people experience pain that’s radiating from their back. The other symptom that’s constant with hip replacement is stiffness. People that have difficulty putting their socks and shoes on, having a hard time getting down to the toes, that may suggest that their hip joint is now getting a little bit stiff and losing range of motion.

    Melanie: So Dr. Brown, what question should patients ask their doctor when they’re considering a hip replacement?

    Dr. Brown: I think the two most important ones are, number one, the frequency in which the orthopedic surgeon performs the procedure. I think that’s like any other procedure; the more you do it, the more proficient you become at it. So I think the literature shows that surgeons that perform more than 50 hip replacements per year are pretty good at it, so I think that’s probably a good place to start with your surgeon. Secondly would be what type of approach is used or different ways of getting into the hip joint, whether from the posterior or from the backside of the hip or from the lateral approach or, more recently, a direct anterior approach, which facilitates recovery a bit.

    Melanie: Tell us a little bit about hip replacement. People are afraid, Dr. Brown, of getting a new hip, and as someone who has done their rehab so many times, I can tell you and tell them that this is one of the least recovery time, right? Tell us a little bit about the surgery and recovery time.

    Dr. Brown: Yeah. Obviously, it’s a big operation, and people are understandably anxious about it, but it’s probably one of the most successful operations performed to alleviate pain and restore function.

    Melanie: That’s what I’m saying.

    Dr. Brown: I think probably one of the biggest regrets patients have is waiting before they have their surgery after they actually decide to proceed. But again, the recovery is fairly quick. We try to get people up, out of bed, on the day of surgery to do some walking, and normally, you’re able to put full weight on your new hip right away. The stay in the hospital can be as short as overnight to 2 or 3 days, depending on the circumstances and what type of condition people are in before the surgery. But the recovery and the pain relief is really quite striking and quite dramatic early on. People would often wake up from the surgery, and the deep pain they had from their arthritic hip is gone.

    Melanie: How long does the surgery take?

    Dr. Brown: Depending on the size of the patient and the complexity of the arthritis and the reconstruction required, it can be anywhere from 1 to 2 hours for a primary hip replacement.

    Melanie: When people are experiencing this before, do you recommend, Dr. Brown, that they do some prehab before they’re going to get their new hip? Do you want them doing anything? People assume that once they’ve got a new hip, everything else is all perfect. Do you want them doing some things to the muscles that are going to surround that new hip?

    Dr. Brown: That’s a great point. I think that the stronger and more fit you are coming into the operation, the easier recovery will be. I think that’s important that patients understand that even with an arthritic hip, you can still try to be active. And if you are experiencing pain prior to surgery, you’re not really causing any damage, but it’s good to strengthen the muscles beforehand, which actually will improve and speed up your recovery after the surgery.

    Melanie: Now, are there some people who are not candidates for this type of surgery?

    Dr. Brown: There are certain medical conditions that would prohibit performing hip replacement. And normally, we try to exhaust all non-operative treatment options for patients before resorting to hip replacement surgery, and that would include some physical therapy, some medications, and occasionally, an injection into the joint itself may provide some temporary relief for pain.

    Melanie: People experience pain from osteoarthritis, from rheumatoid arthritis when they’re walking, when they’re moving, but what about if they’ve got that pain that continues while resting? Is that one of those kind of red flags that would send them to see you?

    Dr. Brown: Yeah, I think usually that’s one of the factors that will finally make people decide it’s time to proceed with surgery when they cannot escape from the pain. I think everyone will start to curtail their activity, park the car closer to the grocery store, take the elevator instead of the stairs, and so forth, and do fewer things around the house. But once the pain permeates their rest and sleep time, then it’s hard to escape. I think that will be one of the deciding factors to consider having their hip replaced.

    Melanie: Dr. Brown, what about weight loss? Do you encourage weight loss before this surgery or even afterward? Is somebody’s weight a factor in whether their hip gets degraded or not?

    Dr. Brown: Absolutely. I think from a surgical standpoint, the lighter a patient comes in, the safer the entire experience is—from the anesthetic standpoint, from the surgical standpoint, the risks are lower if you come in at an ideal body weight. So that certainly is an important thing to consider before embarking on a joint replacement. From a standpoint of trying to avoid or postpone surgery, certainly, the lighter you are, the more stress you place on your hip joint. Just walking down the street, your hip is experiencing four to five times your body weight with every step you take, especially when you’re going up or down stairs. So even a modest weight loss of 5 or 10 pounds will have a big impact on the amount of force that the arthritic hip joint experiences, and that sometimes can make a difference in allowing people to put up with it for a longer period of time.

    Melanie: How long do the hip replacement -- are they a lifetime thing? They last? When can people resume that normal activity—walking? What should they be doing?

    Dr. Brown: Durability of the replacements is getting better all the time. I think historically, it was 10 to 15 years, but we have really very, very good techniques of fixing the prosthesis to the bone, which involves biologic fixation, where the bone actually grows into the metal and becomes a part of you, and that’s very durable. And also, the bearing surfaces—that’s what rubs upon what surface rub together—and we normally use either a metal or a ceramic ball with a hard plastic or polyethylene liner. There’s every indication that these may last for 2 or 3 decades. As far as when you can resume activity, it depends on the type of approaches used for the surgery. For certain techniques, it requires a short period of time where you are avoiding certain motions to allow the surgical approach to heal itself back up. Other approaches require a little bit sooner return to activity with fewer restrictions. But within three months’ time, people are back to doing most activities.

    Melanie: Dr. Brown, tell the listeners why they should come to UVA for a hip replacement.

    Dr. Brown: Well, as I mentioned before, I think experience and numbers are important, and I have two other highly qualified fellowship-trained joint replacement surgeons that work with me. We perform over 1,200 joint replacements annually here at the university. We’re one of the few centers in this area that is certified by the J-Co Certification Agency for Joint Replacement, and we also tackle many of the problems that occur, referred in from around the state for revision surgery. So we’re very careful dealing with almost any issue that arises, and we have a great staff, and I feel that we can get patients a very good opportunity to resume normal activity and alleviate their pain.

    Melanie: Dr. Brown, in just the last minute or so that we have left, give patients your best advice for those considering a hip replacement, and maybe even what their families can do to get them ready for this.

    Dr. Brown: I think probably the best piece of advice I can give is to learn more about the procedure. Do some reading. The Internet is a dangerous place to get information in terms of whether that’s going to be accurate or not, but I think there are good agencies such as the American Academy of Orthopedic Surgeons and also the American Association of the Hip and Knee Surgeons, the Arthritis Organization. All these entities have very good information for patients to learn more about joint replacement. And then discuss it with your family, and most importantly, discuss it with your primary care physician and orthopedic surgeon as to whether or not they feel that they are an appropriate candidate for surgery and if not, what things they can do in preparation for surgery to make the whole experiences safe as possible.

    Melanie: Thank you so much, Dr. Thomas Brown. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Sugar]]>
David Cole Mon, 25 Aug 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/22025-when-to-consider-a-hip-replacement
Treating External Iliac Arteriopathy in Avid Bicyclists http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=22024-treating-external-iliac-arteriopathy-in-avid-bicyclists treating-external-iliac-arteriopathy-in-avid-bicyclistsExternal iliac arteriopathy is a serious vascular condition that primarily affects high-performance cyclists.

Learn more about what causes this condition and how it can be repaired from one of the nation’s leading experts in treating this condition.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1429vh5c.mp3
  • Location: Null
  • Doctors: Cherry, Kenneth
  • Featured Speaker: Dr. Kenneth Cherry
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Kenneth Cherry is a board-certified vascular surgeon whose specialties include arterial disease in athletes.

  • Transcription: Melanie Cole (Host): Most elite athletes are custom to experiencing a certain degree of muscle pain and fatigue during high-intensity exercise. Recently however, some athletes, particularly cyclists, have reported symptoms of leg pain and weakness from an unexpected cause. This could be a serious vascular condition. My guest today is Dr. Kenneth Cherry. He’s a board certified vascular surgeon at UVA Heart and Vascular Center whose specialties include arterial disease in athletes. Welcome to the show, Dr. Cherry. Tell us, what is external iliac arteriopathy?

    Dr. Kenneth Cherry (Guest): Good morning, Melanie. It is a narrowing of the external iliac artery in essentially elite athletes. The external iliac artery, the aorta comes down in just about the level of the belly button and just in front of the spine, divides into the common iliac artery. Then that shortly divides into the internal iliac artery that feeds the pelvis and the external iliac artery. It takes blood down to the legs. In these athletes, the external iliac artery gets narrowed, and oddly enough, it’s just the opposite of all other vascular disease. It’s because they are in such good shape and exercise so much. In this country, we see it mostly in cyclists, but it can be seen in runners, triathletes. It’s being reported in ice skaters, power ice skaters, speed ice skaters. And it’s thought it’s because the external iliac artery is tethered there at the bifurcation, then these people are so fit. Their inguinal ligament is very taut, so there’s no sliding of the artery back and forth under the ligament as there is in less fit people. The other things that go with it, hypertrophy soleus muscle. It’s really the repetitive exercise. These cyclists will cycle anywhere between 5 and 20,000 miles a year, so many of them put more miles on the bicycle than people put in their cars. They’re also putting gallons of blood past their arteries quickly with their great hearts, so it’s a stretch injury, if you will, because when they bend over, they need to lengthen that artery and they can’t do it because of that taut ligament. It’s a bit of a stretch injury and then a flow injury also. I hope I didn’t talk too long on that.

    Melanie: No, that was perfect. Dr. Cherry. It’s amazing to me because the public is used to hearing that if you’re in better shape, you’re opening up your arteries and clearing them out, and this is a narrowing. Who is particularly at risk? If you’re an elite cyclist, are you then going to be more at risk if you’re putting 15-20,000 miles on your bike? Does that give you more risk or are there certain predispositions that are going to make somebody at risk for this?

    Dr. Cherry: Well, it’s an excellent question, and we don’t know the answer yet. Because you could ask, “Why didn’t Lance Armstrong get it? Why didn’t other truly elite athletes get it?” And who does and who doesn’t, we don’t know yet. But we know that cyclists are seeing, speed skaters, runners, and these people are who truly fit and really put themselves up to the limit. One of the things that we, that a radiologist in here and I have sort of independently come to the conclusion is that those cyclists who have very short common iliac arteries, where their external iliac artery begins high in the pelvis, that seems to be starting to be a more prominent theme, and so we’re looking into that right now. But it’s very seldom seen in less than elite athletes. Sometimes a very high-performing amateur can get it, but it’s not very frequent.

    Melanie: Dr. Cherry, how’s it treated? What do you do and what symptom? So they come to you with this claudication with this leg pain. They don’t know why. They can’t explain it. They assume it’s probably muscular or something like that. What do you do for them?

    Dr. Cherry: Well, if indeed they have it and we bring them in and we put them on bicycles, they bring their pedals and we have a cycle, and they cycle until they get their symptoms. We have measured the pressure in their arteries before, and then we do it immediately afterwards to see how far it drops. Invariably, if they have it, it will drop. And then we get specialized our arteriogram, where they put a catheter in their artery and they take a picture. That’s done with the patients supine, lying on their back, as it is with all patients. But then we have these patients flex their hips for the stress position they’d have cycling, and that will accentuate any abnormalities they have. If we see the abnormality and they wish to proceed, then we will go ahead and perform an operation. If it’s localized and early in the state of this disease, we can do what’s called a patch angioplasty; sew a piece of plastic artery over that area with or without an endarterectomy, where we clear it out. It’s an interesting arterial problem because it involves all the layers of the wall. It’s not just the inside of the wall of the entire artery; all three layers are involved. If it is more extensive, then we’ll replace that part of the artery with a bypass graft. And we’re also relaxing the inguinal ligament with the small incision there and hope don’t recapitulate the injury later.

    Melanie: Well, that would certainly be the goal so our athletes are able to return to their peak performance, unless they’re ready to settle down into a sedentary lifestyle, Dr. Cherry. This current treatment, this is what you’re doing. Are they able to return to their lifestyle that they have?

    Dr. Cherry: The majority, around 85 percent will go back to their peak performance or performance they’re happy with. There’s been one of my patients who’s spending the last two Olympics in bicycling and has done well, and there are others that do well. Some don’t do as well, and some of it has to do -- you know, if I’d do the same operation and a 70-year-old who needs it because they can’t walk to the grocery store, they’re having [rest] pain, I probably have all sorts of leeway in the link so I can make that graft. With these very elite athletes who are putting these grafts to such stress, I have much less leeway. If you make it too short, they’ll narrow where you sew it in. It’ll pull taut there. If you make it too long, it will kink. So there’s a very narrow window in there to get the length right. And I think that has a lot to do with it also, with those that don’t recover fully.

    Melanie: Do you have any advice for athletes when you first meet them? They’re worried because this is a lifestyle that they’ve developed and that they are used to. Do you have any best advice for them either before or after the surgery what they should be doing differently?

    Dr. Cherry: Well, we used to have a physical therapist here who’s a very avid and very excellent cyclist, and I would link him up with these patients when they came. Because of his knowledge of bicycling and his interest in it, some of these people, he could spot and say, “Well, you know, they had their pedals fired too far forward, or, “The seat height wasn't right.” One of the things that we do, especially if it’s early, is have them work with a trainer to see if some adjustments in the seat height, where the pedals are, their mechanics might make a difference. There are some things that I’m not clever enough myself to spot, but people who deal in that, the physical therapists and the trainers can. Then it becomes a question of how much they wish to proceed. Many of these people don’t have to go to a sedentary lifestyle, but if they didn’t want the operation, would have to accept a less strenuous lifestyle. And for these young people who’ve made it their lives, that’s a hard thing to do, so most of them wish to proceed.

    Melanie: Dr. Cherry, other than the fact that you are one of the nation’s foremost experts on this condition, why should someone come to UVA for their treatment?

    Dr. Cherry: Well, I think because we’ve seen that it’s a rare condition. I get calls from people all the time say, “Well, we’ve got the arteriogram and they don’t have it.” Yet when we review the arteriogram, they do have it, because they’re at first subtle changes that you see. As I say, I think over the course of time, it’s like anything. If you do enough of it, you pick up subtleties and nuances that you didn’t realize just a few years ago. We published a paper about 2 years ago on this, and many of the things that we do then, we have changed subtly in the time period because of a number of patients we see. So I think that’s the benefit.

    Melanie: Well, thank you so much, Dr. Kenneth Cherry. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thank you so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic, Heart Disease]]>
David Cole Mon, 18 Aug 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/22024-treating-external-iliac-arteriopathy-in-avid-bicyclists
When Children May Benefit from Robotic Surgery http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=22023-when-children-may-benefit-from-robotic-surgery when-children-may-benefit-from-robotic-surgeryRobotic surgery has increasingly become a minimally invasive option for adults in recent years, but what about for children?

Learn when robotic surgery may be a choice for pediatric patients from a UVA specialist in pediatric urology surgeries.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1429vh5b.mp3
  • Location: Null
  • Doctors: Corbett, Sean
  • Featured Speaker: Dr. Sean Corbett
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio:

    Dr. Sean Corbett is a fellowship-trained pediatric urologist whose specialties include caring for a wide range of kidney conditions in children.


    UVA Children’s Hospital

  • Transcription: Melanie Cole (Host): Robotic Surgery has increasingly become a minimally invasive option for adults in recent years, but what about for children? My guest is Dr. Sean Corbett. He’s a fellowship-trained pediatric urologist whose specialties include caring for a wide range of kidney conditions in children at UVA Children’s Hospital. Welcome to the show, Dr. Corbett. Tell us a little bit about robotic surgery, and what are some of the goals of using it?

    Dr. Sean Corbett (Guest): Well, thanks Melanie, and thanks for this opportunity. Robotic surgery is one of the tools in our tool box which has expanded our ability to treat patients of all ages in a minimally invasive approach. The robot just facilitates what we used to or traditionally did with laparoscopic surgery, where it allows much greater range of movement and hand visibility with 10 times magnification, improved precision, high-definition 3D visualization. So it really facilitated our ability to do a lot of things that we’ve traditionally done laparoscopically but now are able to do robotically in a much easier fashion.

    Melanie: Dr. Corbett, give us an example of some of the conditions that you’re using robotic surgery to treat.

    Dr. Corbett: Sure. Well, there are number of conditions. And really, the envelope continues to be pushed by centers, with the greatest amount of experience here at UVA. Some of the conditions that we’ve treated are certainly most commonly what’s known as hydronephrosis or children with ureteropelvic junction obstruction. We’ve treated them with robotic-assisted laparoscopic pyeloplasty but also kidney reflux, duplicated kidney systems, ureteroceles, bladder surgery where we need to augment the bladder in the case of children with spina bifida. So really, a whole host of procedures across the board with regards to pediatric urologic condition.

    Melanie: Now, what children might this be an option for? Are there some that really are not candidates for robotic surgery?

    Dr. Corbett: I think that’s a very good question, Melanie. I think in the appropriate hand, the robot really facilitates robotic surgery across the board. Certainly, in my experience, for the really small child or infants, rather -- and we’re talking less than 5 kilograms, it becomes certainly a much greater challenge to perform a procedure on that smaller, infant, child laparoscopically or robotically. But aside from the size -- and there aren’t a lot of children that aren’t good candidates for robotic surgery unless they’ve had multiple previous abdominal surgeries. That might be the only other indication where robotic surgery is not the best first option.

    Melanie: So, Dr. Corbett, let’s talk a little bit about some specific conditions. Hernia repair. This is quite common in children—boys, especially. Tell us a little bit about what’s involved in hernia repair. How would a parent spot a hernia in their child?

    Dr. Corbett: Well, a hernia in a small child or an infant, it’s a very different disease condition that it might be in an adult. A hernia in a child is something that’s known as congenital abnormality, and the connection between the abdominal cavity and the scrotum remains open, which allows either fluid to communicate or even the intestines to herniate through. And that is a surgical condition that typically or certainly, traditionally, has been treated with an open incision in the groin in order to repair the defect. But more frequently, we are approaching this from a minimally invasive standpoint and a laparoscopic approach or a laparoscopic percutaneous approach is what I commonly employ in the infants that I’ve worked with. The robot, because the procedure is so quick and have a specific role as of yet in the treatment of this condition.

    Melanie: What can parents expect after a hernia? Is there a long recovery period, or are the children pretty much great afterward?

    Dr. Corbett: You know, it’s somewhat dependent on the age of the child. But most of the infants and children are back to their normal routine, really, within a day or two. That’s the great thing about the minimally invasive approach, especially, but also working with children infants, is that they tend to recover very quickly and even more so with the minimally invasive approach.

    Melanie: Now, so with the robotic surgery, discuss one of the treatments that you use it directly for on children and what you’ve seen as the outcome.

    Dr. Corbett: Sure. I mean the most common to these conditions that I would treat with the use of the robot is what’s called performing a pyeloplasty. So we do a robotic-assisted laparoscopic approach, and essentially, that’s a condition where the urine draining from the kidney is blocked at the junction between the kidney, essentially, and what’s called the ureter tube, which is the draining tube from the kidney. So there’s a congenital abnormality that results in a blockage there. So, with the robot, were able to go in, cut out that defect or the abnormal portion, so that you could portion this back together. The children do really well with this. The procedure itself takes about two hours, a little bit longer just in terms of the time that they’ve been in the operating room that’s until to put them to sleep to wake them up, to do the imaging studies at the beginning of the procedure. But the overall procedure is about two hours. The children usually stayed just overnight in the hospital and so, almost all of them will go home by the next morning, or certainly, early afternoon. And they recover very quickly. I mean it’s fantastic to see the difference between the way children recover. When I started this and we were doing all of these procedures through open flank incision—so, a generous incision through the flank underneath the ribcage—and now we do it with three smaller little incisions. So the children do fantastic with it and the repair rates are fantastic. I mean, they’re certainly comparable, if not better, I think in certain hands, then the traditional open or even the laparoscopic approach is.

    Melanie: Dr. Corbett, you’re dealing with parents—worried, scared parents. What do you tell them when you say, “We’re going to use robotic surgery.” how do you calm their fears?

    Dr. Corbett: Well, I mean I think that’s not significantly different irrespective of the type of procedure that’s being performed. Again, the robotic approach is a minimally invasive approach, just like the laparoscopic approach is, but the goals of the operation are the same, irrespective of how we’re approaching it, whether it’s a minimally invasive or if it’s an open procedure, a traditional open procedure. So, in talking to the parents, number one, I always try to put myself in their shoes and relate it to my own children, and certainly, if they needed this type of procedure, would I have it done on them. Obviously, I think not every child needs an operation, and we’re not going to push it if it’s not necessary. But in those children that are candidates, it’s reassuring to the parents to know that if it was my child, I would use the same technology. Again, we have the capability here at UVA to do it minimally invasively—that’s robotically or pure laparoscopically—or open. But again, I think the benefits of the robot are starting to prove themselves. And again, if it was my child, I would operate on them robotically or have it done robotically, I shouldn’t say. Personally, I think it’s a little hard to operate on your own children, but I think that helps relieve some of the fears or tensions they have to know that we’re doing the same operation irrespective of the approach. But the robot certainly offers a nice approach for them with the same outcomes as the other approaches.

    Melanie: Dr. Corbett, in just the last minute, why should families come to UVA Children’s Hospital for their pediatric urologic care?

    Dr. Corbett: Well, I think we’re fortunate here because we have some of the greatest specialists certainly in the state. We’re the only institution in the state that offers robotic surgery for pediatric urologic conditions, and so, the expertise that we’ve been able to develop here, I think, is a very nice option for families that want to first do a minimally invasive approach for management of disease conditions within their children.

    Melanie: Well, thank you so very much. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health, Sugar]]>
David Cole Mon, 11 Aug 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/22023-when-children-may-benefit-from-robotic-surgery
Streamlining Weeks of Cancer Treatment to One Day http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=22022-streamlining-weeks-of-cancer-treatment-to-one-day streamlining-weeks-of-cancer-treatment-to-one-dayA team at the UVA Cancer Center is streamlining treatments for patients with tumors that have spread to the bone from weeks to a single day.

Learn more about how the treatments work and which patients may benefit from a UVA radiation oncologist who specializes in improving radiation therapy.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1429vh5a.mp3
  • Location: Null
  • Doctors: Read, Paul
  • Featured Speaker: Dr. Paul Read
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Paul Read is a board-certified radiation oncologist who specializes in working to develop more effective cancer treatments with fewer side effects.

  • Transcription: Melanie Cole (Host): A team at the UVA Cancer Center streamlining treatments for patients with tumors that have spread to the bone from weeks to a single day. My guest is Dr. Paul Read. He’s a board certified radiation oncologist at the UVA Cancer Center who specializes in working to develop more effective cancer treatments with fewer side effects. Welcome to the show, Dr. Read. Tell us, describe for us how your team’s approach is different for treating cancer that had spread to the bone.

    Dr. Paul Read (Guest): All right. We recognize that this is a very painful condition for patients and that anything that we could do make this process simpler for them and more efficient would be of great value to the patient, and their families, who have to bring patients, sometimes from a long distances, to get treatment. We analyze the entire workflow of treating somebody who has spread of cancer to the bone and came up with a strategy that included making sure that all of the people who need to perform a specific task knew exactly when we’re going to treat them, when they needed to do their part, their role. Instead of doing a kind of one day then the next day, then the next day, we were going to do it over very short time period, and also developed whole new systems for doing quality assurance for patients to make sure that the treatments are safe. And when we combined these approaches, we came up with a strategy to treat patients in actually less than a single day. We’re actually looking at patients in under three hours. So they come in and have a consultation with the radiation oncologist, and they have a CT scan. And then we draw on that CT scan the area where the tumor is and what we want to treat, and then we develop a treatment plan and we do the quality assurance, and then we give the patient the treatment, all within about three hours. In most places in the country, when patients go to get treated for spread of cancer to the bone, it’s over a five to ten treatment course. So you can imagine driving back and forth if you live 50 miles from UVA with painful bone cancer, how much better and more efficient this would be for patients.

    Melanie: Dr. Read, that’s amazing. Tell us how that multidisciplinary approach, how do you get everybody on the team together for that one day? Aren’t people running in all different directions and busy with different other things? How do you get them all together for that one patient?

    Dr. Read: Well, I think the people who are involved include the physicians. People call dosimetrists; who do the radiation planning, CT technologists; physicists, who check the safety of the plan; and then radiation therapist, who actually deliver the treatment. And in addition, the nurse will see the patient to make sure that they have adequate pain management during this process. Redesigning workflows isn’t that hard. All this work has to be done regardless, as long as we basically have built a system where we have email that get sent out to everybody and we also discuss things, that we have a patient that’s coming in two days and this is how it’s -- when we’re going to do this, start the treatment, and this is when the process we anticipate ending it, and we just make sure that everyone knows to adjust their schedule accordingly so that they can do their part. It’d be like if you went to a restaurant for dinner, and all you got the first day was salad, and then you went to the second day and you got your main course, and then you went your third day and you got your dessert. That’s how it currently is in many places. But if you can coordinate it so that you go once and have the entire process, it’s just much easier for patients.

    Melanie: I think it’s amazing for patients. So which patients may benefit from this treatment option?

    Dr. Read: We’re treating patients who have spread of cancer to bones, for the most part. That’s where we’ve started this procedure. We may ultimately extend it to other types of cancer patients, but right now, we have a clinical trial that’s open, and we have funding from Medicare to develop this process, this new type of workflow process for patients. We’re focusing on patients that have pain from spread of cancer to bone and one to three places on this trial.

    Melanie: So, what other changes to cancer treatment are you examining there?

    Dr. Read: Well, I’m working with several palliative care physicians within our department, which is a very unique situation. There’s been a lot of publications recently and discussion at national-level meetings and organizations that have really recognized the value of having palliative care physicians who focus on the patients’ wellbeing and their quality of life during their cancer treatments. We have palliative care physicians who work in our department. We work very closely with them, and we’re pioneering a new strategy called patient-reported outcomes. In this strategy, when patients come to the cancer center, particularly patients who have advanced cancer with a lot of symptoms, we have them fill out a very simple questionnaire on an iPad. It asks them questions like how much pain do you have and questions about whether or not they have anxiety or depression and how their bowels are functioning and so forth. All of this goes into the computer and it’s tracked over time. So instead of the electronic medical record just having numbers of blood values and things that physicians or nurses say, this is a place for the patients’ voice of how they’ve felt during this process, whether they’re feeling better or worse. And in just a couple of weeks, we’re going to automate this to have automatic triggers so that if a patient tells us that their anxiety or depression or pain has gone way up or has gone beyond the threshold, it’s going to have a big flag alert when you open up their chart that this patient needs to have this addressed. This is a distressing problem for them. We actually have a group from Duke who’s coming up to visit us to kind of see exactly what we’re doing because it’s very pioneering type approach. It sounds simple, but actually making it happen with large groups of people, making sure that everyone understands how the process works takes some time. But we think that this is really going to benefit patients. Another thing that we’re doing within our department that I’m not directly related with but that is very exciting is breast intraoperative radiation therapy. And Dr. Kim [Shaw-Walter] is the radiation oncologist at UVA, and the breast surgeons are actually doing lumpectomies of the breast, removing tumorous tissues and normal tissue around it, and then doing the radiation all at one time while the patient’s under anesthesia so that they can have their surgery and a full course of radiation all at one time. They don’t have to come back and forth for radiation after the surgery. And this is also being done on a clinical trial. So, very exciting, I think.

    Melanie: It’s so important that patients have a voice, and how wonderful that they get it there. So, why should cancer patients come to UVA Cancer Center for their care, Dr. Read?

    Dr. Read: Well, it’s unusual if you live in a rural location like Charlottesville to have a resource like this with as many nationally recognized experts as we have and specialists in so many areas who really focus on what your particular problem might be. So you can come and have really nationally recognized experts take care of you and give recommendations. I think it’s very important that patients consider coming to UVA even if they have been seen by their local oncologists for consideration of getting a second opinion to make sure that there’s not options that haven’t been fully described to them that may be available to them. We also have very advanced technology, and there’s a real emphasis on teamwork and quality right now that I think is just terrific, and I think it’s just going to make the care better and better.

    Melanie: That’s wonderful, Dr. Read. And in just the last minute that we have left, really give us your best advice for how patients benefit from this streamlined cancer care.

    Dr. Read: Well, first of all, the treatment itself is highly targeted to the tumor, so the radiation is targeted really just to the area where the bone metastasis is as best as we can so that we spare the normal tissues around these high doses of radiation to minimize toxicity. We have shown that patients really get very rapid pain relief because we give a fairly high dose of radiation with this. On this clinical trial, we’re giving what would be a week or two weeks’ worth of radiation in a single setting. So it’s fairly high dose radiation. And patients get rapid relief within a week and can start taking this pain medication. It’s a cost-effective approach. If the patient have has significant co-pays, perhaps this would benefit them. And it’s obviously very convenient for patients and their family. So, cancer really affects not just the patient but their family. If somebody has a painful disease, frequently a family member has to bring them and take off from work. And if you can provide a service to patients like this in such a convenient setting where we frequently try and organize it so that it’s around another visit with another physician even at the cancer center so that they can come, have this done, perhaps see another physician for another reason, that’s just, I think, a win-win for the patient and their family.

    Melanie: Thank you so much, Dr. Paul Read. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 04 Aug 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/22022-streamlining-weeks-of-cancer-treatment-to-one-day
Diagnosing Neuromuscular Disorders http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=20675-diagnosing-neuromuscular-disorders diagnosing-neuromuscular-disordersNeuromuscular disorders include a range of diseases from muscular dystrophy to ALS, or Lou Gehrig’s disease.

Learn more about how these diseases affect your body and how they are diagnosed from a UVA neurologist who specializes in neuromuscular disorders.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1425vh5d.mp3
  • Location: Null
  • Doctors: Gwathmey, Kelly
  • Featured Speaker: Dr. Kelly Gwathmey
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Kelly Gwathmey is a board-certified neurologist at the UVA Health System who specializes in caring for patients with neuromuscular disorders.

  • Transcription: Melanie Cole (Host): Neuromuscular disorders include a range of diseases from muscular dystrophy to ALS or Lou Gehrig’s Disease. We’re going to learn today about how these diseases affect your body and how they are diagnosed from a UVA Neurologist who specializes in neuromuscular disorders. My guest is Dr. Kelly Gwathmey. She’s a board-certified neurologist at the UVA Health System who does specialize in caring for patients with neuromuscular disorders. Welcome to the show, Dr. Gwathmey. So what are neuromuscular disorders? For the listeners, what parts of the body do they generally affect?

    Dr. Kelly Gwathmey (Guest): Hi Melanie, thanks for having me. Yes, neuromuscular disorders are any neurological disorder that affects the peripheral nervous system, which is pretty much everything outside of the brain and the spinal cord. The neuromuscular conditions can include any disorder that affects the muscle, the nerves, the nerve and muscle junction, the nerve routes as they exit from the spinal cord, or the anterior horn cells, which are the motor nerve cell bodies in the spinal cord. That’s what’s affected in ALS or Lou Gehrig’s Disease.

    Melanie: So people hear about these, Dr. Gwathmey, and they are scared. I mean, right off the bat, people think of neuromuscular disorders and they think of losing their abilities to move, to think, to walk. So tell us a little bit about the neuromuscular disorders. What are some common symptoms? People always want to know symptoms in case they need to run to a doctor.

    Dr. Gwathmey: Right. So the patients that I see with neuromuscular conditions usually have weakness or numbness. A lot of times they’ll just have burning or tingling in their hands or their feet. Sometimes I see patients with double vision—they see two of everything. And sometimes, patients even develop difficulty swallowing or slurred speech, and sometimes shortness of breath.

    Melanie: So if people are experiencing these symptoms and they have them for just a little while, then they come in to see you, what can they expect from testing for a neuromuscular disorder? How do you find out what it is they got?

    Dr. Gwathmey: Right. So with any patient, we take a good history, and then we’ll do a very thorough neurological exam. And most of the time, that’s followed by an EMG or electromyography, which is really our main tool that we have to aid in the diagnosis of neuromuscular disorders. The stuff is two parts, and the first part is the nerve conduction studies where what we’ll do is we stimulate over the nerves in the arms and the legs with a little bit of electrical current and we record the responses. And then the second part is the EMG or electromyography, where we use a tiny little needle and we study the muscles in the arms and the legs, and sometimes, in the back muscles as well. So this test helps us diagnose the vast majority of any peripheral nervous system problem.

    Melanie: So once you have diagnosed one of these diseases -- and I know we’re talking in very broad terms here, but something like ALS, people hear that, Lou Gehrig’s Disease, and it’s pretty scary-sounding. So what kinds of treatments are out there for general neuromuscular disorders? And you could even pick a few out if you want, like ALS, and give us some of the things that you do for patients to help them, whether it’s symptom management or all-out treatment.

    Dr. Gwathmey: Right. So it does vary, depending on the disease, of course. A lot of the patients that I follow have auto-immune conditions, so their immune system is attacking a part of their peripheral nervous system, if it’s the muscles or the nerves, or even the nerve and muscle junctions, such as the Myasthenia gravis. And the good news about these conditions is it does respond very well to immunosuppressant or immunomodulatory therapies, so medications that target the immune system. And those patients, we have a lot of success treating them. Sometimes, in our patients that have neuropathies—so burning, tingling, pain in their feet or numbness in their feet, we can’t identify a treatable or reversible cause. And so then our attention shifts to symptom management so we can treat their symptoms with medications to take away that burning or tingling pain. And then you asked about ALS or Lou Gehrig’s Disease. Right now, there is no cure for that disease. We do have one medication that’s FDA-approved that we treat patients with a pill, and we follow these patients in our multidisciplinary ALS clinic, which is a wonderful clinic that has both physical therapists and occupational therapists. We also have respiratory therapy, nutritionists, physicians like myself and a nurse coordinator. So those patients that require a lot of different things can kind of come to UVA for one-stop shopping, if you will, and see a lot of different practitioners and visit, which is something nice that we have to offer.

    Melanie: So with this multidisciplinary approach, whether it’s physical therapy, occupational therapy—and I’m talking about ALS here—so what can they expect? What are, not the outcomes per se, but what are the intended treatment plans for occupational therapy, speech therapy, breathing care, any of these things they might need for ALS?

    Dr. Gwathmey: Right. So it’s very nice. So we typically see the patient once every three to four months on average. And again, they’re seen by all these different practitioners. And then we have a team meeting both before the clinic starts and also after the clinic is over to discuss every patient in detail. So we really formulate a plan for the patient as a team, which is something that’s very unique to this multidisciplinary clinic. So the respiratory therapist, for instance, will make recommendations regarding what settings the patient needs for their breathing equipment, whereas the neurologist might make recommendations for how to treat their secretions that they have or their cramping. So we all kind of work together as a team to make sure the patient has everything that they need, and they’re followed very closely by the clinic. And additionally, the nurse coordinator keeps in touch with them on a weekly to monthly basis by phone or email as well to just check in, which is nice.

    Melanie: What about sort of support and coping? A disease like this can be devastating to a family and to get that news. What do you say to your patients to give them a little bit of hope through this treatment?

    Dr. Gwathmey: Right. It is, of course, a very devastating diagnosis. So here at UVA, we do participate in clinical trials as they become available, and we’re always looking for clinical trials to participate in, specifically for ALS since it is such a devastating disease. For that reason, UVA is a great choice because that will be available to our patients as they come along. Also, I think we really emphasize that we will do everything for the patient as well as the family members to support them through this very difficult time. We have also social workers available in the clinic. We have representatives from the ALS Association and Muscular Dystrophy Association that help provide all the resources that the families need.

    Melanie: Okay. So when people are going through this, there’s plenty of multidisciplinary approaches and a lot of coping and support for these neuromuscular disorders. And if you would, just in the last couple of minutes, Dr. Gwathmey, tell us, why should patients with neuromuscular disorders come to UVA for their care?

    Dr. Gwathmey: Right. So patients with neuromuscular conditions should come to UVA for many reasons. We have several neuromuscular specialists who have dedicated their careers to studying and treating this patient population. In addition to using EMG now at our lab at UVA, we’re starting to use also nerve and muscle ultrasound, which is painless and non-invasive, to help diagnose some of these disorders. So that’s sort of exciting. And then finally, as I mentioned earlier, we’re participating in a lot of different clinical trials for everything from nerve problems to muscle problems to the nerve and muscle junction problems such as myasthenia gravis. So it’s a very exciting time. We almost always have something new to offer to our patients that maybe have gone somewhere else and sort of exhausted all of their options. We always have something new, a new trick up our sleeves to try.

    Melanie: Well, thank you so much, Dr. Kelly Gwathmey, board-certified neurologist at the UVA Health System who specializes in caring for patients with neuromuscular disorders. You’re listening to UVA Health System’s Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Neurological Disorders]]>
David Cole Mon, 28 Jul 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/20675-diagnosing-neuromuscular-disorders
Spotting and Treating Aortic Aneurysms http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=20639-spotting-and-treating-aortic-aneurysms spotting-and-treating-aortic-aneurysmsFor patients with aortic aneurysms, symptoms often don’t begin until the aneurysm ruptures, which can be fatal for patients.

Learn more about the risk factors and treatment options from a surgeon at the UVA Heart and Vascular Center who specializes in treating aortic aneurysms.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1425vh5c.mp3
  • Location: Null
  • Doctors: Ghanta, Ravi K.
  • Featured Speaker: Dr. Ravi K. Ghanta
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Ravi K. Ghanta is a board-certified surgeon who specializes in caring for patients who need heart surgery, including patients with aortic aneurysms.

  • Transcription: Melanie Cole (Host): For patients with aortic aneurysms, symptoms often don’t begin until the aneurysm ruptures, which can be fatal for patients. My guest is Dr. Ravi Ghanta. He’s a board certified surgeon who specializes in caring for patients who need heart surgery, including patients with aortic aneurysms. Welcome to the show, Dr. Ghanta. What is an aortic aneurysm?

    Dr. Ravi Ghanta (Guest): Well, thank you, Melanie. Thank you for having me on your program. An aortic aneurysm is an enlargement of the aorta that is one and a half times its normal size. I don’t know if everyone knows, but the aorta is the largest blood vessel in the body. It extends from the heart all the way down to the abdomen. The feared complication of an aortic aneurysm is that it may burst or tear. We call bursting a ruptured aneurysm, and we call tearing an aortic dissection. Larger aneurysms are more at risk for bursting or tearing, and when it happens, the outcomes can be poor. So our goal as doctors is to prevent this from happening. We characterize aortic aneurysms based on their location in the body. I kind of think when I talk about the aorta, I describe it as shaped like a candy cane and a short stalk emerges from the heart, and that short part of the candy cane is called the ascending aorta, and this gives rise to arteries to the heart, actually. The curve of the candy cane is called the aortic arch, and this gives rise to the blood vessels, to the shoulder, to the arms, and the head. The long stalk of the candy cane is called the descending aorta, and the descending aorta is also divided into the chest and the abdomen. The chest portion is called the thoracic aorta, and the abdominal portion is called the abdominal aorta. The diagnosis and management of aortic aneurysms really depend on where in the body the aneurysm is located.

    Melanie: Okay. Who is at risk? Are there certain risk factors controllable and maybe non-controllable for aortic aneurysm?

    Dr. Ghanta: There are. Older patients or elder folks are definitely more of a risk for aortic aneurysm. They do develop over time. Patients with a long-standing history of high blood pressure or hypertension are at risk for developing aortic aneurysms. Patients who have a long history of smoking are at risk for developing aortic aneurysm. And certain aortic aneurysms tend to reign in families, so if you have someone in your family who’s had an aortic aneurysm, or multiple family members who’ve had an aortic aneurysm, you’re at a higher risk for having one yourself. Patients who have connective tissue disorders, such as Marfan’s disease, Ehlers-Danlos syndrome, Loeys-Dietz syndrome. And these are rarer conditions, but they are definitely genetic conditions that run through families. Other patients have what’s called a bicuspid aortic valve or an abnormal aortic valve, where a normal aortic valve, which is a valve in the heart, has three leaflets. A bicuspid aortic valve only has two leaflets, and patients who have those tend to also have aortic aneurysms. So, those type of patients who are elderly, who smoke, who have long-standing history of hypertension, or who have had other family members with aortic aneurysms, they are at an increased risk of having an aneurysm themselves.

    Melanie: Are there some symptoms, Dr. Ghanta -- so that people are afraid as you discuss a tear or rupture, are there some symptoms that would send us to see a doctor that could catch this before that happens?

    Dr. Ghanta: There are, but unfortunately, most aortic aneurysms are asymptomatic or have no symptoms. They often are identified incidentally. For example, often they’re identified when a patient needs to have another procedure and gets a chest x-ray just in preparation for that procedure—say, they have any shoulder operation, or a knee operation, and then on the chest x-ray, their aorta looks a little big. That’s how they’re identified as having aortic aneurysm. That’s often why that the first presentation is either bursting or tearing, which can be problematic. But some people do have symptoms with aortic aneurysm, and pain is a common symptom in those that have symptoms. Pain can be either in the chest or in the back or in the abdomen. Some patients have symptoms of a cough, unexplained cough, and that’s due to the aneurysm compressing on their airway. Some patients present with a change in their voice. They have a hoarse voice, and that’s because the aneurysm is compressing on the recurrent laryngeal nerve, which supplies the vocal cord. Symptoms of pain, cough, hoarse voice are associated with aortic aneurysm. That could also be due to other things, but they are associated with aneurysms. But a lot are asymptomatic.

    Melanie: If someone does come to see you, how does this get identified? Are there certain tests?

    Dr. Ghanta: There are multiple different tests. The best test is a CAT scan. It’s a two-dimensional, cross-sectional image of the body so you can see the aorta and its entirety and you can measure its size along the entire extent. And so, CAT scans are the best measurement, and they’re non-invasive, but they do involve some radiation. At present, we don’t use them as screening tests per se, unless there’s a high suspicion for an aneurysm based on risk factors or any symptoms. Other tests, as I mentioned earlier, many patients are noted to have an aneurysm on chest x-rays, so you can identify them on x-rays. Ultrasounds are also useful for identifying aneurysms. You can get an ultrasound of the heart, which does look at the initial portion of the aorta, and if that can detect enlargement, and we use ultrasounds of the heart as screening tools for aortic aneurysm to certain people, specifically people with connective tissue disorders, because they tend to have aneurysms formed at the early part of the aorta, which can be easily seen with the ultrasound of the heart. It’s also called an echocardiogram. Patients who have abdominal aortic aneurysms can also be evaluated with ultrasound at the abdomen, where the aorta can be well visualized. Unfortunately, the ultrasound cannot be used to see very well the aneurysms that involve the arch or the descending thoracic aorta. So, to identify those, we have to use a CT scan.

    Melanie: So what are some treatment options? If someone comes in, they’ve been diagnosed with an aortic aneurysm, what do you do for them?

    Dr. Ghanta: Well, when we see, identify an aortic aneurysm, the first thing that has to be done is optimal medical management. We have to maintain good control of a patient’s blood pressure, and we have to make sure they’re on appropriate medications. The appropriate medications include a class of medications called beta blockers. Some common ones are Metoprolol or Lopressor and ACE inhibitor. A common one is Lisinopril. These medications control the blood pressure and also alters the way the aorta remodels, and both those things, we believe, will reduce the rate of growth of aortic aneurysms. So it’s important when someone has identified to have an aortic aneurysm, as we have to determine the size and location and extent of the aneurysm. If the aneurysm is not large enough for us to recommend an invasive treatment, we optimize the medical management and then surveillance of the aneurysm over time. So the doctor may say, “You have an aneurysm. It measures 3.7 centimeters. It’s not large enough to require surgery or any intervention. We’ll keep your medication under optimal control, and we’ll reimage you in three months or six months.” So, surveillance. Now, when aneurysm’s either enlarged or they enlarge further or they’re already big when we identified them, then we may opt for an interventional treatment. And the intervention does depend on where the aneurysm is located, and there are really two types of interventions we do. One is open surgery, and it’s a big but safe operation. It involves the ascending aorta. It involves an incision through the breastbone, and it will be open heart surgery with the heart-lung machine, where the enlarged aorta is removed and a new aorta that’s consisted of a fabric tube is sewn in its place. If it’s an aneurysm that involves the descending thoracic aorta, surgery can be done through the ribs. And that also is a big, big operation, but it’s safe and involves replacement of the abnormal aorta with the fabric tube. Depending on the exact anatomy and location, we typically deal with descending thoracic aneurysms with a catheter-based approach, where we go through the groin with a catheter and put in a stent with a stent graft into the groin up into the descending thoracic aorta and cover the aneurysm with the stent graft. That is an evolving technology that we use quite frequently now in descending thoracic aneurysms.

    Melanie: Dr. Ghanta, in just the last minute, please tell us why patients should choose UVA for their aneurysm care.

    Dr. Ghanta: Well, UVA has a long history in management of complex aortic and cardiovascular disease. We have taken care of patients with connective tissue disorders such as Marfan’s and complex aortic aneurysms that involve virtually the entire aorta. We’re fortunate to have a multidisciplinary team here at UVA consisting of medical cardiologists who specialize in the treatment of aortic conditions and medically genetic team, which can help evaluate aneurysms that run in families and help identify other members of your family that might be at risk for aortic aneurysms. We have interventional radiologists who are really at the forefront in pioneering new interventional techniques that reduce the invasiveness of aneurysm procedures. We have vascular surgeons who also do open surgery and endovascular surgery, and we have heart surgeons who do complex aortic surgery. And so, this multidisciplinary team allows us to tailor treatments individually for patients, and really, we’re pioneering new techniques for the entire country in terms of using this new endovascular and open techniques.

    Melanie: Thank you so much, Dr. Ravi Ghanta. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thank you so much for listening. Have a great day!
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Mon, 21 Jul 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/20639-spotting-and-treating-aortic-aneurysms
Sarcomas: A Rare, Serious Cancer http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=20638-sarcomas-a-rare-serious-cancer sarcomas-a-rare-serious-cancerA rare but serious form of cancer, sarcomas often have no symptoms or non-specific symptoms and can affect almost any part of the body.

Learn more about symptoms and the treatment options available from a UVA Cancer Center specialist in sarcomas.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1425vh5b.mp3
  • Location: Null
  • Doctors: Douvas, Michael G
  • Featured Speaker: Dr. Michael G. Douvas
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Michael G. Douvas is a board-certified pediatric hematologist/oncologist and adult oncologist who specializes in caring for patients with leukemia, lymphoma and sarcoma.

  • Transcription: Melanie Cole (Host): A rare but serious form of cancer, sarcomas often have no symptoms or non-specific symptoms and can affect almost any part of the body. My guest is Dr. Michael Douvas. He’s a board certified pediatric chemotologist-oncologist and adult hematologist who specializes in caring for patients with leukemia, lymphoma, and sarcoma. Welcome to the show, Dr. Douvas. So tell us, what is a sarcoma?

    Dr. Michael Douvas (Guest): Well, in short, sarcoma is a cancer of connective tissue. We’re all used to thinking of cancers of organs, like breast, liver, lungs. Sarcomas are cancers of the material that keeps us together—muscles, bones, cartilage, fat.

    Melanie: Okay. People don’t tend to think of those, as you say. Are there any risk factors? Because we hear about risk factors for breast cancer or colon cancer, but what about for sarcoma? Are there certain risk factors that we can control and some that we maybe can’t?

    Dr. Douvas: Sarcomas affect roughly 12 to 13 thousand people in the United States annually. That’s the number that’s diagnosed. The vast majority of those patients do not have any identifiable risk factors for the development of sarcomas. The known ones are radiation, which can be either radiation that’s used a therapy—so patients who have had prior radiation for breast cancer are of very small risk for developing radiation in the radiation field. And similarly, patients who were treated with radiation for other cancers have small, defined risks for the development of sarcoma. Otherwise, there are a group of rare genetic disorders, such neurofibromatosis, Gardner’s syndrome, Li–Fraumeni syndrome, tuberous sclerosis, where there’s a risk for sarcoma. These are all pretty rare syndromes, and not everybody who has them develops the sarcoma, but they are associated.

    Melanie: So you mentioned some hereditary, some rare ones, and you mentioned radiation. I’ve heard that maybe chemical exposure, and also people have heard about Kaposi’s sarcoma. That’s immune-deficient and such. How rare are these?

    Dr. Douvas: Chemical exposure is one that’s pretty rare in terms of association with sarcoma. It’s often difficult to establish associations between chemical exposures to cancers. Kaposi’s sarcoma is, again, sort of rare sarcoma within a -- again, sarcomas are a relatively rare cancer. They are most often seen within patients with immune deficiency, most often acquired through HIV infection. Kaposi’s sarcoma was much more common in the 1980s and 1990s before the advent of highly effective therapies for HIV, and so, fortunately, it since has decreased significantly in the last 20 years with better treatments for HIV and AIDS.

    Melanie: Dr. Douvas, are there any symptoms that people might come across that would send them to see you in the first place?

    Dr. Douvas: The hard thing, as you mentioned in the introduction, is that sarcomas can occur really anywhere in the body—on the limbs, on the torso, in the head and neck. And because they’re cancers of the things that put us together, they can occur anywhere. As a consequence, they can cause different symptoms. The most common, however, are the development of a lump of some type and/or unusual pain that doesn’t go away in a particular area of the body.

    Melanie: What would someone do when they found a lump or they found particular pain? They come to see you. You do some tests. What do you do?

    Dr. Douvas: Most often, people will have been diagnosed before they see me. They’ll often go to a primary care physician or the emergency room, and in the workup of a lump or a pain, most often, a scan of some type discovers a tumor. And then they are often referred to a general surgeon or an orthopedist or a neurosurgeon for a biopsy. And then it’s after that point when a diagnosis is made that they often end up seeing me. It sometimes occurs that I’m involved in the evaluation of a tumor that’s suspected to be a sarcoma, but I’d say it’s more often that a diagnosis is established before people get to see me.

    Melanie: Dr. Douvas, what treatment options are available once it is diagnosed as a sarcoma?

    Dr. Douvas: In general, for cancer, there are three groups of treatment often, the first being surgical resection, the second being radiation, and the third being chemotherapy, which is just a large word that means medicine to treat cancer. Sometimes the chemotherapies fall within the bounds of things that people traditionally associate with chemotherapy—that is, medicines that go in through an IV and sometimes cause issues: nausea, vomiting, hair loss, the traditional chemotherapy that people think about. More often, recently, there are pills that are being used for cancer in general and sometimes for sarcomas that we call targeted therapy, where individual cancer has an identified genetic problem and a drug has been designed to specifically address that. A good example is -- there’s a tumor called a gastrointestinal stromal tumor, or a GIST, which is a sarcoma that most often arises in the stomach. It is a distinct entity from stomach cancer, and it very often has a particular molecular abnormality that a medicine called Imatinib or Glivec, that was initially developed to treat a chronic leukemia specifically addresses. These tumors used to be treated with traditional chemotherapy, and the effects were, I would say, less than optimal in terms of their ability to shrink tumors and control their growth. Imatinib, in a targeted way, attacks the tumor in a very different way by playing into its specific genetic abnormality and can be an extremely effective treatment for patients with tumors that are unresectable, or after their resection in order to prevent their recurrence. And so, again, in general, all of these modalities—surgery, radiation, traditional chemotherapy, and targeted therapies—are used to treat sarcomas.

    Melanie: And Dr. Douvas, what advice do you have for listeners about coping, support, things that they should do while they’re going through any one of these treatments, whether they’ve had surgery, radiation, chemotherapy, as you’ve discussed? When they’re going through all of these things, what do you tell them to help them?

    Dr. Douvas: Well, that’s a difficult question. There are a variety of support services that are available usually through the local treatment center. There are a lot of great support services that are through national foundations that are often specific to the type of disease that a patient has. And then, there are often a lot of services that can be found on the Internet on the web. I have a lot of patients who have found great support groups where they linked with other patients who have similar types of cancers and are going through similar types of treatments and have found these support groups extremely helpful in terms of understanding what others are experiencing and helping them to cope with their situation.

    Melanie: And why should patients come to UVA Cancer Center for their sarcoma care?

    Dr. Douvas: It’s a good question. I would say there are several reasons. Sarcoma is a pretty uncommon disease. I mentioned before that about 12 to 13 thousand people will be diagnosed with sarcoma in the United States in a year. To compare that, there are about 200 to 250 thousand cases of breast and lung cancer diagnosed annually in the United States. What this means is that hematologist-oncologists, blood and cancer doctors, are significantly less familiar with the treatment of sarcomas than they are with more common cancers. In addition, there are between 50 and a hundred different types of sarcomas, so they are a rare disease, but they’re also a very heterogeneous group. So it’s difficult even for people at major cancer centers to develop a lot of familiarity with all the individual types because they’re just, fortunately, aren’t that many of them out there. But the benefit of coming to a place like UVA is that although it’s a rare disease, we still see a significant proportion of patients diagnosed within the state and therefore are familiar with the treatments that are given, whether they’re specialized surgical techniques for resection and, potentially, reconstruction of limbs. We have dedicated orthopedic-oncologists for patients who have bone-based tumors or bone-based sarcomas. We have radiation oncologists who specialize in the latest techniques of really targeting radiation to specific areas. And, as medical oncologists, we have more familiarity with the regimens that are given for these rare tumors and how they work, what side effects to expect, how to prepare patients to go through it, and to know what is out there as far as new development, such as new targeted therapies for relatively rare tumors.

    Melanie: Thank you so much, Dr. Michael Douvas. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thank you so much for listening, and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 14 Jul 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/20638-sarcomas-a-rare-serious-cancer
When to Be Concerned About Your Child’s Stomach Pain http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=20636-when-to-be-concerned-about-your-child-s-stomach-pain when-to-be-concerned-about-your-child-s-stomach-painYoung children will sometimes have tummy aches, but when do they signal a potentially serious problem?

Learn more from a UVA Children’s Hospital specialist in children’s gastrointestinal conditions.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1425vh5a.mp3
  • Location: Null
  • Doctors: Barnes, Barrett H
  • Featured Speaker: Dr. Barrett H. Barnes
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Barrett H. Barnes is a board-certified pediatrician who specializes in caring for children with gastrointestinal conditions.

  • Transcription: Melanie Cole (Host): Little children will sometimes have tummy aches, but when do they signal a potentially serious problem? My guest is Dr. Barrett Barnes. He’s a board certified pediatrician who specializes in caring for children with gastrointestinal conditions. Welcome to the show, Dr. Barnes. What are the most common causes of stomach pains in children because they get tummy aches all the time?

    Dr. Barret Barnes (Guest): Right. I agree. Thanks for having me, Melanie. This is certainly a very common condition. We see it a lot. Ask your colleagues out in the community. It’s a huge list that if we try to rock and roll through that very quickly, it can be difficult, but I’ll try to do my best. In general, we look at the timing. Is it pain that’s been going on for more or less than two months? What is the age of the child? Are they verbal? Can they express why and where and how? Where do they localize the pain? If we then take that and divide that into things that are more common, and often, while the symptoms are real, not as necessarily harmful, we would say those are usually what we call functional disorders. They interfere with daily function. Irritable bowel syndrome is a classic example of that. In younger children, in school-age children, the most common probably functional disorder is constipation. It’s about a third of the children that we see, and it causes a lot of complaints—nausea, reflex symptoms, especially abdominal pain. And then, functional abdominal pain of childhood or what parents used to call school belly, kids that get belly pain kind of during the school year, typically gets better on holidays or on weekends. And then, even more rare conditions that are still in the functional spectrum, abdominal migraine. These children are having migraines. They’re just having more gastrointestinal symptoms than headaches. And then there is the most serious, which are thankfully less common, and those we typically think about in terms of broad categories. Could this be infectious—chronic infections like GRD or H. pylori? Could this be an anatomic issue? Could this be an acute appendicitis? Is this a chronic inflammatory condition, like inflammatory bowel disease? Is this immune-mediated—say, celiac disease? Or is this actually a manifestation of an allergic disorder, like eosinophilic esophagitis? And then finally, the last thing we have to think about is is this truly gastrointestinal or not? Many children will complain about abdominal pain, and it may have nothing to do with the gastrointestinal tract. And so, thinking about other organ systems like the renal system, et cetera.

    Melanie: Well, Dr. Barnes, you did rock and roll through all of those. So, no, that was great. When kids complain about stomachaches and, as you say, the school belly and constipation, so common, and of course, it causes all kinds of pain, when should parents be concerned that it is something more? How do we know if it’s just constipation? As a parent who keeps track of their children’s poop, I know if they’re constipated, but not all parents do. How do we know to bring them in to you?

    Dr. Barnes: Exactly, that’s a great question and one we see. First and foremost, I think any pediatrician and family doc out there in a community would always want to see your child if you have concerns. That’s if nothing else for reassurance. In general, we talk about, what we call “red flag signs” or symptoms. These are concerning signs or symptoms that the pediatrician or family doc may recognize anything that would get our attention quickly. So if you notice your child is not gaining weight, or growing well, that’s not normal. Children are supposed to gain weight and grow. If the child is having belly pain and lots of vomiting that can’t be explained, just having one too many “viral infections.” Blood from either end is never normal and needs to be seen right away. Children with recurrent trouble swallowing and children with recurrent urinary tract symptoms, any of those things would get our attention. And sometimes they can subtle. You’re exactly right. Trying to find out what your child is doing in the bathroom, for some families, it’s easier than others. There’s some families where it’s totally, developmentally normal that once the child is potty trained, they may not discuss or describe with their parents in detail what they’re doing in the bathroom. That’s normal, but that means that there are times when what they’re saying they’re doing in the bathroom, they’re not, especially with regards to go and poop. So sometimes, having that somewhat embarrassing conversation with your preteen needs to happen to make sure that they’re actually going to the bathroom every day.

    Melanie: So if parents come to see the pediatrician and it’s determined that it isn’t something more serious, then what can parents do at home? You started by saying have that discussion, learn to kind of find out what your kids are doing in the bathroom. Maybe occasionally take a look, see if there’s blood or anything so that you know. What else can we do at home? Are there over-the-counter things? What can we do?

    Dr. Barnes: Great. That’s a great question. Typically, in addition to doing what we just described, making certain that their diet is healthy, that they’re not having overt indiscretions with things that can upset the stomach. Certainly, simple sugar is a big player there, kids that drink a lot of soda, or from the Midwest pop, sweet tea, those kinds of things. They can upset the stomach, especially if you overdo it. Kids are getting way too much caffeine. Caffeine’s a great bowel stimulate. They can cause diarrhea and belly pain. So, really trying to look and see that the ingredients are. Making certain they’re having normal bowel habits. And then, is the pain distractible or not? Can you somehow get them to distract will also help. Focusing on it a lot can actually make it worse. And then, in terms of over-the-counter, there’s really not one great remedy out there. Otherwise, there would be one bottle that we’d all get in the counter instead of lots of choices. And it’s really hard to know which one to use in younger children. Toddler, infant age, we wouldn’t recommend any of those things. There are some supplements that have been shown in the literature to offer some benefit. Probiotics in particular, these are good bacterial species. We’re all supposed to be colonized with them, and taking them on a regular basis can reduce many gastrointestinal complaints. The kids that are having belly pains with some reflux complaints or heartburn, trying a topical antacid like calcium carbonate—the brand name there would be something like Tums, or something similar like Maalox—can offer relief. And if they’re having headache at the same time and they’re old enough to take medications like nsaids or acetaminophen, that’s a reasonable choice. It’s just, again, you don’t want to overdo it. You may cause more problems. Those are the simple things we usually tell families to do at home. And if those aren’t working, then it may be time to consider seeing a pediatrician again or, more importantly, a pediatric gastroenterologist.

    Melanie: Dr. Barnes, I’d like to jump back to probiotics for a minute because this is a great suggestion. Do you have any specific way? I mean, can kids get it by eating a good quality Greek yogurt? Can they get it in a chewable tablet? How do you like them to get their probiotics?

    Dr. Barnes: Yeah, it’s a great question. There are lots of different ones available on the market. There are a few that have actually been studied in the literature, a few species and multiple species. Typically, that part of the market is -- there are lots of varieties now: powders, capsules, and chewable forms. And then, obviously, yogurt manufacturers have started to add those products back in. In general, there’s not one we think that is better than the others yet. They’re probably will at some point be a combination that is really proven to be the best. And so, in general, we just say a standard probiotic once a day is probably beneficial. Yogurt is an easy and great way to get it into your child. However, you need to make certain that the yogurt actually have not just live cultures but the added probiotic. And they only work if you take them every day. If you stop taking them or use them intermittently, you will revert invariably almost back to your native species, which may or may not be what you’re born with. It may have changed over time depending upon where you’ve lived, what you’ve eaten, antibiotics, et cetera.

    Melanie: This is such great information. And what about preventing the stomachaches? We’ve talked about probiotics and good diet. Is there something psychologically we can do with our children, Dr. Barnes, to kind of ward off before they have, maybe, school belly? We don’t have a lot of time, but is there a way that parents can kind of just pass it off?

    Dr. Barnes: Sure. It’s common sense things. Hand hygiene. In school, you’re washing your hands to reduce the risk of infection with soap and water. Asking your pediatrician, “Why is my child going on antibiotics? Is this truly a bacterial protection?” So avoiding overuse of antibiotics, making certain they have a healthy diet with a variety of food sources, trying to eliminate stress and finding healthy outlets for stress, physical activity, exercise, family time together, doing things; working together to try to reduce stress; increasing physical activity; and then, obviously, paying attention without going overboard to bowel habits—how often they’re pooping, what does it look like, any concerns.

    Melanie: And why should families come to UVA Children’s Hospital to receive care for stomach problems?

    Dr. Barnes: I can give you multiple reasons, but I’m going to give you two quick ones. One is that we have four outstanding pediatric, board-certified gastroenterologists, three outstanding nurses, one nutritionist, and two administrative assistants that all practice state-of-the-art medicine. A more specific example is you really want to go to a place where you’re at the cutting edge, and a good example of that is our eosinophilic esophagitis clinic that’s a multidisciplinary clinic within PGI, where you’re going to see a gastroenterologist, two allergists, a nutritionist, and it’s all put together by an outstanding nurse coordinator that allows Dr. Commins or Tropathy, our two allergists and myself to think at our highest level. And then, we work very closely. We’re taking medical nutritionists to make certain that the families are getting the whole picture. So, for a relatively rare disorder, a food allergy problem, you’re going to see three different doctors, a nutritionist, and then have a nurse put it all together. You’re not going to get that in most communities. So, whether you have a general GI issue and you just need to see a gastroenterologist that’s going to be able to kind of piece that out, whether it’s simple constipation, or maybe something more worrisome, like inflammatory bowel disease, or you truly have a relatively rare disorder, eosinophilic esophagitis, a food allergy condition that leads to troubled swallowing. We’re going to offer that all here at UVA in a way that’s family-centered and family-friendly.

    Melanie: Thank you so much, Dr. Barrett Barnes. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening. Have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Mon, 07 Jul 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/20636-when-to-be-concerned-about-your-child-s-stomach-pain
Signs and Symptoms of Dementia http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=19950-signs-and-symptoms-of-dementia signs-and-symptoms-of-dementiaWhile memory loss is the best known symptom of dementia, it’s not the only symptom – and memory loss alone doesn’t mean you have dementia.

Learn more from a UVA specialist in dementia and other memory disorders.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1420vh5d.mp3
  • Location: Null
  • Doctors: Manning, Carol
  • Featured Speaker: Dr. Carol Manning
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Carol Manning is a board-certified clinical neuropsychologist who directs UVA’s Memory and Aging Care Clinic and specializes in caring for patients with memory disorders such as dementia.

  • Transcription: Melanie Cole (Host): While memory loss is the best known symptom of dementia, it’s not the only symptom, and memory loss alone does not mean that you have dementia. My guest is Dr. Carol Manning. She’s a board-certified clinical neuropsychologist who directs UVA’s Memory and Aging Care Clinic and specializes in caring for patients with memory disorders such as dementia. Welcome to the show, Dr. Manning. What is dementia?

    Dr. Carol Manning (Guest): As you said, dementia is not just memory loss that occurs with normal aging. Dementia is an umbrella term for several disorders, and what dementia is, it describes what happens when there’s a decline from normal levels of ability—of when there are changes in memory, attention, concentration, abstract thinking—all kinds of cognition that we rely upon when there’s a decline that’s greater than what we would expect with normal aging. So dementia describes constellation of symptoms, but it doesn’t describe the exact disease process.

    Melanie: So these most common symptoms, what would send up a red flag that would signal somebody really, something is going on here?

    Dr. Manning: With, for example, normal aging and memory loss, we would anticipate that someone might forget where they parked their car in a parking lot. But if they forget what their car looks like, that would be a signal to me that there’s something wrong. With normal aging, what we might see is that people forget proper nouns. They forget names. That’s very normal. With dementia, people lose the ability to speak fluently altogether—so spontaneous speech decline. Losing your keys is normal, but putting things in highly unusual places and then suspecting that someone else took them, that would be something that would be out of the norm.

    Melanie: So, suspecting that someone else took them. Is there a generalized paranoia? Do you start to look for these things if it’s happening in yourself or if it’s happening for your loved one and you start to notice these things?

    Dr. Manning: That often occurs later on in dementia, and the paranoia is because people may not be aware of the fact that they put them there and there’s something called confabulation, where people make up things to fit with other things that they can’t put together. For example, they don’t have a memory that they put their keys somewhere unusual, and so they assume that someone took them. I can give you another example of a change that would concern me: someone who’s been making the same favorite dish for many, many years and suddenly gets in the kitchen and can’t remember how to do it. So things that are well-learned, that we’ve known for a long period of time and suddenly can’t do them anymore.

    Melanie: What is the difference, Dr. Manning, between dementia and Alzheimer’s disease? Because these symptoms that you’re mentioning, right away, people are going to start to be very concerned that this is not an age-related dementia but something much more serious.

    Dr. Manning: “Dementia” is a general term, and Alzheimer’s disease is a kind of dementia. Alzheimer’s disease happens to be the most common kind of dementia, but there are other dementias as well. There is dementia that’s associated with vascular change, vascular dementia. There is dementia that can occur with Parkinson’s disease—so for example, Parkinson’s disease dementia. The umbrella term is “dementia,” and Alzheimer’s disease is a kind of dementia. By far, it’s the most common kind.

    Melanie: So then, what treatments are available? If somebody experiences these symptoms or you notice it in a loved one, and then you go to see a doctor such as yourself, what can you do about it?

    Dr. Manning: Well, I think, first, it’s important, extremely important to get a diagnosis and to get an accurate diagnosis, because to assume that it’s Alzheimer’s disease or that it’s a dementia that we can’t treat is doing the person a disservice. There are some dementias and there are conditions that are treatable, and we definitely want to treat them. So if there’s a thyroid problem, or if there’s a vitamin deficiency, we want to treat it. If it’s depression, which can look like dementia, we definitely want to treat the depression. So it’s really important to go to a specialized memory disorders clinic to make sure that you get the right diagnosis. Then, once you have the diagnosis, we want to treat what’s treatable, and we want to also treat symptoms even if we can’t cure. So for example, currently, with Alzheimer’s disease, there’s a lot of research being done to actually try to cure it. At this moment, we can’t. But what we can do is to treat the symptoms, and we have medications that we can prescribe that slow the rate of decline. We also want to work with people on behavioral management because there are behavioral strategies that can be used to help minimize the effects of the dementia or the Alzheimer’s.

    Melanie: Some of the medications that you mentioned, Dr. Manning, do they also help to slow the development of these symptoms?

    Dr. Manning: What they do is, yes, they slow the rate of decline. And there’s research looking at these drugs, and what they do is slow the rate of decline for about three years. And what they can do is slow the rate of decline such that people may not have to go into facilities, memory disorders, memory units, or nursing homes. It can prolong placement because of the slow in the rate of decline. While they don’t cure, they can be really helpful to patients and the care groups.

    Melanie: Explain a little bit about some of the therapies that you mentioned. If you’re giving a behavioral therapy, modifying tasks, or the environment around this person, what’s involved in that?

    Dr. Manning: Well, it’s involved when you’re with professionals who can help understand what the behavior is and what’s causing it. There’s a behavior that’s common in Alzheimer’s disease called sun downing, and that is that people with Alzheimer’s disease will often become more agitated or upset late afternoon or late evening. So it’s working with the caregiver and the patient to try to understand what is provoking the person to become more upset at that time of day. For some people, it’s that there’s too much activity. We want to minimize what’s going on around that person and put them in a calmer environment. So turn down the lights and get soothing music or soothing activity. For other people, it can be that there’s not enough stimulation and they have too much energy and they get agitated. We, in large part, work with caregivers to try to strategize to make things easier for both the patient and for the caregiver. This is a disease that affects entire families. And because Alzheimer’s disease is a progressive condition, it’s always changing. It requires ongoing current treatment and working with patients and families to cope with the changes as they occur.

    Melanie: Dr. Manning, why should patients come to UVA for treatment of dementia?

    Dr. Manning: I think they should come because we have a multidisciplinary clinic with people who are board certified and trained in behavioral neurology and neuropsychology. We have an entire multidisciplinary team involved—social work, neuropsychology, neurology, geriatric psychiatry. We have a nurse practitioner. We also have clinical trials which enable us to give our patients medications that aren’t available elsewhere but are really promising in terms of treating the disease. We have a full family approach, not just for the patient, but we look at the patient and the needs of the entire family and try to help them not just with the diagnosis but with ongoing care as the disease progresses.

    Melanie: Dr. Manning, please, in the last minute, give us your very best advice for people who are starting to experience some of those symptoms of dementia, or for if you see it in your loved ones. Give us your best advice for things at home.

    Dr. Manning: My best advice is go ahead and go to a memory disorders clinic and get a diagnosis so that you can make plans and understand what’s going on. Sometimes it’s not dementia, and you want to know that. And sometimes, unfortunately, it is, and you want to be prepared. People often try to avoid it and deny it and said, “I don’t want this person to know that they have dementia.” Our experience is that people know that there’s something wrong, and it’s actually a release to get a good diagnosis and to get good care and to be able to plan for the future.

    Melanie: So important and such great information. You’re listening to UVA Health Systems Radio. And for more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening, and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Brain & Nervous System]]>
David Cole Mon, 30 Jun 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/19950-signs-and-symptoms-of-dementia
Reducing Your Risk for Ovarian Cancer http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=19949-reducing-your-risk-for-ovarian-cancer reducing-your-risk-for-ovarian-cancerU.S. women have a 1 in 72 chance of developing ovarian cancer, according to the American Cancer Society.

Learn the most common risk factors and how to reduce your risk for ovarian from a UVA specialist in gynecologic cancer.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1420vh5c.mp3
  • Location: Null
  • Doctors: Modesitt, Susan
  • Featured Speaker: Dr. Susan Modesitt
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Susan Modesitt is a board-certified gynecologic oncologist who serves as director of UVA’s Gynecologic Oncology Division and co-director of UVA’s High Risk Breast and Ovarian Cancer Clinic.

  • Transcription: Melanie Cole (Host): US women have a 1 in 72 chance of developing ovarian cancer. My guest is Dr. Susan Modesitt. She’s a board-certified gynecological oncologist who serves as director of UVA’s Gynecologic Oncology Division and co-director of UVA’s High-Risk Breast and Ovarian Cancer Clinic. Welcome to the show, Dr. Modesitt.
    Please tell us, what are the most common risk factors for ovarian cancer?

    Dr. Susan Modesitt (Guest): Most women with ovarian cancer don’t have a family history of breast or ovarian cancer, but that would be one of the strongest risk factors for developing ovarian cancer. Most of the other risk factors are not something you can modify, but it’s never having been pregnant, having infertility, having endometriosis, being older aged—most women with ovarian cancer are in their 60s or 70s. And again, those aren’t modifiable.
    Some things that reduce your risk of ovarian cancer are having been pregnant, taking birth control pills for at least five years in the past; having your tubes tied; or even having a hysterectomy; and obviously, having your ovaries removed. We don’t recommend that for most women.

    Melanie: So if women want to reduce their risk factors but they’ve already passed the time when they might have gotten pregnant earlier, taken birth control, any of these things, are there some things that they can do?

    Dr. Modesitt: Again, being aware of their risk factors. If they’re past the age where we would recommend doing birth control pills for risk reduction—and we wouldn’t recommend surgery unless they were very, very high risk—there’s not a lot more to do besides the things that we recommend for reducing your cancer risk overall, which are maintaining a healthy weight and exercising. Those are two key factors in a lot of cancer—not as much ovarian as some of the other ones. But those are the things that people can do.

    Melanie: Dr. Modesitt, ovarian cancer has been called silent cancer. You know that people have heard that there are no signs and symptoms until it’s progressed a bit. Tell us about the symptoms of ovarian cancer, and what red flags might stand up that would send us to see you?

    Dr. Modesitt: So the hard part about ovarian cancer is, unlike some of the other women’s cancers, like breast cancer or cervical cancer, where we have good screening, ovarian cancer doesn’t have any screening—and we’ll talk about that in a minute. But the symptoms are very vague and very subtle, and women mistake them for other things—that they’re just going through menopause, they’re getting older—and kind of let it go to the back burner. So the hallmark symptoms are feeling full—when you start to eat, you feel full very quickly—feeling bloated, and having abdominal pelvic discomfort. And the hard part is, again, these are pretty common symptoms. And if you think about, for example, pregnancy, which a lot of women go through pregnancy, it takes a long time before a mass gets big enough for it to really impair things. And so, women often don’t know that they have a mass on their ovary or their fallopian tubes until it becomes really obvious. Again, the hallmarks are bloating, feeling full, and abdominal discomfort. That happens more times in a month than not—for example, having it at least 12 times during the month. If it just happens once in a while, once in a month, once every other month, that’s not something we worry about. But if it’s a persistent thing, they should come and talk to their doctor.

    Melanie: As you say, these are common situations for women. We feel bloated sometimes all the time, you know, discomfort. These kinds of things are so common for women, whether you’re younger or older, 12 times a month or all the time. Because that’s the confusing thing, Dr. Modesitt, is that women don’t know when they’re being too alarmist, when do you really go see your gynecologist and say, “I’d like to get checked for ovarian cancer.”

    Dr. Modesitt: I would err on the side of caution. If it’s something that is persistent—again, not just happening once a month—I would go and talk to your doctor about it. The things we can do, again, I mentioned earlier, that there is no good ovarian cancer screening method. But if you’re having symptoms, there are very good methods to evaluate that. For example, an ultrasound can look at your ovaries and your fallopian tubes and also look into the abdomen. CT scans can be used—again, only for symptoms, not for screening—and there are some blood tests that can give us a clue that there might be a problem. But again, this is to evaluate symptom.

    Melanie: So there are no screening tests, and you can evaluate symptoms. And then what happens, Dr. Modesitt?

    Dr. Modesitt: Right. Well, let me talk just a little bit about screening for a second. Because there’s a lot of information in the [lay press] that you should go in and you should ask your doctor for some of these test—for example, an ultrasound to look at your ovaries, or a blood test called a CA 125 to screen for ovarian cancer. And the hard part is these tests are normal, often, in early-stage ovarian cancer, and they can be abnormal in benign conditions, like endometriosis or fibroid or things like that, that aren’t cancer. Again, they’re good to evaluate symptoms, but they don’t pick up a cancer early, which is what we would want for a screening to have. We’re actually doing a lot of research on some other novel things like short RNA fragments, and micro RNAs to try to find another way to screen women for ovarian cancer. But as of right now, there’s not any screening for normal-risk women.

    Melanie: So then, what? If you do get in to your doctor and you have been diagnosed with ovarian cancer, what treatment options are available at UVA?

    Dr. Modesitt: Treatment options have improved a lot. There’ve been several breakthroughs. We’re still not where we wanted to be, which is why we have a lot of clinical trials to continue to evaluate better treatments. But of some of the new breakthroughs have been using intraperitoneal chemotherapy. So the first step is usually—not always—but usually, surgery, where we remove all of the tumor that we can that is visible. And then sometimes, you can give the chemotherapy right into the abdomen. Ovarian cancer spreads on the surfaces of the organs in the abdomen, so giving the chemotherapy right into the abdomen has been shown to vastly improve survival for women. And so that’s been a breakthrough. Looking at some of the more targeted therapies is something that we’re looking at and have included some in clinical trials. Again, having an advanced surgical procedure, either before chemo or after chemo, improves survival. So those are the key things about treatment for ovarian cancer.

    Melanie: Does a complete hysterectomy eliminate your risk then of ovarian cancer?

    Dr. Modesitt: So hysterectomy is removal of the uterus. A salpingo-oophorectomy -- we like to make things hard to name so that only doctors know what we’re talking about.

    Melanie: Absolutely.

    Dr. Modesitt: But removal of the uterus is a hysterectomy. Removal of the tubes and the ovaries is a salpingo-oophorectomy. So to really reduce your risk of ovarian cancer to as low as it can go, you need to have the tubes and the ovaries removed. There’s a bit of a theory now that much of ovarian cancer actually starts with small cells that are abnormal in the fallopian tube that then gets spread into the abdomen as tiny little cells but then all grow up together. That is part of the reason we think the screening that we have doesn’t work. It doesn’t start as a small area that gets bigger and bigger and then spread. It starts as small areas that spread and then all get bigger. It’s just really tough to see it right now, to find early.
    One thing we haven’t talked about that I do want to mention is I talked about family history a little bit earlier. For women that are considered very high risk—and these are women that have a family history of breast cancer, ovarian cancer, or carry one of the genes, the BRCA mutations that put those women at almost a 40 percent risk of ovarian cancer and 85 percent risk of breast cancer—women with that situation, we actually do things much more aggressively than we do in women without those risk factors. These women, we follow very closely. We do some screening and we do recommend that they have surgery to remove their tubes and their ovaries once they have completed childbearing—again, because we know the screening doesn’t work very well and they’re just at such high risk. Instead of a 1 percent risk, they’re at a 40 percent risk for ovarian cancer, so we don’t want to take that chance. And so we do risk-reducing surgery.

    Melanie: So if women have the BRCA gene, it puts them at a higher risk, and then it’s just a much more aggressive approach to prevention. Please tell us, Dr. Modesitt, why should women come to UVA for their ovarian cancer care?

    Dr. Modesitt: Well, there’s been a lot of studies showing that you need to go to someone that’s an expert—so what’s called a high-volume center for surgery—for the option of getting clinical trials or intraperitoneal chemotherapy. These are things that we do every day. And so the benefit of coming to UVA is you see women or men positions who are top doctors for cancer and have access to all of the newest options.

    Melanie: That’s really great information. Thank you so much, Dr. Susan Modesitt. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Women’s Health, Cancer]]>
David Cole Mon, 23 Jun 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/19949-reducing-your-risk-for-ovarian-cancer
Helping Children Address Issues with Communicating and Eating http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=19948-helping-children-address-issues-with-communicating-and-eating helping-children-address-issues-with-communicating-and-eatingChildren with developmental disorders, traumatic brain injury or throat deformities may have difficulties communicating or problems swallowing and eating.

Learn about the treatment options available for children dealing with these conditions from a UVA specialist in speech language pathology.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1420vh5b.mp3
  • Location: Null
  • Doctors: Bickley, Polly
  • Featured Speaker: Polly Bickley
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Polly Bickley is a speech language pathologist and director of the Encouragement Feeding Program at UVA Children's Hospital.

    UVA Speech Language Therapy
  • Transcription: Melanie Cole (Host): Children with development disorders, traumatic brain injury, or throat deformities may have difficulties communicating or problems swallowing and eating. My guest is Polly Bickley. She’s a speech language pathologist and director of the Encouragement Feeding Program at UVA Children’s Hospital. Welcome to the show, Polly. What are some of the most common communication and eating disorders? What are the conditions that would cause children to have these issues?

    Polly Bickley (Guest): Well, in this day and age, we’ve had such advances in medical technology that we’re having children survive as early as 24 weeks. So one of the biggest things we see is premature birth, children born at 24th to 26th to 28th weeks. We know that those children’s systems are still immature. The lungs, the heart, the GI system aren’t really ready to be working perfectly coordinated together. And so, a lot of times, we’ll see children who are not able to eat safely, efficiently, effectively; who are not able to breathe very well—so the very complicated kiddos who stay in the hospital for quite a while. That environment, as good as we try to make it, isn’t really the best place for children to start learning and developing their eating skills and their communication skills.
    We’re also pretty darn amazing at being able to fix some cardiac anomalies that we were not able to fix even 5 or 10 years ago. So we see a lot of children with very complex heart deformities that are now reparable, being fixed. And so they’re also in the hospital for a very long time, very, very medically fragile, and they’re not able to do the things that most babies do right away—which is eat and start to babble and start to learn language from listening to their parents talk to them. Those things kind of put them behind the eight ball.
    We’re also seeing a much greater incidence of autism, where children don’t really understand the point of communication—that if I point at something, you’ll give it to me, or if I say a word, that’s identifying what I’m wanting. So those are all things that are keeping us busy in the world of speech pathology.

    Melanie: So then, what about the eating disorders that go along with these conditions that you’re talking about? What kinds of treatments are available and what are some of the signs and symptoms that parents should be looking out for, red flags, Polly?

    Bickley: Right. Well, eating should be effortless at birth. For the first several months, it’s a reflexive behavior that children do. If that is not going smoothly, if your child is not taking a bottle or breastfeeding in an easy manner, if it’s effortful, if it takes a long time, if they’re choking or coughing or changing colors, or if they’re not growing well, that is definitely a red flag that we need to help them. We need to look at them and figure out what is not working, why is this child not enjoying this activity, why it’s not happening smoothly?
    The other thing is we want to look at children as they advance through going from bottle to breast, from breast to baby food, and then to table food. That usually happens between four to five to six and nine to twelve months. That should really be smooth and effortless, and children should enjoy eating and they should give you good cues that they’re enjoying eating. And some of our children don’t enjoy eating because perhaps it hurts when they swallow. They might have reflux. They might have something else that interferes with them eating in a safe and efficient manner. So we’re going to want to get some help for those things pretty quickly. We have a saying in the speech pathology world, at least at UVA, that we want quality over quantity. We know that parents really want to see their child eat a good quantity of food, but we want children to eat happily and efficiently and effectively, even if it’s smaller amounts. Those are the things that we would like to look at. So if you’re worried that your child is not eating the volume that they should and the manner that they should because they’re not enjoying it, definitely, touching base with your pediatrician, who then could make a referral to one of us, would be helpful.

    Melanie: How are these conditions diagnosed, Polly? Do you do some tests to see what’s going on in there?

    Bickley: Mm-hmm. It kind of depends on what we’re seeing from a clinical standpoint. The speech pathologist is going to want to watch the child eat, whether it be an infant taking a bottle or an older child eating some sort of pureed or table foods and we’re looking for signs that they’re having difficulty swallowing, or maybe this food is actually going into their lungs instead of their stomach. That’s called aspiration. We see signs of wet, gurgly vocal quality. We see their eyes tear up, they do some coughing. Or they’ve had respiratory illnesses in the past that are not explained by other lung issues. And so we’re going to want to look at that first. And then we may recommend a video fluoroscopic swallow study, where we actually have a child take food with barium in it and the radiologist takes a picture of the child swallowing so we can see if there’s any physical reason for them not to be swallowing safely. A lot of times, however, it’s more than just a physical issue. It becomes more of a, “This doesn’t feel good. When I eat, it hurts later. Therefore, I don’t want to eat.” And so, we do have some behavioral avoidance of eating or seeing children now that are extremely picky. So it’s not just, “I don’t know how to eat because I was so medically fragile I didn’t get to practice eating,” but, “I can eat fine, but I only want to eat blue food when the moon is full and my mom is singing ‘Happy Birthday’ because I’m very picky and rigid about what I’ll eat because I’m a little overwhelmed by this activity. It’s not as easy as I’d like it to be.” So, with those kiddos, we’re looking at what the diet is, what textures, what flavors, what types of foods they’d like to eat efficiently, and which ones they have a trouble and then reject.

    Melanie: Then what treatment options are available? What interventions do you use to get those children to be able to eat and to enjoy it, more importantly, as you say, because then, the behavioral issues start coming in because they’re remembering these things? What treatment options are available?

    Bickley: Right, right. Well, from the very get go, my coworkers that are working over in the NICU, again, have that mantra of good quality over quantity. And so they’re looking at babies very young and saying, “How can I make this baby eat efficiently and effectively in a manner that’s comfortable to them?” So they’re going to be looking at what type of nipple to use, how to position the baby, how not to overwhelm the baby, and what type of viscosity of the formula. Should we be thickening it? Should we just use a very slow-flow nipple so that the child can coordinate that suck-swallow-breathe pattern that they feel comfortable eating? When they get a little bit older, my co-workers and I who work in the outpatient setting are looking at what is it about this food that is hard for you. Is it too sharp? Are the crumbs too sharp—because your mouth is a lot more hypersensitive than my mouth would be? Or is the weight of this pureed food, does that end up making you gag, and why is that? And then, how can we gently, consistently, in a playful manner, teach you that this isn’t going to hurt you? We’re going to practice it so many times in a fun, playful manner that it’s not going to hurt you anymore. And again, that’s hard, because a lot of times, we have to get the calories in to get the child to grow and thrive, but we have to do it in a manner that’s not painful, so that they don’t start to avoid more things.
    Many times, this particular picky, rigid eating are what we call selective eating disorder, goes along with a bigger picture; goes a long with significant rigidity; sometimes goes along with the diagnosis of autism; goes along with the diagnosis of anxiety, hyper vigilance about the world. And so, we really need to back up and look at those things because the mouth is a symptom. The eating is necessarily a symptom of the bigger picture. So it really takes a whole team. We’re referring back to their physicians. We’re referring to the GI doctors. We’re referring to some psychologists. We’re referring to developmental pediatricians, occupational therapists so that we can look at the whole kit and caboodle to figure out what’s broken and fix the whole child, not just the symptom of feeding.

    Melanie: Well, it’s a real multidisciplinary approach, Polly. So why should families come to UVA for treatment of these conditions?

    Bickley: Well, I think there’s numerous reasons, I think the first reason being that the clinicians that are currently at UVA have probably pretty much an average of at least 15 to 20 years’ experience among all of us. So there’s many us that have been here for an extremely long time, therefore we’ve been around the block and we’ve seen this quite a bit. The other issue is that UVA is really committed to research and continuing ed, so I feel like we really have some cutting edge opportunities in working in the NICU and seeing the children and the surgeries that they’re doing and some of the research that’s coming out of there. And then, I think that the other big thing is that we really do work well together as a team. And so, when I am puzzled about a child, I have so many resources to go to very close at hand that we can problem-solve together.

    Melanie: That is great information. Thank you so much for all you do, Polly. You’re listening to UVA Health Systems Radio. And for more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening, and have a great day./AT/rj/es
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Mon, 16 Jun 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/19948-helping-children-address-issues-with-communicating-and-eating
Heart Health at Home http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=19947-heart-health-at-home heart-health-at-homeFor patients recently discharged from the hospital with serious conditions such as heart failure, preventing them from being readmitted to the hospital is an important goal.

Learn how UVA works to keep heart failure patients living safely at home from a heart failure specialist who works in UVA’s Heart Health at Home program.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1420vh5a.mp3
  • Location: Null
  • Doctors: Thomas, Craig
  • Featured Speaker: Craig Thomas
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Craig Thomas is a certified acute care nurse practitioner at the UVA Advanced Heart Failure and Transplant Center who specializes in caring for heart failure patients.
  • Transcription: Melanie Cole (Host): For patients recently discharged from the hospital with serious conditions such as heart failure, preventing them from being readmitted to the hospital is a very important goal. My guest is Craig Thomas. He’s a certified acute care nurse practitioner at the UVA Advanced Heart Failure and Transplant Center who specializes in caring for heart failure patients. Welcome to the show. Craig, tell us. What are the challenges of living at home for heart failure patients?

    Craig Thomas (Guest): Certainly, Melanie. Thank you for having me today. Well, there are many challenges for patients with heart failure living at home. It is a chronic condition, and the nature of that alone means that this is a condition that these patients, most will live with for the remainder of their lives. There was the medical treatment for heart failure patients. There are at least four drug classes that we’d like to have patients on—that is, if they only have heart failure only. Many of our patients will have multiple other comorbidities, other disease processes that have led them to the heart failure, be that a coronary artery disease, uncontrolled hypertension, high blood pressure. All of these things would also, in addition, require other medications and such that would make it more challenging for these patients. But many of the people that I take care of will be on an excess of eight medications, specifically for their heart and their heart disease. That alone means that you have to take multiple medications every day several times a day. That can be challenging.
    Also, with heart failure, there are a lot of diet recommendations; things, such as restricting fluids. That’s just one of the major problems with heart failures, the fluid accumulation, and things such as reduced sodium content in your food as well, which is quite difficult in our Americanized diet to avoid those high-sodium foods. And there’s a lot of monitoring. The symptoms of somebody’s heart failure becoming worse for them can be different between different individuals. And so, folks being able to understand what their heart failure symptoms are, being able to recognize those and alert a care provider in an appropriate, timely manner is hugely important to managing heart failure at home.

    Melanie: So, Craig, how does the Heart Health at Home Program work to help patients with heart failure? And does it help their families? As you say, it can be a very confusing situation with the medications and the diet, fluid and sodium restriction, adherence to all the protocol that you set out for heart failure patients. How does this program work to help them coordinate all of this?

    Dr. Thomas: Certainly. Our Heart Health at Home Program is set up to introduce this program to patients as they are hospitalized for heart failure. We know that when folks are in the hospital with heart failure that that is sort of the worst state of their condition when they need to be hospitalized for that. And so, we know that these people that are there are at very high risk for having relapses in their condition. And so, we contact patients as they are admitted to the University Medical Center and ask them about this program and if they feel like they could benefit from having additional resources at home to help them. Like you’d mentioned, this program helps the patient for sure. And also, note that families are very happy to have some extra eyes in the home and to have a skilled healthcare provider there. Our program works essentially -- I meet and enroll patients while they’re in the hospital. Once they are discharged, a member of my team, they have certified nurse aides that are specifically trained in heart failure and cardiac care. Those are the folks that make our home visit to these patients once they’re discharged.
    Our program is set up to see the patient first in their home about 24 to 48 hours after they’ve been discharged from the hospital. And then we make those home visits three to four times the first week at their home, and then maybe two to three times the week following that. And we stage our visits down over time based on the patient’s understanding, the patient and the family’s need for our support. Now, we know with this patient population that hospitalization is an indexed or acute events that mark significant concern for their heart failure, and the further they get out from the hospitalization, the less likely it is that they will have trouble. Now, our program is set up to meet with them frequently and early post-discharge and then taper off as needed.
    We’ll follow patients for up to one year in our program, and certainly, if people have additional re-hospitalization, then they’re eligible to restart their services with us. We’ve been in operation going on a year and a half now and have over 100 patients that we’ve enrolled in helping manage their heart failure from home.

    Melanie: Craig, are there certain prerequisites for participation in the Heart Health at Home Program?

    Dr. Thomas: Sure. We do have some criteria—certainly, being in the hospital as the enrollment location. Our program is set to help people that don’t have any other services to help them. There are other services other than the Heart Health Program that are options for patients at UVA Medical Center—things such as Home Health. So if the patient already has Home Health or is in need of Home Health services, which is different from us, then we would not follow that patient in this Heart Health at Home program. They also must live within 60 miles of the medical center just due to our traveling and schedules and trying to keep my team with patients making an impact rather than on the road so much.

    Melanie: Just wondering if the program has improved outcomes for the heart failure patients.

    Dr. Thomas: It certainly has. We track the outcomes of our patients. We know that nationally, currently, the re-admission rate for heart failure patients is running around 18 or 19 percent. With the Heart Health at Home program, last year, in the calendar 2013, our re-admission rate was just under 9.5 percent. We are at least a 50 percent reduction in patient care for our program that are returning back to the hospital within that 30 days.

    Melanie: Craig, why should patients choose UVA for their heart failure care?

    Dr. Thomas: UVA has a very skilled and dynamic advanced heart failure center. We have multiple options for advanced therapies. We have a large skilled team that can work with patients and their families through their chronic care of the heart failure—things such as ventricular assist devices. We are a heart transplant center as well. And then, having these unique programs, such as the Heart Health at Home Program, are hugely beneficial to the patients and their families. I cannot see any other reason why you should not choose UVA for your heart failure care.

    Melanie: Give us, please, in the last minute here your best advice for patients living with heart failure and things that they can do to make their lives just a little bit better.

    Dr. Thomas: There’s a lot of focus currently in the heart failure care world. Many hospitals like UVA are coming up with different ways to support patients in their home. The challenge, as I mentioned at the beginning, is it may seem simple and seem like something that would be very easy to do. My advice would be to accept any assistance programs that the hospital or medical center may offer. These programs are set up so that we can support you. We know what the needs are of this patient population, and those programs are set up to do that.

    Melanie: That’s great information about the UVA Heart Health at Home program. For more information, you can go to uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole. Thanks so much for listening, and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Mon, 09 Jun 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/19947-heart-health-at-home
Should You Get Screened for Vascular Disease? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=19525-should-you-get-screened-for-vascular-disease should-you-get-screened-for-vascular-disease

Millions of Americans are at risk for vascular diseases, which can lead to serious health conditions such as a stroke.

Learn from a UVA expert in vascular surgery if you should consider getting screened for vascular disease.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1408vh5e.mp3
  • Location: Null
  • Doctors: Upchurch, Jr, Gilbert R
  • Featured Speaker: Dr. Gilbert R. Upchurch Jr.
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Gilbert R. Upchurch Jr. is a board-certified vascular surgeon and chief of the Division of Vascular and Endovascular Surgery at UVA Health System.

  • Transcription: Melanie Cole (Host): Millions of Americans are at risk for vascular diseases, which can lead to serious health conditions such as stroke. My guest is Dr. Gilbert Upchurch, Jr. He’s a board certified vascular surgeon and Chief of the Division of Vascular and Endovascular Surgery at UVA Health System. Welcome to the show, Dr. Upchurch. Tell us a little bit about vascular disease. What are the most common types?

    Dr. Gilbert Upchurch (Guest):    Well, thanks, Melanie, for having me on. The two most common types, really, are atherosclerosis or hardening of the arteries, as it used to be called, which is really plaque buildup in an artery over time. It could be really almost in any artery. The arteries that it most commonly occur in are arteries to your brain, which, if you have a plaque going in your carotid artery, you may end up having a stroke; atherosclerosis in your coronary arteries, which are more centrally, and that can lead to heart attack; or blockages going to your legs, which can lead to pain when you walk, all the way from pain when you walk to gangrene and loss of limb. That’s really number one. The second most common vascular disease we see is an aneurysm. An aneurysm also can really occur in almost any artery in the body, most often occurs in the abdominal aorta, which is relevant to this vascular screening conversation we’re going to have. You think about aneurysm as sort of a worn-out tire. Your blood vessels are a certain size when you’re born and they get somewhat larger as your grow, but the inner tubes give out over time. And so, an aortic aneurysm, for example, can grow from two centimeters or an inch to five, six, seven, ten centimeters. With that growth, there’s always the risk of rupture and if patient -- depending on what bed it is, if an aneurysm ruptures, often, it’s lethal. So I would say atherosclerosis, blockage in the arteries, and aneurysms are the two most common diseases we treat.

    Melanie: What people are at risk, Dr. Upchurch? Who would be the people that would want to get screened?

    Dr. Upchurch: We divide the risk factors into non-modifiable and modifiable. The non-modifiable ones are people as they get older, people who have a strong family history of either atherosclerosis or aneurysms, people who, for instance, have atherosclerosis in other beds, or people who have high cholesterol. Those are sort of the people who are most at risk. There’s another group of people that I think the ones you can do the most about. That is the group of people who smoke. Smoking is a risk factor for causing both atherosclerosis or hardening of the arteries as well as aneurysm formation. It’s a big-time inducer of both of those things. And I think high blood pressure is another thing that induces both atherosclerosis as well as aortic aneurysms, and so having your blood pressure well-managed and being on the right cardiovascular protective medications are really important.

    Melanie: We have the controllable risk factors and the uncontrollable risk factors. So what’s involved in the screening process? If somebody has high blood pressure or diabetes or they smoke or a family history of heart disease, any of these things, vascular disease that might put them at risk, what’s involved in the screening process?

    Dr. Upchurch: The screening process is really just a non-painful ultrasound, and this particular screening process involves taking a snapshot of the blood vessels going to your neck or your carotid arteries looking at the carotid bifurcation to see if there’s plaque there. It looks at your infrarenal aorta and does a snapshot of that to see whether there is blockage and/or an aneurysm in your infrarenal aorta, and then it uses a blood pressure cuff on your arm, in your legs, to check the amount of blood flow going to your legs. And your arms. But most of the time, peripheral vascular disease affects the legs. These are non-invasive tests that’s done rapidly, relatively inexpensively, and will give you a good snapshot of what your cardiovascular health risks are.

    Melanie: Dr. Upchurch, do you feel that even people that are not necessarily at risk should have these done? And how often? Is this part of our yearly physical? Is it something that’s only done if it needs to be done?

    Dr. Upchurch: I think a lot of it depends on how old you are when you’re screened. The aortic aneurysm is just in your infrarenal aorta. There is pretty good literature looking at your aorta once at the age of 60 or 65. If there’s no aneurysm there, you’re likely never going to develop aneurysm in your lifetime. Carotid disease, especially if you’re a non-smoker, a single look at your carotid bifurcation is probably adequate. And really, unless you have worsening symptoms of what’s called claudication or pain in your calves, hip, or buttocks when walking a reproducible distance, if you have a normal screening ABI or ankle brachial index, then you should be capable of not needing to be screened again—unless you develop symptoms, of course. And then, of course, you could always have another test done.

    Melanie: Let’s speak about symptoms for a minute, Dr. Upchurch. When does chest pain -- people want to know -- or pain in their arms, or, as you described, pain the legs, claudication during activity, when does that warrant seeing a doctor versus saying, “Oh, it’s probably gas or muscular,” something like that? People are never quite sure about those symptoms.

    Dr. Upchurch: Yes. The coronary symptoms are actually -- in my own biases, the chest pain, especially with exertion, radiating down the left arm, those should always be evaluated and taken very seriously. The lower extremity pain in your legs, the blockages in your arteries can often be confused, and these patients are sort of taken aback a little bit by this. It can also be confused with what’s called neurogenic claudication or pain from having your discs, your spinal roots compressed by your vertebral column, so you end up getting pain shooting down the back of your leg when you walk or when you stretch or whatever. It’s a test like this, this ankle brachial index, where we use the blood pressure cuffs, that often helps us to distinguish whether it’s some radiation pain from your back or whether it’s actually legitimate blockage in your legs. What people fear—and this is with the peripheral vascular occlusive disease or atherosclerotic disease or PAD—is that when they’re having pain when they walk, that means they’re heading towards gangrene and losing a limb. The truth is that people who have pain when they walk, only about one percent per year will go on to require an amputation, which means 99 percent of people will be fine. And the truth is, especially in the beginning, the best therapy is exercise and stopping smoking and getting your diet under control. Our job as vascular surgeons and care providers with patients of vascular disease is to help them modify what they’re doing. And to be honest, exercise works almost all the time in these patients if you can get them to, as I said, stop smoking, start exercising. So that’s the first line therapy—no stent, balloon, et cetera are needed.

    Melanie: Why should patients come to UVA for their vascular screening and come to see you?

    Dr. Upchurch: I think we have an amazing group of experts as good as anywhere in the country at taking care of patients with vascular disease. We have vascular surgeons, cardiac surgeons, cardiovascular medicine physicians, physicians who are specialist in management of your lipids, smoking sensation, and we’ll help you from that critical transition if you need it—from lifestyle changes, et cetera, to more invasive imaging, perhaps an angiogram or just a CAT scan, all the way to the most invasive options, which are ballooning, stenting, and open bypass surgery. So I think you’ve come to a place like this, you will find an amazing group of care providers. And really, for the whole spectrum of your needs, not just making the diagnosis but also taking care of you should you require something to prevent you from having a stroke or prevent you from having your aneurysm rupture or prevent you from losing a leg. That’s one of the things that we in the Heart and Vascular Center here at the University of Virginia pride ourselves on. It’s just sort of one-stop shopping.

    Melanie: Thank you so much, Dr. Gilbert Upchurch, Jr., Chief of the Division of Vascular and Endovascular Surgery at the UVA Health System. You’re listening to UVA Health System Radio. For more information on the UVA Heart and Vascular Center, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health, Heart Disease]]>
David Cole Mon, 02 Jun 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/19525-should-you-get-screened-for-vascular-disease
Advances in Heart Failure Treatment http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=19387-advances-in-heart-failure-treatment advances-in-heart-failure-treatmentFor patients with heart failure, recent years have brought an increasing number of treatment options for this serious condition.

Learn more about the latest treatment options from a UVA specialist in heart failure.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1416vh5e.mp3
  • Location: Null
  • Doctors: Bergin, James
  • Featured Speaker: Dr. James Bergin
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. James Bergin is board-certified in cardiovascular disease and is medical director of cardiac transplant/heart failure at UVA.
  • Transcription: Melanie Cole (Host): For patients with heart failure, recent years have brought an increasing number of treatment options for this serious condition. My guest is Dr. Jim Bergin, he is board certified in cardiovascular disease and is medical director of Cardiac Transplant Heart Failure at UVA. Welcome to the show Dr. Bergin, please explain for the listeners, what is heart failure because they always associate this with heart attack, two different things.

    Dr. Jim Bergin (Guest): Yes, thank you for having me, on the difference between or the problem with heart failure is that heart is not able to meet the demands of the body, so the primary issue with that most people consider it as a weak heart pump and so that’s the easiest way to think about someone just not getting enough flow to their body to do the natural things that they would like to do.

    Melanie: Okay, so what would be some of the symptoms that would signal that this is what they have?

    Dr. Bergin: The most common symptoms are going to be fatigue, they just get playing tired doing everything they want to do, shortness of breath, and those two often times go hand in hand, other symptoms that we can talk about are going to be things like early satiety, so they eat and fill out very quickly and despite that they continue to gain weight and the reason behind that would be that they are gaining fluid and so they gain fluid in their liver, gain fluid in their feet and so they will see those puffy ankles.

    Melanie: Now, you know, it tends to affect older patients, who is at risk for heart failure?

    Dr. Bergin: So, in my opening comment, I mentioned that’s weak heart pump and so often times you are right, it is the older patients and about 60% or so the people that we see or that are seen nationally are going to have had a prior heart attack, so its related to heart attack, but prior heart attack because of the damage to the heart muscle, so you see a big group of those people are at risk, so someone who has had a big heart attack involving the front wall of their heart will be at risk for heart failure in the long term, there are people who have multivessel coronary artery disease or diabetic that tend to have diffuse disease, but the other group that is quite common and makes up about 50% of all the heart failure patients we see are the older patients who have had a long history of hypertension and diabetes and so their problem is their heart muscle is quite strong, but it just doesn’t relax, so you get this thick kind of muscle bound heart or heart is infiltrated with some protein for example and it just cannot relax and so the pressures inside the heart go up and cause the exact same symptoms.

    Melanie: So, someone has had high blood pressure for many years or diabetes, that is going to predispose them to have.

    Dr. Bergin: Exactly right.

    Melanie: So, in the recent years, what has come up for treatments for people that are suffering from congestive heart failure?

    Dr. Russel: So sadly, the last script that we just talked about those with diabetes and high blood pressure who have the thick heart muscle that squeezes well and they have a lot of symptoms and unfortunately that group, not a whole lot of advancements have been made. The other group, that weak heart muscle group, is really where we have done much better and the advancements are the medical therapies to help the heart muscle unload the blood that comes into it and that would be drugs like what are called ACE inhibitors or angiotensin receptor blockers and then we tend to use a lot of beta-blockers with drugs like for example carvedilol and metoprolol and those help out the heart muscle and try to keep it from continuing to dilate and weaken over time. We use a lot of diuretics to help out with symptoms, so if someone doesn’t have shortness of breath or doesn’t have swelling then they don’t need a diuretic, but otherwise we like to use those to keep the fluid off of those people and so those are the kind of mainstays of therapy and then a drug that has been around forever is a drug called spironolactone, its kind of a weak diuretic and we use that also and that’s also been shown to be very helpful in those group. The other things that have come out has been around for about a decade now that’s going to be the pacemaker, so defibrillators to prevent heart rhythm disturbances and then pacemakers in selected patients, they can improve the heart function. Those are patients who have what are called bundle branch blocks and then often times in that group of people, we can significantly improve their symptoms by putting in a pacemaker.

    Melanie: What would you like patients to do at home whether or not they have got a pacemaker and they are adhering to their medications, are there some lifestyle management things you want them to be aware of?

    Dr. Bergin: There are, we preach a lot in clinic about salt reduction. There is some controversy about that, but I think that a controlled salt diet would be helpful for anyone who has congestive type symptoms, so what you want to shoot for is about 2 g of sodium or less per day. You want to limit the amount of fluid you take in because the more fluid you take in, the more you have to get rid of, otherwise it just builds up in your system and causes congestion whether it’s the weak heart muscle or the strong heart muscle, so we like people to do that, we really like people to weigh themselves daily so that they can keep an eye on whether fluid is creeping up on them, we really like people to exercise. Exercise is really a key part. It doesn’t really strengthen the heart so much but keeps the rest of the body in much better shape and so that patients do much better long term with that kind of approach.

    Melanie: How would someone know if fluid is building up a little bit?

    Dr. Bergin: The symptoms really are just going to be that early satiety and so they start to fill up, so they are eating less precariously, they are gaining weight and that just doesn’t go along well together and so that often times means fluid is building and then we also ask people, you know, to weigh yourself if you have gained more than 3 pounds over a 24-hour cycle or more than 5 pounds in a week that more commonly is fluid rather than calorie type weight gain and so you can look for those and then often times people will notice their sock lines, you know, where the sock is on your leg, it starts to leave a line or you have to let the belt out another notch or two because your belly is expanding from fluid, so those are the primary things we ask people to watch for.

    Melanie: And should they reduce their fluids, I mean, it would seem that’s a little bit confusing if they think that they could be building up fluids in their body, you know, and should they stop drinking so much water.

    Dr. Bergin: So, often times people feel like if they drink more, they will go to the bathroom more and so they will not try to flush the system, but that really works against you. Its actually kind of remarkable that if you add up, just take those space of a month for example if you, everything that you drink in or everything that you eat that has fluid in it has to be matched by what you get rid off, so whether you sweat or spit or go to the bathroom, all of that has to be equal, otherwise you are going to gain or, you know, gain too much fluid or dehydrate, so the body is just remarkable on that control, but the more you drink in, if your body is not able to control that, so your kidneys are not quite getting the same amount of blood flow or they are not working quite as well because the heart congestion is leading to kidney problems then you are not going to eliminate the fluid the same ways if you take in, you know, lots of fluid and you don’t get rid of it then you just fill up, so we do like to try to limit people to about 2 liters of fluid a day or less.

    Melanie: And what are some of the newest treatments available now at UVA?

    Dr. Bergin: The big areas that we, you know, for a long time, we have been doing heart transplantation, bigger area that is coming along now is using these left ventricle assist pumps. We put them into people for either is a what’s called the bridge to transplantation or we put them in as a sole therapy which is called destination therapy, so a lot of the research now has been in these heart pumps to make them smaller, make them better, make them easier to live with and eventually those will continue to improve, so it will be fully implantable and so that’s really the direction that everyone is headed with these assisted devices. The other thing that we have been doing have been part of studies to put in monitors for example, so you can put a pressure monitor within the heart and that can help alert you to the fact that someone is gaining fluid or losing fluid too rapidly and you can make more kind of day-to-day or moment-to-moment adjustments in their fluid intake, so those are probably the big areas where the monitoring in the assist pumps.

    Melanie: And Dr. Bergin, please give us your best advice for people living with congestive heart failure and why should patients come to UVA’s Heart Failure and Transplant Center for their care?

    Dr. Bergin: I think my advice would be to don’t give up, often times with therapy we can take people who are feeling poorly and limited and improve their quality of life and you never know when new advancements will come along that will revolutionize how we treat, so I say don’t give up, keep socializing, keep getting out there and try to do the best you can with your heart failure disease and I think the reason to come to UVA is because we do have a fully comprehensive center, so its from the nurses that greet you, the nurse practitioners that help out with the care, the physicians that put the care along side the surgeons to putting the new pumps and taking care of these patients, we really offer a full service network.

    Melanie: Thank you so much Dr. Jim Bergin, board certified in cardiovascular disease and medical director of the Cardiac Transplant and Heart Failure Center at UVA. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Disease, Heart Health]]>
David Cole Mon, 26 May 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/19387-advances-in-heart-failure-treatment
How a Pediatric Orthopaedist Can Help Your Child http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=19385-how-a-pediatric-orthopaedist-can-help-your-child how-a-pediatric-orthopaedist-can-help-your-child

When could your child benefit from a pediatric orthopaedist?

Learn about some of the common conditions treated by specialists in pediatric orthopaedics, as well as the ways they can help your child

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1416vh5c.mp3
  • Location: Null
  • Doctors: Abel, Mark
  • Featured Speaker: Dr. Mark Abel
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio:

    Dr. Mark Abel is a board-certified orthopaedic surgeon who specializes in caring for children at UVA Children’s Hospital.

  • Transcription:

    Melanie Cole (Host): When could your child benefit from a pediatric orthopedist. My guest is Dr. Mark Abel, he is a board certified orthopedic surgeon who specializes in caring for children at UVA Children’s Hospital. Welcome to the show Dr. Abel, tell us exactly what is a pediatric orthopedist?

    Dr. Mark Abel (Guest): Thank you very much Melanie. Well, a pediatric orthopedist is someone who specializes in muscles, bones, and joint problems in children. It used to be that pediatric orthopedist were board certified surgeons like myself, but I would say that only 10 to 20% of the conditions we see in children require surgery, so I have a board certified pediatrician as well as a physician’s assistant that works with me and my surgical partner, Mark Romness.

    Melanie: What types of patients do you typically see?

    Dr. Abel: Well as you might imagine, children injure themselves, so especially when the warm weather comes, we always keep clinic spots open for fractures in bones and joint injuries in children and they get back to play and it’s a very gratifying practice that we have, but in addition to the fractures and sport injuries, we also see children whose limbs may grow in a bowing or knock kneed fashion, my practice entails a lot of management of spinal deformities in children which is rare fortunately, but we still see a number of these kids and then we take care of a number of kids who aren’t healthy, who have conditions like cerebral palsy and muscular dystrophies and as a result of those conditions develop growth abnormalities of their bones. I would say that unlike other specialities, children’s orthopedic specialist manage children’s conditions across the body, the one common denominator is that these are growing children and our practice specializes in getting them back to activities as quickly as possible and understanding how open growth plates in growth influence treatment.

    Melanie: Dr. Abel, you know so many children are playing sports today and we are seeing more sports injuries from chronic repetitive play, you know, sports specific training children are doing these days, ACL injuries in girls, soccer players, when should parents know to bring their child to a pediatric orthopedic, what would be the pre-disposer symptoms that would say, you know, get yourself to this doctor.

    Dr. Able: Well, most of the time, parents take their children to their primary care doctor, but more and more commonly, pediatric orthopedist become the primary care specialist for any child with a musculoskeletal complaint that doesn’t go away. The tip-off that I give to the parents is if you actually see swelling of the joint or the extremity or the child really isn’t able to function then you should seek medical attention and we see many-many kids as the first entry into the medical system, so we are prepared to be the primary care physicians for musculoskeletal complaints.

    Melanie: And what are some of the common treatments that you provide?

    Dr. Abel: Well, you are right Melanie about the emphasis on sports, so we try to be cognizant of the fact that these kids need to be active, it is healthy for them to be active. They need to get back, so we try to provide a graduated rehabilitation from injury beginning with typically some form of immobilization if it in the early phase with elevation, ice, and then a therapy program to reeducate the muscles, the injured muscles and joints, strengthening and watch them to see that they are really back to full capacity before we put them out on the field, so we use our physical therapist as well.

    Melanie: So, you know, a child goes through physical therapy, they return to play, do you then advise them afterward about cross training and may be working with their physical therapist to make sure that this isn’t a recurring thing or something that becomes a chronic condition.

    Dr. Abel: Very good question and I am a strong proponent of cross training, Melanie. The cross training is not only and for those who don’t understand cross training is where you use multiple exercise techniques, light repetitive weights as well as nonimpact aerobic conditioning and stretching, swimming, and cycling where you use a variety of exercises to cover all muscle groups and this is not only important in the maintenance of high level playing condition, but I also use cross training a lot to bring a child back from injury, so that the rest of the body doesn’t become deconditioned, so just because a child has an ankle injury does not mean that they have to be sedentary and I think that’s extremely important to avoid reinjury as they reenter the competitive field again.

    Melanie: What would you like parents to know about treating their children if they do have something and you mentioned elevation and compression, is there, you know, are we still using RICE, are we moving after injury or we are staying still, what do parents need to know if their child sustains an injury out on the field or even at home walking around or playing in their backyard, what do you want parents to do right after that?

    Dr. Abel: Well, I tell parents that when your child has an injury and of course when we talk about injury, we have everything from muscle bruises, sprains to fractures and so, you know, the first thing you need to do is assess your child and make sure that the extremity if you see swelling right away or if you see obvious deformity in the extremity then you really need to seek urgent care in emergency room. Our office at UVA, we have a provider everyday and we will often let them walk in and make a determination, that’s the first thing, if it is more minor than that, a child doesn’t want to play, they could be clearly hurt, then yes I bring him in off the field, ice it down, give them time to calm down and then reassess. If they are still having pain the next day then I would get an opinion and seek a medical opinion about that injury. In general, if you can mobilize the extremity, you should and the more severe sprains and fractures obviously for the first couple of weeks, we can do splint or brace to prevent motion to allow the tissues to heal and the swelling to go down. Ice is very important, so are the nonsteroidal antiinflammatory agents, that’s group of drugs like ibuprofen and Naprosyn are very-very helpful for musculoskeletal injury.

    Melanie: Dr. Abel, why should families choose UVA Children’s Hospital for their orthopedic care?

    Dr. Abel: Well, I am proud to say that the four pediatric orthopedists that work with me are a unique group. There are no fellowship trained specialists and pediatric orthopedists on this side, the west side of Richmond and our understanding of growth dynamics and how to bring child back as quickly as possible on the priorities of a child give us, I think, the upper hand in the management of these children.

    Melanie: Thank you so much Dr. Mark Abel, board certified orthopedic surgeon specializing in caring for children at UVA Children’s Hospital. You are listening to UVA Health Systems Radio and for more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Mon, 19 May 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/19385-how-a-pediatric-orthopaedist-can-help-your-child
Helping Adolescents Live with Epilepsy http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=19383-helping-adolescents-live-with-epilepsy helping-adolescents-live-with-epilepsy

Being an adolescent can be challenging enough, but being an adolescent while dealing with epilepsy can be even tougher.

Learn more about the unique challenges faced by adolescents from a UVA specialist, who discusses a unique clinic set up just for these patients.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1416vh5b.mp3
  • Location: Null
  • Doctors: Langer, Jennifer
  • Featured Speaker: Dr. Jennifer Langer
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio:

    Dr. Jennifer Langer is a board-certified neurologist and neurophysiologist who specializes in caring for adolescents with epilepsy.

  • Transcription:

    Melanie Cole (Host): Being an adolescent can be challenging enough and being an adolescent while dealing with epilepsy can be even tougher. My guest is Dr. Jennifer Langer, she is board certified neurologist and neurophysiologist who specializes in caring for adolescents with epilepsy. Welcome to the show Dr. Langer, first give us a brief explanation if you would about what epilepsy is and how it affects adolescents.

    Dr. Jennifer Langer (Guest): Sure, thanks so much for having me. So, first epilepsy means a tendency towards having unprovoked seizures and by unprovoked, I mean seizures that are not caused by drugs or alcohol or medicine, it means a tendency that brain has towards having seizures. There are only two broad categories of epilepsy, the first is a generalized epilepsy meaning seizures are detected everywhere in the brain at the same time versus a focal or partial epilepsy where seizures start in one area and adolescents can have either type. For an adolescent, epilepsy can really occur in two ways, the first is it can occur as children and continue to have seizures through adolescence and young adulthood so that 50% of kids with epilepsy will not outgrow their seizures and they will continue into that time period. The second possibility is that epilepsy and seizures start in adolescence and those patients can be a little bit different.

    Melanie: So really when children reach adolescence, as we said at the beginning, it is pretty tough time anyway, what are some of the unique challenges that a child that has been diagnosed with epilepsy might face.

    Dr. Langer: Absolutely, so I think back to my own period of adolescence and I think all of us can and it is a challenging time for everybody. There are physical changes, emotional changes and social changes that happen and there is a new issue that teens face, they face peer pressure, they face issues with driving, in sport, the new social challenges like drinking, sex, and things like that. It is also really critical time where identity forms and all these things can be made more difficult and more challenging by having a chronic disease, particularly a chronic disease like epilepsy.

    Melanie: If you have epilepsy as an adolescent, are you allowed to drive, what are the restrictions there?

    Dr. Langer: So good question, the restrictions first of all are state specific. In the State of Virginia, adolescents or adults and even who has had a seizure cannot drive for six months after that seizure, so your ride has implications on starting drivers ed, on getting learner’s permit and then feeling independent being able to drive by themselves.

    Melanie: What about seizure awareness, as an adolescent, I mean you have a lot of friends, you know hopefully and there are people around and at the school, is there a seizure awareness that you think the adolescent needs to make people aware of so that if this happens, people know what to do because it can be quite frightening.

    Dr. Langer: Sure, I always encourage my adolescents to let their friends know they have epilepsy, particularly if they have more frequent seizures and I think it is important to number 1, it reduces the stigma associated with epilepsy, so the more information we get out to teens and we get after the schools, the more people know about epilepsy and the less frightened they are about encountering someone with epilepsy or not knowing what to do if a seizure occurs, so I always tell my teens to let their friends and family know if they have a seizure, the best thing that their friends and family can do is stay calm, to make sure they were in a safe place, lower them to the ground if it’s a convulsion, turn them on their side and just allow the seizure to continue while maintaining safety for the patient, never put anything in the person’s mouth, if they can time is often very helpful. Most seizures are short-lasting, less than two or three minutes, if a seizure lasts longer than that, then the rescue squad or EMS should be called.

    Melanie: What do you focus on to help your patients, what are the main sort of management things that you really truly focus on?

    Dr. Langer: Well, being primarily an epilepsy doctor, my main focus is in the treatment of epilepsy, so for all my patients, my goal is always seizure freedom and seizure freedom without side effects of medicines. For the small percentage of patients with epilepsy that are intractable, meaning their seizures are not well controlled with medicine, we often think of other approaches like epilepsy surgery, devices like a vagal nerve stimulator or diet treatment with a modified Atkins diet. So for me, the first focus is always in the treatment of epilepsy, but particularly in adolescents, there is also I think a really important additional focus and that is on quality of life, it is that we know like I said earlier is that in a teen with epilepsy, it is really hard, so we try to focus a lot on how we can make that better, so whether it is teaching teens about their epilepsy because they were diagnosed as a kid and really never had a discussion with their provider themselves on why they have epilepsy, what epilepsy means. We focus a lot on the importance of taking medicine and help teens troubleshoot for taking their medicine more consistently and we really help them focus on taking control of their epilepsy, so that as they grow older into adulthood, they are able to manage their disease by themselves and that takes knowledge and that also takes empowerment and then also focus on just somebody ins and outs of living with epilepsy.

    Melanie: And why should patients come to UVA’s Adolescent Epilepsy Clinic for their care.

    Dr. Langer: So, our adolescent clinic is the only clinic of its type in the region and that is because we really focus on adolescents as being different because adolescents are not kids with epilepsy and they are not adults with epilepsy and they have their own unique set of concerns and we focus on that. The clinic consists of myself, Mary Thompson who is a nurse practitioner and Debra Morley who is nurse coordinator and all of us bring a different area of expertise to the care of adolescents. In addition, we are housed inside an epilepsy center and the epilepsy center of UVA provides us with the ability to take care of patients who have really tough to control seizures and we have access to different diagnostic testing and treatment modalities that would be afforded at any large scale epilepsy center.

    Melanie: And in just the last minute or so, your best advice for the parents listening and the adolescents that have epilepsy.

    Dr. Langer: So, I think first thing first is you are not alone. Epilepsy in adolescents is probably the most common neurologic problem in adolescents because it is important to know that you are not alone, there are other teens out there and there are places you can go for help, so we are happy to see teens that help with the management of epilepsy and help deal with the other problems that come along with epilepsy and there are also some reasonable web based resources as well including information that we have at UVA and others like epilepsy.com that can provide some really good information for teens living with epilepsy.

    Melanie: And you do advise them to let their friends know and take the stigma out of it and the school system so that everyone is aware and knows what to do in the case of a seizure but it mostly focuses on preventing those seizures in the first place, correct.

    Dr. Langer: Absolutely.

    Melanie: Thank you so much Dr. Jennifer Langer, board certified neurologist and neurophysiologist who specializes in caring for adolescents with epilepsy. You are listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. This is Melanie Cole. Thanks for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
David Cole Mon, 12 May 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/19383-helping-adolescents-live-with-epilepsy
Effective Treatment Options for Carpal Tunnel Syndrome http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=19382-effective-treatment-options-for-carpal-tunnel-syndrome effective-treatment-options-for-carpal-tunnel-syndromeCarpal tunnel syndrome is a common hand condition that can cause pain, numbness and even leave you unable to grab items or perform other manual tasks.

Learn from an expert at the UVA Hand Center about the range of available treatment options to relieve your pain.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1416vh5a.mp3
  • Location: Null
  • Doctors: Chhabra, Bobby
  • Featured Speaker: Dr. Bobby Chhabra
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio:     Dr. Bobby Chhabra    is a board-certified hand surgeon, co-founder of the UVA Hand Center and chair of UVA’s Department of Orthopaedic Surgery.

    UVA Hand Center
  • Transcription: Melanie Cole (Host): Carpal tunnel syndrome is a common hand condition that can cause pain, numbness and even leave you unable to grab items or perform other manual tasks. My guest is Dr. Bobby Chhabra, he is a Board Certified Hand Surgeon and cofounder of the UVA Hand Center and chair of UVA’s Department of Orthopedic Surgery. Welcome to the show Dr. Chhabra, tell us about carpal tunnel syndrome, what is it.

    Dr. Bobby Chhabra (Guest): Thank you Melanie for having me on the show. Carpal tunnel syndrome is compression of the median nerve at the wrist. The median nerve provides sensation to the thumb, index, middle and part of the ring finger and also provides motor function to the thumb muscle, so carpal tunnel syndrome is compression of that nerve at the wrist joint like someone stepping on a garden hose, the nerve conductions are slowed down across the nerve at the wrist and it affects your sensory and motor function to the hand.

    Melanie: Dr. Chhabra who is most at risk for developing carpal tunnel syndrome and give us some of the causes, things that we are doing that might predispose us to this.

    Dr. Chhabra: Pretty much anyone with time and as we age can be susceptible to carpal tunnel syndrome. There is no specific one thing that can cause carpal tunnel syndrome but there is a variety of things, repetitive type wrist flexion activities, a lot of people who work at a desk on a computer can get symptoms, people who are very active if they are doing repetitive wrist flexion exercises or just repetitive type gripping exercises can be susceptible to carpal tunnel syndrome as they get older. There is also carpal tunnel syndrome associated with fractures of the wrist joint, distal radius or fractures of the wrist and those are acute carpal tunnel syndrome issues but the vast majority of carpal tunnel symptoms and people who have carpal tunnel, it is a slow process where it starts out with numbness of the fingers and then progresses to constant numbness of the fingers and then eventually can lead to weakness in the hand.

    Melanie: So the numbness starts out, that is the first symptom. People tend to, Dr. Chhabra, think oh may be it’s a pinched nerve in my neck or how do we define the difference between something that is located in the hand and something that may be is coming from somewhere else.

    Dr. Chhabra: So that is a very good question, it is sometimes difficult because all the nerves start up in the neck from the spinal cord and it can sometimes be a combination of pinched nerve at your neck as well as the nerve compression at your wrist. A lot of times, a pinched nerve in the neck will present as hand pain and numbness, so you need to be evaluated by someone who deals with peripheral nerve compression or hand surgeon will be able to delineate that. Frequently, people who have pinched nerve at their neck will have neck pain that radiates down the arm. People with carpal tunnel syndrome usually first start out by having nighttime symptoms, they wake up at night, their hand feels numb, they will have tingling and a pins and needles feeling in their fingers and as they shake their hand when they wake up, the symptoms improve, so frequently carpal tunnel syndrome starts out with night symptoms and then it will progress to symptoms during the day with specific activities, using a computer for a long period of time or talking on the phone for a long period of time holding a phone to your ear, you can end up getting symptoms in your hand that will resolve but eventually the symptoms become more persistent during the course of the day and untreated carpal tunnel syndrome will result in more constant pain, numbness in the fingers and then as I said eventually the muscle does not get normal nerve signal, so the muscle begins to get weak. The analogy I use is frequently if someone step on a garden hose long enough, the grass does not get enough water and it begins to die and that is really what happens with carpal tunnel syndrome, if your sensory nerve endings and your muscle in the hand do not get normal nerve signal with time, you begin to get constant numbness and weakness in the hand.

    Melanie: So what treatments are available if it becomes something that a person really cannot live with and they cannot use their hand very well, what do you do for them Dr. Chhabra.

    Dr. Chhabra: So frequently, the initial treatment is first diagnosing the problem correctly, making sure it is not a pinched nerve in your neck, cubital tunnel syndrome is a pinched nerve at the elbow that usually causes numbness into the small and part of the ring finger, so you are having seeing someone who can make the correct diagnosis is the first correct step in treatment, then there is different options for treatment, it can be as simple as wearing a splint at night to keep you from fluttering your wrist while you are sleeping and that is helpful particularly if you have nighttime symptoms. Then there is, if some people just have, it can well respond to appropriate vitamins, combination of vitamin B6 and splinting and that has been shown to help people who have mild cases of carpal tunnel syndrome and as the disease progresses and it is usually progressive with time, there are other treatment options such as cortisone injections into the carpal tunnel to help limit the irritation of the nerve and that may provide some part-time benefit but frequently as symptoms progress or if they don’t improve, the best option is surgical treatment and that involves dividing the ligament that, the carpal tunnel is a space where there are several tendons and the nerve together and it is a confined space and a carpal tunnel surgery is where you release the ligament that is on top of that space, so it gives more room for the nerve.

    Melanie: What is involved in the surgery, is it a long recovery process, are we splinted for long time afterward.

    Dr. Chhabra: Right, there are different ways to do a carpal tunnel release. In open carpal tunnel release through a small incision in the palm is done, it is a very frequent procedure and it is about four to six week recovery, some surgeons splint the patient for a short period of time, a week or 10 days and then start a therapy program to appropriate nerve gliding and allow the wound to heal in the palm in several weeks and there is often tenderness in the palm that may take a couple months to improve but most people are back to activities and desk type activities, computer work within a few days or within 7 to 10 days. Another way to do the procedure is endoscopically with a small camera, a minimally invasive technique where the incision is actually in the forearm and a camera just like a knee arthroscopy or a knee scope, you use a camera to see the ligament that is on top of the carpal tunnel and you divide it with a minimally invasive technique, those patients frequently do not require splinting and can get back to activities faster and have less pain but ultimately whether it is done with an open procedure or an endoscopic procedure, patients tend to do very well, this procedure has high success rate if the diagnosis is correct and the recovery after about two months is the same between either approach but our literature has shown that endoscopic procedures, people tend to have less pain and can get back to activities faster.

    Melanie: Dr. Chhabra, why should patients choose UVA Hand Center for their care.

    Dr. Chhabra: Well, in our region we are the only true hand center, we have a one location where you will be seen and evaluated by a hand and upper extremity specialist. My team of physicians and physicians assistants only take care of the hand, wrist, elbow and nerve problems and we have specialized cast technicians or therapists that are in the clinic, so when you come to clinic after surgery or if you need therapy, if we are managing you nonsurgically, you will see the therapist at that time right there in clinic. Our MRI scanner or x-rays, everything you need for care of your problem in the hand or upper extremity is taken care of in one location. We have fellowship trained hand and upper extremity surgeons, we have therapists who are certified, are hand therapists and we have cast technicians and wound specialists and we are the only center in our region that is available 24 x 7 not just for arthritis or nerve problems but for trauma of the hand and upper extremity and we have the fellowship trained surgeons, we have the ability to take care of you whether you have a traumatic injury, if you injure your hand in a car accident or while mowing the lawn, we have the specialists to be able to take care of that and my partners just do hand, wrist, elbow and nerve surgeries, so the level of care and expertise of care is really the highest you will receive anywhere, so having this consolidated approach and having everyone in one place provides for an efficient patient care experience, our goal is to make sure the patient has an excellent experience in our clinic, we have educators in our clinic that can help you understand the problem that you have and the best way to get back to the things you normally like to do, so we treat everything from arthritis, nerve compression, fractures, trauma, sports related injuries, congenital hand issues and we do it all in one location.

    Melanie: Thank you for such great information Dr. Bobby Chhabra, board certified hand surgeon and cofounder of the UVA Hand Center. You are listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic]]>
David Cole Mon, 05 May 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/19382-effective-treatment-options-for-carpal-tunnel-syndrome
Protecting Yourself Against Skin Cancer http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=19386-protecting-yourself-against-skin-cancer protecting-yourself-against-skin-cancer

What are the best ways to protect yourself against skin cancer?

What symptoms should lead you to see a doctor?

Get some prevention tips and learn when you need to see a doctor from a UVA dermatologist who specializes in treating skin cancer.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1416vh5d.mp3
  • Location: Null
  • Doctors: Russell, Mark
  • Featured Speaker: Dr. Mark Russell
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio:

    Dr. Mark Russell is a board-certified dermatologist and who specializes in treating skin cancer.

  • Transcription:

    Melanie Cole (Host): What are the best ways to protect yourself against skin cancer and what symptoms should lead you to see a doctor. My guest is Dr. Mark Russell, he is board certified dermatologist who specializes in treating skin cancer. Welcome to the show Dr. Russell, tell us what are some of the best ways to protect ourselves from skin cancer.

    Dr. Mark Russell (Guest): Well, I think there are three areas that you should focus on prevention, early detection, and effective treatment. Along lines of prevention, sun exposure is the most preventable risk factor for all skin cancers including melanoma and you can prevent your risk by seeking shade whenever appropriate and usually the sun’s rays are strongest around 10:00 am to about 4:00 p.m., so if you are out in the sun at this point in the day then you should try to seek shade whenever possible, wear protective clothing such as a long sleeved shirt, pants, broad brimmed hat and sunglasses whenever possible. The use of sunscreen is also very important and we generally recommend the sun protection factor of 30 or greater as well as a broad spectrum sunscreen and this should be applied evenly and about 20 minutes before going out into the sun and re-apply it about every two hours even on cloudy days and may be more frequently when you are swimming or in the water. You should also use extra caution when you are around water, snow, or sand because you not only get this sun coming from the sky but you can also get reflected ultraviolet radiation coming from below and finally you want to avoid tanning beds because there are ultraviolet radiation rays that come from tanning beds as well which have been shown to increase your risk for not only sunburn, but also skin cancer.

    Melanie: Dr. Russell if people were to give themselves a check and to see a dermatologist regularly to get themselves checked out for skin cancer, what would we be looking for? What are some of the signs, you know, that would send us to a doctor? What do they look like?

    Dr. Russell: Well, you want to be aware of new growths on the skin. We do have the potential to get spots on our skin. They come especially with aging and the vast majority of these are not cancerous, but new growths that come up that may bleed or the crust or that are painful or tender that don’t heal or they heal and then recur in the same area would warrant further examination by a physician. Spots that may come up that look different than other spots on your skin, those should be checked out. A spot that has a change in sensation or develops sensation such as itchiness, tingling, burning, crawling sensation that could be suspicious, moles that change, that become larger, darker or irregular at the border would be a reason to get checked by a physician.

    Melanie: So, what treatment options are available. If you spot something, we go to see you and you say yes this is something that we really need to take a second look at, what is the first thing that you do with patients?

    Dr. Russell: Well, the first thing we do is we look over the entire patient to make sure we know what we are dealing with and how many potential spots are suspicious. We would move into doing biopsy if necessary to help confirm our suspicion and to develop the most specific diagnosis of skin cancer that we can get and then we move into a variety of potential treatment options and those will vary depending on things such as the type of skin cancer, the location of skin cancer, what if any previous treatments have been used and the patient’s age. We have fortunately a large number of treatment options including topical medications, various types of surgery, photodynamic therapy, laser treatment, radiation treatment, chemotherapies, and immunotherapies if necessary and really the best treatment plan is developed by a physician or even a team of physicians experienced in dealing with skin cancer.

    Melanie: When you do a biopsy and you are checking to see if this is something more serious like melanoma, is there a chance that it’s going to come back right in the same place, do you do a mohs where you are really getting those markers very well, how does a patient kind of assess that this is what you are doing?

    Dr. Russell: Well, we start with a biopsy to figure out exactly what the diagnosis is and then we may go further to do a surgical excision or procedure that will definitively remove the remainder of the cancer and it really depends on what type of cancer as to what type of treatment is best and the patient has to confer with the physician to understand exactly what it is the physician is treating and what the endpoint is in terms of removing the cancer. Generally, we try to remove all the cancer, get the margins clear and make sure that there is no cancer remaining and then put the patient into a surveillance routine where they are coming back checking with the physician periodically just to monitor for not only recurrence of the spot that was treated, but also potentially new spots that come up because when a patient has skin cancer, they are at risk for future skin cancers.

    Melanie: So, Dr. Russel, you mentioned, you know, skin protection and there are so many sunscreens on the market, its so confusing, what do you want us to know when we are looking for these to protect ourselves from skin cancer, should we be reading the labels?

    Dr. Russell: Absolutely, there are some components of a sunscreen that have been designated as being more effective. I would like to think of designation of BW30 when I am deciding on sunscreen, the B stands for broad-spectrum that means it protects not only against the ultraviolet B rays, but also with ultraviolet A rays. You would like to get a sun protection factor, an SPF of 30 or above and you also want it to be a water resistant sunscreen which is a designation that implies that it stays on longer in water when you are either swimming or participating in water sports or even out in the hot weather and sweating. An SPF of less than 15 would not be considered effective at preventing skin cancer or photoaging merely reducing your chance of sunburn, so you would like to look for those three factors, broad-spectrum, water resistant, and an SPF of 30 or above.

    Melanie: Do you care if it’s a spray or a cream?

    Dr. Russell: As long as is applied uniformly and evenly, both sprays and creams have been found to be effective.

    Melanie: Because, you know, I mean for parents especially when they are trying to keep their kids from getting sunburn, those sprays are really one of the better inventions and they get much easier to get the kids as long as you say we get really good coverage and we make sure to put it on pretty thick.

    Dr. Russell: Exactly, you just want to make sure that with those sprays, you are not doing it in a windy area because that can make it less effective, but once the spray or the cream or the lotion or whatever the type of sunscreen is put on, as long as it is put on evenly, it should distribute and be protective and it should be put on about 15 minutes before you actually go out into the sun to allow it to stabilize and settle.

    Melanie: Dr. Russel, why should patients come to the UVA Cancer Center and please give us your best advice for preventing skin cancer.

    Dr. Russell: Well, I think the physicians at the University of Virginia Health System are well-prepared to deal with everything from the relatively simple and uncomplicated cases of skin cancer to the most complex and when the need arises, the team at the University of Virginia can come together to gather their collective wisdom. There are many experts as are needed to develop a comprehensive plan for the patients and there is an outstanding team of physicians in UVA Health System with excellent training and substantial experience dealing with skin cancer. I think its this training and experience that leads the best outcomes for our patients, so in terms of best advice protect yourself, be prudent when out in the sun, try to minimize your ultraviolet exposure both from the sun and from tanning beds, monitor your skin monthly, any changing or suspicious spots on the skin, get those checked out early with the physician because the best chance of effective outcomes or good outcomes are to detect skin cancer early and treat it effectively.

    Melanie: Thank you so much Dr. Mark Russell, board certified dermatologist, specializing in treating skin cancer. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 05 May 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/19386-protecting-yourself-against-skin-cancer
A “Defibrillator for the Brain” to Treat Epliepsy http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=18827-a-defibrillator-for-the-brain-to-treat-epliepsy a-defibrillator-for-the-brain-to-treat-epliepsy

While many epilepsy patients can be effectively treated with medication or surgery, those treatments aren’t an option for all patients.

Learn more from a UVA epileptologist about a new treatment option – described as a “defibrillator for the brain” – that UVA is among the first to provide.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1412vh5e.mp3
  • Location: Null
  • Doctors: Fountain, Nathan
  • Featured Speaker: Dr. Nathan Fountain
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio:

    Dr. Nathan Fountain is a board-certified neurologist and neurophysiologist who serves as director of UVA Health System’s F.E. Dreifuss Comprehensive Epilepsy Program.

  • Transcription:

    Melanie Cole (Host): Well, many epilepsy patients can be effectively treated with medication or surgery. Those treatments aren’t always an option for all patients. My guest is Dr. Nathan Fountain. He is a board-certified neurologist and neurophysiologist who serves as director of UVA Health Systems F.E. Dreifuss Comprehensive Epilepsy Program. Welcome to the show, Dr. Fountain. Tell us what is epilepsy and how does it affect patients.

    Dr. Nathan Fountain (Guest): Thank you. Epilepsy is a common condition that we should talk about very specifically because it often has a stigma associated with it or some preconceived notions, so talking about what it is, is definitely the place to start and epilepsy is really any condition that causes seizures. Seizures are an electrical storm of the brain and the kind of seizure that most people think about is what used to be called a grand mal seizure, we now call a generalized tonic clonic seizure and in this case, the electrical storm of the brain grabs the whole brain at once. The patients typically stiffen and fall to the ground and jerk all over. It’s very dramatic to see fortunately for the patients having it, they are usually unconscious, so they don't experience anything necessarily unpleasant during the seizure, but is very dramatic and because it's so dramatic, people are often scared by that, may be appropriate so because it is something that can be pretty scary and intimidating to see, but in fact, the electrical storm that affects the brain most often doesn't affect the whole brain, but instead just affects one small part and that kind of seizure that comes out or is manifest depends on which part of the brain is affected, so for example, if just a small part of the brain that controls the left hand is what having the electrical storm then in that case it will just cause left hand jerking and people will otherwise be perfectly aware of what's going on. They are perfectly conscious, hey look my hand is jerking that’s what my seizure is. If instead the seizure or electrical storm affects just the vision part of the brain for instance then it could just be spots or dots or have other kinds of things in the vision. The most common spot that seizures occur is in the temporal lobe and the temporal lobe controls consciousness and awareness of memory, so in this case, this kind of seizure typically called a complex partial seizure has patients just stop and stare. They are kind of zoned out or staring off into space for just a few moments and they don’t do anything else, they return to normal and that’s actually is the most common kind of seizure. The seizure itself can affect individuals in many very specific ways that only just for a few moments because their characteristic of it is that people who are otherwise perfectly fine had a seizure that starts all of a sudden, goes on for a minute or two and then the seizure stops and people return to normal. A bigger problem for epilepsy is what happens in between seizures because people might be so scared by the seizures that they are afraid of the person which is of course entirely inappropriate. Epilepsy is not a psychiatric disease and most people who have epilepsy are otherwise perfectly fine than having seizure, so it affects patients both by having seizures but also in other ways in between.

    Melanie: Dr. Fountain, I understand that with the different types, will come different types of treatment, but what do you generally do as a standard treatment option and how do you decide which work for what patients?

    Dr. Fountain: Certainly, the place to start is with medication. There are number of medications. In the past about 15 years, there have been about 15 new medications approved and that means we have almost 20 medications to choose from. Which medication we choose depends on which kind of seizure occurs, but also other characteristics that people might have. The things that might need to be treated in addition to the seizures or particularly side effects with medications that you might avoid, so some seizure medications for an instance cause weight loss, so if you are overweight, you might actually like that medication, but if you're particularly skinny then that's not going to work for you. Some medications will treat migraine headache in addition to seizures, so if you have migraine headaches then that particular medication might be a great option. Older medicines if we go back 15 or 20 years, today they cause things like sleepiness and drowsiness. They could affect the liver and the blood work, so older medications required a lot of blood work and tend to be a little bit more fickle. So, we try to avoid those and choose newer medication. Fortunately, about half of patients with epilepsy will respond to the first medication we try. In other words, someone comes in with new onset seizure, they have just had one or two seizures that seems to be result of epilepsy and we start the medication and they don’t have any more seizures as long as they are taking the medication. So that works for about half of people. It’s about another quarter of people that we have to try number of different medications and after trying a number of medications then they are well-controlled. So, their seizures are well-controlled on their medication, but for about 25 or 30% of people despite our best efforts, they continue to have seizures.

    Melanie: So now tell us about the new treatment option UVA is offering for epilepsy treatment.

    Dr. Fountain: There are a number of new treatments, of course besides the standard medication, the new medication, then there are research medications. We always have ongoing trials, but sort of a new breakthrough or a new way to approach epilepsy is through devices. There has been a device that has been around for quite a while, but doesn't actually stimulate the brain, but instead stimulates the different part of the body. It stimulates the nerves in the neck and that’s the standard therapy that has been around a while. The new treatment today at UVA and other places that have been involved in this research project is sort of a Star Wars like device in which electrode wire that can monitor the seizure are placed onto the brain where the seizures come from and a small computer chip is implanted in the skull and it monitors the brainwave activity and when it detects a seizure coming from the area the seizures arrive, then it provides a little zap, a little electrical stimulation to that part of the brain to stop the seizure. It also can provide at the other time and by stimulating the place where the seizures arrives in the brain, it can prevent them from occurring, so the reason this is so novel is because it's responsive neurostimulation. In response to seizure occurring, this little electrical stimulation can prevent it and the reason that it is such a nice thing for people with epilepsy is because as I mentioned before, the medications often cause problems with drowsiness or sleepiness or other things like that, but this new device doesn't have any of those problem. Of course, it does require surgery to have it implanted and the device is new, so we are not really sure how long it will last, but it seems that the battery life for most people will probably be at least a year and hopefully in the future, it will be rechargeable.

    Melanie: Dr. Fountain, which patients might benefit from this?

    Dr. Fountain: It’s really most appropriate for patients who are not controlled with medication because the great advantage to medications is that if someone is having seizures, it starts them on a medication, if that seizures go away, it's great, if the seizures come back and they don’t tolerate the medications, you can stop the medication and then they are off the medication and have no after affects from it, but for devices, once they are implanted, the intention is to keep it there even if it's not beneficial because the risk of removing is probably greater than the risk of leaving it there and that means that you really have a strong inclination to implanted to begin with, so the people who are most appropriate are people with epilepsy who haven’t responded to medications, so what that means as I mentioned before, it's appropriate for about 25 to 30% of people with epilepsy.

    Melanie: Now why should patients with epilepsy choose UVA for their care?

    Dr. Fountain: Oh, it is certainly a leader in epilepsy care. The Comprehensive Epilepsy Program at UVA was one of the first three comprehensive epilepsy centers in the world that was started by a grant from NIH, the National Institutes for Health that designs comprehensive care for epilepsy and really we have been a leader since then, the faculties are internationally renowned. We have many accolades. We do a lot of research, but for most people what I think they appreciate is individual care. Our comprehensive care is aimed at treating each individual depending on the specific problem that they are having. We have nurse case managers or case coordinators in our clinic who are able to coordinate all the care. We tend to service the medical home for people with epilepsy, so we don't provide primary care. If somebody has a cold or an infection, a common medical problem, we would send them to their primary care doctor, but because often epilepsy determines many other aspects of their lives then their care coordinator can help decide what needs to be done for that. I would say that it were certainly the largest epilepsy center in a mini state radius, but beyond that, it’s the individual care that we provide for people that I think separates us from other epilepsy program.

    Melanie: That's very exciting. Thank you so much Dr. Nathan Fountain. You are listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.

  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Brain & Nervous System]]>
David Cole Mon, 28 Apr 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/18827-a-defibrillator-for-the-brain-to-treat-epliepsy
Treatment Advances for Heart Rhythm Disorders http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=18826-treatment-advances-for-heart-rhythm-disorders treatment-advances-for-heart-rhythm-disordersOne potential effect of heart rhythm disorders known as arrhythmias is sudden cardiac arrest, which causes the heart to stop beating and can cause death in minutes.

UVA is among the first hospitals in the U.S. to offer a new device for sudden cardiac arrest – learn more from a UVA expert in heart rhythm disorders.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1412vh5d.mp3
  • Location: Null
  • Doctors: Darby, Andrew
  • Featured Speaker: Dr. Andrew Darby
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Andrew Darby is board-certified in internal medicine, cardiovascular disease and cardiac electrophysiology. He specializes in treating patients with heart rhythm disorders.

  • Transcription: Melanie Cole (Host): What are heart rhythm disorders and what are some of the new exciting treatment advances for heart rhythm disorders. My guest is Dr. Andrew Darby. He is board certified in internal medicine, cardiovascular disease, and cardiac electrophysiology. Welcome to the show, Dr. Darby. Tell us what are heart rhythm disorders?

    Dr. Andrew Darby (Guest): Hi. Good morning. Thank you. Heart rhythm disorders are essentially electrical abnormalities of the heart which affect the timing of the heart rate and heart rhythm and they can either make the heart beat too quickly or too slowly. Some are completely benign, but they can cause bothersome symptoms whereas others can increase the risk of stroke and that’s primarily a rhythm called atrial fibrillation which is a very common heart rhythm disorder in adults and still other heart arrhythmias can actually be life-threatening and these are the ventricular arrhythmias which are abnormal rhythms that arise from the lower chambers of the heart and these arrhythmias include ventricular tachycardia and ventricular fibrillation.

    Melanie: Typically doctor, treatment for, you know atrial fibrillation as you said is becoming more common. People go on Coumadin and blood thinners, all of these things. What is after that, if those things are not working for them? Tell us about some of the new treatment advances for heart rhythm disorders.

    Dr. Darby: Sure, so for atrial fibrillation, there are actually a lot of exciting therapies for the patients who have symptomatic atrial fibrillation meaning they feel their heart racing, they feel their heart beating irregularly. We have medications we can use to try to control the heart rhythm to try to keep patients in normal rhythm. We also have procedures that we can do called catheter ablation where we can minimally invasively insert catheters into the heart to identify the areas where the arrhythmia is coming from and basically burn those areas out and eliminate them to try to maintain a normal rhythm. You mentioned Coumadin which is a blood thinner. One of the main risks with atrial fibrillation is that it can increase the risk of stroke. Over the past few years, a number of new medications have been developed as alternative to Coumadin. These medications are nice in that they don't involve any blood testing which Coumadin requires. They tend to be very reliable on how they work that can be very effective and relatively safe. For patients who can't take blood thinners, there are number of new exciting alternatives to protect patients from a stroke. There are procedures that we can do to essentially seal off the part of the heart where clots tend to form and one of those procedures can be done through by inserting catheters into their veins in the leg and one of the procedures can be done actually by accessing the space around the heart and actually sealing off the place where the clots form, so for the patients who can't take blood thinners, those therapies are nice alternative. For other arrhythmias such as the ventricular arrhythmias like ventricular tachycardia, we have a lot of exciting new therapies to treat those as well. There is catheter ablation just like I mentioned for atrial fibrillation. There is a catheter ablation procedure, we could do to treat that as well as implantable defibrillators which are heart rhythm devices that monitor the heart rhythm and restore normal heart rhythm should patients develop one of these life-threatening heart arrhythmias.

    Melanie: So, Dr. Darby speak about the subcutaneous implantable cardioverter defibrillator that's a lot to say, but this is a new exciting treatment, so tell the listeners what that is?

    Dr. Darby: Sure, so let me first start by talking about the standard defibrillator which up until now has been the only version available, so the previously available defibrillators are systems that we call transvenous defibrillators and what that means is there's not only a defibrillator unit which is something that we implant under the skin in the chest, but there's a wire that we place into the heart to monitor the heart rhythm, so standard defibrillators as we have had available involve inserting one or more wires into the heart and in the way, we implant these devices as we make a incision in the upper part of the chest. The defibrillator device, the actual defibrillator unit, is placed under the skin and then more and more wires are placed into a vein in the upper part of the chest and through that vein, we are able to pass these wires into the heart and traditionally, the wires have been the weakest link or the weakest part of the defibrillator system, so the wires are actually secured to the heart muscle and so they move with each heartbeat and you can imagine if someone has an average heart rate of 70 or 80 beats per minute that's about hundred thousand heartbeats in a day and these devices are supposed to last for years and years and years and decade and that’s a lot of wear and tear and lot of stress on these wires over time and one problem with the standard defibrillator is that the wire can sometimes fracture, can break which can lead to other issues for the patient and so the subcutaneous defibrillator has been developed as an alternative to this and hopefully will be a more durable device and so the biggest differences I would say between the subcutaneous device and the defibrillators that we have traditionally had are that the subcutaneous device is as the name implies, completely subcutaneous, so it does not involve placing anything inside the bloodstream or anything inside the heart. The way we implant it is we make a small incision on the side of the chest for the defibrillator unit to fit in and then two smaller incisions are made along the left side of the breastbone and those smaller incisions are what we use to actually implant the wire that’s attached to the defibrillator, so there is a wire just like we have with standard defibrillators, but this wire is just subcutaneous, it’s just under the skin. That wire essentially is the antenna for the device. That’s how the device monitors the heart rhythm and helps to detect whether the patient is going into a dangerous heart arrhythmia.

    Melanie: That is so cool Dr. Darby. Who is a candidate for this?

    Dr. Darby: It’s a good question. I think anyone being considered for a defibrillator is a potential candidate for subcutaneous device. I think anyone who has had, has blood vessel problems where we might have difficulty accessing the heart or placing the standard transvenous leads into the heart, it would be a good candidate for subcutaneous device. Patients with infectious issues, if the patients have had bloodstream infections or have had recurrent bloodstream infections, we don't want to implant something in the body that could potentially become infected, so the subcutaneous device is out of the bloodstream, so it's nice in that regard. I think especially for young patients, patients who might have the device for years and years and years for decades, with them the subcutaneous device is going to be much more durable because we don't run to the issues with the lead or the wire or the antenna fracturing. I think one thing that should be emphasized is who might not be a candidate for the subcutaneous device, so one limitation of the subcutaneous device is that it cannot function as a pacemaker, so the standard defibrillators that involve the wire going into the heart like I mentioned, those devices can also be pacemaker, so for patients who have a slow heart rate, who also require cardiac pacing, meaning they require some assistance to the device to maintain a normal heart rate to speed their heart rate up, that cannot be done with the subcutaneous device, so the patients who require both a defibrillator which would protect them from life-threatening arrhythmias and the patients who require a pacemaker, patients who require both would be better served by the standard defibrillator. Patients who don't require any pacing assistance would be perfectly fine with the subcutaneous device.

    Melanie: Dr. Darby and just the last minute please, why should patients come to UVA for heart rhythm diagnosis and treatment?

    Dr. Darby: Very good question. I think every patient should come to UVA, but I'm biased. I think we have very well-trained, highly experienced staff both as far as physicians as well as our non-physician staff to support us in these procedures. The University of Virginia was actually the first hospital in the State of Virginia to have an electrophysiologist about 30 years ago, Dr. John DiMarco and we have grown and grown and grown our program over the past few decades and we have the most experience of any program in the state. We have done thousands and thousands and thousands of catheter ablation procedures and device implants and I think that experience matters and another nice thing about being a University Academic Medical Center is that we often have exposure and are given access to these new technologies sooner than other hospitals are and so, we will be the first hospital in Central Virginia to be implanting the subcutaneous defibrillator and we will all have access and do have access to other ablation technologies and other device technologies that other hospitals don't have and so I think for those reasons the experience and the access to new better technologies, I think these are some of the big reasons to come to the University of Virginia.

    Melanie: Thank you so much. That's great information. You are listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Health]]>
David Cole Mon, 21 Apr 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/18826-treatment-advances-for-heart-rhythm-disorders
Providing Cancer Care for Older Patients http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=18824-providing-cancer-care-for-older-patients providing-cancer-care-for-older-patientsFor patients ages 65 and older with cancer, what are some of the unique challenges these patients and their caregivers face?

Learn more from a specialist with UVA Cancer Center’s Geriatric Oncology Clinic.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1412vh5c.mp3
  • Location: Null
  • Doctors: Ramsdale, Erica
  • Featured Speaker: Dr. Erika Ramsdale
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Erika Ramsdale is a board-certified specialist in internal medicine and geriatric medicine who specializes in geriatric cancer care.

    Organization: UVA Cancer Center
  • Transcription: Melanie Cole (Host): For patients aged 65 and older with cancer, there are some unique challenges these patients and their caregivers face. My guest is Dr. Erika Ramsdale, she is a board-certified specialist in internal medicine and geriatric medicine who specializes in geriatric cancer care. Welcome to the show, Dr. Ramsdale. What is geriatric oncology?

    Dr. Erika Ramsdale (Guest): Well, thank you very much for having me on, so geriatric oncology is a pretty new field and it combines two different specialties focusing on the care of older adults with a diagnosis of cancer, so geriatric oncologist like myself often have training and certification in both geriatric medicine and oncology.

    Melanie: So, what are some of the unique challenges that an older patient with cancer might face different than their younger counterparts.

    Dr. Ramsdale: Sure so, as we know, you know, as we age, our physiology changes. I tell patients you don't have the same body at 80 as you did at 20, so we become susceptible to more health problems and that includes cancer. Older adults can be more at risk also for complications from their cancer and from their treatment compared to younger patients, so some are more risk for side effects or they may have other complex health problems affecting them, for example, they may have a mobility issue that makes getting back and forth to the clinic difficult, so I think determining the right treatment plan is sometimes not easy and really requires thinking about the whole person, not just the cancer. On the other hand, I would say aging doesn't happen at the same rate in everyone, so age really is just a number, some healthy and fit older adults are not offered treatment for their cancer because of their age and this is unfortunate because some might really benefit.

    Melanie: Well and as you mentioned that they might have other medical problems in addition to cancer, whether it's mobility issues, arthritis, or you know any of these things, they also might not have as easily access to transportation and social support, that sort of thing, so what are some important things that caregivers of these geriatric and elderly patients need to know.

    Dr. Ramsdale: The caregivers are critical parts of the cancer care for older adults. They are really important to all patients going through cancer treatment, though maybe especially for older adults and especially as you mentioned for those with complex health problems, mobility problems, memory loss, and things like that, there's a lot of accumulating data that our social support structure is really critical for these patients and does affect the outcomes of treatment in older patients to a very significant degree. On the other hand, caregiving can be really tough on the caregiver and so I would say, he or she needs to know how to access health, so I always encourage patients to have their caregivers present at clinic appointment, so that they can ask questions about what to expect. I also strongly encourage all my patients really at any age to talk about their wishes and goals with their primary caregivers and to also designate a power of attorney for healthcare in case they become unable at some point to make decisions for their healthcare. This really helps the caregivers be better advocates for the patient and especially for older patients if something unexpected happens or the end of life.

    Melanie: I think it's also important that the caregivers help with that advocacy because a lot of time, you know, the hearing is even an issue, so that the elderly patient can't even hear the doctor’s instructions or hear their prognosis, you know, those are the kinds of things that that advocate, that caregiver is so important. Now, where do emotions come in Dr. Ramsdale, can depression for example affect treatment and outcomes?

    Dr. Ramsdale: Yes, most definitely. There is a lot of data that problems with mood including depression can significantly impact outcomes for cancer patients.

    Melanie: And what about the risk factors for elderly patients like their susceptibility to falling maybe if treatment gives them a little bit of nausea, something that they're not that used to. What do you tell them and their caregivers to watch out for?

    Dr. Ramsdale: Well, I think you point out that it's true that, you know, older adults have less what we call reserve, so things that might not bother younger patient or might not push them into a serious situation can be sometimes very serious for older adults, so I tell them to speak up and the caregivers to speak up if they experience any side effects because we need to react quickly in many cases to prevent complications like falls which can obviously be very devastating.

    Melanie: Where does nutrition play a part in treatment for cancer care for older patients?

    Dr. Ramsdale: Well, as you are going through cancer treatment, I always encourage my patients to maintain their weight as much as possible. Often patients have weight loss and then in older patient, they predominantly lose muscle mass when they lose weight and this actually increases the risk of mobility problems, and to falling, and other, you know, adverse health outcomes, so the role of nutrition is particularly important for older adults.

    Melanie: Do you like to, you know, recommend some of the nutritional supplements, cans and things that are out there to help them keep up that nutrition while they are going through treatment?

    Dr. Ramsdale: I do. I think a lot of patients are obviously scared by a diagnosis of cancer, so they really want to make some changes in their diet, but I tell people the most important thing going through cancer treatment is to again maintain your weight, so that is calories and that is protein, so certainly I often recommend shakes like, you know, Ensure Boost, some of the calories supplementing shakes because these are sometimes easier especially when someone has a lower appetite because of their treatment or because of the cancer, so yes this is something I often recommend.

    Melanie: Now doctor, one of the things that kind of goes along with being older and then also having cancer is that you are on so many medications for these other things. How do you work with the patients and the medications that they are on for blood pressure or diabetes or their arthritis or any number of things and what they're going through for their cancer care?

    Dr. Ramsdale: Yes, so you are right, older adults are often on many medication for other health problems and also older adults metabolize drugs differently, so I always do a very detailed review of their medication list, what they're taking and how they're taking it and look at potential interactions between those medications and also potential interaction with the cancer treatment itself, so these are very important things to be aware of and their actually criteria out there to help us look at these medications and decide how we should be tailoring therapy.

    Melanie: Well, it's such a wonderful field that you're in, this new burgeoning field and tell the listeners why geriatric cancer patients should choose UVA for their care.

    Dr. Ramsdale: Well, at UVA, we just started the Geriatric Oncology Clinic, it’s located in the Emily Couric Clinical Cancer Center where the cancer patients receive most of their care, so in that clinic, I am the physician there and we see patients on the request of their treating physician and so the patients can get referred to the clinic for a variety of reasons, not just advanced age because, you know, they have additional concerns about some other conditions we have been talking about and so we do a comprehensive assessment of the older person's functioning, not just their physical functioning, but some of the domains that we have talked about like cognitive status or social functioning, emotional functioning, how their nutrition is. We look at their other health problems in depth and we review their medications as I mentioned and their potential interactions with cancer treatment that allows me to give an individualized summary and recommendation back to the treating physician and this helps with decision making for the patient. For example, what's the right cancer therapy for them, are they likely to tolerate this therapy, what’s likelihood of significant side effects, you know, how will the cancer impact other health problems and these are obviously very important questions in an older adult, so I would say UVA contributes, this is not a clinic that is available at a lot of other sites. Obviously, a diagnosis of cancer requires really multidisciplinary expertise with experts from different fields working together for the patient and UVA, I have really seen how successful the experts are in individualizing care and I've been really impressed by how motivated my colleagues are to work together to find the best plan for the patient because this is what really leads to excellent care, so we have not only the geriatric oncology clinic, but excellent supportive care services, palliative care experts, social workers, nutritionists, physical therapy and I think we really offer comprehensive care for older patients and this is really what we need to ensure the best outcome.

    Melanie: Thank you so much Dr. Erika Ramsdale. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
David Cole Mon, 14 Apr 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/18824-providing-cancer-care-for-older-patients
The Benefits of Breastfeeding http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=18823-the-benefits-of-breastfeeding the-benefits-of-breastfeedingWhy is breastfeeding the best option for both newborns and their moms? Learn from a UVA pediatrician and certified lactation consultant who serves as medical director of UVA's Newborn Nursery.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1412vh5b.mp3
  • Location: Null
  • Doctors: Kellams, Ann
  • Featured Speaker: Dr. Ann Kellams
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Ann Kellams is a board-certified pediatrician and director of UVA’s Breastfeeding Medicine Program.

  • Transcription: Melanie Cole (Host): Breastfeeding has been shown to be the best option for both newborn and their moms. My guest is Dr. Ann Kellams, she is a board certified pediatrician and director of UVA’s breastfeeding medicine program. Welcome to the show, Dr. Kellams, tell us a little bit for newborns, what are the health benefits of breastfeeding.

    Dr. Ann Kellams (Guest): Thank you for having me. I think the first thing to know is that human milk is really perfectly designed for human babies, it is different than cow’s milk or goat’s milk or squirrel’s milk, any other mammal and so there is no question that a baby getting its mother milk has added health benefits or may be that is the norm and may be wish to think about that what are the risks of not using breast milk. Babies who breastfeed tend to have lower infections and that is because their mother as they are exposed to the environment or making antibodies specific to what the baby sees, they also have lower rates of sudden infant death syndrome, probably because babies are supposed to be close to their moms, feeding frequently but that elegant cueing system where the baby shows a little sign and the mother responds, they sleep differently, there is even long term effects such as lower rates of diabetes type 1 and type 2 later in childhood, all kinds of good stuff.

    Melanie: So, Dr. Kellams, other than the bonding which is so wonderful for mom and baby, what are some of the benefits of breastfeeding for the new mom.

    Dr. Kellams: Yeah, so for the new moms, it has been shown that if you breastfeed, your rates of breast cancer are lower, your rates of ovarian cancer are lower and then there are some immediate postpartum effects such as lower rates of postpartum depression which you mentioned, less blood loss, so less of that bleeding after delivery and moms do get down to their normal size more quickly after delivery.

    Melanie: In your role with UVA’s breastfeeding medicine program, what are the most common issues new moms face with breastfeeding because some women, this is not as much as they would like to think, a natural process and for some women Dr. Kellams, it is not always that natural of a feeling right off the bat, is it.

    Dr. Kellams: I agree with you. I think that when I think about that breastfeeding is natural, I have to remind myself that a lot of things that we do in the hospital as part of our routines for, you know, preserving safety and health during the birthing process are not natural and so, it used to be routine that you would have your baby and then it would be whisked off to a warmer or to a room down the hall called the newborn nursery where they were supposed to live but they can come out and visit mom and so all of these kinds of separations and interventions, medications that mom get, IV fluids serve for the purpose and have helped us to make the birthing process safer but on the backend, it can make the establishment of this natural feeding patterns unresponsive, a little more tricky so. One of the things we do in the clinic is meet with women prenatally, particularly if they have had trouble breastfeeding another child or they are worried or they have a particular medical condition or medication they are taking that might put them at more risk of having trouble right away. We see a lot of moms for reassurance about supply, so we do a full exam of the baby, we look at the weight pattern, we look at that output pattern and try to come up with a plan for her to either increase her milk supply or reassure her that things are going well because it is really hard to know would you have not done this before. We work on latch and sometimes the baby is doing something funny with its tongue or with its lips or not get on deeply enough, really trying to make sure that both mom and baby are comfortable because generally, a painful latch which you hear so much about seems so common, really is an indicator generally that the baby is doing something on the front or shallow or the angle is such that the nipple is really rubbing the tongue that we try to help fix that because really a deep comfortable latch is what we are going for. The other thing we do is work with moms either when the baby has been premature or may be ill in the hospital, so there has been a separation or a medical condition that prevented them from getting it going and so then we can help them to, on the backend, get the baby back to the breast. Sometimes, that takes a couple of days and depending on the issue, sometimes it takes a couple of weeks but usually its possible.

    Melanie: So, Dr. Kellams, as you address all of these issues with new moms, how do you help them set up a breastfeeding routine because that becomes something that does help them adjust much more easily getting into that routine, looking forward to it.

    Dr. Kellams: Yeah, well and I think that part of helping them is helping them to realize that if you don’t feel like you are pro at this until it has been a few weeks because newborns are sloppy and sleepy and they forget what they are doing and they move their arm in the way and so, you kind of need the no going into it that it is going to feel very hit or miss and for women in our society are used to kind of having it altogether and that can be really tough, it is the first time for many in years that they have not been able to call the shots about their life and so we really focus on the interaction between the mom and the baby and getting teaching the mom what the little subtle feeding cues are or how to maximize the effectiveness of a certain feeding if the baby thinks they are done and you do a little hand expression and then they kind of wake up and get more interested or may be it is time to burp or change the diaper and finish that diet or something like that, so a lot of paying attention to what the baby is showing and paying attention to mom’s body because moms can get used to telling oh wait, I’m empty, that was a great feeling, you know, versus ha, this is then go very well, so I am going to be watching you and the next time you stir, we have got to finish that, so we do a lot of kind of getting to know that baby and seeing how they interact and seeing how we can help them get into a groove.

    Melanie: And how do you help the family and even the father get involved with this bonding, how can the father and the family be involved as well.

    Dr. Kellams: Yeah, that is a great question because so many women will say something like well, I do want to breastfeed but I want the dad to be involved. There are so many things that dads, partners, grandparents, helpers can do. In the first few weeks, the baby is going to have Brazilian diapers, mom is going to need to rest when the baby is resting, so that means anything like laundry, cooking, cleaning, answering all the myriad of phone calls that are coming in, can all sort of handled by them and then right after a feeding when moms kind of get in back together and may be needs to go to the bathroom or something, the baby will often be sleepy and that is a great time for grandma or dad to hold and snuggle the baby and other really great thing for newborns is that as I mentioned they do sometimes fall asleep at the breast but they are not quite done so that is a great time to hand the baby off to one of those people that kind of be like, hey what are you doing and may be burp or may be change the diaper to kind of make them stir a little bit and then hand them back to mom to finish the feeding, so it is definitely a team effort. Mamma has the good, good milk that her body is making but that only happens for, you know, if you add it up an hour or two out of the 24 hours of the day, so lots of ways for people to get involved.

    Melanie: So, there are so many ways and it is so helpful to the mom and to the baby if everybody else is involved in just the less 30 or 40 seconds if you would Dr. Kellams, tell us why families should choose UVA for their pediatric care.

    Dr. Kellams: Well, I think UVA has come a long way in the past seven years in terms of really looking at the evidence of what helps moms successfully achieve their feeding plans and implementing those changes, so babies that are born at UVA go right to mom’s chest and they stay there until the first feeding is accomplished. We do not have a room called the newborn nursery anymore and only would separate mom and baby for a medical procedure or indication and now for the past two years, we have had a breastfeeding medicine program whether you are in the surgical ICU as a mom with a baby at home or your baby is readmitted to the pediatric floor or you are just home and having trouble, we have a way for you to see a lactation and a consultant pediatrician for help and so kind of comprehensive from prenatal all the way through to being home and at work, we have designed a program to help and we have not really advertised and it is all word of mouth and people are coming because this is feeling a need that previously was not addressed.

    Melanie: Thank you so much Dr. Ann Kellams, sounds like a wonderful support system. You are listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. This is Melanie Cole, thanks so much for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Women’s Health]]>
David Cole Mon, 07 Apr 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/18823-the-benefits-of-breastfeeding
How Does a Living Donor Liver Transplant Work? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=18821-how-does-a-living-donor-liver-transplant-work how-does-a-living-donor-liver-transplant-workFor patients in need of a liver transplant, a shortage of livers available for a transplant has long been an issue.

One solution for helping address the shortage is living donor liver transplants.

How do they work?

Learn more from a UVA specialist in liver transplantation.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1412vh5a.mp3
  • Location: Null
  • Doctors: Pelletier, Shawn
  • Featured Speaker: Dr. Shawn Pelletier
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Shawn Pelletier is a board-certified surgeon and surgical director of liver transplantation at UVA.

    Organization: UVA Transplant Center
      
  • Transcription: Melanie Cole (Host): For patients in need of a liver transplant, a shortage of livers available for transplant has long been an issue. One solution for helping address this issue and this shortage is living donor liver transplants. My guest is Dr. Shawn Pelletier, he is a board certified surgeon and surgical director of liver transplantation at UVA. Welcome to the show Dr. Pelletier. How does a living liver donation work?

    Dr. Pelletier (Guest): Well Melanie, we start first by identifying a candidate who needs a liver transplant. So, for the most part, people will come forward who have liver disease, if their symptoms are severe enough, we will work towards getting them on the waiting list for a liver transplant, and at that point, we will talk to the candidate about how the waiting list works and their options and whether or not finding a friend or relative to donate part of their liver would be the right step for them. Once we get to that step, then we would bring in the living donor and meet them and talk to them, it sounds like that is going to lead into your next question.

    Melanie: So, what are the benefits for the patient first to a living donor versus, you know, another type of donor.

    Dr. Pelletier: Right, there are several benefits to the transplant candidate. First of all, the waiting list works pretty well. We are able to get a liver for about 80% of people on the list, what that means is that there’s somewhere close to one in five people who we see who needs a liver transplant never gets one in time and either gets too sick to the point where they are not a candidate anymore or they might die waiting. So, if you have a living donor, you can avoid that risk in a sense you are bringing your own liver, so you are almost, you know, you increase your chances of getting a liver transplant in time. The other is that the way the system works right now is that the sickest person who’s on the list that’s most likely to get the next liver available. So, you have to wait not only until you are sick enough to need a liver transplant but then to the point where you are sicker than everyone else who is on the list before liver comes to you. So, if you have a living donor, we can wait, we can evaluate the candidate, wait till there, at their best that they are healthiest and do it rather than waiting until they are so sick that it’s kind of at the last minute and saving their life at the last minute.

    Melanie: And what is this like for the donor and what eligibility requirements do they have to fulfil.

    Dr. Pelletier: For the donor, it really starts out with us asking the candidates to talk to the potential donors. If they are interested, they can either call or they can go to a website and give some basic information. For the most part, people who can be potential donors have to be pretty healthy, they have to be an adult less than 55 years old and if they fit and then also be blood type compatible, so as far as matching the organs, matching a liver is one of the easier organs that do as long as their blood types are similar or compatible then we are able to do it. At that point, we would have the donor coming to meet our team, we talk to them about the different risks and the benefits, what’s involved, there is a number of different tests we have to do to make sure that if we could do the surgery safely for the donor and it includes getting a CT scan and an MRI looking at the blood vessels going to the liver, essentially looking to see if we can put the liver into two pieces and that both pieces will work okay.

    Melanie: So, what should a potential donor know before making this decision. What is the recovery and the surgery like for the donor?

    Dr. Pelletier: For the most part, the donors do relatively well. There is some information that they have to know and part of what we want them to know is the risk to the recipient and why anyone would consider doing this and you know really it’s a pretty big benefit that the recipient is getting that we talked about little bit earlier as far as not having beyond the waiting list and die waiting. The other part though is the risks for them. We can do the donor surgery safely and we can get donors through it somewhere around 99.5 to 99.7% of the time. So, some people come and say, you know, the odds are way in my favour, it won’t happen to me. Obviously, we take even that small risk whenever we operate on someone who’s healthy and doesn’t need that surgery very seriously. So, we let them know that we would only do the surgery if we thought that we could do it safely and that they agree that the benefit to helping their friend or relative is enough for them to get through it. Usually, the recovery is that would come in on the same day of surgery. The surgery itself takes somewhere around five hours for the donor. We watch them in the ICU for one night assuming that everything is going okay, they are usually in the hospital for five or seven days and then somewhere around four weeks, six weeks after the surgery, they come in and say, wow that was kind of a big surgery, but I’m starting to feel better and then somewhere around six to eight weeks after the surgery, they can get back into their normal life. So, in a sense what we are asking a living donor to do is to take two months out of their life to potentially save the life of their friend or loved one.

    Melanie: And what happens to the liver of the donor. Does this grow back, people always want to know if now that donor is liver deficient, the liver itself grows back.

    Dr. Pelletier: Yeah, it’s an amazing process. So, if you are removing part of a liver for a different reason for cancer or something like that, you can remove up to 80% of a healthy person’s liver and they can survive that and the liver will regenerate and come back. When we do the process for the living donor, we remove up to about 65% of the liver, so really we might take even a little bit more than half of the donor’s liver and give to the recipient. As fast as four or six weeks down the road, both sides of those liver, one in the donor and the one in the recipient will both be somewhere around 90 to 100% normal size again. So, the donor and the recipient don’t grow, if you get the right side of the liver, you don’t grow a left side, it’s just that the right side grows bigger, so you make up the difference, but it’s a pretty amazing thing and then for the most part, donors have normal liver function for the rest of their life.

    Melanie: And what are you seeing for the patient when they get a living liver donation, is the recovery process for them a little bit quicker.

    Dr. Pelletier: It’s varied a little bit, so that is a part of this. For liver transplant, when you get a whole liver from the waiting list, the liver is little bit bigger, the blood vessels are bigger, so in a sense, the surgery for the surgeon is a little bit easier to do. So, if we had a whole liver that is our preference, when we get a living donor liver, we only get a part of the liver, so the piece is smaller, the blood vessels are smaller, so the chance of having a complication is little bit higher, but on the other hand, we can do it when the patient is not at their sickest and when, you know, they are relatively at their strongest. So, it kind of forms a little bit of a mixture where the surgery is a little bit more difficult to do, but the patient is in better condition. So, for the most part, we do the same as someone who got a liver from the waiting list and what that means is the average person in the hospital somewhere around 10 days, their recovery is, you know, little bit slow for the first two or three months, somewhere around three months, they come in and they say they feel better and then somewhere between six months to a year down the road, they come in and they come in and they booed and even realize how sick I was, I have not felt this good in 10 years, and most of those people who receive a liver are able to go back to living and enjoying their life.

    Melanie: In just the last minute Dr. Pelletier, tell us why patients should come to UVA for their transplant care.

    Dr. Pelletier: I can tell you the strongest reason is the team approach that we take, that if someone comes in with liver disease or kidney disease, the first approach is to help them to maintain their own organs and to keep those functioning and we really take an approach from the entire patient including, you know, from a social perspective and all those different reasons along with medical and surgical approaches. If it’s needed, we help people get on the list, maintain them on the list until an organ becomes available and then as a team, we really get them through the whole process and back to, you know, normal life.

    Melanie: Thank you so much Dr. Shawn Pelletier. You are listening to UVA Health System Radio. For more information, you can go to UVAhealth.com. This is Melanie Cole, thanks for listening.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Transplant]]>
David Cole Mon, 31 Mar 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/18821-how-does-a-living-donor-liver-transplant-work
Treating Concussions in Children http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=18281-treating-concussions-in-children treating-concussions-in-childrenWhat are the signs of a concussion?

Are there other sports in addition to football where concussions occur?

Learn about common concussion signs and symptoms in young athletes and what to do if your child suffers a concussion from a UVA Health System neurologist.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1408vh5c.mp3
  • Location: Null
  • Doctors: Jaffee, Michael
  • Featured Speaker: Dr. Michael Jaffee
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Michael Jaffee is a retired U.S. Air Force colonel who joined UVA as a neurologist specializing in concussions and traumatic brain injury following a military career that included service as national director of the Defense and Veterans Brain Injury Center.

    Organization: UVA Brain Injury and Sports Concussion Clinic
  • Transcription: Melanie Cole (Host): What are the signs of a concussion, and what should you do
    if your child has suffered from one? My guest is Dr. Michael Jaffee. He’s a neurologist specializing in concussions and traumatic brain injury, and he was prior the National Director of Defense in Veteran Brain Injury Center. Welcome to the show, Dr. Jaffee. What is a concussion?

    Dr. Michael Jaffee (Guest): Thanks. It’s great to be here. Concussion has been really getting a lot of attention lately. We used to think that concussions require a loss of consciousness following a blow to the head, but we know a lot more now, and we realize that a concussion can be caused by any attack to the head or any force that is transmitted to the brain. And what we see can not only be a loss of consciousness but what we call an alteration of consciousness, and that could be something as simple as seeing stars or feeling dazed and confused for a couple of minutes following such an impact. What we’re really looking at is on the outside of what’s happening on the inside, a transient surge or release of chemicals in the brain caused by that force.

    Melanie: What are the most common concussion symptoms? I wonder this both for parents, for the coaches, and even for other athletes that might be, including the buddy system out on the field, that can keep an eye on each other. What is it we’re looking for?

    Dr. Jaffee: That’s a great question. The way we think about that is we kind of divide the offenses to three different symptom types or symptom clusters. You can have physical symptoms, cognitive symptoms, or behavioral symptoms. Some of the most common physical symptoms include headaches, dizziness, sensitivity to light, and difficulty with your sleep. Some of the most cognitive symptoms include difficulties with attention or difficulty with short-term memory, and then some of the most common behavioral symptoms may include things like irritability or changes in mood. And people can have one or two of any of these symptoms or different combinations, and people present the symptoms of their concussion differently. But I would say that those are probably the most common types of symptoms that people are going to be causing people problems.

    Melanie: Dr. Jaffee, with the equipment today, are we seeing a decrease in the incidence of concussion as we’re hearing more about them? But in sports such as football, they’ve got helmets on. Are these protective? Can parents rest a little easier, or no, not so much?

    Dr. Jaffee: I think there’s a combination of things that’s happening, one of which is improvements in equipments, in helmets, and things like that. But I think the most important thing is the awareness that’s going on, and there’s a lot more recognition of this. There’s now more guidance for parents and coaches and teachers and doctors to provide appropriate management for when a concussion does occur to a child or anyone, and a lot of states now have requirements. There’s baseline testing done before season, in some of the organized sports and a whole protocol that’s being done, and we’re seeing that mirrored from the professional level to the NCAA down to the high school and other recreational sports levels, that increased awareness. And so we’re better able to recognize what’s happening and manage it, and by doing that, we’re really preventing long-term problems and really promoting quick recoveries.

    Melanie: If you suspect that your child has a concussion, what are the treatments? How is it treated? Do we give Ibuprofen or Tylenol at home, keep a close watch? Do we keep them home from school?

    Dr. Jaffee: Well, that’s a great question. First thing we want to do is protect the child from having any other concussions. So if they suffered a concussion in a sports event, we want to remove them from play at that point in time and not send them back to the game that same day. Give them a chance to recover. So what we’ve come up with is really a combination of refresh at least the full day, and then a form of active recovery. And that active recovery is going to be done in a graduated manner. At first, when we see that the symptoms are resolved at rest, we know that sometimes, if you start exerting yourself, that can bring about a headache or dizziness or some of the symptoms you were suffering from. And as part of the recovery process though, to keep that going and prevent recovery from plateauing we come up with an active program in that we sort of return them to activity gradually to see if they can tolerate that, and then we move them up. And we don't really get back to contact activities until they’ve gone through aerobics and other types of exertion showing that they’ve recovered from that. The other aspect you ask about is school, and there’s a similar approach to that, and that should be initially brief, like a day. But then it’s active. So rather than keep someone from school, we want to get someone the benefit of education if they can, start gradually exercising their brains, just as you was gradually exercise your body, and give them accommodations initially that they need a little bit of extra time to take a test or delayed taking exam. But we want them to not stay out of the classroom for too long and start figuring out ways to keep going, because we want to exercise that brain, and that helps promote recovery.

    Melanie: When you say exercise the brain, what about things like video games and television? On the day right after a concussion, do you let your child sit there and play video games? Is there any risk to this?

    Dr. Jaffee: I think that’s part of the brief rest component, where right away we would want to do things to reduce the stimuli. A couple of things is, especially with the light sensitivity that can happen with concussion and the multiple stimulation that happens with video games, it might be a little bit too much right initially. So I would say for the first day or so to not do that. And then with everything else, we would go with a graduated return, and that starts with watching videos or work on the computer, seeing how that goes, making sure that doesn’t produce a headache or dizziness, and if they can tolerate that for the day, then gradually on up until you get all the way back up to those full video games with all the stimulation that’s involved. So that’s part of the whole model of brief rest and active recovery.

    Melanie: During active recovery, when do you know that your child can return to play? If they sustain this concussion during football or even soccer, any of these sports, when do you know they’re safe to return?

    Dr. Jaffee: One of the things we do now is we look at a couple of things with that, one of which is if the symptoms that they were having resolved, have those gone away? And if we put them to physical activity, do they stay at bay. They haven’t come back because you’re running or increasing your heart rate. That’s just the one part of the self-report symptom aspect. And then with a healthcare professional who has some training in this, they can do an examination, make sure there’s no subtle signs of any residual injury or damage to the individual. In some cases, we may do some additional diagnostic assessments using some form of cognitive testing looking at how well you perform with your memory, making sure that that looks well and tested well and all those things together really combine to make an informed decision for returning to play and returning to activities.

    Melanie: How is the UVA Brain Injury and Sports Concussion Clinic working to improve concussion care, doctor?

    Dr. Jaffee: Well, there’s this really an exciting initiative we have at the University of Virginia because it’s truly multidisciplinary. What we’ve done is we brought together a number of different professionals together to provide individualized and tailored care for people who may be having problems in recovering from their concussion. So under one roof, we have adult neurology, child and adolescent neurology, physical therapy, occupational therapy, physical medicine rehabilitation, neuropsychology with ready access to other specialties such as pain management, neurosurgery, sports medicine. We actually have with us in the clinic experts in psychiatry and sleep medicine. And so for people who are having challenges where all of us together can evaluate the individual and come up with an individualized and coordinated plan of care. And the other exciting aspect of this is recovering all forms of injury, not just sports injury, and every severity of injuries—concussion on up through the moderate to severe injuries. So we really cover the entire spectrum and the entire patient population in a coordinated way, and we actually have members of our team who are helping with the inpatient care for those who have more severe injuries and helping to provide a system of care as they go through the medical system, as they are leaving the hospital making sure they have good tracking and appropriate follow-up. Our individuals are very much involved with outreach and education in the community, working with local school systems, making sure they’re up to date on the latest innovations in concussion care, and we’re very well ingrained with the UVA athletic department. And so it’s really exciting to have this synergy and cooperation with all of these people together.

    Melanie: In just the last 30 seconds or so, Dr. Jaffee, give us your best advice regarding concussion prevention, your best advice for parents.

    Dr. Jaffee: Kids want to do the sports they love, so our job is to try and make sure they find the safest way to do it, and that involves taking care of the appropriate practices, using the appropriate policies, appropriate equipment, and appropriate management. So I would just make sure to ask the school what their policy is. Most schools now are required to have one, and if they don’t, we can certainly link them to a professional to help with that education because our goal is to promote the activities that people love but to do it in a safe way.

    Melanie: Thank you so much, Dr. Michael Jaffee. You’re listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening. Have a great day.


  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
Melanie Cole, MS Mon, 24 Mar 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/18281-treating-concussions-in-children
How to Prevent and Treat Polycystic Ovary Syndrome http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=18282-how-to-prevent-and-treat-polycystic-ovary-syndrome how-to-prevent-and-treat-polycystic-ovary-syndromePolycystic ovary syndrome can cause infertility and hair loss and increase your risk for heart disease, diabetes and uterine cancer.

Learn some of the simple steps you can take to reduce your risk from a UVA Children's Hospital pediatric endocrinologist.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1408vh5d.mp3
  • Location: Null
  • Doctors: Burt-Solorzano, Christine
  • Featured Speaker: Dr. Christine Burt-Solorzano
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Christine Burt Solorzano is a pediatric endocrinologist at UVA Children's Hospital whose specialties include polycystic ovary syndrome.

    Organization: UVA Children's Hospital
  • Transcription: Melanie Cole (Host): Polycystic ovary syndrome is a health problem that can affect a woman’s menstrual cycle, hormones, blood vessels and more. My guest is Dr. Christine Burt Solorzano. She’s a pediatric endocrinologist at UVA Children’s Hospital whose specialties include polycystic ovary syndrome. Welcome to the show, Dr. Burt Solorzano. Tell us a little bit about polycystic ovary syndrome.

    Dr. Christine Burt Solorzano (Guest): Thank you. Polycystic ovary syndrome or PCOS is disorder where the ovaries of a woman make too much male hormone. It leads to acne, facial hair, and other male pattern hair growth, and also to irregular menstrual cycles. The irregular menstrual cycles mean that women can have trouble with infertility later when they want to start a family. And in fact, polycystic ovary syndrome is the leading cause of inovulatory infertility in women, affecting 46 percent of all reproductive-age women.

    Melanie: What are some of the risk factors for PCOS?

    Dr. Solorzano: One of the biggest risk factors for PCOS is excess weight, and this is likely related to insulin resistance. Insulin resistance is where your body has trouble using the insulin that it makes and therefore makes more insulin to help keep blood sugars normal. Girls and women with insulin resistance often have dark skin around their necks. That’s when you can tell if you might be at risk for it. And in research studies here at UVA, we found that about 60 percent of girls with obesity already have elevated male hormone levels. This group of girls are at very high risk to go on to develop full-blown PCOS during or shortly after puberty. Other groups of girls and women may have insulin resistance without obesity—those born small or prematurely, daughters of women with PCOS or girls who get early body odor or pubic hair.

    Melanie: Are there some symptoms that would send up a red flag and send them to see you?

    Dr. Solorzano: The main symptoms of PCOS are signs of male hormone excess, so bad acne or facial hair, especially if they’re having trouble with their periods, very irregular menstrual cycles or missing menstrual cycles.

    Melanie: What happens if they are diagnosed with PCOS? What treatments are available?

    Dr. Solorzano: The gold standard treatment, even with all our medications that are available, is still diet and exercise, and that’s even if a girl’s weight is normal. That’s because this helps with the insulin resistance that we were talking about. But medications containing progesterone like birth control pills can be helpful because they quiet the ovaries so they don’t make too much male hormone. And also, Metformin is commonly used, especially in girls, because it helps with insulin resistance. And it may be used for women or girls with early signs of PCOS when they’re early in the progression or later if they’re considering pregnancy.

    Melanie: Because insulin resistance is such a big part of this, doctor, do we assume, or does this put them at a higher risk to diabetes?

    Dr. Solorzano: Yes. Girls and women with PCOS are at higher risk of diabetes, both type 2 and gestational diabetes. And also, other metabolic syndrome kind of problems related to insulin resistance, like high blood pressure, cardiovascular, and problems including heart attack and stroke.

    Melanie: And then what about fertility? You mentioned it was one of the leading causes of infertility. How does it affect fertility?

    Dr. Solorzano: The reason it affects fertility is because you don’t ovulate during your cycle. So if you don’t ovulate, there’s no egg there to be fertilized. And it can be very hard to get the body to ovulate regularly with PCOS. So Metformin or diet and exercise can help the cycles be more ovulatory, have eggs produced each cycle. But if you’re having trouble and you want to become pregnant, then fertility stimulation treatments, which basically induce ovulation, can also be used.

    Melanie: And what if a woman does get pregnant and she’s got PCOS? How does this affect her pregnancy?

    Dr. Solorzano: PCOS can affect the pregnancy in that they’re at higher risk for gestational diabetes. They’re also at a higher risk for premature birth or for problems with preeclampsia. So it puts the woman at a slightly higher risk during the pregnancy. It also exposes the baby to higher male hormone levels, and we’re still learning what that means. But we do know that daughters of women with PCOS are at a higher risk of PCOS themselves.

    Melanie: What about the emotional effects of PCOS, doctor? Because the appearance factor, you mentioned acne and male hormones and hair on the face. What are the emotional aspects of this?

    Dr. Solorzano: Yes. These things can be very hard for girls and women to talk about, but especially teenage girls. You know, to have a teen, it’s hard enough to have normal puberty developing, but to be getting facial hair on top of it can really create a lot of problems with self-esteem, which eventually can lead to depression or anxiety or other problems like that.

    Melanie: So what do you do? If it’s your child and they’re exhibiting these symptoms, do you also include a multidisciplinary approach and have them see someone for those emotional effects?

    Dr. Solorzano: Yes. So the best treatment for the whole variety of problems that occur with PCOS is to see an endocrinologist or a gynecologist to help with the symptoms of PCOS. But that person should also partner with a primary care provider to help connect the girl into resources for counseling and other support. And also here at UVA, we have a program called Go Girls, which is where girls who have problems with insulin resistance or PCOS or diabetes get together and we exercise. We do Zumba together, and we talk about healthy topics and we also talk about self-empowerment ideas as a support for these girls.

    Melanie: Really, what are the most important steps that a woman can take to prevent PCOS?

    Dr. Solorzano: The important things to do to prevent PCOS are to keep a normal weight, eat a balanced diet, avoiding fast foods, get lots of fruits and veggies, plenty of water, no sugary beverages, make sure to get at least 30 minutes of exercise every day. Just a 20-minute walk after eating can really help your body use insulin better. Those are the most important things to prevent PCOS.

    Melanie: What’s on the horizon? Are there some more advanced treatments, things that we can look for and advances in PCOS?

    Dr. Solorzano: At UVA, we’re doing ongoing research to help understand exactly why PCOS starts. We believe that it starts during puberty. And so, by learning more about what causes PCOS, where it starts and how it affects the brain and how it communicates with the ovaries, we’re hopeful that we will be able to pinpoint exactly what and in which girls different treatments can be helpful.

    Melanie: Is there an increased risk of cancer, Doctor, if you have PCOS with ovarian cyst, or is that something to be worried about?

    Dr. Solorzano: Actually, ovarian cyst and irregular menstrual cycles put you at a slightly lower risk of ovarian cancer, but it puts you at a higher risk of uterine cancer, because the uterus needs an endometrial lining to shed at least a couple of times of year. And if you’re not having that menstrual bleeding, then it can put you theoretically at a higher risk of uterine cancer.

    Melanie: Which makes your yearly exams and your visits with your physician even that much more important, correct?

    Dr. Solorzano: That’s right.

    Melanie: So why should women come to UVA for help with their PCOS and other endocrine conditions?

    Dr. Solorzano: UVA has a team of endocrinologists and gynecologists who specialize in PCOS and other endocrine disorders for both children and adults. I think the other important thing is that we use the experiences with our patients to identify which areas of PCOS we don’t understand, and we use those questions to conduct ongoing research to help us understand how to treat girls with PCOS better. And then the other thing that I mentioned is the Go Girls Program. I think it has helped me connect with my patients in a way that I couldn’t in an exam room and has really provided valuable support to lots of girls in our local community.

    Melanie: And your best advice, Dr. Christine Burt Solorzano, for women with PCOS, your best advice for dealing with this?

    Dr. Solorzano: The best advice for dealing with it is to talk about it with your healthcare providers so that if you’re having bothersome symptoms, you can be referred for treatment. And then the other thing is to know that you’re not alone—it affects a lot of women—and that lifestyle changes, even the small ones can make a big difference in the long-term progression of this disease.

    Melanie: Thank you so much. You’re listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening, and have a great day.
  • Length (mins): 10
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Women’s Health]]>
Melanie Cole, MS Mon, 17 Mar 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/18282-how-to-prevent-and-treat-polycystic-ovary-syndrome
Minimally Invasive Surgery for Rectal Cancer http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=18280-minimally-invasive-surgery-for-rectal-cancer minimally-invasive-surgery-for-rectal-cancerFor patients with rectal cancer, minimally invasive surgery is an option. Learn more about how this surgical procedure – Transanal Endoscopic Microsurgery – can benefit patients from a colorectal surgeon at UVA Cancer Center.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1408vh5b.mp3
  • Location: Null
  • Doctors: Hedrick, Traci
  • Featured Speaker: Null
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Traci Hedrick is a colorectal surgeon at UVA Cancer Center who specializes in minimally invasive colon and rectal surgery.

    Organization: UVA Cancer Center
  • Transcription: Melanie Cole (Host): For patients with rectal cancer, there’s a minimally invasive surgery that is an option. My guest is Dr. Traci Hedrick. She’s a colorectal surgeon at UVA Cancer Center who specializes in minimally invasive colon and rectal surgery. Welcome to the show, Dr. Hedrick. Tell us a little bit about what would send up red flags. What are some symptoms of rectal cancer?

    Dr. Traci Hedrick (Guest): Thank you, Melanie, for having me. The main symptoms that most people have with rectal cancer are rectal bleeding. A lot of times, patients mistake that for hemorrhoids in the beginning. But rectal bleeding that particularly is mixed in with the stool should be evaluated and can be a sign of rectal cancer.

    Melanie: You said mixed in with the stool. So if you see bright red blood -- because people get terrified. They could eat beets and see bright red blood when they go to the bathroom. So this has got to be something a little bit different that’s mixed in. That’s what would send them to see you.

    Dr. Hedrick: That’s the most worrisome. But certainly, even if it is bright red blood, any bleeding, if it persists, should be evaluated by a physician. But certainly, most bright, red bleeding is from hemorrhoids. But an older person with any kind of bleeding should be evaluated.

    Melanie: If they are diagnosed with rectal cancer, what is the standard treatment?

    Dr. Hedrick: Well, the treatment depends largely on the stage of the cancer, and that includes how deep the cancer has faded into the rectum, but also whether or not it spread anywhere. For cancers that have spread into the wall of the rectum or have spread to the lymph nodes, the treatment usually includes chemotherapy and radiation for about five weeks, followed by a very large operation, but oftentimes can include at least a temporary, if not permanent, colostomy, and then more chemotherapy. For smaller tumors that haven’t spread quite so extensively, in most cases, the patients still require a very large operation for the earliest of cancer. So if they’re caught in time, the minimally invasive approach through the bottom may be an option.

    Melanie: So you use this minimally invasive approach, the trans-anal endoscopic microsurgery. How is that different than the standard approach?

    Dr. Hedrick: It is quite different. Unlike the standard approach, where we’re making an incision in the abdomen to completely remove the rectum, trans-anal endoscopic microsurgery or TEM, as we refer to it, is a lot like laparoscopy, and that’s the way that most patients have their gallbladders removed, with the long instruments and the scope and the high-definition camera. We’re using all that same equipment except for that we’re doing this surgery through the actual rectum itself, and it allows us to take out tumors within the rectum that we are unable to reach otherwise.

    Melanie: So what are some advantages to patients for this type of surgery?

    Dr. Hedrick: Well, the surgery itself is very well tolerated because we’re not making any incision in the skin. In many cases, patients don’t have any pain at all. That’s a relatively minor surgery. The patients usually go home either the same day or early the following morning, and there really is a very low complication rate with the surgery itself. That’s compared to a very large operation if we have to completely remove the rectum, which can forever change a patient’s quality of life and can be associated with high complication rates. This surgery is not right for everybody. It’s only effective for patients with very early cancers, but it’s something that certainly can be an option in that situation.

    Melanie: And what about something like bowel obstructions after surgery? Is that an increased risk with this or less?

    Dr. Hedrick: Much less because we’re not making incisions into the abdomen. There is a risk of scar tissue in the rectum itself from the surgery, but that chance is very low.

    Melanie: In addition to rectal cancer, can endoscopic microsurgery be used for other conditions?

    Dr. Hedrick: It can be used for other conditions. It’s highly effective for treating polyps, which are what we know are the precursors to cancer. There are a lot of patients out there that have very large polyps in the rectum that can be very difficult to treat and are at risk of turning into cancer. Without TEM many times, these patients have to go undergo repeated procedures to try to keep these polyps at bay from turning into cancers, and they have a tendency of coming back. Or the alternative in that case as well is to have a very large operation to have the rectum removed. However, with TEM, I'm able to completely remove the polyp with a very low chance of it ever coming back or turning into a cancer. And in fact, I'm getting ready to do one for that reason right now. That’s the main other indication. It has been described for treating other conditions such as fistula, which are connections that can occur between the rectum and other structures. But for the most part, TEM is really used to either prevent cancer by getting rid of a polyp or to treat early rectal cancers.

    Melanie: What are some advances, Dr. Hedrick, in rectal cancer? What are some of the new things going on today?

    Dr. Hedrick: Well, rectal cancer, like many other cancers, is really becoming an individualized condition. Here at UVA, whenever a patient is diagnosed with rectal cancer, we have a multidisciplinary group, and we get together and we discuss that patient. There really are several different options. One is this minimally invasive approach through the bottom. If it’s too extensive to be taken up that way, either there are minimally invasive approaches to doing the larger operation as well, which we’re doing here at UVA. We actually have a couple of clinical trials that are available to patients with rectal cancer here. One of the large cooperative national trial that looks at whether or not we can avoid radiation in some patients that have rectal cancer. I actually have a clinical trial that I'm doing as well where we’re looking at potentially being able to sample the lymph nodes with TEM to try to be able to expand this minimally invasive procedure to patients with even more advanced rectal cancers. There’s really a lot on the horizon with rectal cancer, as there is with many other cancers as well.

    Melanie: Thank you so much, Dr. Hedrick. In just the last minute, please, why should patients come to UVA for their cancer care?

    Dr. Hedrick: Well, unlike many other centers, at UVA, we have physicians and nurses in every specialty that are dedicated to specializing in colorectal cancer. Like I mentioned before, we have these weekly multidisciplinary meetings where we focus and individualize the care for each patient. With regard to surgery, my partner and I specialize in colorectal surgery. It’s all we do, and we do hundreds of these complex operations every year as opposed to only a handful. We have these various innovative ways for dealing with patients with rectal cancer. Certainly, for rectal cancer, it’s been shown that patients do better and they live longer if their surgery is done by a specialist in colorectal surgery. So I think for all those reasons, we are top-notch at colorectal cancer care.

    Melanie: Thank you so much, Dr. Traci Hedrick. You’re listening to UVA Healthsystem Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening, and have a great day.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Sugar, Cancer]]>
Melanie Cole, MS Mon, 10 Mar 2014 17:00:00 +0000 http://radiomd.com/uvhs/item/18280-minimally-invasive-surgery-for-rectal-cancer
What You Need to Know Before Your Imaging Exam http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=18278-what-you-need-to-know-before-your-imaging-exam what-you-need-to-know-before-your-imaging-examBefore your next imaging exam, learn more from a UVA Health System radiologist about what radiologists do and why it is so important to have your imaging done by a radiologist who specializes in the area of the body you need examined.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1408vh5a.mp3
  • Location: Null
  • Doctors: Matsumoto, Alan
  • Featured Speaker: Dr. Alan Matsumoto
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Alan Matsumoto is an interventional radiologist and chair of the Department of Radiology and Medical Imaging at UVA Health System.

    Organization: UVA Department of Radiology and Medical Imaging
  • Transcription: Melanie Cole (Host): What does a radiologist do? And why is it so important to have your imaging done by a radiologist who specializes in the area of the body that you need examined?  My guest is Dr. Allan Matsumoto. He’s an Interventional Radiologist and Chair of the Department of Radiology and Medical Imaging at UVA Health System. Welcome to the show Dr. Matsumoto.  Tell us what is a radiologist and what role do they play in diagnosing and treating medical conditions?

    Dr. Allan Matsumoto (Guest): Melanie, a radiologist is a medical doctor; a physician. We’ve gone to medical school and we spend four years of training after our internship just to learn anatomy and physiology, and the technology of how images are obtained with an ultrasound, a CAT Scan, an MRI or a PET Scan, so we can look at the pictures that are obtained to tell a patient and the referring provider what is normal, what is abnormal, what is an incidental finding, and more importantly, based upon the findings, direct the provider and the patients to the best treatment options, if it needs treatment or further diagnostic tests that needs to be provided. In addition to providing diagnostic imaging interpretation, radiologists also use imaging technology to look inside someone’s body, to figure out what a problem is and to either decide: does it need to be biopsied? And then, perform the biopsy to get a diagnosis, or to treat it like there’s an abnormal fluid collection, like an infection. They can go in and drain the infection, or identify an abnormal site of bleeding and stop the bleeding.

    Melanie: You know there are many types of imaging exams now, Dr. Matsumoto and people do worry about risks. Are there any risks to the general types of imaging that radiologists perform and diagnose and look at?

    Dr. Matsumoto: With any imaging test that you undergo, or any procedure you undergo, there will be risks and benefits. One risk is the cost, but the thing you’re referring to probably most prominent now is the risk for radiation exposure. That’s why it’s very important to have a trained and subspecialized and board certified radiologist involved with obtaining the examination to minimize the amount of radiation exposure and making sure that the right exam is done for the right reason, at the right time. So, with risk benefit analysis, the radiologist can have a significant impact in optimizing the benefit for the minimum amount of risk.

    Melanie: Why is it so important to have your imaging done by a radiologist who specializes in the area of the body that you need examined?

    Dr. Matsumoto: Melanie, much like you might take your child to see a pediatrician, or a sports injury to an orthopedic surgeon, radiologists specialize in those areas as well. So the advantage of a subspecialty radiologist is that they interpret the area of their specialty. So, a breast imaging specialist, that’s all they do day in and day out. They look at breast images, mammography, MRI of the breast. A neuroradiologist look at studies of the brain and spine. A musculoskeletal radiologist looks at knee joints, hip joints, muscles, tendons. A cardiovascular radiologist looks at the heart. So it’s very important, just like you’d want someone in your family to get the specialty care, the specialized radiologist does make a difference as compared to a generalized radiologist.

    Melanie: So really it parallels the medical or surgical specialty. You want somebody that knows that part of the body really inside and out because those pictures, we see them, Dr. Matsumoto, you know we look as we kind of exit the room and really most of us don’t know what we’re looking at. How do you know what you’re looking at?

    Dr. Matsumoto: With years of training and the additional specialty experience all of our faculty have done what are called fellowships. And these are extra one to three years of training to learn in specific, more detail, about the information on these images, specific to the questions that are being asked. So even though a primary care physician may order a brain MRI, when our neuroradiologists look at it, and based upon the symptoms and what the patient is complaining about, we can oftentimes direct the primary care physicians or the provider to the appropriate referrals going forward for the patient. So, clearly, a subspecialty-trained radiologist can have a significant impact on the well-being of a patient.

    Melanie: How might a patient come in contact with a radiologist, Dr. Matsumoto?

    Dr. Matsumoto: As we talked about, there’re really two different types of radiologists – those that do procedures and those that look at images for diagnosis. Those that do procedures come in to patients on a daily basis. Those that breast biopsy, they meet the radiologist. They talk with them. The radiologist explains what is being done. Myself, I’m an interventional radiologist. I have a clinic. I see patients there, but I also do minimally-invasive, image guided procedures and we interact with patients at the level, much like a surgeon or cardiologist interacts with a patient. The diagnostic radiologist oftentimes work with the technologists who are then performing the procedures for getting the CAT Scan and the MRIs, in conjunction with the radiologist. In those situations, the radiologist does not typically come in contact with the patient, but they will be glad to see a patient. The radiologist oftentimes interacts with the provider to ensure that the patient gets the appropriate the care and that the information is communicated to the referring provider.

    Melanie: That’s a great distinction between an interventional radiologist and a diagnostic radiologist, Dr. Matsumoto. With an interventional radiologist, such as yourself, do we expect our results while you’re doing procedures, or is it we wait until your done and then you say, “Okay, it will be a day or two,” or you can give us the results pretty quickly?

    Dr. Matsumoto: If it is the biopsy procedure there’s often at time period because we submit the specimen to pathologists who then look at it. And depending upon the nature of the question being asked, it can take anywhere from 48 hours to 96 hours for the pathologist to be able to look at the information. So oftentimes with a biopsy it takes a little bit of a time to get the result back. If you’re undergoing a procedure, for instance if you have an aneurism, or if you have a place of bleeding and the interventional radiologist goes in and treats the aneurism or treats the bleeding, then we often, much like a surgeon, would talk to a patient. The interventional radiologist says, “We found the site of bleeding. We believe we stopped it. We’ll know over the next few hours whether the bleeding has stopped.” So it depends upon the specific circumstance.

    Melanie: Dr. Matsumoto, we have a few minutes left. Would you tell us why a patient should choose UVA for their imaging services?

    Dr. Matsumoto: Well, at UVA our radiologists consider it to be a privilege to be involved in the patient’s care and we really take pride in performing the right imaging tests, or the right procedure for the right reason, at the right time. It’s very important for us to have the technology available to us, and at University of Virginia all our equipment is state-of-the-art. In addition, all the images that are interpreted and all the procedures performed are done by sub-specialists that are in that area of interest. So, they are all subspecialty radiologist. So again, a pediatric X-ray is read by a pediatric radiologist. A heart MRI is read by a cardiac MR. That makes a huge difference for the patient’s well-being. Plus the technology makes the difference. Not all equipment is the same. Those of you that have a laptop, you have a smartphone, you have a television, you know that it’s important for the state-of-the-art equipment. If your camera only takes 4 megapixel pictures, you’re not going to be able to see the level of detail to see if there’s a subtle cartilage there. So, not only are our radiologists specialized, they’re working on state-of-the-art equipment, but they’re also physically here on campus and live in the Charlottesville community.  Lastly many of our radiologists have developed the technology so once it becomes widespread we have been using it for five years. And not only that, we’re teaching other radiologists how to do this. So we are, in many instances, the expert.  A couple of other bonus points about being at UVA is we’re at multiple locations, whether it’s at the main campus, Northridge, Zion Crossroads, Fontaine, we have accessed imaging studies at night and weekends at multiple sites with all state-of-the-art equipment. And lastly patients access their reports and their images through our electronic medical record through something called MyChart and MyView. So, you put that all together, we provide the entire package; the subspecialty physicians who care, the technology that cares, the specially-trained technologists that take the images, the multiple locations patients can access and access to the information. And lastly, our radiologists are often leading the way. So we have experienced interpreting and utilizing the state-of-the-art equipment that many other institutions around us don’t have that luxury.

    Melanie: That is great information, Dr. Allan Matsumoto. Thank you so much.  You’re listening to UVA HealthSystem Radio. And for more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening. Have a great day.
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  • Hosts: Melanie Cole, MS
Tagged under: MRI]]>
Melanie Cole, MS Mon, 03 Mar 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/18278-what-you-need-to-know-before-your-imaging-exam
Advanced Imaging Options for Heart Disease http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=18056-advanced-imaging-options-for-heart-disease advanced-imaging-options-for-heart-diseaseAdvances in heart imaging can help doctors better identify heart disease.

Learn about the latest technology – and when patients and their doctors should consider these advanced heart imaging techniques – from a UVA Health System cardiologist.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1403vh5e.mp3
  • Location: Null
  • Doctors: Bourque, Jamie
  • Featured Speaker: Dr. Jamie Bourque
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Jamieson Bourque is a cardiologist at UVA Health System specializing in heart imaging.

    Organization: UVA Heart and Vascular Center
  • Transcription: Melanie Cole (Host): New advances in heart imaging can help doctors better identify heart disease. My guest is Dr. Jamie Bourque. He's a cardiologist at UVA Health System. Welcome to the show, Dr. Borque. Tell us what are some of the advanced imaging options available at UVA to identify heart disease.

    Dr. Jamie Bourque (Guest): Well, thank you very much for having me. We have several advanced imaging options available now, including Cardiac Magnetic Resonance Imaging or Cardiac MRI, which gives very detailed images of the structure and function of the heart and has some additional features, such as scar imaging that is particularly useful; Cardiac Computed Tomography which allows us to look at the coronary arteries in a non-invasive fashion, without actually having to put a catheter in the body. But the one that I'm particularly excited about and that we recently started using is an advanced form of stress-test imaging called Cardiac Positron Emission Tomography, or Cardiac PET for short.

    Melanie: And what exactly is that? How does it differ from the standard imaging?

    Dr. Bourque: Cardiac PET stress testing allows us to more accurately diagnose chest pain that we think is due to coronary artery disease more quickly that our standard stress imaging and also with less radiation. Those are all advantages, but the most exciting feature is its ability to image the microvasculature—that is, the small blood vessels that supply the heart. Using this technique, we can identify the cause of chest pain in patients with convincing symptom but who have a negative workup, including a cardiac cauterization. These patients have previously been told there is nothing wrong with their heart, but we now know that sometimes that is not the case. They may have coronary microvascular dysfunction, and this test allows us to look for that.

    Melanie: So it gives you a better view of those micro-vessels that we didn't have before.

    Dr. Bourque: Yeah. Previously, there was no way to actually assess those vessels, and this is now an option that is available to us.

    Melanie: So who benefits most from these new imaging techniques?

    Dr. Bourque: Again, patients who have a negative cardiac workup previously but may have continued symptoms, or who had a stress test that was previously equivocal, as in they weren't quite sure whether it was positive or negative, which can sometimes happen with our stress testing. Those sorts of patients particularly benefit from Cardiac PET Imaging. However, because of its improved diagnostic accuracy in patients who have multi-vessel disease, it's also very useful in patients who have diabetes and kidney disease, as well as patients who may carry a little more weight.

    Melanie: So in the Cardiac PET stress test, are there limiting factors as in a regular stress test, where maybe the quadriceps start to burn early, or the person can't keep up with the treadmill? Are there those limiting factors, or have those been removed?

    Dr. Bourque: It's a good question. Unfortunately, the current tracers available don't allow us to use exercise for stress. By the time the patient got on the table after exercising, the tracer would already be gone, which is good because it means low radiation for the patient, but it's unfortunate we can't use exercise. There are some imaging tracers in the research pipeline that will allow exercise stress, but for the moment, what we do is we give a medication that dilates the blood vessels, and that simulates stress on the heart. It's very safe but also allows us to stress the heart without actually having them walk on a treadmill.

    Melanie: So Dr. Bourque, what would you recommend for heart imaging exams that patients should undergo routinely, and how often?

    Dr. Bourque: It turns out that most of our cardiac imaging really should only be done when a patient is symptomatic. So they may have chest pain or shortness of breath. There are very specific instances where noninvasive imaging may be helpful, such as someone with a very significant family history in multiple cardiac risk factors, or someone who is particularly high risk and plans to undergo non-cardiac surgery. But for most patients, we actually would wait to do any imaging until they had symptoms. This has really been an advance in our field. Cardiac imaging is something that has been overused to the significant expense of patients and insurance companies, and then, also, significant expenditures to patient time and effort. For the most part, patients should really be symptomatic before undergoing these tests.

    Melanie: Are there different rules for men versus women?

    Dr. Bourque: Basically, men do have a higher risk of coronary disease. However, that difference has been shrinking, partly due to the sort of rise of obesity, increased tobacco use in women. While that might have been the case in the past, it's less true now.

    Melanie: If someone is experiencing chest pain, shortness of breath, how do you determine? Do you go right into testing? How do you determine whether this is anxiety? Because we're a very stressed out society these days, Dr. Bourque, and sometimes those symptoms can be associated with a number of different other conditions.

    Dr. Bourque: Absolutely. There's no question that both chest pain and shortness of breath can be due to non-cardiac reasons, or even to cardiac reasons other than decreased blood flow to the heart. The initial screen that we do is with a careful history in physical. And oftentimes, in talking with patients and finding out when they have their symptoms and the quality of their symptoms we're able to make a determination, "Well, that chest pain that you get when you're just sitting still on the couch and it's worse after a fatty meal, that's probably not coronary disease, whereas chest pain or shortness of breath that comes on three minutes or every time you go up a flight of stairs, or every time you walk up a hill, causing you to sweat and pant and have to stop at the top and resting makes it better, that's very concerning symptomatology."

    Melanie: What about other imaging tests that have been used previously, like carotid ultrasounds or looking at cholesterol levels, plaques in arteries? Are we still using these, even CRP?

    Dr. Bourque: Those are all good methods for risk stratification for patients. Again, those sorts of testing are probably better, as you were saying before, for the asymptomatic patient, where we may want to look at someone who has a family history, or who has multiple cardiovascular risk factors and do plaque imaging. Or actually, the most effective method we have right now is calcium scoring, which is a non-invasive cardiovascular imaging test, relatively inexpensive. We do offer that at UVA. But usually, looking at blood pressure, blood glucose, cholesterol, all of the standard cardiac risk factors gives us a pretty good idea of who to test. CRP can be used in patients where you sort of have a borderline, "Should we treat this patient or not?" after looking at their risk factors? The CRP, Calcium Scoring, which we do offer, Carotid Intima-Medial Thickness Measurement, but calcium scoring is probably a better method.

    Melanie: Why should patients choose patients choose UVA for their heart care?

    Dr. Bourque: I'm biased, but I do believe that UVA is an excellent choice for anyone who's looking for compassionate care and for a comprehensive evaluation of their heart by highly trained physicians using the latest tools that are available anywhere. I believe that our up-to-date knowledge and our cutting-edge diagnostic testing and the treatments that we have available make us the clear choice for cardiac care.

    Melanie: Dr. Bourque, give us your best advice in the last minute for preventing heart disease, and maybe then, we don't have to come see you.

    Dr. Bourque: Absolutely. I think that the best thing that folks can do to prevent heart disease are to watch their risk factors. Get an annual physical, monitor the blood pressure, monitor cholesterol, watch your diet. A Mediterranean diet, we know now, is probably the best way to go. Keep one's weight down, keep from becoming overweight. And probably, most importantly—and I know you like to hear this as an exercise physiologist—we need to get out and exercise more. And I think if patients do all of those things...

    Melanie: Thank you so much. If they do all of those things, then maybe they can help to prevent heart disease in this Heart Health Month. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thank you so much for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Heart Disease]]>
Melanie Cole, MS Mon, 24 Feb 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/18056-advanced-imaging-options-for-heart-disease
Neurocutaneous Disorders: Tumors Caused by Genetic Factors http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=17440-neurocutaneous-disorders-tumors-caused-by-genetic-factors neurocutaneous-disorders-tumors-caused-by-genetic-factorsWhile most people associate tumors with cancer, they can also be caused by genetic factors.

Learn more about the most common neurocutaneous disorders, what causes them and how they can be treated from a UVA neurosurgeon who specializes in these conditions.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1403vh5d.mp3
  • Location: Null
  • Doctors: Asthagiri, Ashok
  • Featured Speaker: Dr. Ashok Asthagiri
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Ashok Asthagiri is a neurosurgeon at UVA Health System, where he leads a multidisciplinary team in treating neurocutaneous disorders.

    Organization: UVA Health System Neurosciences
  • Transcription: Melanie Cole (Host): While most people associate tumors with cancers, they can also be caused by genetic factors. Today we're talking about neurocutaneous disorders and their treatment options.My guest is Dr. Ashok Asthagiri. He's a neurosurgeon at UVA Health System, where he leads a multi-disciplinary team in treating neurocutaneous disorders. Welcome to the show. So tell the listeners or people who aren't familiar, what are neurocutaneous disorders?

    Ashok Asthagiri (Guest): Great. Neurocutaneous disorders are a constellation of different disorders that have been grouped together because of certain components that are very similar. The folks with any type of neurocutaneous disorder will have neurologic problems—that's where the neuro part comes—and oftentimes also have cutaneous signs or skin alterations that can be readily apparent on physical examination. That's how these groups of disorders have been clustered together.In addition to that, this group of disorders also carries what you had mentioned earlier, a genetic component, that we understand that many of them are actually caused by known mutations in DNA and can be inherited from parent to child. So we've lumped all these together because they sort of fall under the same category of common symptoms that may cluster together, and that's why they've been historically grouped together.

    Melanie: Do we know what causes them? How common are they, really?

    Dr. Asthagiri: Well, the reason that we're still talking about neurocutaneous disorders and that it's not widespread knowledge what they are is because of their relative rarity. If we cluster them all together as a group, they occur at about one in every 1,000 persons living in the United States. When we think about that, that's a pretty small number. In fact, they are actually covered under the terminology of rare disease by the Office of Rare Diseases in the National Institute of Health. Having said that, that's also what has propelled them to the forefront of research and investigation and actually has really gone into why we are able to definitively say what causes these types of syndromes.The mainstay of what causes them are genetic mutations. So for example, there are several of them that are quite common. There are the neurofibromatosis, Von Hippel-Lindau Syndrome, and tuberous sclerosis. And we know that genes that are involved that actually cause these, and we can actually do genetic testing to identify that there are these genetic mutations that are present.

    Melanie: Now, if somebody does have these genetic mutations, are there certain treatments? Is this something that is a chronic situation in their lives? Tell us about treatments.

    Dr. Asthagiri: Yeah. Even though it is oftentimes passed from parent to child, it is not just a pediatric disorder that folks grow out of—as you mentioned, chronic condition, a lifelong condition. For many of these syndromes, the adult aspect is equally, if not more, important to their chronic care as their pediatric years are. It's really a lifelong process of continual surveillance and treatment that's really needed in order to manage patients with these types of disorders effectively.As research and investigation of these disorders have developed, the treatments have been really ratified over the last 20 years. Let me give you a few examples of how things have changed. And there, I think it epitomizes what medicine is evolving too in many conditions. Thirty, 40 years ago, what happened with all of these types of patients is you wait until you get a problem, you see the doctor, and we might identify a tumor in the nervous system that's causing a problem, and then it gets taken out. For some conditions now, we have actually developed certain types of alternatives: surgical therapy and also the use of radiosurgery, which is focused radiation, to manage some of the tumors. In other situations, it also progressed to very efficacious types of medical therapies that can absolutely control some of the symptoms that developed, such as hearing loss and some of the condition, and also, tumors that are growing, they can cause seizures. Some very effective medications exists or that and are under clinical investigation, clinical trials. So epitomizes the transition from a reactive type of treatment—when you have a problem, we take care of it.In general, medicine has evolved such that we're not trying to react to problems that develop, but rather, be proactive, be able to figure out problems, where they come on, number one. And number two, try to treat them in a more holistic approach and try to treat things in a less morbid, even less surgical approach. That's where things are moving to, and that's what we're trying to evolve to and create new treatments for them.

    Melanie: You're focusing more on preventing or maximizing the person's capabilities at home and in the community, correct?

    Dr. Asthagiri: Absolutely, because folks with neurocutaneous disorders oftentimes develop multiple nervous system tumors. If you have three brain tumors, two spinal tumors, and one or two tumors on the peripheral nerve, there's no way to get rid of all of the tumors. We don't operate on all of the tumors just because they're there. Instead, we follow them very closely. And if they develop symptoms, naturally, we would have to treat, but part of the issue is trying to figure out a way to optimize their ability to work and function in the community, and then also try to delay or prevent symptom evolution. That's where things are headed. That's where we would like to be in 10, 15, 20 years, and we're getting there. I think we're making our steps into those types of advances.

    Melanie: Doctor, you lead a multi-disciplinary team in treating neurocutaneous disorders. What does that mean, and why should patients come to UVA for their care?

    Dr. Asthagiri: Well, one of the reasons that I actually came back to the University of Virginia is because of this commitment to the multi-disciplinary aspect of these patients. Patients with neurocutaneous disorders not only have problems with tumors in their nervous system and from skin changes. They also have, at times, cardiac abnormality and brain tumors that can cause high blood pressure. They also can develop renal cell cancer and many other types of organs that can be involved. So for each of the subtypes of neurocutaneous disorders, we've developed a multi-disciplinary first point of contact team that has agreed to help manage patients with these specific types and conditions. For a long time, folks with neurocutaneous disorders would have to go to a center, one center, or get an appointment in to go see a neurosurgeon and then three weeks later, have a disjointed appointment with another doctor who may not know about the neurosurgeon, that wasn't very coordinated.

    Melanie: Now, we don't have much time, so what you're saying here, doctor, is that you can provide all of those different aspects in one place, yes?

    Dr. Asthagiri: That's right, yeah. That's what the University of Virginia has to offer for folks with neurocutaneous disorders. That's right.

    Melanie: Well, thank you so very much. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. You've been listening to our discussion on neurocutaneous disorders and the multi-disciplinary approach at University of Virginia Health System. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Genetics]]>
Melanie Cole, MS Mon, 17 Feb 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/17440-neurocutaneous-disorders-tumors-caused-by-genetic-factors
Caring for Newborns with Congenital Heart Defects http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=17438-caring-for-newborns-with-congenital-heart-defects caring-for-newborns-with-congenital-heart-defectsEight of every 1,000 babies is born with a heart defect.

Newborns with heart defects now have a range of treatment options, including heart surgery and even heart transplants.

Learn more about the available treatments from a UVA pediatric cardiologist.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1403vh5c.mp3
  • Location: Null
  • Doctors: L’Ecuyer, Thomas
  • Featured Speaker: Dr. Thomas L'Ecuyer
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Thomas L'Ecuyer is the Division Chief of Pediatric Cardiology at UVA Children's Hospital.

    Organization: UVA Fetal Heart Program at UVA Children's Hospital
  • Transcription: Melanie Cole (Host): Eight of every 1,000 babies is born with a heart defect. Today we're talking about the range of treatment options available from UVA pediatric cardiologist, Dr. Thomas L'Ecuyer. Welcome to the show. So what is congenital heart disease, Dr. L'Ecuyer?

    Thomas L'Ecuyer (Guest): This is formed before a baby is born, and congenital heart disease refers to some abnormality of development of the heart, which can include blood vessels being connected to improper chambers, holes in the heart, and absence of one or more chambers, blocked valves, things such as this. So basically it can be thought of as problems with the plumbing of the heart.

    Melanie: Okay. So how common is this, Dr. L'Ecuyer? You're the Division Chief of Pediatric Cardiology at UVA Children's Hospital. How much are you seeing of this?

    Dr. L'Ecuyer: Well, about 1 percent, a little bit less than 1 percent of babies are born with a Congenital Heart Defect, so we have clinics every day of the week, sometimes with more than one pediatric cardiologist here at UVA, and we're typically seeing 8 to 10 patients in a half-day session, all of which have the suspicion of heart disease and about 25 to 30 percent of which are actually found to have heart disease, so we're seeing quite a bit of it. In fact, I'd say that's 95 percent of the work that we do in pediatric cardiology is taking care of these kids.

    Melanie: What causes this congenital heart disease?

    Dr. L'Ecuyer: It's not known. There are some genetic syndromes where there are chromosomal problems that are associated with congenital heart disease. It is likely that there are genes that are abnormal that contribute to congenital heart disease, but they've largely been unidentified. So we've not identified particular factors that are responsible for this.

    Melanie: How is this diagnosed and treated? Is it something that we know about prenatally, or do you only find out once the baby is born? Tell us a little bit about how that goes along.

    Dr. L'Ecuyer: Well, I think that a significant number nowadays are diagnosed before a baby is born. Obstetricians are routinely doing ultrasounds on developing fetuses before a baby is born, and if a significant abnormality's appearing in the heart, which they attempt to look at, then they'll often ask a pediatric cardiologist to perform on more detailed scan on the heart in particular.Most of our major congenital heart defects, the most important ones are diagnosed before birth, and an additional significant percentage of these are diagnosed after birth, and they most commonly present either with a baby being blue or cyanotic, a baby having difficulty feeding and growing, or with an abnormal exam, such as the presence of a heart murmur.

    Melanie: I imagine that the mother or the parents must be terrified to hear this. Give them some hope in what's going on in the world and the horizon picture of congenital heart disease in infants.

    Dr. L'Ecuyer: Okay. Well, there's a significant percentage of congenital heart disease that does not really required treatment. So I think the most important thing is to connect them with a pediatric cardiologist who can make a specific diagnosis and can talk with them in detail about what the implications are for their child's health.Those that do require treatment most commonly require surgical treatment, and UVA has had a surgical program to treat congenital heart disease now for the last 30 years. It's continuously been present. It's the longest-standing program in the State of Virginia. Recent outcomes after congenital heart surgery are as good as any pediatric hospital in the United States, so we're very proud of this. So those that do require surgical treatments, some of them can be cured with a single surgery, some of them required stage treatments. A very small population will require more dramatic treatments, such as heart transplantation, and we've also have a heart transplant program for more than 20 years, which has been very successful, particularly within the last few years. So there's tremendous treatment options that are available for them.We also have the ability to perform non-surgical treatments of some congenital heart disease. We have a very busy cardiac catherization lab that offers invasive but less invasive treatment options for some kids with certain congenital heart defects. So I think that the idea is that we need to make the diagnosis, we need to meet with the families to discuss the options. There's no treatment option that's available that I don't think is available here at UVA.

    Melanie: What about ongoing medical care after surgeries? Is there anything else do the parents need to know about, Dr. L'Ecuyer? About nutrition, medications, physical activity, future pregnancies? Speak about that for the parents, if you would.

    Dr. L'Ecuyer: Well, those are all part of the counseling treatment program that we deliver to kids that have congenital heart disease. Many defects require one surgical treatment, and they might require periodic follow-up every one to two years throughout a child with the pediatric cardiologist. A smaller number of the diseases that we deal with require additional medical treatment on top of surgical therapy, and some kids are more debilitated than others. Our goal is—and what we are usually able to achieve—is a normal activity level and a normal childhood for these kids.There are some conditions that require restriction of physical activity. Most of them do not, and I think that's an individualized decision that's based on both the specific defect that the child has, their response to treatment, and the end result in terms of their heart function and the ability of their circulation to support vigorous exercise.These decisions are made -- some of them you can predict before the surgery takes place based on the anatomy of the defect that the child has. Many of them we sort of make these decisions based upon their response to treatment. So it's a highly individualized treatment program based on the defect and the child's response.

    Melanie: At home, is this something that parents can deal with at home ongoing and these children have a pretty good outlook? What are the parents doing at home?

    Dr. L'Ecuyer: We basically are able to achieve a normal childhood for the overwhelming majority of kids that have congenital heart disease, even if they require surgery. Most hospital stays after surgery for congenital heart disease are in the order of a week to 10 days, so it doesn't interrupt their lives tremendously. There's a recovery program. They don't need to be restricted from being around other children other than immediately after their surgery. These kids go to regular school, they play on childhood sports teams like everybody else, they learn and progress with the school system. So it's big shock for the families to find out about the diagnosis, and I think that they become surprised at how normally these kids can function. When the kids grow up, there's a slightly increased risk of a child with congenital heart disease having their own kids with congenital heart disease, so we generally have a specific counseling for them about if they choose to have families, it's a good idea to have the opportunity to have a prenatal ultrasound with a fetal echo program before the baby is born so that planning can take place and you'll have an idea before a baby is born about whether they share a similar heart problem or whether they've been part of the 97 percent of kids born to people of heart disease that turn out to have perfectly normal hearts.

    Melanie: How important is nutrition for children who have heart defects as they grow, as you say that they're normal? Is there any kind of nutritional component here?

    Dr. L'Ecuyer: Nutrition's critical, because growth is very important in terms of their response to their treatment for heart disease. We work closely with nutritionists, particularly during their in-patient stays, to develop a nutrition program that's appropriate for each of these kids. It is extremely important; their outcomes are better if they're well nourished. Their outcomes are also better if they're not overweight, so I think that proper childhood nutrition, which is often very similar to the nutrition of a child that doesn't have heart disease, is important, and we help the families make sure that's delivered.

    Melanie: Why should families choose UVA for their treatment, Dr. L'Ecuyer?

    Dr. L'Ecuyer: Well, the first thing is I think we have a very tight focus on providing families what it is that they need, so we provide comprehensive care. Every subspecialty in pediatric cardiology that's needed, whether it be electrophysiology, interventional cardiac catheterization, surgical treatment, medical treatment, as far as transplantation in any complication that comes up, we have specialists that are able to take care of that. That's that first thing. The second thing, is that we work closely with the Pediatricians who provide the medical home for these kids. We work closely with them to keep them out of the hospital and to keep them in the local communities and allow them to achieve the best lives that they can have. Third, I think that our outcomes are comparable to the very best programs in the country. Our goal is continuous improvement. We regularly analyze what we do. We pay attention to what our families say about the service we're providing, and I make sure that we respond to that.

    Melanie: Thank you so much. For more information, you can go to uvahealth.com. You're listening to UVA Health System Radio. I'm Melanie Cole. Thanks for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Children's Health, Heart Health]]>
Melanie Cole, MS Mon, 10 Feb 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/17438-caring-for-newborns-with-congenital-heart-defects
Who Should Be Screened for Lung Cancer? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=17437-who-should-be-screened-for-lung-cancer who-should-be-screened-for-lung-cancerShould you be screened for lung cancer?

Depending on your age and whether you are – or have been – a smoker, you may want to consider getting screened.

Learn which patients are at the highest risk for lung cancer from a UVA Health System radiologist.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1403vh5b.mp3
  • Location: Null
  • Doctors: Olazagasti, Juan
  • Featured Speaker: Dr. Juan Olazagasti
  • Guest Name: Null
  • Guest Title: Null
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  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Juan Olazagasti is a board-certified radiologist at UVA Health System who specializes in thoracic imaging, including the lungs.

    Organization: UVA Cancer Center
  • Transcription: Melanie Cole: Screening for lung cancer means testing for cancer before there are any symptoms, and screening for some types of cancer has reduced deaths by early detection and treatment. My guest is Dr. Juan Olazagasti. He's a board-certified radiologist at UVA Health System who specializes in thoracic imaging including the lungs. Welcome to the show, Dr. Olazagasti. So who should get screened for lung cancer?

    Dr. Juan Olazagasti: The eligibility criteria includes patient with a strong smoking history and we count that as 30-pack years of smoking. That can be thought of as either 30 years smoking one pack a day or 15 years smoking two packs a day or anything similar that would account for that pack-year history. Patient should be between 55 and 79 years of age and if they are a current smoker or a former smoker that quit within the last 15 years.

    Melanie: So why are we screening? Is this something new that's being done?

    Dr. Olazagasti: There was a large study called the national lung cancer screening trial that was performed over eight years and over 50,000 patients comparing chest x-ray or chest radiographs and CT and we did find a 20 percent decrease in mortality related to lung cancer by utilizing CT. The basis of this is the fact that lung cancer is usually diagnosed at a late stage or is usually not treatable and not curable. We have found that if we do find lung cancer early in stage one, it's much, much easier to treat and cure.

    Melanie: Doctor, do you find that people are honest with you about their past history of smoking so that you have a better clearer picture of whether you should do a CT scan to screen for lung cancer?

    Dr. Olazagasti: I believe most patients, when it comes to their health, tend to be honest. We have ways of asking questions to try to obtain the most accurate information and be able to be reliable.

    Melanie: So what does the lung cancer screening involve? Is it strictly a CT scan? I mean I would imagine x-rays don't show that much, but what's involved?

    Dr. Olazagasti: Patient comes in, does not need much more than just to answer some questions and lay on the CT scanner, does not need an intravenous line or a catheter placed in their arms, and they just lay on a machine that looks like a big donut literally. The scan takes only a few minutes. There's no true significant complication regarding the procedure that would make them to be scared or not want to do it. The results will then be reported and a letter will be sent to the referring physician for follow-up.

    Melanie: So what would be the results? Will they see very, very early lung cancer? Will there be spots and things that you might see that you would know are not going to turn cancerous? Because there's a lot of testing going on today, you know, genetic testing and various things that could scare people but this one could really save a life. So what do the results entail?

    Dr. Olazagasti: We're trying to do a screen study if there's either a finding that is concerning for lung cancer or there's not, and we're trying to make it as simple as possible for the referring physician and for the patient. Sometimes there are incidental findings as we scan through the lungs. There's going to be other areas that we're going to see including the heart, some organ pieces, at least part of some organs such as the liver, adrenal glands, the kidneys and we do find sometimes what we call incidental findings. We're going to follow guidelines that tell you which of those findings are important and need to be worked up further and which ones are not.

    Melanie: So if somebody gets a result that says negative, this does not mean that they absolutely do not have lung cancer or never will get it, correct? I mean is this something that you do on a regular basis once every five years or three years or something if you are any of those risk factors that you discussed?

    Dr. Olazagasti: The actual recommendation from that study and the American College of Radiology as well as many other chest and thoracic institutions, including surgery and pulmonology, is that this study is performed yearly for the life of the study with this patient between 55 and 79 years of age. We have found significant amount of cancers on the first scan but at the same time many patients actually develop the findings on CT on their third, fourth, fifth scan. So it's very important that the patients understand that this is not one-time study but that they need to continue coming to the routine follow-ups on a yearly basis.

    Melanie: And is this something that insurance is jumping on board with this type of screening? Might it be considered part of a wellness screening if you were a current or former smoker or fit in to any of those categories?

    Dr. Olazagasti: Yes, actually the United States Preventive Task Force just did a full recommendation, grade B recommendation for this study. There are several insurance companies that are paying for them—right here in Virginia, for example, Anthem is—but we expect that the government will pay for the study as of January 2015.

    Melanie: And what might a suspicious result tell us, Doctor, that would send somebody maybe to see an oncologist, or what would be the next step if somebody gets a suspicious result?

    Dr. Olazagasti: Hopefully we find one that the patient does not need to go directly to the oncologist but can actually go to a surgeon. If we find it on a stage one and the patient is a good surgical candidate, and that's to be obviously evaluated thoroughly, these tumors can be removed early enough surgically and they can actually be considered cured, which the words 'cured in lung cancer' for as far as I've been practicing were not something we would say in the same sentence.

    Melanie: So maybe if they're a good candidate for surgery, they go and get that. And then would they keep having these tests to see if anything has changed? Because that would be quite scary to get a suspicious result of something like this if you were a smoker in college or something along those lines?

    Dr. Olazagasti: Yes, definitely. And once it's taken out, the recommendation is that the patient continues and goes back into the regular follow-up by their thoracic surgeon or oncologist whoever is their primary care at that time. There is known risk factors in a patient that already has lung cancer to develop a second lung cancer. So the follow-up continues basically through their lifetime.

    Melanie: Is there a genetic component to lung cancer?

    Dr. Olazagasti: We believe there is and that relates to the question I was just mentioning. There's actually a study from Europe and we're finding that patients that smoke that have this significant smoking history we talked at the beginning and have a family history of lung cancer have a much higher incidence of also developing lung cancer. So there are certain other factors as many of the diseases are that we find that is not just the smoking but other things that can also predispose patients for lung cancer. The strongest predictor as of now is smoking by itself. In no means I want to transfer information to the population that they believe that if they don't have a family history of lung cancer and they're smokers that they should not get screened. That just adds to the risk factor but the most strong factor at this time in the literature is smoking in itself.

    Melanie: In the last 30 seconds doctor, why should a patient consider UVA for their lung cancer screening?

    Dr. Olazagasti: We have a comprehensive medical team including pulmonologists which will assist the patient for smoking cessation, thoracic surgeons that are purely dedicated and trained in the removal of lung cancer and thoracic malignancies and dedicated thoracic oncologists as well as thoracic radiologists or medial imager, which is what I do, where our focus is purely on the lungs. That does finally give better results for patients.

    Melanie: Thank you so much. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
Melanie Cole, MS Mon, 03 Feb 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/17437-who-should-be-screened-for-lung-cancer
Treating Stroke – Every Moment Counts http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=17436-treating-stroke-every-moment-counts treating-stroke-every-moment-countsEvery second counts when treating a stroke.

Getting a patient the treatment they need quickly can be the difference between a full recovery and permanent disability.

Learn the symptoms and how the UVA Stroke Center is working to speed diagnosis and treatment.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1403vh5a.mp3
  • Location: Null
  • Doctors: Southerland, Andrew
  • Featured Speaker: Dr. Andrew Southerland
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Andrew Southerland is a stroke neurologist at the UVA Stroke Center.

    Organization: UVA Stroke Center
  • Transcription: Melanie Cole (Host): A stroke is a medical emergency, and prompt treatment is crucial. My guest is Dr. Andrew Southerland. He's a stroke neurologist at UVA Stroke Center. Welcome to the show, Dr. Southerland. So tell us, what is a stroke?

    Andrew Southerland (Guest): Thank you, Melanie. I appreciate the opportunity to be with you this morning. In short, a stroke is an abnormality affecting the blood flow to the brain. It can either be an ischemic stroke, which is the majority of strokes, whereby there's a blockage of blood flow from a blood clot or a hardening, atherosclerosis of an artery, for instance, that keeps a certain part of the brain from getting oxygen and nutrient that it needs. This ultimately results in an injury to that part of the brain as many stroke sufferers and family stroke suffers. That leads to unfortunate long-term disability and, in cases, death. Stroke is one of the leading causes of long-term adult disability in this country and around the world.Of course, there can also be hemorrhagic strokes, where there's bleeding on the brain, which are also an emergency and devastating in many cases. This can be related to ruptured blood vessels from high blood pressure, or from a blood vessel abnormality, like aneurysms, like in ruptures and so forth. So a stroke is really a compilation of many different causes all leading to the same unfortunate result, which is disability and injury to the brain.

    Melanie: So Dr. Southerland, what are some of the most common symptoms? Because we hear that based on those symptoms and how fast you act is how well your stroke can be treated. So explain the symptoms of a stroke, whether we would recognize them in ourselves as they happen or in our loved ones as we're watching them happen.

    Dr. Southerland: Well, that's exactly right, Melanie. That's very important. The motto we use in stroke treatment is time is brain. It is very important to recognize these signs and symptoms early and call 911 if you see someone having a stroke, or if you yourself recognize symptoms. The acronym that we're really trying to put forth in the communities supported by The American Heart and American Stroke Association is FAST, and that stands for Face, Arm, Speech, and then of course, Time. The most common signs would be if you see someone with a weakness of one side of the face, commonly called drooping of the face, weakness or a drifting of an arm. And of course, this could be applied to the leg as well, but certainly more recognizable as weakness of an arm, on one side of the body. Any changes in speech starts to manifest, that's slurring speech or horrible speech, or even loss of the ability to get words out. Many people have seen this in stroke sufferers. And then the last, of course, would be time.So if you see any of those signs and symptoms, and for that matter, any new onset neurological symptoms to happen abruptly—this can even be changes in vision or even severe headache—I think the important thing to know is just to call 911 immediately and have that patient evaluated.

    Melanie: How can a stroke be treated? If you call 911 and you don't want to drive someone to the hospital because time, as you say, is so important, time is brain, when you get to the hospital, what can you expect? What are the treatments for stroke?

    Dr. Southerland: Well, in most hospitals -- and of course, we have designations as primary stroke centers, at UVA being having the highest level of designation on the American Stroke Association, the moment to be seen rapidly by an emergency team, and then, in many cases, a neurology team, all combined into a stroke alert of some variety, and there will be rapid neurological evaluation. And then, moving towards getting some sort of head imaging usually a CT Scan of the head to see if there is a difference between a hemorrhagic stroke or ischemic stroke because they will be treated differently. The hallmark treatment for a Ischemic Stroke or blockage of blood vessels is really a novel drug called IBPPA, its just a clot-busting drug. It's been approved for some time but really has changed the game, our ability to substantially decrease one's chance of having long-term disability or death, if we can get that medicine in soon enough. We have a window of time of several hours, but the important thing for people to know is that every minute counts. So every little delay that could happen before getting treated or evaluated may have substantial impact on one's long-term quality of life. So the sooner, the better, and we have many treatments beyond that at our disposal, whether it would interventional procedures or neurosurgical expertise. the main thing is to get the hospital soon.

    Melanie: When stroke is being treated so quickly, what are the benefits? And then what is the resulting outcome?

    Dr. Southerland: Well, I think if we can get TPA and soon enough for instance, for ischemic stroke, and we're able to restore or profuse the brain that might otherwise be limited in getting blood flow, then we can save brain, for instance, brain that may otherwise be at risk, that can be restored, and they can receive blood flow again. That will decrease upwards of 30 percent decreased chance of having long-term disability. It could even be a very simple difference of walking out of the hospital or ending up in a nursing house. So those are the source of quality of life measures that we're really aiming for with our rapid stroke treatment. Most everyone that presents at the hospital and having a stroke will get admitted to our neurological stroke unit, where we have nursing expertise, therapy expertise, and of course, physician expertise to help see folks through that period. And if disability is there, getting them to a rehab setting as soon as possible, start working on obtaining their faculties begin.

    Melanie: Dr. Southerland, tell us about iTREAT, a new UVA program to speed stroke treatment.

    Dr. Southerland: Well, Melanie, iTREAT's a really exciting program that we are starting in the early phases here at UVA. It is a project using mobile to telemedicine, so simple, tablet-based portable devices, such as an iPad and a modem to help communicate with paramedics and EMS workers while they're bringing stroke patients to the hospital. Traditionally, we have to wait for the patient to get to us in order to start a diagnostic and treatment process, but now, with simple mobile teleconferencing equipment, we can take advantage of this increasing technology and wireless Internet to put ourselves in the back of the ambulance. And in a place like UVA, where patients may be traveling from a rural area upwards of half an hour, there's a substantial time that we can go ahead and begin that treatment process and really, again, continue to focus on that aspect, that time is brain, and not letting minutes be wasted from the moment that someone strokes out a stroke to the moment that we can get them lifesaving treatment.

    Melanie: That is amazing. Tell us where we can find out more about iTREAT.

    Dr. Southerland: Well, if you'd like to know more about iTREAT, I would encourage listeners to look on the Internet, also the combination of UVA and UC. That's USEED, it will take you to a link to our current website, where we're raising funds for this feasibility research right now. It also has a lot more information and a little video, and so I encourage our listeners to seek that out. Of course, they can also contact our Stroke Center at 434-924-2783 and/or business referrals or more information as well, so.

    Melanie: The program is called iTREAT. It's a new UVA program to speed stroke treatment for victims that are suffering from a stroke. So Dr. Southerland, in the last minute here, tell us why patients should choose UVA for their stroke care, and your best advice about stroke for us.

    Dr. Southerland: Well, I think that at UVA, we certainly do our best to provide all the possible offerings that one might want related to comprehensive stroke care, and this ranges not only from the stroke neurology team, from which I'm a part of, but also to our nursing staff, to our therapy staff, to world-class neurosurgical care and neurological ICU care. We also have a wonderful interventional neuroradiology team that can do amazing things in some cases of stroke, going up into the brain and actually removing clots from the brain. So lots of novel technology as well as clinical research studies as well. Patients might not otherwise have the opportunities they get in other institutions, and we certainly are doing everything we can to continue to improve the outcomes for our stroke patients, and we can continue to offer these novel going forward.

    Melanie: Thank you so much, Dr. Andrew Southerland. For more information, you can go to uvahealth.com. You're listening to UVA Health System Radio. I'm Melanie Cole. Thanks so much for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Stroke]]>
Melanie Cole, MS Mon, 27 Jan 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/17436-treating-stroke-every-moment-counts
A Minimally Invasive Treatment Option for Atrial Fibrillation http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=16926-a-minimally-invasive-treatment-option-for-atrial-fibrillation a-minimally-invasive-treatment-option-for-atrial-fibrillationMore than 2 million Americans have atrial fibrillation, the most common type of abnormal heart rhythm in the U.S.

Atrial fibrillation makes you five times more likely to have a stroke, but a minimally invasive procedure can help your heart beat regularly again,

And may reduce your risk for a stroke.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1351vh5e.mp3
  • Location: Null
  • Doctors: Ferguson, John
  • Featured Speaker: Dr. John Ferguson
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. John Ferguson is an electrophysiologist at the UVA Atrial Fibrillation Center. Along with atrial fibrillation, he cares for patients with a variety of abnormal heart rhythms, including ventricular tachycardia, supraventricular tachycardia and atrial flutter.

    Organization: UVA Atrial Fibrillation Center
  • Transcription: Melanie Cole (Host): More than two million Americans have atrial fibrillation, the most common type of abnormal heart rhythm in the US. Atrial fibrillation can make you five times more likely to have a stroke, but a minimally invasive procedure can help your heart beat regularly again and may reduce your risk for stroke. My guest is Dr. John Ferguson. He is a electro-physiologist at the UVA Atrial Fibrillation Center. Welcome to the show, Dr. Ferguson. First, explain to the listeners, if you would, what is atrial fibrillation.

    Dr. John Ferguson (Guest): Good morning, Melanie. Good to be with you. Atrial fibrillation is an abnormal rhythm. It's an electrical abnormality in the heart, and it occurs at the atria, which are at the top chambers of the heart. The heart's got four chambers, and the atria are the top two chambers. Atrial fibrillation particularly affects the left atrium. Instead of beating with a nice, regular rhythm of somewhere between 60 and 100 beats a minute, and atrial fibrillation produces an electrical storm, which effectively just makes the atria quiver. These rapid electrical impulses are conducted from the atria, the top chambers, to the ventricles, the lower chambers, which are the main pumping chambers. The effect of this is that it causes the ventricle to beat irregularly and very, very quickly. The symptoms that the patient commonly would experience would be palpitations and irregular sensation of heartbeats in the chest, shortness of breath, lightheadedness and, occasionally, chest pain.

    Melanie: Who is at risk for atrial fibrillation? So, you've explained the symptoms and
    pretty much even the causes. I love that you used the term "electrical storm," because the heart really is an electrical muscle. It's really an electrical device in our body. Who is at risk? Is there anything we can do to decrease that risk?

    Dr. Ferguson: Well, atrial fibrillation predominantly affects older people. Almost one in 10 patients are all people over the age of 75. It can affect the much younger age groups as well. It may occur without any other cardiac or co-morbidities, but it's more common in people who have high blood pressure, coronary artery disease, heart failure, heart valves disease, and also in patients who have other severe illnesses or undergoing heart surgery. We don't have very good data on preventing atrial fibrillation, but we certainly think that the same healthy lifestyle for preventing coronary artery disease is very good for preventing atrial fibrillation.

    Melanie: What are the treatment options if someone is diagnosed? They feel that fluttering. They go to see a doctor. It gets diagnosed as AF. What are the treatment options available?

    Dr. Ferguson: Well, as you mentioned in your segment before the interview, one of the important risks of atrial fibrillation is stroke. So before we even start thinking about treating symptoms, we think first about preventing stroke. We look at certain clinical risks to tell us how high an individual patient's risk of stroke would be. Those clinical factors that we look at, we look at the presence of heart failure, hypertension, aged over 75, diabetes, and a prior history of stroke. For all of those clinical factors, if you have those, they all raise your risk of stroke. Depending on how high the risk of stroke is, we give blood thinners to prevent stroke, with either aspirin, for those who have relatively low risk of stroke. But as the risk increases, we use stronger blood thinners or anticoagulants such as warfarin, Pradaxa, Xarelto, or Eliquis. Those are some of the main blood thinners we use. That's the first component of treating atrial fibrillation is preventing stroke, and it's very, very important. The second component is managing patient symptoms. There are broadly two strategies for treating patient symptoms. The first is that in patients who are elderly, not very active, and who may not be very symptomatic from the atrial fibrillation, we can simply leave them in atrial fibrillation that gives them medications to slow down their heart rate. That is fine for elderly people who are not very symptomatic. But those who are symptomatic and the rate control strategy doesn't alleviate symptoms very well, and we may, well consider what we call a rhythm control strategy to try and restore regular fineness rhythm and keep people in fineness rhythm. The treatments for restoring rhythm are electrical cardio version, a short anesthetic with an electrical shock while the patients are asleep. That's very effective in getting people back into rhythm. That is not effective with keeping people in regular rhythm. We frequently need to consider medications such as anti-arrhythmic drugs, or catheter ablation.

    Melanie: Okay. Catheter ablation. We don't have a lot of time, Dr. Ferguson, and we want to make sure to get to this as quickly as we can. What are the benefits of ablation therapy versus other options?

    Dr. Ferguson: Anti-arrhythmic drugs are only effective in about 45 percent of cases of atrial fibrillation, whereas catheter ablation is effective in a higher proportion of cases. In the best candidates, it is effective in up to 90 percent of patients. A great advantage is that after having this procedure, you do not need lifelong medication.

    Melanie: That's fantastic. So, who is a candidate? In the last minute or so, give us your best advice why someone would choose UVA for their heart rhythm treatments.

    Dr. Ferguson: The best candidates are patients who are early in the disease process of the atrial fibrillation. The more years that people have atrial fibrillation and the less successful catheter ablation or anti-arrhythmic drugs are in treating that.Catheter oblation has evolved since 1999, and UVA was actually one of the first hospitals—one of the very early hospitals, not only in this country, but in the world—to investigate catheter ablation for atrial fibrillation. We've done more than 6,000 cases over the last 10 years and have developed a team to treat atrial fibrillation and do this with a high success rate and a very, very low complication rate. UVA has about as much experience as anywhere else in the country, and we've had some very good results over the years.

    Melanie: Thank you so much, Dr. Ferguson. You are listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thank you so much for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Heart Health, Heart Disease]]>
Melanie Cole, MS Mon, 20 Jan 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/16926-a-minimally-invasive-treatment-option-for-atrial-fibrillation
When Should You See a Doctor About Low Back Pain? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=16925-when-should-you-see-a-doctor-about-low-back-pain when-should-you-see-a-doctor-about-low-back-painLow back pain is one of the most common ailments we face.

But how can you tell when low back pain signals a more serious condition?

A spine expert from the UVA Spine Center explains when you should see a doctor and the wide range of treatment options available for your back pain.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1351vh5d.mp3
  • Location: Null
  • Doctors: Shimer, Adam
  • Featured Speaker: Dr. Adam Shimer
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Adam Shimer is an orthopaedic surgeon at the UVA Spine Center. He provides comprehensive spinal care, specializing in complex cervical spine surgery, adult spinal deformities and minimally invasive treatment of spinal conditions.

    Organization: UVA Spine Center
  • Transcription: Melanie Cole (Host): Low back pain is one of the most common ailments that we face, and how can you tell when low back pain signals something that might be more serious. My guest is Dr. Adam Shimer. He's an orthopedic surgeon at the UVA Spine Center. Welcome to the show, Dr. Shimer.What are the most common causes of low back pain? Everyone suffers from it, and it also keeps millions of people home from work. It is one of the main reasons people lose work time, too. What are the main causes that you see?

    Dr. Tim Showalter (Guest): Well, I'd like to first thank you, Melanie and Radio MD for having me on. I think you touched on many important points of low back pain. It is the second most common cause of missed work, secondary only to the common colds. It is also one of the leading causes of disability for those at working age. It has not only an impact to the individual but also significant societal and economic impact.
    I think the most common causes of low back pain are those that are not concerning from an emergency standpoint. Those can be simple muscle strains, tendon pulls. One of the more common reasons is what we call degenerative disc disease. Those discs are the cushions in between the bones of the spine. Those, over time, much like you can get arthritis of the hip and knee, can lose some of their mechanical properties and begin to collapse. You may have heard the term "black discs" or "degenerative discs" or "slip discs." Unfortunately, we have a bunch of terms describing more or less the same thing.

    Melanie: Now, is there something we can do, Dr. Shimer, to reduce our risk for low back pain? I mean proper lifting techniques, or if you know that maybe you're subject to arthritis, osteoarthritis or something, that you can keep yourself strong and healthier? Is that going to help?

    Dr. Shimer: Yeah. I tells folks that it seems cliché, but really doing what your mom told you to do: eating right, getting good sleep. Losing weight is one of the key ones that is difficult to talk with patients or folks about. But if you can take off 10 percent of your overall weight, you decrease the strain on your back a considerable amount. Also, smoking. It's not commonly known that smoking is one of the leading causes of increasing the rate of disc degeneration, and folks who smoke have an increased rate of back pain. So I tell people they really need to increase the healthiness of their lifestyle: better eating habits, get good sleep, stop smoking, lose weight, and exercise, cardiovascular, low-impact exercise. These are all really the hallmarks of decreasing your chance of having back pain.
    Melanie: Are there any signs or symptoms that might signal that it's a more serious condition?

    Dr. Shimer: Absolutely. There are conditions such as kidney stones. There are conditions such as aortic aneurisms. These can be more significant things, and you really want to look for any other concerning symptoms, such as recent, unintended weight loss, fevers, chills, rapidly progressing back pains. It's not bothering you one day, and then, three hours later, it's incapacitating. Any weakness of the legs or any change in the ability for you to control your bladder. I think that those examples are really kind of the basic spectrum of things that should be what I call red flags. If either the patients themselves or the primary care physicians, in their assessment of the low back pain, hear those, they really need to be a little bit more concerned and maybe increase the acuity of their evaluation.

    Melanie: Dr. Shimer, if a patient is experiencing low back pain, what is the first line of defense if they come to see you? Do we start with anti-inflammatory medications? Surgery would seem to be -- of late, people would like to make that the very last option, for if it is something serious, disc-related. But what do you do first for low back pain?

    Dr. Shimer: Surgery should absolutely be the last option. I think that, as you have been going since starting me off, handed me the ball and allow me run, but I think anti-inflammatory medications, and that's as tolerated. Certainly, people's stomach can get upset on those. Or if they high blood pressure, those can be some relative contraindications. But as their medical condition allows anti-inflammatories, and those can even be over the counter, such as naproxen or ibuprofen. Also, some good low-impact cardiovascular aerobic exercise. What we want to try to get people to do is strengthen their core. That should really be a flexion-based protocol, so not a whole lot of back extension or stretching your back up, because that puts more strain on the spine. So things to really strengthen the abdominal muscles help back pain quite a bit. And then, really the number one thing is time. This is what I tell patients: patience. I tell patients patience. But they just need to give it a little bit of time. And 95 percent of back pains spontaneously resolves within a week or two. The olden days of recommending prolonged bed rest, so, "Go home and lay in bed for a week," are gone. That is the worst thing to do. You really want to keep patients up and active and sit and decreasing the inflammation associated with back pain with simple, over-the-counter medication.

    Melanie: What about decompression exercises? There's kind of a movement towards almost back to the old school of traction, but this decompression, sort of lengthening out those discs so they're not compressing on each other so much.

    Dr. Shimer: Yeah. There's a few. Not only manual manipulation, it can be done by osteopathic doctors and chiropractors, which I'm never against. I think alternative, non-surgical interventions, if they work, are fabulous. And if people feel better, it works. There's also some more machine-based intervention, such as [VACS-D], that are traction-based devices, but they can charge patients quite a bit out of pocket. And from what I know, the evidence behind them, the peer-reviewed literature is pretty limited. I usually lean my patients more towards physical therapy, core strengthening. If they want to have some sort of manipulation, more doctor-based manipulations instead of being placed on a machine. But that's just my opinion.

    Melanie: If they do have to have surgery, what treatment options are available? We don't have a lot of time, Dr. Shimer, but what kinds of surgery are we seeing now?

    Dr. Shimer: I really try to limit surgery for the end of the line. We predominantly as spine surgeons focus on leg pain from sciatica, or disc problems that are pushing on nerves. Back pain itself from degenerative disc disease is really usually poorly responsive to surgery. For that reason, we do all of the things that we talked about in the previous nine minutes or so to really get patients better.I always say the most minimally invasive surgery is no surgery at all, try to get them better without surgery.

    Melanie: Which is certainly the best option. Now, there are some minimally invasive things that you can do that might give some temporary relief?

    Dr. Shimer: Well, hopefully we choose a procedure that leaves the lowest surgical footprints, so the least damage to the muscle and surrounding tissues. But achieving this surgical goal, and the goal is to get people lasting relief. So if someone has a disc that's bulging and pushing on a nerve, giving them intractable leg pain, we can go in with very small instruments in a microscope and very expertly remove that small piece of disc that's pushing on the nerves. Patients about 85 to 90 percent of the time get good to excellent durable results. I'd like to think that a well-chosen spine surgery that's well-performed, patients get really nice relief, pretty predictably.

    Melanie: Now, in just the last 30 seconds or so, Dr. Shimer, explain to patients why they should choose UVA Spine Center for their care.

    Dr. Shimer: I think it's a combination of things. I believe that UVA itself as an institution has really topnotch academic physicians and surgeons that are up to date not only on the newest technology that may be pushed through advertisements but really the most up-to-date evidence-based, peer-reviewed medical care. So what you're going to get is care that is based on science, not based on advertisement, not based on the shiniest new implant. But really, we can look you in the eye and say, "This is the best care."

    Melanie: Care based on science. I love that. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Orthopedic]]>
Melanie Cole, MS Mon, 13 Jan 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/16925-when-should-you-see-a-doctor-about-low-back-pain
Reducing Breast Cancer Treatment to a Single Day http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=16921-reducing-breast-cancer-treatment-to-a-single-day reducing-breast-cancer-treatment-to-a-single-dayFor patients with breast cancer, treatment can often take several weeks.

But UVA Cancer Center is among the first centers in the U.S. to offer a new breast cancer treatment that reduces treatment time to a single day.

Learn more about the this treatment option for early-stage breast cancer.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1351vh5c.mp3
  • Location: Null
  • Doctors: Showalter, Timothy
  • Featured Speaker: Dr.Timothy Showalter
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Timothy Showalter is a radiation oncologist at the UVA Cancer Center. In addition to caring for patients with breast cancer, he also treats children with cancer as well as patients with prostate cancer, digestive cancers and gynecologic cancers.

    Organization: UVA Cancer Center
  • Transcription: Melanie Cole (Host): For patients with breast cancer, the treatment can often take several weeks. But at UVA Cancer Center, it's among the first centers in the US to offer a new breast cancer treatment that can reduce treatment time to a single day. My guest is Dr. Tim Showalter. He's a radiation oncologist at the UVA Cancer Center. Welcome to this show, Dr. Showalter. Incredible. Tell us about this treatment for breast cancer that can reduce the treatment to a single day. Really?

    Dr. Tim Showalter (Guest): Well, thanks for having me. It's very exciting. One of the recent trends in breast cancer care in general is that there has been this development of intra-operative radiation therapy. Rather than having selected patients come in for a six-or-more-week course of daily radiation therapy, we can actually get their treatment done in a single day right at the time of lumpectomy. So when they get their surgery, they also walk out that day having had their radiation therapy.
    The very exciting component of the IORT program at the University of Virginia is that we're actually doing it quite differently than other places. We have an image-guided intra-operative radiation therapy approach, where we actually use a different style of treatment and different equipment to deliver the IORT. We can actually visualize what we need to treat and visualize the normal tissues and deliver a highly-conformal image-guided radiation therapy plan, all at the same time as the surgery.

    Melanie: How does it work? Is it something different than we've seen with typical radiation therapy?

    Dr. Showalter: It is. We actually use a type of radiation treatment that's called high-dose rate brachytherapy. What's unique about the setup at the University of Virginia is that we have, within the brachytherapy procedure room, we have what's called a CT on rails. It's actually a diagnostic, quality CAT scan that can slide across the floor. The surgeons come in here. The anesthesiologist comes in. The surgeons do the surgical procedure, remove the breast tumor, verify that at least in terms of an early assessment that the margins are negative. They're still staring at the lumpectomy cavity. They can easily visualize what they need to treat. They place a brachytherapy catheter in the lumpectomy cavity, which basically looks like a balloon with a tubing attached to it, and they close the lumpectomy cavity.
    And then we're able to do a CT image right there. Without moving the patient, we acquire the image. We do detailed radiation treatment planning with that patient's CT scan, with the balloon in place. We connect everything and deliver the treatment. The whole time, the patients are being monitored by the anesthesiologist and the breast surgeon. We're able to get the treatment done in time. When the brachytherapy is finished, the surgeons go in and finish closing the wound, remove the catheter, and the patient's on their way.

    Melanie: That's fantastic. What are some of the other advantages to doing this IORT? Shorter treatment time is, obviously, but what about tissues', organs' effect of this?

    Dr. Showalter: Well, inter-operative radiation therapy, in general, as an overall trend, is really exciting, both for the convenience factor but also because you have the ability to actually visualize what you need to treat at the time of surgery. It gives us a lot more information and control, and we're treating a smaller amount of tissue. We expose less normal tissues to radiation therapy. That's important because standard forms of radiation can expose significant volumes of the heart, if it's a left-sided breast cancer, or the lungs and ribs as well. What's very exciting about the UVA version is that for most inter-operative radiation therapy approaches, it's being done in an operating room without benefit of imaging or the ability to scalp the dose. So we end up with a radiation treatment plan that looks like a simple sphere, and it's something that we can't control or adjust with a misguided planning or any sort of computer modeling. With our approach, we actually take the tools that we use in other situations for breast cancer care and really distill it down into a brief, hour-long procedure that's done at the time of lumpectomy. We use all of our CT scanning and computer planning. We use the ability to use a radiation source in multiple passageways within the applicators so that we can really carve a specialized and highly-conformal radiation plan for that individual patient.

    Melanie: Now, are there some particular groups of breast cancer patients who would most benefit from this treatment?

    Dr. Showalter: Yeah. This type of treatment is really only appropriate for women who have a relatively small—so generally less than 3 centimeters—breast cancers that are low grade and considered favorable. Part of the rationale is that we're not treating the entire breast. This isn't for women who have more advanced tumors or who are extremely high risk of recurrence. That would be the case overall for anytime we're using what's called accelerated partial breast radiation, which we're just treating part of the breast, or when we're using inter-operative radiation therapy.

    Melanie: Are there any side effects? And what are your outcomes, generally?

    Dr. Showalter: Well, this is relatively new program for us. This type of treatment, in terms of the inter-operative radiation therapy, is a brand new program for us. While we have a clinical trial that's helping us keep track of outcomes for this, so far, things have gone well, and we can also look at the data from the clinical trials of the other forms of inter-operative radiation, which don't use image-guided planning but do treat a similar volume of tissue. Those have been very large studies with hundreds of women who have agreed to participate in them, and the outcomes look excellent from those studies. It's considered a safe and effective treatment option, and we think that our version has some additional advantages even beyond that.

    Melanie: Well, additional advantages. If the patient has to undergo a mastectomy, or something along those lines, is it going to give them options to make this a little bit less drastic or dramatic, like nipple-sparing surgery, such like that?

    Dr. Showalter: We're not sure. Just to be clear, this type of radiation is only added to lumpectomy. So it wouldn't be helpful for women who have chosen to undergo a mastectomy or have a medical reason based on their tumor stage that they're going to undergo mastectomy. We think certainly that when women have a partial breast radiation, in general, the future options are less difficult than if they have their whole breast treated. But that's a very individualized scenario that may vary from patient to patient.

    Melanie: It's very exciting. Dr. Showalter, what are you seeing on the horizon for this type of radiation therapy?

    Dr. Showalter: Well, UVA's unique, currently in terms of the particular layout of our equipment, and we're very fortunate that we're able to offer this for our patients and to be the leaders in developing this type of inter-operative radiation therapy. I think in the future, the next stage for us is going to be working with our colleagues at other institutions. Once we've gained more experience with this, they try to bring them on board and to do larger scale studies. One of the exciting things from an oncology perspective about this version of breast inter-operative radiation therapy, because we have some added advantages in terms of the technique, you can actually deliver a higher dose than what's delivered in other forms of inter-operative radiation therapy. We think that may be helpful for patients in terms of reducing risk of recurrence. I think our next step, I'd like to see this expand to other centers. And I've heard rumors that other facilities across the country are looking at getting brachytherapy procedure areas set up like this with in-room CT imaging. I think that would be the next step.Moving forward, the other approach is that there are other centers that are currently working on extremely short course brachytherapy for breast cancer that is not done at the time of surgery. I think that our results will help inform those trials and may help those centers move their studies forward and help deliver another convenient alternative for patients.

    Melanie: In the last just 20 seconds or so, Dr. Showalter, tell us why patients should consider UVA Cancer Center for their breast cancer treatment.

    Dr. Showalter: Well, I think this a great example of UVA really pushing forward all of the shared missions. First and foremost, we're a cutting-edge medical center that serves its community. I think this is an example of a clinical program that lots of us, a very large team of folks, have worked hard on to bring forward. It's an excellent program that uses our most advanced technologies and does something that's convenient and I think beneficial for patients. But it also demonstrates our role as a national leader.

    Melanie: Thank you so much for listening to UVA Health System Radio. I'm Melanie Cole. Thanks for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Women’s Health, Cancer]]>
Melanie Cole, MS Mon, 06 Jan 2014 19:00:00 +0000 http://radiomd.com/uvhs/item/16921-reducing-breast-cancer-treatment-to-a-single-day
Understanding a Common Prenatal Condition http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=16920-understanding-a-common-prenatal-condition understanding-a-common-prenatal-conditionPrenatal Hydronephrosis is the most common condition identified in babies during prenatal ultrasounds.

Learn more about Prenatal Hydronephrosis, including the available treatments, from a specialist in pediatric urology at UVA Children's Hospital.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1351vh5b.mp3
  • Location: Null
  • Doctors: Herndon, C.D. Anthony
  • Featured Speaker: Dr. C.D. Anthony Herndon
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. C.D. Anthony Herndon is a specialist in pediatric urology who serves as Director of the Division of Pediatric Urology at UVA Children's Hospital.

    Organization: UVA Children's Hospital
  • Transcription: Melanie Cole (Host): Prenatal hydronephrosis is the most common condition identified in babies during prenatal ultrasounds. My guest is Dr. Tony Herndon. He's a specialist in pediatric urology, who serves as the Director of the Division of Pediatric Urology at UVA Children's Hospital. Welcome to the show, Dr. Herndon. Tell us a little bit about this prenatal condition that most people have not even heard of.

    Dr. Tony Herndon (Guest): Thanks for having me on today. Prenatal hydronephrosis is the identification during the maternal fetal or the obstetrician ultrasound of the mother, where the baby inside of the mother has fluid on the kidney or dilation of the kidney. There are varying grades of this. The most common is grade one, which is very minimal fluid on the kidney, and the most severe is grade four, and that's less common. That's where the fluid causes tension to the point where it compresses the normal kidney tissue, and that can be seen fairly readily with an ultrasound because the fluid is actually urine. That's very easy to discern. That's one of the reasons it's the most common condition diagnosed. It's easy to pick up.

    Melanie: What causes it, Dr. Herndon? If urine is putting pressure on his kidney, pregnant women have enough pressure going on in all sorts of places anyway. So you spot this on an ultrasound, what is the cause?

    Dr. Herndon: Well, I have a discussion with the families directed at that. The most common cause is transient, actually. There's fluid that builds up on the kidney, and if you follow the kidneys throughout pregnancy, in about two-thirds to 70 percent, most of those kidneys normalize within the first six months postnatally. Almost all of these kids, as a whole, you can assure the families that everything's going to be okay. There's a subset of kids that have a specific diagnosis that puts them at a little bit higher risk of an infection, the need for surgery, or kidney damage. The issue though is you can't always sort those kids out prenatally, and that's done based on postnatal testing. We have a risk stratification that we use that puts them in kind of a low, medium or high risk, and depending on the risk, that prompts things such as the need for preventative antibiotics postnatally, invasive testing, where we would actually put a little tube in the bladder and inject dye to look at the bladder anatomy, or do further imaging of the kidneys to look at drainage and function.

    Melanie: So this is what happens during pregnancy. How does it affect the newborn?

    Dr. Herndon: Well, the newborn, during pregnancy, the mother is providing kidney functions. So in terms of the kidney functions, it's very uncommon for us to do anything or have the need to do anything prenatally because the mother is providing the kidney function. In a very select subset, the baby is not urinating, and the urine, during pregnancy, allows fluid to go around the baby and the lungs to develop. That's the only condition that we actually do something prenatally. That's the first thing that we tell the families. Then we check off the list that there's plenty of fluid, amniotic fluid, around the baby that we can safely follow the baby postnatally. When the baby is born, we need to do a kidney ultrasound of the baby, very similar to what the mom had, an ultrasound, and that's done before the baby leaves the hospital. That sets the tone for further testing. Some kids need to be followed very, very closely, and some kids, as I mentioned previously, might resolve or significantly downgrade their kidney dilation.

    Melanie: After the baby is born, you do an ultrasound of the baby's bladder, kidneys, and then you kind of keep a watch on them. What could happen, Dr. Herndon? Could they reflex back up into the system? Could they sort of be toxic, a little bit?

    Dr. Herndon: Well, the kids—and that's where this risk stratification comes into play—as a group, as a whole, pediatric urologists have tried to get away from using preventative antibiotics. It's developed this risk stratification [I have] to try and classify kids into groups that are at low risk of infection, and that's based on the degree of kidney dilation that we see prenatally. Kids who are at moderate risk and high risk, those kids, if they do have urine that backs up, which is one of the [ideologies], they're at high risk of having kidney infection and toxic, like you said. If they're at low risk of infection, even if they do have urine that backs up, they're probably not going to get infected, hence not become toxic. That's the tricky part is we don't study every child. If we did, we would pick up disease in kids that might not necessarily have an issue with it. They keep up with this disease. One of these conditions is reflux, where the urine backs up. Those kids are managed with long-term antibiotics. We're trying to get away from that.
    The other ideology is kidney obstruction. But luckily, those kids predominantly have severe kidney dilation, grades three and four, so those kids, we kind of know based on that ultrasound. The kids that tend to get that trouble, we kind of have a lead on that, because of the severity of the kidney dilation in terms of the kidney blockage. Kids that have urine that back up to the system reflux, the ultrasound helps us classify the risk of infection, and that's what directs the intervention with the invasive testing to diagnose the urine that backs up to the kidney.

    Melanie: For the most part, are they able to filter this out when you see? Of course, you can't study every baby, but are they able to filter this out? If they're not, is there surgery required? Are there other certain other interventions besides the long-term antibiotics?

    Dr. Herndon: Sure. Going back to the ideologies, the most common is transient, meaning it does go away. That takes care of 70 percent. The urine that backs up the reflux, those kids typically do well that are picked up prenatally. If you look at that group, they get infected, but at a much lower rate than kids that present later in life with reflux and infections. Infections, when you're dealing with urine that backs up to the kidney, that drives surgical intervention, not necessarily the presence of urine backing up. Some of those kids will have surgery, probably about 20 percent because of infections, but a little bit depends on the severity of urine backing up. Kids that have the same volume that's in the bladder backing up to their kidneys, those kids are more likely to have surgery. Kids that have minimal urine backing up from bladder to the kidneys are less likely to have surgery. That group of refluxing patients, that's what we call that Vesicoureteral reflux. Those kids, they're a spectrum; most kids will not need surgery, but a subset will, and those are the same kids that are getting infected or have very high-grade reflux.

    Melanie: Dr. Herndon, these babies in the prenatal NICU, are they, when they're born, they've got this condition?

    Dr. Herndon: No. Most babies are not. Most babies are born on the regular ward, and a small subset will be delivered in the NICU, but that's very uncommon. Most of these babies are delivered at community hospitals, or they might be delivered at UVA. They have an ultrasound after the baby's born. Most of this work up is done as ambulatory, so in the clinic. They would come back and see me at one month, and we would repeat the ultrasound. If the patient is one of those moderate- to high-risk stratifications, then we would have the invasive testing, where we slip a little catheter in the bladder and use contrast to determine if urine backs up to the kidney, or if there's an abnormality with the urethra, the tube that leads from the bladder.

    Melanie: Dr. Herndon, in the last 20 seconds or so, explain to the listeners why they should choose UVA Children's Hospital for care for this condition.

    Dr. Herndon: One of the reasons is we offer a multi-specialty approach. I run a prenatal clinic with maternal-fetal specialist, Chris Chisolm and his group here at UVA. That gives us the opportunity to meet the families prenatally and to meet the mother and to explain to her what the risk stratification is for her baby. And then that allows one, for education; and two, for her to know what to expect postnatally.

    Melanie:   Thank you so much. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Women’s Health]]>
Melanie Cole, MS Mon, 30 Dec 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/16920-understanding-a-common-prenatal-condition
What Are the Signs of Huntington’s Disease? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=16919-what-are-the-signs-of-huntington-s-disease what-are-the-signs-of-huntington-s-diseaseHuntington's Disease is one of the most common genetic disorders in the U.S., affecting more than 250,000 Americans.

Learn more about the symptoms and treatment options available from the multidisciplinary team at UVA Health System's Huntington's Disease Program.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1351vh5a.mp3
  • Location: Null
  • Doctors: Harrison, Madaline
  • Featured Speaker: Dr. Madaline Harrison
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Madaline Harrison is the director of the UVA Huntington's Disease Program, recognized as a Center of Excellence by the Huntington's Disease Society of America. In addition to Huntington's disease, she cares for patients with a range of movement disorders, including Parkinson's disease, tremor, dystonia and Tourette's syndrome.

    Organization: UVA Huntington's Disease Program
  • Transcription: Melanie Cole (Host): Huntington's disease is one of the most common genetic disorders in the United States affecting more than 250,000 Americans. My guest is Dr. Madeline Harrison. She is the Director of the UVA Huntington's Disease Program, recognized as a center of excellence by the Huntington's Disease Society of America. Welcome to the show, Dr. Harrison.
    Tell us, what is Huntington's disease?

    Dr. Madeline Harrison (Guest): Huntington's disease is a hereditary neurodegenerative disorder, meaning that it is inherited and causes loss of brain cells that results in a number of symptoms that progress over time.

    Melanie: What age do you typically see the onset?

    Dr. Harrison: It's more variable than we originally thought, but most typically, the symptoms become apparent somewhere between the ages of 35 and 55.

    Melanie: So what causes it? Is there a genetic component? Are there certain risk factors people can be aware of?

    Dr. Harrison: It is a genetic disorder, so that the principal risk factor is coming from a family with Huntington's disease. When they've identified the specific change in the gene that causes the disorder, it's a specific expansion, and it's passed from parent to child so that each child of an affected individual has a 50 percent chance of inheriting the genes.

    Melanie: So if a parent had that, do you recommend a genetic test? Do they need a genetic test to say whether they have that gene or not?

    Dr. Harrison: Well, the genetic test is highly specific and will certainly indicate if they have the genes. About 95 percent of the time, the mutation is very specific and has specific features. That's called a CAG repeat expansion. There's a certain of repeat sequences that will result in the disease. Deciding to have genetic testing is a very individual decision, because you have the genes on birth. But the symptoms may not appear into midlife, as we discussed. So, for diagnostic purposes, it's very helpful. But the clinical symptoms are what actually indicate that the disease has begun.

    Melanie: What are the symptoms of Huntington's disease? When do they appear? What do you notice?

    Dr. Harrison: It's variable, but there are three areas that are affected in the majority of the individuals at some point along the course of the disease. Often, the first changes are subtle changes in cognitive efficiency—ability to organize information. Sometimes, there are mood and personality changes early on. The most characteristic symptoms are changes in motor function. People develop extra involuntary movement called chorea. It's the most common. And also, difficulty coordinating movements necessary for simple tasks, for walking, for performing coordinated tasks with your hands. Those are the symptoms that are the most definite indications that the disease has started.

    Melanie: These are movement disorders. What about cognitive disorders, or psychiatric? Are there any others that go along with these?

    Dr. Harrison: Yes, there certainly are. There's a very high incidence of psychiatric disorders that can really take any form. Most common are what we call mood disorders. People maybe come in depressed. There's a high rate of serious depression, even suicide, in the illness. Often, people who are very even-tempered can become irritable unexpectedly and unpredictably. But these are fortunately very treatable symptoms. The cognitive changes are not. They are really organization and information handling. It's not as much of a memory problem as, say, something like Alzheimer's that people are more familiar with. But it certainly can create difficulties at home and at work, particularly with complex tasks.

    Melanie: What treatments are available for Huntington's disease? If you start to notice some of these symptoms, cognitive disorders, movement disorders, can there be something done to slow the progression, or is it symptom management? What kinds of treatments are available?

    Dr. Harrison: Currently, what we have available are treatments for symptom management. Fortunately, we can generally very effectively management the mood or psychiatric symptoms using the same treatments that are successful in other settings—the same antidepressants that are useful in a wide range of conditions are helpful here, for example, and similarly for some of the other symptoms. We can also help suppress the extra movements if they're causing problems. Sometimes they're very visible, but not limiting the person. But we do have treatments, and the only FDA-approved treatment for Huntington's disease is actually directed at the chorea component of the disease. For the cognitive, we don't have specific treatments, but there's a lot of workaround and strategies that we work closely with physical and occupational therapy to help people manage effectively in spite of some of these limitations. What we don't have yet is neuroprotective diseases therapies, or what we call disease-modifying therapies, which could slow the progression of the disease. But there's very active research going on worldwide into promising treatments that would actually give us the ability to slow down or, one day, we hope, prevent the development of the symptoms.

    Melanie: Tell us a little bit about what UVA does to help patients with Huntington's disease, Dr. Harrison. Are the family members involved? Because I would imagine this is a difficult disease both for the patient and for the family members involved.

    Dr. Harrison: Well, that's absolutely correct. Family members are very much involved. It's really a team approach between the professional team and the affected individual and their family or caregivers. We have a monthly clinic with participation by , myself and a nurse practitioner and another neurologist. We now recently have a psychiatrist who has joined us. There's a physical therapist, occupational therapist, speech language pathologist. Our genetic counselor is there, and we have neuropsychology services available as well, for both counselling and for cognitive assessments. In the monthly clinic, the patient and family arrive, and they're seen by each of the professionals in the course of a morning or afternoon visit. They help assess where they are functioning, what they need for safety, what medications they may need to help manage their symptoms and to assist them with planning and resource utilization. And I've neglected to mention, a very important member is our social worker, who works with families before and after clinic to get the kind of help they need.We have all these in one visit at one place. I'm fortunate to have a team that many of them have been working together close to 15 years doing this now.

    Melanie: It sounds like a very multidisciplinary approach and really very complementary and would help the families. Give us your best advice for patients with Huntington's disease or someone that they love might be suffering from this disease.

    Dr. Harrison: Well, I think the most important advice I would give you would be to see someone who has experience with Huntington's disease. Although, there are estimates of, as you mentioned, close to 200,000 people with or at risk for Huntington's disease, it's still not a disorder that most physicians are familiar with, and certainly not in terms of the day-to-day management. So I think it's very important to get advice from someone who has specialized experience with Huntington's disease. And many movement disorders physicians are in a position to offer good advice. There are centers around the country with specialized teams, both the HDSA centers and other specialty clinics. I think that there are more and more available to patients and families, and the HDSA also has a network of support groups which can be critically important, particularly for the caregivers. And then, I think working with the team and partnering with the local physicians to make use of that expertise can make it a big difference in how well people manage with the disorder.

    Melanie: Thank you so much, Dr. Madeline Harrison, the Director of the UVA Huntington's Disease Program. For more information, you can go to uvahealth.com. You're listening to UVA Health System radio. I'm Melanie Cole. Have a great day.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Genetics]]>
Melanie Cole, MS Mon, 23 Dec 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/16919-what-are-the-signs-of-huntington-s-disease
The UVA Health System NICU http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=16285-the-uva-health-system-nicu the-uva-health-system-nicu

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1346vh5e.mp3
  • Location: Null
  • Doctors: Kaufman, David
  • Featured Speaker: Dr. David Kaufman
  • Guest Name: Null
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  • Book Title: Null
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  • Guest Bio: David Kaufman is a neonatologist at UVA Children's Hospital. He's board certified in pediatrics as well as neonatal-perinatal medicine.

    Organization: UVA Neonatal Intensive Care Unit
  • Transcription: Melanie Cole (Host): Hi. My guest is Dr. David Kauffman. He is a neonatologist at UVA Children's Hospital. Welcome to the show, Dr. Kauffman. Let's talk about the NICU at the University of Virginia Health System. What type of patients do you typically see there?

    Dr. David Kauffman (Guest): Well probably most people think of a NICU as a place for pre-term babies, and we take care of some of the most immature babies born at 22, 23 weeks of gestation, when pregnancies are complicated by preterm labor or need to deliver early. But we also take care of a lot of term infants. For some families, unfortunately, there may be a child with a birth defect or there's a difficult delivery, and the babies need additional care after it's born.

    Melanie: So, term infants and premature babies are there. Now, what types of conditions might make a baby be in the NICU, and in such a scary place for the parents, too? So first, speak about the conditions a little bit. What are you doing for them?

    Dr. Kauffman: Some of the most difficult situations is when someone is expecting a normal, healthy child, and something happens around the time of delivery and the baby needs additional support, whether it's a ventilator or some oxygen. But oftentimes, these babies might be at risk for brain injury because of the difficulties at delivery. So one thing we have at UVA is a cooling protocol, in which kids who may be at risk for brain injury get cooled from normal temperature, 98.6 degrees to 92 degrees for three days. This helps prevent some of the cells that might be in shock from what happened at delivery to recover and improve outcomes for those families and those kids.

    Melanie: You mentioned that one of the more difficult is when you're expecting a healthy delivery, and all of a sudden, something does go wrong. Now, are many of the things that you see things that have been predicted so the parents kind of have a little bit of an expectation that they're going to deliver a baby that's going to be in the NICU?

    Dr. Kauffman: Yes. Sometimes, with birth defects, families will be referred to UVA, our perinatologists who help take care of them while they're pregnant. We as the neonatologists take care of the baby and the family after delivery. One of those defects is called the congenital diaphragmatic hernia. For example, these patients would be referred here. We have an excellent team that includes pediatric surgeons, the neonatologist. Everyone in the NICU is specialized in neonatology, from the nurses, neonatal nurse practitioners, and all the care partners. These babies, their diaphragm of their lung has a hole, and the intestines migrate into the chest, preventing normal lung development. So they can be very sick at birth and need sort of general ventilation. At times, they may be very, very sick and need to be put on a heart lung bypass machine for several days. With this team and this approach, we have great outcomes similar to major centers elsewhere, and it's good that those patients can get that care right here in Charlottesville.

    Melanie: Speak about the team approach. Who is involved in the NICU? What is the team that really works with the babies and with the parents? Because as I said before, how scary for parents. They've been expecting this very happy time, and all of a sudden, it's turned into something that could be very serious and scary. How does your team deal with both the parents and the baby, and who is involved?

    Dr. Kauffman: Well, initially, there are a lot of people from just getting greeted at the desk when they come in by our health care coordinators, and then, at the bedside, the nurse plays an invaluable role in just meeting the family, orienting them to everything that is happening to the baby, and the physicians and neonatal nurse practitioners as well. I think the biggest thing when we've looked at what families need is they need to feel they can trust us and they sort of know what's going to happen the next 24 hours. So I think them getting to know us and us communicating openly, talking about everything that happened and what's going to happen the next hour or the next 24 hours, it helps families give trust. Obviously, we want and they want to be with their baby at home, and to give up that care to the NICU is challenging. So I think establishing a good relationship and communicating what's going on really helps ease families through this roller coaster in the NICU.

    Melanie: Dr. Kauffman, what makes them so specialized, the nurse practitioners and doctors such as yourself? I mean, this specialty, you have to really be trained to do this, correct?

    Dr. Kauffman: Yes. So for the physicians, they go through a three-year pediatric residency and then additional three years of neonatal medicine. The nurses, in addition to nursing school, get special training when they first get to the NICU for about half a year to a year, and then their years of experience. Similarly, the nurse practitioners are nurses who then go through a two-year training to become neonatal nurse practitioners.

    Melanie: It takes a lot extra training and a certain amount of empathy for what these parents are going through. So speak about how you deal with the parents, because some are probably more difficult to deal with than others. How do you calm their fears?

    Dr. Kauffman: Well, I think listening to families really helps us know what each family needs. Sometimes they just need to know what's going on. Sometimes they just need to know how much the team cares about their baby who's in the NICU. And I think just listening to their questions and trying to guide them to what's happening. They're worried if the baby will survive or not come home or not come home this week versus a week from now. You know, it's really about trying to figure out what they need to know to help. The other thing we try to do is get them involved in the care, even if it's the littlest thing of touching their baby. Like at 24 weeks, the baby is so small. Their wrist is as big as a wedding band ring, and people are afraid. They don't know if they can touch their own babies. So just helping them know they can do that, they can read to their child, and they can still care for the baby, they know we're doing it together with them.

    Melanie: That's really great to hear, Dr. Kauffman. We've all seen those little babies in there and what they look like, and they're just so small and so helpless, and so I can only imagine what parents are going through, and I certainly applaud all the work that you do. Now, what about outcomes? The real positive stuff, give us some of the hope that you've seen going on.

    Dr. Kauffman: Well, through the years, it would be unthinkable for certain babies to survive, but even at pregnancy where someone has to deliver at 23 or 24 weeks, the majority of those babies can now survive where 20 years ago, almost all of those babies would not be able to go home with their families. Every week makes a big difference as far as how the babies do. All have some risks of developmental delay, and that's something we work and follow the kids once they leave the hospital. But for example, at 24 weeks, about 80 percent of the kids survive now, and about 70 percent have normal outcomes. Then once you get to 28 or 29 weeks, 90, 95 percent of the kids are surviving with good outcomes.

    Melanie: That's great information for parents that are scared and that the UVA Health System in the NICU, these doctors are specially trained, as are the nurse practitioners. They're sensitive to what you're going through and have such positive outcomes that there is really a lot of hope that things are going to go well. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Women’s Health]]>
Melanie Cole, MS Mon, 16 Dec 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/16285-the-uva-health-system-nicu
House Calls for Your Children http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=16190-house-calls-for-your-children house-calls-for-your-childrenSome doctors still make house calls.

Learn more about the pediatric home visit program from UVA Health System Pediatrics, including which patients are eligible, the types of care provided at home visits and how patients benefit.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1346vh5c.mp3
  • Location: Null
  • Doctors: Brown, Amy
  • Featured Speaker: Dr. Amy Brown
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Amy Brown is a pediatrician who runs the pediatric home visit program out of the UVA Health System Primary Care Center.

    Organization: UVA General Pediatrics at the Primary Care Center
  • Transcription: Melanie Cole (Host): Some doctors still do make house calls. Do you have one that does? Pediatric Home Visit Programs from UVA Health System Pediatrics are something you should look into. My guest is Dr. Amy Brown. She's a pediatrician who runs the Pediatric Home Visit Program out of the UVA Health System Primary Care Center. Welcome to the show, Dr. Brown. Why are home visits so important? What is the difference between getting parents to bring their kids in for their well visits, for their appointments to the doctor's office, and the advantages of having your doctor come to you?

    Dr. Amy Brown (Guest): Yes. Thanks so much for having me on the show today. Home visits are an incredibly useful tool for pediatricians, and really, all of the auxiliary services that are involved in child health in the community. Somebody said, "A picture is worth a thousand words." That is definitely true. When you go to a child's home, apart from a 10- or 15-minute visit in the office, you gain so much more information about the child's circumstances, the family dynamics, safety issues. You are able to better assess a child's development in their own natural environment. It helps pediatricians, I think, guide services for these children and plug them into community resources that prepare them for school readiness, and catch kids that are falling by the wayside.

    Melanie: Now, Dr. Brown, this is not necessarily for underserved population, is it?

    Dr. Brown: No, absolutely not. The Department of Health and Human Services is really taking a look at this, especially with the authorization of the Affordable Care Act. It's primarily focused on early interventions targeting prenatal, postnatal visits, and infants and young children. Doctors have been doing house calls for generations. Decades ago, this was the standard. Your doctor came to your home. They knew your family. They knew where you lived. I think that's an art of medicine that we have really lost in our generation, in our current healthcare system, because doctors have lost the ability to know their patients that way.

    Melanie: Do you all have enough time in your day? Because I see pediatric offices, and I applaud all of you pediatricians, because what a field you have entered. But do you have enough hours in your day to see as many patients as you could if you have to go house to house?

    Dr. Brown: It's certainly difficult, especially with current reimbursement structures with health insurance companies. But what we've tried to do at UVA, we train a lot of future pediatricians here. We have a well-developed residency program. Back in 1995, one of our attending physicians really had the forethought to say, "You know, this is important for young physicians to understand where their families come from and the neighborhoods in which they live and to get outside of the hospital." What we've done is we've incorporated that into part of the residency training, where once a month, we take a team of physicians, small group of physicians, and we're able to spend an entire day going and visiting our primary care patient from our pediatric center here at UVA. It's been effective, and I hope that the community also sees the services for them that they don't have to fight the traffic and drive four kids into the clinic. We make it actually useful for them to stay at home, and we bring everything to them.

    Melanie: I think it's awesome. I would absolutely love a pediatric home visit because fighting the traffic, waiting for the other kids to finish. Pediatric offices are well-known to be germ infested.

    Dr. Brown: Yes, definitely.

    Melanie: It's like you go in there for a well visit and you're worried, you're looking around and all the kids that are in there being sick. I think it's incredible that you're doing this, and certainly at UVA Health System. Now, early intervention. You can catch children with any kinds of needs for early intervention. Also, as you stated, looking at the home environment. Are there effects that you can look at maybe decreasing child abuse, possibly, or smoking in the home, educating the entire family as opposed to just what you do with the child?

    Dr. Brown: Absolutely. Some of that never comes out in an office visit. But when you're in a home, you see such a better picture of what's going. It's a great opportunity to sit there and say, "You know, I noticed such and such about your house. I noticed you have stairs but you don't have a gate on, and you have a toddler." Then we are able to discuss the risks of fall hazards or other safety issues in the home that we would have never been able to know in the office. That's something that is really coming down the pipeline when we look at the outcome measures of home visiting programs for young children and infants. But they're really trying to improve prevention of child injuries, prevention of child neglect, child abuse, addressing early developmental skills and school readiness. I think we're going to see that there's some great research that comes out of that.

    Melanie: In the high-risk populations, I would suspect that this is even doubled in its long-term effects that you can be looking at things like child abuse, as you say, and neglect, and even possible criminal behavior of the parents. You can get a handle on all of it, and you're the expert, so you can help the family as a unit.

    Dr. Brown: Absolutely. There have been some studies that have shown kids or young children with families that received home visits were able to keep their well child checks 3 to 10 times higher than families who didn't. That just ties them back into the medical system where they actually have a medical home. For us, we see it as we're our patients medical home but we're out in their communities. We're out in their houses, and we know their neighbors. For us, that's a great benefit. That's why many of us went into medicine in the first place.

    Melanie: Is there a different type of care you provide at the home visit? You're still doing blood pressure. You're carrying around your sphygmomanometer with you. You're still doing vaccinations. Are you carrying all these things with you?

    Dr. Brown: Yes, absolutely. We actually take everything into the home so we can do the head circumference, the weight, the height. We bring vaccines on our visits. Many times, we're doing more extensive developmental assessments than we would be able to do in the clinic. I think another benefit of the home visits for us is to really plug those kids in that have chronic medical illnesses. We're not sure what the compliance is at home with their therapies, and so we're able to address kids with chronic asthma or chronic eczema, ADHD. We do really a full spectrum of visits in the home.

    Melanie: Plus, you're making sure that these kids are getting vaccinated, where maybe parents say, "It's just a well visit. I'll blow it off this year. We'll do it in a couple of months." This way kids are getting their flu shots and their vaccinations on time because you're coming to them.

    Dr. Brown: Yes, absolutely. There are a lot of kids that have missed well child checks, so it's an opportunity for us to really call those families and say, "You know what? How about we come to you?" Because sometimes transportation is an issue or missing work for a parent is a big issue. To be able to go to the house and take care of that and catch up on their vaccines and really assess how this child is doing after not having seen them for a couple of months, it's very helpful for us, and important.

    Melanie: Now, with UVA's Child Care In-Home Pediatric Visits, tell us a little bit about how you go about getting involved in this program.

    Dr. Brown: Sure. We offer home visits typically on the third Friday of every month, then we try to stack the whole day with families that we're going to see within up to an hour of our academic center here in Charlottesville. Well child checks, it's fixed visits, it's follow-up visits from the ER, newborn follow-up visits from the new born nursery, and anybody who considers the Pediatric Primary Care Center their medical home are eligible to participate in the program.

    Melanie: Do you have to sign up? Do you have to meet special requirements? Or if you're just part of this pediatric care program, you can get in on that? It's third Friday of every month, correct?

    Dr. Brown: Mm-hmm. Yes. Usually, we consider everybody eligible. Obviously, we try to save some appointments for some of those kids that have been lost to the medical system, so can really pull them back in and then get them caught up in the vaccines or whatever. But anybody is eligible that considers us their primary care or clinic or medical home.

    Melanie: What a great reason to use UVA Health System's Primary Care Center Pediatric Home Visits. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
Melanie Cole, MS Mon, 09 Dec 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/16190-house-calls-for-your-children
Options for Treating Heart Failure http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=16191-options-for-treating-heart-failure options-for-treating-heart-failureMore than 5 million Americans have heart failure, and tens of thousands of Americans die from this condition each year.

However, treatment advances are providing new hope to patients.

Learn more about the treatment options – including heart transplants and implantable devices – available at UVA.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1346vh5d.mp3
  • Location: Null
  • Doctors: Kennedy, Jamie
  • Featured Speaker: Dr. Jamie Kennedy
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Jamie Kennedy is a fellowship-trained specialist in heart failure who is board-certified in both internal medicine and cardiovascular disease.

    Organization: UVA Heart Failure and Transplant Center
  • Transcription: Melanie Cole (Host): More than 5 million Americans have heart failure. The treatment advances that are providing new hope to patients with this often serious condition are out there. My guest is Dr. Jamie Kennedy. She's a fellowship-trained specialist in heart failure who is board certified in both internal medicine and cardiovascular disease. Welcome to the show, Dr. Kennedy. Please explain for the listeners: what is heart failure? They hear heart failure, they think heart attack, stroke, but it's different. It's a condition and can be a chronic condition. Explain a little bit about heart failure for us.

    Dr. Jaime Kennedy (Guest): Heart failure describes a whole host of different disease processes that all have similar symptoms. That's namely fluid retention, so swelling in the legs and in other body parts as well. The other key symptom is exercise intolerance. Patients may be comfortable sitting still, but when they do more strenuous activities as far as climbing stairs or walking up a hill, they develop shortness of breath and fatigue to the point where they're not able to do those activities anymore.

    Melanie: Heart failure, Dr. Kennedy, can develop over time as the heart's pumping action grows a little bit weaker. So it's not pumping that fluid out of the lungs, around the lungs, and up from the legs, correct?

    Dr. Kennedy: It's a combination of inability of the heart to pump efficient blood to the rest of the body and then the body's compensatory mechanism that cause fluid retention in the legs, in the lung, everywhere.

    Melanie: If you notice this fluid retention, you notice this edema in your legs, in your ankles, around your abdomen, or you're coughing, you're having exercise intolerances, you say, which is not just normal exercise intolerance but a little bit more severe, and they come to see you, what can they expect? How is this diagnosed?

    Dr. Kennedy: We use a lot of different tools. One of the most important is just talking with the patient to explore their symptoms and then examining the patient to look for signs that we see in patients with heart failure. As far as more specific testing, what's called an EKG is very helpful. It just looks at the electrical activity of the heart, and that helps us to know if abnormal heart rhythms are part of the problem. The other test we rely on a lot is that called an echocardiogram. That's basically an ultrasound of the heart. It's very much used to look at pregnant women, the babies that they're developing in the uterus. But we're using the same technology to look at the function of the heart that helps us to know if the heart muscle is weak, if there's heart valve problems, either leaking or not opening well, a whole host of problems in the heart that can lead to the heart failure syndrome.

    Melanie: Now, how is this treated? If there are underlying causes such as coronary heart disease, blood pressure problems, diabetes, anything that might contribute to congestive heart failure, what do you do for treatment?

    Dr. Kennedy: That goes back to the wide range of different disease processes that can lead to heart failure, and then we have to look into each one of those processes and treat it appropriately. Like you said, if a patient has high blood pressure, then we need to get that blood pressure under control. If a patient has coronary artery disease narrowing their blockages and heart arteries, then we consider whether bypass surgery or stents in those arteries would be helpful. If patients have valvular heart disease—one of their valves is too tight, it doesn't open enough or if it's open [wide too well] it leaks—then we consider whether repairing or replacing the valve in some way would be helpful. If the heart muscle itself it weak, unfortunately, there's no perfect fix for that, but we do have medications which can help the heart to recover in some cases, and in many, many cases can, help a heart to be as efficient as possible despite its weakened state. All of these things, the goal, of course, is to keep people feeling well, as active as they possibly can be, keep them out of the hospital, and obviously, keep them alive.

    Melanie: When you're talking about treatments—and you mentioned medications, making sure to get the blood pressure down to reduce the strain on your heart—what about things like diuretics? If fluid does start to build up, is this something that you're on permanently now for the rest of your life?

    Dr. Kennedy: It really depends. We use diuretics, of course, or medications to help people get rid of extra fluid. Some patients will need them forever. Some patients, as we treat the other processes involved, their need for diuretics can be reduced or even, at times, eliminated. Diuretics, we really use as we need to. It's not mandatory necessarily. The patient will need a diuretic only when fluid retention is a problem.

    Melanie: What about lifestyle changes, Dr. Kennedy? Do you work with patients in lifestyle changes so that the workload of their heart is reduced? What are those lifestyle changes you might work with them about?

    Dr. Kennedy: Yes. Absolutely. Lifestyle modifications are a huge component as well. We do encourage patients to exercise, though I ask them to try to be smart about it. I ask them not to push themselves to the point of gasping for breath. I also ask them to avoid any really heavy lifting type activities to where they're straining. Then, obviously, if they are feeling profoundly short of breath, chest pain, lightheaded or dizzy, or passing out, they need to stop whatever exercise they're doing and rest and recover. Dietary changes are also a big part of heart failure care. Especially in patients who tend to retain fluid, keeping the amount of sodium in your diet to a reasonable level can help with that problem because sodium, where sodium goes, water tends to follow. In general, Americans eat a colossal amount of sodium every day, at least 4 to 5 grams in the average American diet. We ask patients with heart failure to try to keep that closer to 2 grams of sodium a day. Obviously, sodium is necessary for your body's processes and you cannot eliminate it completely because that is equally harmful. But trying to keep it to a moderate level can be helpful. Also in patients who tend to retain fluid, we ask them to limit the amount of fluid that they take in to minimize the fluid retention problem. Again, you do need some fluid. You can't eliminate that completely. But we ask folks to keep it to about two liters of fluid a day.

    Melanie: What about alcohol?

    Dr. Kennedy: Alcohol actually can cause heart failure in itself in patients who drink to excess. There are some people who have a very difficult time controlling their alcohol intake. And those individuals, I tell them that they need to eliminate it completely. In patients who enjoy a drink once a week, I think that's a reasonable thing to continue. There's a little bit of data that red wine can be somewhat helpful for heart function. If you're going to drink something, red wine might be something to drink.

    Melanie: Okay. You've talked about fluid intake. You've talked about alcohol and lifestyle changes and exercise, and I do want to just bring out that you mentioned about heavy lifting, that Valsalva maneuver, that holding your breath and pushing really hard, that can actually worsen congestive heart failure, correct? It can aggravate it.

    Dr. Kennedy: Patients just tend to not tolerate that sort of activity very well. They tend to get profoundly short of breath and also extremely lightheaded and can pass out.

    Melanie: If you would just sort of wrap it up for us, heart failure patients coming to UVA for care, what can they expect, and what are the most recent advances that you can tell them about?

    Dr. Kennedy: I think it's a very tailored treatment plan because it does depend so much on the individual's characteristics as far as our disease process as well as the rest of their life. But we can promise it's a very individualized treatment plan depending on what the individual needs.

    Melanie: It's an individualized treatment plan, and there's lifestyle changes, medication, and it's symptom management and getting that heart failure under control, and all of the things that might go along with it. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Disease]]>
Melanie Cole, MS Mon, 09 Dec 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/16191-options-for-treating-heart-failure
What Are Your Options for Preventing Colorectal Cancer? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=16189-what-are-your-options-for-preventing-colorectal-cancer what-are-your-options-for-preventing-colorectal-cancerColorectal cancer is preventable.

Learn more about the symptoms and the best screening options to protect yourself, as well as the advanced screening and treatment options available for patients from the multidisciplinary team at UVA Cancer Center.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1346vh5b.mp3
  • Location: Null
  • Doctors: Friel, Charles
  • Featured Speaker: Dr. Charles Friel
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Charles Friel is the Chief of Colon and Rectal Surgery at UVA Health System. His specialties include surgical treatments for colorectal cancer and inflammatory bowel disease.

    Organization: UVA Colorectal Surgery and UVA Cancer Center
  • Transcription: Melanie Cole (Host): Colorectal cancer is preventable. You can learn more here about the symptoms and the best screenings and options to protect yourself. My guest is Dr. Charles Friel. He's the Chief of Colon and Rectal Surgery at UVA Health System. Welcome to the show, Dr. Friel. Let's first talk about commons signs and symptoms of colorectal cancer. Then we're going to move on to the screening process.

    Dr. Charles Friel (Guest): The first thing to really understand is that a lot of times, there are really no signs and symptoms of colorectal cancer. I think the most important kind of risk factor is age. As we get older, this is something we need to think about. Fifty is the key age to remember. Having said that, certainly, if you have any kind of changes in your bowel habits, if you see blood in your stool, if you see a change in constipation, perhaps your stool becomes a little bit smaller or thinner, or you have crampy abdominal pain or chronic anemia, all those things can be symptoms of colon cancer. If you have any of those things, then you should be evaluated by your doctor, and your doctor may suggest a test such as a colonoscopy. But not all people have symptoms, so just keep that in mind.

    Melanie: Dr. Friel, you mentioned blood in your stool. Hemorrhoids cause blood. People freak out. They see blood. They run to a guy like you and say, "Oh my god." Is there a difference that you can tell when you see blood like that?

    Dr. Friel: There can be. There are classic findings of hemorrhoids where there's a little blood on your toilet paper. But I think a common mistake is that people just dismiss blood in the stool as being hemorrhoids. While it's most common, especially if you're young, that you have a little blood from hemorrhoids, it really should be evaluated. Unfortunately, I've even seen very young people with colon cancer. Just don't dismiss your bleeding as your hemorrhoids, and get it evaluated, because it could be a sign of colon cancer.

    Melanie: You mentioned 50. When should people start getting screened? I get my colonoscopies every three years. Because things run in my family, I started younger. But what time should people typically start getting their colonoscopies?

    Dr. Friel: Now, you raise a very important point. The first risk factor, as I talked about, is age. We screen people who are considered to be moderate risk for colon cancer. All of us, by definition, become moderate risk at age 50. I think for the general population, you should remember age 50. You should be getting your first screening test. Most of the time, that involves colonoscopy, but there are other options, and you can talk to your doctor about those other options. However, some people are at higher risk. Family history can be significant. If you have a family member who has colon cancer, your doctor may recommend that you begin screening earlier. That could be typically at age 40. Other risk factors are some genetic disorders that are associated with colon cancer. If you have any genetic disorders, you might be getting a screening earlier. Certain diseases like ulcerative colitis can put you at risk factor for colon cancer. There are other higher risk factor groups, and you just discuss these with your doctor and they would make recommendations. But 50 is the key age to remember.

    Melanie: Let's give a quick running definition of the colonoscopy. It's not nearly as bad as people think. The prep is really only the bad part. You're not even awake for most of it. They say bye-bye and you're out, and when you wake back up, it's already done. Tell people how easy this great preventive screening test is, Dr. Friel.

    Dr. Friel: Absolutely right. It's a pretty straightforward test. I have had one myself. As you pointed out, I think even the prep, people can tolerate pretty well. But I think that's the most difficult part for people. It is critically important though that you work hard at your prep because we need a nice, clean colon to get a good look at your colon. If you don't do a good prep, then you will have a poor test. If you have a poor test, it really is not as effective for you. So work hard on your prep. But once you get to the procedure room, we do give you some medications which make you nice and sleepy. Most people don't remember anything. The next thing they do is they wake up and the first thing they ask me is, "Have you started yet?" and by then, the test is over.

    Melanie: It's so easy. It really is. Now, what if you tell them that you've found polyps? Is that something to be scared of?

    Dr. Friel: Actually, we don't want to have polyps if we can avoid it. But if there is a polyp in your colon, you want it removed. One of the real advantages of colonoscopy is not only are we looking for an early cancer. Hopefully, if you have polyps, we'll find your polyps and we can remove your polyps. Polyps are not cancers, but we do consider them to be pre-cancerous. If you remove the polyp, we can in fact potentially prevent a cancer from forming in you over time. While none of us want to have polyps, you shouldn't be afraid of them. If they're in you, we want to remove them, and we can do that easily with a colonoscopy.

    Melanie: Then you test the polyps, make sure that these are benign, nothing that we should be scared of. What if, God forbid, they're malignant?

    Dr. Friel: As you just pointed out, polyps, by definition, are considered to be benign. They're considered to be pre-cancerous. A malignant polyp just has a little bit of cancer in it. By definition, then you actually technically have colon cancer. Most of the time, that may involve an operation, but sometimes not. But most of the time, that's going to involve an operation, and that is something that I do on a regular basis. We can cure many, many people with colon cancer. It's not something to be afraid of. It's a treatable disease. You just need to consult your doctors, and they can help you with that.

    Melanie: Treatments. You can have surgery to remove any of the cancers that you see. What else? Is there chemotherapy involved? Radiation? People are scared of this cancer, Dr. Friel, and you're giving us a lot of hope and positive messages. Continue that. Speak about the treatments.

    Dr. Friel: I think it's really important to understand that getting a cancer diagnosis is extremely difficult, and it can be quite scary. But colon cancer is a very treatable disease. It almost always involves an operation where we remove the colon cancer itself. Most of the time, we can put your colon back together so you don't have to have any bag—the other thing that people are really quite frightened about. Is that the case all the time? Unfortunately, it's not. But for most patients, we can take the piece of the colon out and do this without any significant long-term problems. As far as other treatments are concerned, it really depends on the stage of your colon cancer. If you have a little bit more advanced disease, which is still curable, we will frequently use chemotherapy. As for radiation therapy, it usually revolves around people who have what we call rectal cancer, which is just a slightly different version of colon cancer. But oftentimes, we will use radiation for rectal cancer.

    Melanie: Are there drugs that, like with breast cancer, maybe you go on tamoxifen for five years or something? And then what's the follow up?

    Dr. Friel: Yes. We don't typically leave you on long-term medications for colon cancer, but it is important that you have continued follow-up. Some cancers can come back, but we actually have pretty good treatment for that too. The most common place that a colon cancer will come back is in your liver. Here at University of Virginia, we've got several specialists who are liver surgeons who can remove these cancers from your liver, and you can still have a very good long-term result. It is important that we do frequent surveillance of your entire body, which will probably include a CT scan. The other thing that's important is, as just you pointed out, you get your colonoscopies every three years. If you've had a previous colon cancer, you are at risk to develop another colon cancer in the future or another polyp. We probably would put you on a schedule. We would be doing more frequent colonoscopies for the rest your life.

    Melanie: When patients are choosing UVA for their colorectal cancer screenings and treatment, what can they expect?

    Dr. Friel: I think what you can expect is a comprehensive team of doctors that's thinking about you personally. We try to look at your case individually. We have a multidisciplinary tumor board that will include doctors that are gastroenterologists; it will include surgeons like myself, who operate almost exclusively on the colon; and we have liver specialists; an oncologist who will be looking at your case and thinking about you and thinking about all the options that are available to you. We try to treat you in a comprehensive manner with all doctors that are really thinking about this disease, that are specialists in their area.

    Melanie: In the last 20 seconds, Dr. Friel, best advice on colorectal cancer screening and prevention.

    Dr. Friel: Probably the most important thing is that you do get your screening. Remember, age 50 is the year. When you get your 50th birthday, that's your birthday present: a colonoscopy.

    Melanie: I love that advice. That's great advice. Give yourself a 50th birthday present that's going to give you many more birthdays. Get your colonoscopy. It's easy. It's not as difficult as you might think. It could save your life. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
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  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
Melanie Cole, MS Mon, 02 Dec 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/16189-what-are-your-options-for-preventing-colorectal-cancer
Is it Normal Aging or Alzheimer’s Disease? http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=16188-is-it-normal-aging-or-alzheimer-s-disease is-it-normal-aging-or-alzheimer-s-diseaseIs the memory loss you're experiencing a common part of aging, or could it be the sign of a memory disorder like Alzheimer's disease?

Learn how to tell the difference between the normal changes that occur as you get older and more troubling symptoms from a memory disorders specialist from UVA Health System.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1346vh5a.mp3
  • Location: Null
  • Doctors: Fernandez-Romero, Roberto
  • Featured Speaker: Dr. Roberto Fernandez-Romero
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Roberto Fernandez-Romero is a neurologist at UVA Health System's Memory and Aging Care Clinic. He specializes in treating patients with Alzheimer's disease and dementia.

    Organization: UVA Memory and Aging Care Clinic
  • Transcription: Melanie Cole (Host):Is the memory loss you're experiencing a common part of aging, or could it be a sign of a memory disorder like Alzheimer's disease? My guest is Dr. Roberto Fernandez Romero. He's a neurologist at UVA Health System's Memory and Aging Care Clinic. Welcome to the show, Dr. Fernandez. What are some of the normal changes to your brain's function that you can expect? We have age-related dementia, and sometimes we forget little things, but what are some of the things that we can expect to happen as a normal part of aging?

    Dr.Roberto Romero (Guest): Just like the rest of our body, our brains experience significant changes as we get older. However, not all of these changes have to be negative. Actually, there are many brain functions that can benefit from life experiences and the things that we tend to practice and do on a regular basis so they can actually improve with age. Things like vocabulary, for example, or just general knowledge can be better or get better with age because we tend to accumulate those memories and experiences over time. They can also shape the way we react in certain situations, and so we sometimes tend to be better at responding in certain circumstances. That's something that many people call wisdom, which is something that comes with age. However, there are many other brain functions that do get affected negatively with age. These are cognitive functions that typically rely on things like quick thinking or fast reaction or mental flexibility, and also things like attention, which can be sustained attention, just keeping focused on something in particular, or divided attention, which is focusing on different things at the same time. These are things that require a lot of brain activity and require sharp connections between different parts of the brain, and those can get affected with age. It is not uncommon for older individuals to have more difficulty with things like multitasking, for example, that requires the ability to divide our attention between different tasks or problem solving or quick decision making, which are things that are not so much dependent on our life experience and practice but, rather, our ability to respond quickly. Likewise, the reaction times that require, for example, a motor action in response to a stimulus are things that we see typically that tend to decline with age. Perhaps the best example of this would be driving a vehicle, which requires your ability to respond quickly in certain circumstances.

    Melanie: We do notice, Dr. Fernandez, that older people, their response time in driving gets a little bit less. We worry about them having their licenses longer, and that's part of that brain function. But what are some of the signs? If you lose where your keys are, that's one thing. What are some of the red flags that might signal that somebody is sort of entering that first phase of Alzheimer's that might send them to see someone such as yourself?

    Dr.Romero: Yes. The important thing to keep in mind is that there are subtle things that happen with age, with memory, like you mentioned just losing your keys every once in a while or things like forgetting a word now and then. But when these things become frequent enough that they are actually interfering with the way you do things, or when family members or friends or caregivers start noticing that these memory lapses or these changes in behavior are affecting your day-to-day activities, that's when you should start getting concerned. Things like difficulty, other than memory problems is the first thing we would think about with Alzheimer's disease. This can be having trouble remembering recent conversations, or if people start repeating themselves or asking the same questions over and over again. That should always be a red flag. Misplacing things around the house every now and then is okay. But if you're constantly misplacing your glasses or your keys and have to search for them and cannot find them, then that can be also concerning. But there are other signs that are not necessarily related to memory that is important to keep in mind because we typically don't tend to associate those with Alzheimer's but they are actually very frequent, and those are things like getting lost or disoriented in familiar places when driving, having trouble finding their way around, or things like having difficulties finding words in casual conversation all the time, or even things like having trouble balancing the checkbook. Those are the things that are concerning and we should keep in mind.

    Melanie: Are there personality changes that go along with this that we might notice mood changes, personality changes?

    Dr.Romero: Yes. There are personality changes. It is not uncommon actually to see patients with early dementia who also have depression. However, depression by itself can mimic dementia. It's always a fine line between which one is causing the symptoms. But we also have to keep in mind, particularly with younger people—so people below the age of 65—there are other types of dementia that have more significant behavioral problems as opposed to memory problems. Even though these are less common or rather rare conditions, they still happen, and they can often be misdiagnosed because people are not looking for dementias in that age.

    Melanie: In younger people. That's true. Now, what can UVA's Memory and Aging Care Clinic do to help patients? What's the treatment? If you bring somebody in, they've got mild Alzheimer's, they're in their first stages and you've noticed those personality changes—getting lost, trouble paying bills and handling money, normal daily tasks, any of these things that you've said signal a red flag that would send them in to see you—there's no cure, right? There's nothing we can do to stop the progression? But can we slow it? What can we do about it, Dr. Fernandez?

    Dr.Romero: Yes, you're absolutely right in the sense that we currently and unfortunately don't have a cure. There's not necessarily even a medication that we can give to significantly slow down the progression. However, there are advances coming up all the time and there are new therapeutic experimental treatments that are promising. So, making an early diagnosis is still very important. But also, you have to realize that the treatment and care of patients with dementia doesn't just stop with medications and treatments like that, but it also involves giving the support to the families and caregivers and the patients. That includes education so that people know how to cope with the condition and also are aware of how to plan ahead for the future. For the University of Virginia, we are very fortunate. We have the Memory and Aging Care Center, which has a highly specialized multidisciplinary of team of professionals, and that includes neurologists, neuropsychologists, nurses, nurse practitioners, social worker, and even a representative from the Alzheimer's Association. We all work together as a team to give a more comprehensive care to these patients. Also, as an academic center, we have, aside from the expertise to make a diagnosis and begin the appropriate treatment, a significant amount of cutting-edge diagnostic tools that can be particularly helpful in those rare dementias and disorders that I mentioned briefly before.

    Melanie: In just the last 30 seconds, Dr. Fernandez, wrap it up. Give hope to the people listening and your best advice about Alzheimer's disease.

    Dr.Romero: The best advice is to, first of all, to seek treatment early because, again, there are medications that can help with the symptoms. Also, there's support that can be given to caregivers and families, and also to understand that most of the time, Alzheimer's is a condition that progresses slowly over time. Since we're not necessarily all about memory, there are still many brain functions and qualities that will be preserved for a long time, and so it's important to keep an open mind and be optimistic about the future.

    Melanie: Thank you so much. You're listening to UVA Health System Radio. This is Melanie Cole. Thanks for listening.
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  • Hosts: Melanie Cole, MS
Tagged under: Brain & Nervous System]]>
Melanie Cole, MS Mon, 25 Nov 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/16188-is-it-normal-aging-or-alzheimer-s-disease
Helping Children with Cerebral Palsy http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=15501-helping-children-with-cerebral-palsy helping-children-with-cerebral-palsyThousands of children are diagnosed each year with cerebral palsy, which can affect how children can move.

Learn what causes cerebral palsy and more about the treatments available from specialists at UVA Children's Hospital that can help improve quality of life for cerebral palsy patients and their families.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1342vh5e.mp3
  • Location: Null
  • Doctors: Romness, Mark
  • Featured Speaker: Dr. Mark Romness
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Mark Romness is a pediatric orthopedic surgeon at UVA Children's Hospital. He specializes in treating children with special needs, including children with cerebral palsy and spina bifida; gait abnormalities, pediatric lower extremity problems and trauma; and osteogenesis imperfecta.

    Organization: Pediatric orthopedics at UVA Children's Hospital
  • Transcription: Melanie Cole (Host): Thousands of children are diagnosed each year with cerebral palsy. What treatments can help improve the quality of life for these children? My guest is Dr. Mark Romness. He's a Pediatric Orthopedic Surgeon at UVA Children's Hospital. Welcome to the show, Dr. Romness. Describe a little bit about what cerebral palsy is and how common it is these days.

    Dr. Mark Romness (Guest): Cerebral palsy or CP, as we often call it, is actually a group of conditions, sometimes called an umbrella term. It's where there's abnormal development of movement and posture, type of activities, and that causes limitations in their activity. About two to three children out of every thousand born have cerebral palsy, and about 10,000 babies are born each year that will develop cerebral palsy. There are different types of cerebral palsy and sort of a spectrum involvement. The most common type is what's called spastic cerebral palsy, where the child has muscle spasticity or tightness, most commonly of the extremities, sometimes, the trunk. The spectrum itself is very broad—very mild involvement and very few limitations to much more severe involvement and extensive involvement, where the child requires full assistance for all activities.

    Melanie: Now, what about risk factors during pregnancy? Is there anything that you can do, and is this something that's spotted on ultrasound or amnio early?

    Dr. Romness: Not usually. It is caused by an injury to the developing fetal or infant brain, so there is something related to the brain injury itself that can occur intrauterine, but there's no specific known causes during pregnancy that can be addressed.

    Melanie: Women worry about things like this. Is it something you'll know right when you have that baby? Is it something that you can diagnose, Dr. Romness, pretty much right after the baby is born, or is it something that you start to see with developmental and motor delays?

    Dr. Romness: It's not usually completely obvious at birth because it takes some time for the brain and the child and the peripheral nerves to develop before you actually start to see lack of development. That's usually how the diagnosis is made.

    Melanie: Okay. So once you start to notice these sorts of things -- and I imagine, for parents, it's pretty scary. So, Dr. Romness, explain a little bit about the progression of this disease, of this condition or set of conditions. Really, starting from the very early age of diagnosis, even six months to a year old, what are parents doing? What are doctors such as yourself doing and even working with early intervention in their school systems? Take us right through.

    Dr. Romness: Right. First, the entry to the brain itself is considered permanent but non-progressive, meaning that the brain injury doesn't get worse. But the symptoms that you see in the child can be progressive with time, especially during growth. So they will start to develop problems as they get older. That's why it is a progressive condition, but the injury to the brain is not necessarily progressive. What's done is you sort of monitor those things initially as diagnosis, and again, they are developing ways to diagnose it at earlier ages. People have been coming up with different ways of assessing that and finding things in children that suggest that the child will develop more issues down the road. Your other question was related to treatment something?

    Melanie: Treatment plan. As you map out a treatment plan and the parents are thinking long-term of what they're going to do for this child as they grow and what -- physical therapy, occupational therapy, speech and language, how does that all tie together?

    Dr. Romness: As you mentioned, it does start early. Really, as soon as diagnosis is made, it's been found that intervention with therapies and treatments like that are helpful. In most of the states, they even have what's called an early intervention program, or it's also sometimes a birth to three where they will evaluate the child, and it'll determine which therapies will be best for the child to keep them progressing and get them going. From a medical standpoint, most of the treatments are individualized, because each kid has a unique pattern that there's no standard protocol for treatment. But the treatments tend to be individualized specifically for that patient. Most common treatments used, like you mentioned, are physical, occupational, and speech therapy. Other things we tend to use are [bracing], or sometimes called orthotics or orthoses, and those are used to help position the limb. Sometimes, as they get older, we'll get into equipment issues such as walkers, crutches, wheelchairs, and then there's also some medications to help with some of the conditions, like the spasticity. There are some medications available to try and treat spasticity. Then, surgically, which I'm involved with as an orthopedic surgeon, tends to deal with things like joints and fractures, foot position, hip issues, spine and scoliosis.

    Melanie: Okay. So these types of surgeries that you would be involved in, what are they intended to do?

    Dr. Romness: The main goal is probably function. You're trying to maximize their function, both short-term and long-term. Surgeries are usually sort of restoring or repositioning the hip, the leg into a more functional position.

    Melanie: Now, does that stay? Is that permanent? If you do that and you restore that hip into a more functional position, is that something that then will -- the muscles will get lax again and retreat back to where it was, or is this something that would last for the child's life?

    Dr. Romness: Again, it's somewhat age-dependent. There are some surgeries that are better done at a young age, and then they will help the child down the road. But there are some procedures that we actually wait until the child is a little bit older because if we do it at a young age, the recurrence is pretty high. So some of the bone procedures where we turn the bone or correct the foot position, we found that it's better to wait until they're older and it's less likely that they're going to need another surgery for that.

    Melanie: Now, how is UVA equipped? How are you helping children with cerebral palsy? In your department, Dr. Romness, braces and things, working with all of that, what are you doing there?

    Dr. Romness: As part of the Department of Orthopedics, we do have these orthotics and prosthetics, which is the brace place, and so they're involved with us in terms of a lot of bracing issues. My approach is what we call family-focused approach. We don't just look at the child. We look at the child in their family setting because we find that all that works together. What I do is I kind of assess each child for the unique aspects, determine what I can do to help them now, things that I need to worry about for the future, and then I sort of say, "What I can do to prevent future problems and keep them going?" I then determine which treatment is best, both for now and the future, and then discuss that with the family.

    Melanie: In the last minute, Dr. Romness, wrap it up for us about CP and working with the families and giving the best quality of life to children with this.

    Dr. Romness: Right. Like I said, this is family-focused. I will say that UVA is one of the leaders in that kind of treatment because we have such a diverse field of specialists who are not only competent but they're comfortable and excited about taking care of kids with special needs. We have the therapist, we have a dietary and feeding specialist, behavior and developmental specialist, dental, ENT, gastroenterology or GI, orthopedist, neurosurgeons, to name a few. One of our developmental pediatricians, Richard Stevenson, he was just elected President of the American Academy for Cerebral Palsy in Developmental Medicine, which is the main organization for practitioners. Probably you could say that we're at the forefront of the field with that.

    Melanie: That is great. Such good news. Thank you so much, Dr. Mark Romness. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health, Bone Health]]>
Melanie Cole, MS Mon, 18 Nov 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/15501-helping-children-with-cerebral-palsy
Latest Options for Heart Valve Repair http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=15179-latest-options-for-heart-valve-repair latest-options-for-heart-valve-repairMinimally invasive techniques for repairing heart valves are now available for patients who aren't candidates for traditional heart surgery.

Interventional cardiologist Dr. Scott Lim, co-director of the UVA Cardiac Valve Center, discusses some of the less-invasive options available to patients.

Dr. Lim is part of a heart valve treatment team that includes cardiologists, heart surgeons, clinical researchers and nurses who specialize in treating and caring for patients living with heart valve disease.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 5
  • Audio File: virginia_health/1340vh5e.mp3
  • Location: Null
  • Doctors: Lim, Scott
  • Featured Speaker: Dr. Scott Lim
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Scott Lim is co-director of UVA's Cardiac Valve Center and is noted internationally for his expertise in novel percutaneous approaches to heart valve disease. He specializes in children and adults with congenital heart disease. Dr. Lim is also the co-director of the Adult Congenital Heart Disease Center at UVA.

    Organization: Cardiac Valve Center
  • Transcription: Melanie Cole (Host): Minimally invasive techniques for repairing heart valves are now available for patients who aren't necessarily candidates for traditional heart surgery. My guest is Dr. Scott Lim. He's the co-director of UVA's Cardiac Valve Center, and he's noted internationally for his expertise in novel percutaneous approaches to heart valve disease. Welcome to the show, Dr. Lim. Speak about what cardiac valve disease is with a little bit of a lesson for us on what valves do.

    Dr. Scott Lim (Guest): Sure. First of all, I'm honored to be on this segment here. Now, as far as what heart valve disease is, all of us have four valves in our hearts. They help regulate the flow of blood through the heart and out to the body. Most commonly, two of the valves on the left side heart can, in certain people, strictly as we get older, cause problems. Now, the most common problem is either that the valve itself doesn't completely open, and as such, the heart is under a lot more stress and strain as it's trying to pump the blood past a narrowed heart valve. Most commonly, that's something called aortic stenosis, which can affect many people as they get older. Another common problem is a valve doesn't completely close so that the blood can leak backwards, particularly towards the lungs, giving a patient the sensation of increasing shortness of breath, particularly with activity. Those are probably the two of more the common types of heart valve issues plaguing people as they get older.

    Melanie: So you certainly don't want blood backing up or going back into the lungs. We want it really strongly pushed out through that left ventricle out into the body. So the valves that you mentioned on the left side that typically have issues, what are some reasons that they would have these issues? Are there symptoms, Dr. Lim, that might signal that you've got some kind of -- you know, do you have shortness of breath? What might people feel?

    Dr. Lim: Sure. From a patient's standpoint, the most common symptom that they would feel is increasing shortness of breath with activity, with exercise. Other potential symptoms can be chest pain or chest tightness or palpitations or raising heartbeat. Now, the most common reason why the valve is failing this way is related to age-type changes. For some Americans, as they get older, into their '70s and older, they can have degeneration of these valves as we're all living longer and, as a result, those valves start malfunctioning. Less commonly, it can also be due to an abnormality or a birth defect to the valve that was present since birth but then really starts to become more of a problem as the person gets older.

    Melanie: People picture these valves, Dr. Lim, and I know that in graduate school that's how I pictured them, as something you might see on a car that prevents that back flow. They're these so important bit of our heart and bits of our body. Now, if somebody does have a problem with the valve and you need to help them, what are the treatment options available at UVA in the cardiac valve center? What are you doing for them?

    Dr. Lim: Sure. Probably the most important thing is, first of all, the evaluation of it, because not everything has to require a replacement or repair, something more invasive. So when the patients first come to us, they get a multidisciplinary approach. They get to see cardiologists involved in imaging their heart valve through ultrasound or CAT scan or MRI and so forth. They also get to meet with specialists in deciding what's the proper therapy, as well as the surgeon or the cardiologist involved in doing that therapy. Now, if it turns out that the patient has a significant heart valve problem, in most cases, medicines are not effective for that. In most cases, you have to either repair the valve or replace the valve. Traditionally, that's been something that's only been done by a relatively invasive open-chest, open-heart surgery type of approach. More recently, we've done a lot of work allowing research, as well as coming into the forefront of medical care, of how to repair or replace valves through catheters. Small tubes are inserted into the blood vessels in either the leg to the side of the body. That's really allowed a less invasive approach for many people, allowing them to undergo such procedures that may not have been warranted for them in the past, as well as allowing them to heal up much quicker than a more traditional, more invasive approach.

    Melanie: And minimally invasive in these trans-catheter procedures, what are you doing when you repair versus changing the whole valve?

    Dr. Lim: When we're repairing a valve, a good example is a valve that's leaking. There is the traditional way, which involves opening up the chest and opening up the heart, stopping the heart, looking at the valve, and trying to figure out where and how we can put in a series of stitches on the valve. A less invasive way to doing it, or a trans-catheter based way to do it, is using tiny little metal clips called MitraClips that are introduced through a catheter and then placed onto the leaking part of the valve, clipping it back together. This is all done with the catheter while the heart is still beating, while the chest is still closed, and it's guided by the use of ultrasound so that we can see what we're doing.

    Melanie: That is so cool. Is this a lifetime thing, or is there a possibility later that they might need the valve replaced?

    Dr. Lim: The goal with this is a lifetime repair. However, many of these newer technologies have not been in existence for an entire lifetime. So we may have eight or 10 ten years of experience on it, but we certainly don't have 40 or 50 years of experience, so we don't really know that answer. We think it is a permanent repair, and we certainly hope so. That still has yet to be proven.

    Melanie: Recovery time for the trans-catheter, more minimally invasive, and then we'll talk about a full replacement.

    Dr. Lim: Sure. So in terms of a trans-catheter repair of a valve using some of these MitraClip type procedures, that's commonly done where the patient comes in, gets the procedure, we watch them one or two days in the hospital, and then they're able to head home and resume more normal activities. Now, instead of repairing the valve, we're replacing it. Much of the time, that depends on how we do it, but oftentimes the patients are in the hospital maybe three or four days on average compared to if they underwent a standard open-chest, open-heart surgical approach, where they'd be in the hospital a week or slightly longer.

    Melanie: And if you have to replace the entire valve, then -- we only have a couple of minutes left, but what's involved in that?

    Dr. Lim: Sure. What that is is we take almost the same valve that's inserted by a standard open-chest surgery. Instead, we compress it down so it can then go through that catheter from the blood vessel in the leg or the side of the body, and we spread that up into the heart, where, as it comes out of the catheter, we re-expand it into the normal size. It pushes aside the old malfunctioned valve and starts working right away.

    Melanie: Wow. That is fascinating. And then recovery, if you've had a valve replaced, aortic valve, a mitral valve, what can they look for for the rest of their life? Is this something that really is a new lease—no more shortness of breath? Pretty exciting.

    Dr. Lim: It is very exciting, and yes, that is the goal that the patient's main symptoms that got them there in the first place, be it shortness of breath or chest pain, that the patient has resolution of those symptoms.

    Melanie: So give us your best advice for cardiac valve disease in the last one minute, Dr. Lim, if you would.

    Dr. Lim: Sure. I think one of the most important things is that this whole field of heart valve disease is rapidly changing. There's a lot of really new, exciting things available and on the horizon. So it's very important for a patient with heart valve disease not only get an opinion from a cardiologist, a physician they trust, but in certain cases, it's worth seeking out a second opinion from a center that has a lot of experience in these newer things.

    Melanie: Thank you so much. Dr. Scott Lim is the co-director of UVA's cardiac valve center, and he's noted internationally for his expertise in novel percutaneous approaches to heart valve disease. You're listening to UVA Health System Radio. For more information on the cardiac valve center at UVA, you can go to uvahealth.com. This is Melanie Cole. Thank you so much for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Heart Disease]]>
Melanie Cole, MS Mon, 11 Nov 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/15179-latest-options-for-heart-valve-repair
Treatment Options for Adults with Spinal Deformities http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=15500-treatment-options-for-adults-with-spinal-deformities treatment-options-for-adults-with-spinal-deformitiesYou may think of scoliosis as a condition that affects children.

However, many adults also need help dealing with scoliosis and other spinal deformities, also known as curves in the spine.

Learn more about what causes spinal deformities and the available treatment options for these painful conditions.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1342vh5d.mp3
  • Location: Null
  • Doctors: Smith, Justin
  • Featured Speaker: Dr. Justin Smith
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Justin Smith is a neurosurgeon and co-director of the UVA Spine Center. He specializes in treating patients with scoliosis and other spinal deformities, as well as patients with disc conditions and patients with back and neck pain.

    Organization: UVA Spine Center
  • Transcription: Melanie Cole (Host): You may think that scoliosis is a condition that affects children, but many adults need help dealing with scoliosis and other spinal deformities. My guest is Dr. Justin Smith. He's a neurosurgeon and co-director of the UVA Spine Center. Welcome to the show, Dr. Smith. What are the most common spinal deformities in adults? We've heard about children wearing those back braces when they're young to keep their spines set while they grow, but what about adults?

    Dr. Justin Smith (Guest): Thank you for having me. In older adults, the most common spinal deformities result from the spine wearing out, and they're referred to as degenerative conditions or degenerative scoliosis. It's actually fairly prevalent in older adults. In younger adults, it's often leftover deformity from childhood or adolescence that either didn't need to be treated and has progressed somewhat or perhaps just was not treated sufficiently. So, in younger adults, it's often leftover deformity from childhood; in older adults, it's often accumulated changes of wear and tear that result in the deformities.

    Melanie: Now, people are back pain, leg pain, pain going through your buttocks. Back pain is so common. So how do you know that it's an actual deformity versus some sort of a stenosis or really muscular pain, anything?

    Dr. Smith: Right. That's a great question. Often, people don't know that they have a deformity until they come in and have an x-ray done and the x-ray shows that there is a curvature to the spine. In younger children, the curves are often very pronounced and obvious from the outside, but in older adults, the curves can be much less dramatic, and maybe only apparent on x-rays. And so, really, the way we diagnose it is based on plain x-rays in the office.

    Melanie: Okay. So you've done your plane x-rays. Is this something that had they seen it earlier, would they have seen it as a child? Would they have seen it as a teenager or in their twenties and been able to maybe do something in advance to that?

    Dr. Smith: That's a great question as well. In older adults, there's often nothing that can really be done other than just trying to stay fit and taking care of yourself and not smoking and some of the risk factors for the spine wearing out. But there really isn't a way of preventing it. Certainly, in children, there are ways, sometimes, with braces and surgical treatment to try to treat it so that it doesn't become as much of a problem in adulthood. But the most common form is as the spine wears out, there really isn't, unfortunately, a lot to do at this point to prevent that.

    Melanie: What about treatments? If this is something that you find out that you have, is it painful just like an arthritic condition? Is it more painful? What are you doing about it?

    Dr. Smith: In older adults, the prevalence of this kind of a condition is very high. There are some studies that suggest that once we reach our sixties and seventies, about half of us will have some curvature to the spine. So obviously, there are a lot of patients out there, people out there who don't have symptoms from it, and if they don't have any symptoms or concerns, we don't do anything about it other than perhaps following it over time, when patients present -- they're often presenting with back pain, as you mentioned, or leg pain because nerves may get pinched from the deformity or narrowing or stenosis as we call it. In those kinds of situations, we often try to really pursue non-operative treatments first, such as physical therapy, medications, sometimes steroid injections, and we try to help patients with the symptoms. Certainly, if they present with neuro deficits, such as weakness or evidence of spinal cord compression or something eminent, then we may talk about surgeries sooner than later. But otherwise, we try to avoid surgery if we can. In patients who don't respond to those non-operative treatments, surgery can become an option, preferably large surgeries, typically though so we try to avoid them if we can.

    Melanie: Since this occurs in many older adults, surgery then becomes a little bit even more something controversial. You're not sure you want to do it. It's a big deal for older people. Now, if we're talking about physical therapy, stretching, strengthening exercises and you mentioned medications. Do anti-inflammatories, things for -- is it pain management? What are you doing medication-wise?

    Dr. Smith: For the medications, anti-inflammatories are often very helpful, such as the nonsteroidals. Of course, we have to be careful with kidney function and other issues as well, but the nonsteroidals can often be very helpful. Other medications such as Neurontin to help sometimes with some of the nerve pain. Narcotics, we typically try to avoid if we can, because they tend to not, because long-term solutions, for most cases. But that's typically as far as medications go, and we often will send people to a pain management specialist if it gets to that point where we want to try some of the more atypical medications.

    Melanie: Now, I know that you mentioned narcotics, so this is something I know you want to steer clear of. In pain management, is that what they're doing? What are they doing for that pain?

    Dr. Smith: Different pain management specialists have different philosophies. I generally would encourage patients to avoid narcotics if they can. Sometimes, they're very older adults who are not good surgical candidates, but nothing else seems to be helping and pain specialists will try a limited dose of narcotics. Sometimes, that's enough to help them get through the day. But by in large, a long-term solution with narcotics is often not the best, because it's really kind of masking the symptoms and patients can build tolerance to the narcotics. That's often not the best solution.

    Melanie: Now, is there a time when spine stabilization surgery is required?

    Dr. Smith: Required is a word...

    Melanie: Okay, not required. It might be called for or might be something that the patient...

    Dr. Smith: Considered, right. Sometimes, it can be more or less required if there's spinal cord compression or progressive neurological deficits, which isn't as common. But in those kinds of cases where you could consider acquired. But otherwise, it's a very personal decision. It really comes down to quality of life and how much the deformity and the pain is impacting the patient. If it gets to a point where the non-operative therapies are just not providing satisfactory quality of life and relief of the symptoms and the pain, then surgical options are often discussed with the patient.

    Melanie: Is it worthwhile to keep fit, to keep stretching, strengthening, keep the muscles around your spine strong? And please, what about back braces?

    Dr. Smith: Absolutely. It is certainly important to keep strong. I often -- when I initially see patients in the clinic, we'll send them for, of course, a physical therapy and some basic conditioning. If they can't tolerate land-based, sometimes, we'll do aqua therapy, so physical therapy in the water. I think it's very important to stay fit and to keep the muscles around the spine strong. As far as back braces in adults, they really have not been shown to be of benefit. My concern with those is that they can lead to some deconditioning of the muscles. In children while they're still growing and the deformity is rapidly progressing because their bones are still growing, braces can be helpful to hold the spine in place as it's growing. But in adults, I generally try to steer clear of braces.

    Melanie: That's good advice. Is there something people can do for their own lifestyle pain management at home? Icing your back, any of those kinds of things, do they work?

    Dr. Smith: I think it's very individualized, and I often tell patients that -- they'll ask if heat or ice is better, and I'll say, "Try each and see what works better." It's really a personalized situation. Some patients may find that laying in certain positions or stretching in certain ways are helpful, and I think, really, the key is just finding what helps for the individual.

    Melanie: Certainly, it is. It's very personal. Now, can you sort of wrap it up in the last minute or and a half or so, Dr. Smith, about adult spinal deformities, adult scoliosis? Give the patients a little bit of information how you work at UVA.

    Dr. Smith: At UVA, I see quite a few initial patients each day, and I often just get to know them first and talk about what their condition is and go through their imaging studies and discuss their symptoms and try to come with a plan. Again, as I mentioned, I try to avoid surgery when we can. Certainly, when it comes to the point, if they need surgery, we're a center that does a lot of adult deformity surgery, and we're a center where patients should consider coming because you want a specialist for these kinds of big surgeries. But that said, we're not a center that really pushes surgery. We're a center that tends to focus on non-operative therapies first, and when those fail, then we can talk about surgical options. The goal is really just to try to individualize the therapy and help to improve the quality of life of each individual patient.

    Melanie: Thank you so much, Dr. Justin Smith, neurosurgeon and co-director of the UVA Spine Center. For more information, you can go to uvahealth.com. You're listening to UVA Health System Radio. I'm Melanie Cole. Thanks for listening. Have a great day.
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  • Hosts: Melanie Cole, MS
Tagged under: Bone Health]]>
Melanie Cole, MS Mon, 11 Nov 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/15500-treatment-options-for-adults-with-spinal-deformities
The Future of Cancer Care http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=15178-the-future-of-cancer-care the-future-of-cancer-careDr. Thomas P. Loughran Jr., the new director of the UVA Cancer Center, discussing his plans for enhancing the care available to patients at UVA.

Learn more about Dr. Loughran's aim to better combine UVA's patient care and research efforts to help develop breakthrough treatments for cancer while continuing to provide state-of-the-art care for patients in Central Virginia and beyond.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 4
  • Audio File: virginia_health/1340vh5d.mp3
  • Location: Null
  • Doctors: Loughran Jr, Thomas P
  • Featured Speaker: Dr. Thomas P. Loughran Jr
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Thomas P. Loughran Jr. is director of the UVA Cancer Center. He comes to UVA after 10 years as the founding director of the Penn State Hershey Cancer Institute. Dr. Loughran discovered large granular lymphocyte (LGL) leukemia and has had his research published in numerous peer-reviewed journals, including The New England Journal of Medicine, Annals of Internal Medicine, Lancet, Journal of Clinical Investigation, Journal of Clinical Oncology, and Blood.

    Organization: UVA Cancer Center
  • Transcription: Melanie Cole (Host): Dr. Thomas P. Loughran Jr., the new director of the UVA Cancer Center, is here with us today to discuss his plans for enhancing the care available to patients at UVA. Welcome to the show, Dr. Loughran. Let's start about what attracted you to the UVA Cancer Center.

    Dr. Thomas Loughran, Jr. (Guest): Sure. Well, I just arrived from Penn State, the medical school there, where I was founding director of the Penn State Cancer Institute. There were several reasons that attracted me. I think foremost in those is the University of Virginia is obviously well-known as a prestigious, outstanding institution. Within that, the cancer center has been one of the major centers in the country over the past 26 years, receiving a special designation from the National Cancer Institute and recognition on the tremendous work being done here. Second point was that even though UVA is great and the cancer center is great, there are still amazing opportunities to build programs and make them stronger. Lastly, Charlottesville is a very attractive feature of the entire package, if you will.

    Melanie: So as great as UVA Cancer Center was before you got there, I'm sure that you have some goals, some things you'd like to see happen and to accomplish. So what are you looking for there?

    Dr. Loughran, Jr.: Sure. There're only two major goals on my arrival. The first one is to connect the outstanding basic research better to what's going on in the clinic, with the obvious goal there to advance patient care. Secondly, kind of a longer-term goal is to achieve from the NCI, National Cancer Institute, recognition as a comprehensive cancer center.

    Melanie: Which means what, for the listeners?

    Dr. Loughran, Jr.: Yes. I was going to say an explanation there. There are right now about 68 cancer centers that are designated across country as outstanding and received this recognition from the National Cancer Institute. There are all kinds of different flavors of these centers. Some of them are basic research centers only. Others are more focused on clinical research. But the higher designation is this comprehensive status. So of the 68, 41 of them are comprehensive, and comprehensive means that, simply put, you take maximum advantage of all the strengths of your university to have a direct impact on the people that you serve.

    Melanie: So you have a cancer treatment team there at the cancer center. As I understand, this involves nurses and surgeons and radiologists and, really, patient care advocates, all.

    Dr. Loughran, Jr.: Yes. We refer to that as multidisciplinary care. Sometimes people call it multi-D, for short. The goal here is it's already well-established, but certainly can be improved. The whole focus is patient-centered, so we want to make it easier and for the patient, particularly, those who are just diagnosed with cancer, which can be a life-threatening diagnosis. So for example, we have strength in all the major cancers so that we can establish clinics just that specialize, for example, in breast cancer or colon cancer or lung cancer. So all the major kinds of cancer. The idea would be that a patient anywhere in Virginia or even outside of Virginia recently diagnosed, let's just say, with colon cancer, could come and see all the doctors that they needed to see. So that would be radiation therapists, medical oncologists, surgical oncologists, and then others that play a role in that care, such as primary nurses, social workers, and all the ancillary care.

    Melanie: Along with all of these different types of cancer that you can help people deal with, and treating the patient as a whole patient -- and you even have a pediatric cancer, right?

    Dr. Loughran, Jr.: Yes, mm-hmm.

    Melanie: So you've got all of these different multidisciplinary or multi-D, and you're treating the patient, ,really as a whole patient with nurse navigators and all of that. How do you see cancer care in general, sort of the direction that it's moving now, different than maybe it was when you started in this business?

    Dr. Loughran, Jr.: Okay. That's a good question. I started about 30 years ago, so it's quite some time. So really, there is a focus in all of medicine, but I think what really has had the most impact so far in the past 10 years certainly is something called targeted treatment. Other popular terms for this are personalized medicine or precision medicine. This basically means that the three previous main ways of treating patients were surgery—and I want to emphasize that it's still probably the best and most effective treatment for the most common cancers. In this whole area, it really relies on early detection. Secondly would be medical oncology, which is my field, where we treat patients with kind of a major assault type of approach with chemotherapy, and then lastly, radiation treatment, delivering x-ray treatment to patients. All of these treatments, particularly the last two, really, the idea there was to deliver the most treatments possible that the patient can tolerate to get rid of all the cancer cells, and then the normal cells would grow back. But that has a lot of side effects associated with that, and the treatment may not be that specific. So the newer concept—let's just call it targeted treatment—is with the knowledge of the underlying fundamental problems in cancer. Say one gene, for example—and it's a simplistic explanation—maybe one cancer is caused by one gene that's constantly turned on. We want to develop drugs that will turn that protein off. Since the cancer cells rely on that protein and normal cells don't, this is kind of the ideal type of treatment, because it would be potentially much better in terms of killing the cancer cell and then secondly, cause less side effects.

    Melanie: So Dr. Loughran, explain a little bit about research going on, because research, as you're talking about genetic and turning it on and off and mutations, this is where the research is going. So discuss the importance a little bit. We only have about a minute and a half left, so give us a little bit about the research in providing this high-quality cancer care.

    Dr. Loughran, Jr.: Okay, sure. The way we're organized is basic research, clinical research, translational research, and population research. This last category may be the most unfamiliar to your listeners, but it's very important because this means that our goal is to keep everyone in Virginia healthy and for them never to develop cancer. So cancer prevention and research in cancer prevention is extremely important. Perhaps it might be the single most important thing we could do. If we could just get patients to stop smoking, that would get a long way to preventing cancer. We have a lot of other research going on, the basic science area, the genetics and mutations of cancer you already highlighted. Clinical research, our goal here is to develop new therapies, develop new drugs for treatment of cancer. And translational cancer is about reach, which I mentioned in my introduction today, which is to speed up the discoveries in a lab to make sure that they are reaching the clinics as best as we can so it can benefit our patients.

    Melanie: That's wonderful. In the last 20 second, wrap it up for us, Dr. Loughran, and give us your best, most enthusiastic words of wisdom about the cancer center at UVA.

    Dr. Loughran, Jr.: Well, it's a great place to come. We provide steady care, and we also are developing new therapy for patients. We have a wonderful, relatively new outpatient cancer center providing state-of-the-art holistic care for patients with cancer.

    Melanie: Thank you so much. You're listening to UVA Health System Radio. For more information, you can go to UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
Melanie Cole, MS Mon, 04 Nov 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/15178-the-future-of-cancer-care
Treatment Options for Parkinson's Disease http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=15499-treatment-options-for-parkinsons-disease treatment-options-for-parkinsons-diseaseParkinson's disease affects millions of Americans, but potential new treatments being examined by UVA neurologists and neurosurgeons may give patients more options.

Learn more about the causes, risk factors and treatments for Parkinson's with a specialist in movement disorders.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1342vh5c.mp3
  • Location: Null
  • Doctors: Shah, Binit
  • Featured Speaker: Dr. Binit Shah
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Binit Shah is a neurologist at UVA Health System, specializing in treatments for Parkinson's disease and other movement disorders.

    Organization: Functional Neurosurgery at UVA Health System
  • Transcription: Melanie Cole (Host): Parkinson's Disease affects millions of patients worldwide, but potential new treatments being examined by UVA neurologists and neurosurgeons may give patients more options. My guest is Dr. Binit Shah. He's a neurologist at UVA Health System specializing in treatments for Parkinson's disease and other movement disorders. Welcome to the show, Dr. Shah. Let's speak a little bit about Parkinson's disease. People don't often really know what it is or what causes it. Are there certain risk factors?

    Dr. Binit Shah (Guest): Well, what it is, at least from our understanding, is we know that it's what's called a neurodegenerative disorder. In other words, that means parts of the brain start to degenerate and die off, leading to abnormal neurologic symptoms. The exact cause of that, we don't know, at least on a molecular level. But how it tends to present is that patients can have any constellation of slowing of movement, either on one side of the body or notice slowing of walking, stiffness, particularly stiffness on one side of the body as well, but really can affect both sides even early, or a typical tremor that we see. So unlike other types of tremor where it's usually seen with action or intentional movement, oftentimes, this tremor tends to happen more when people are sitting quietly and resting or particularly stressed or anxious. As far as what the risk factors are, I think that's a hot area of research. We've known for a long time that age is the biggest risk factor. In other words, the incidence of Parkinson's disease goes up after the age of 60, but younger patients can be affected as well. Understanding what those risks are are important. Some things that we know about repetitive head trauma increases the risk of developing Parkinson's, but we don't exactly know what. Also, a family history of Parkinson's disease can increase somebody's risk of developing Parkinson's, so that overall amplitude effect is fairly low. So just because there's a first degree relative affected, while that increases another person's chance of developing Parkinson's, it still remains well below one percent of a chance. And then there's some other studies looking at various sorts of environmental exposures, things like pesticides, and particularly other things associated with farming or rural communities, that have been shown to potentially be associated with Parkinson's. But again, we still don't know exactly why that's the case.

    Melanie: Now, people often see that tremor in people, which can happen for so many reasons, really. Right away, they think Parkinson's, but there are other more telling symptoms, aren't there, that, Dr. Shah, would signal really getting to a neurologist pretty quickly because you want to catch this as early as possible?

    Dr. Shah: Exactly. Tremor, as you mentioned, is very common, and it happens to, really, the majority of people at some point in their lives. And it may not be related to anything that's leading to degeneration of neurologic functions. So when we're thinking about Parkinson's, it's not only a tremor that we're looking for. There are really other features that can be subtle, especially early on. But if they're recognized, and certainly people who specialize in Parkinson's or see a lot of Parkinson's patients, whether that be a Parkinson's specialist, a general neurologist, or even a family physician, can pick up on subtle cues like slowing of movements, deterioration of writing in particular patterns, that can help us make the diagnosis.

    Melanie: So once you've made this diagnosis -- and is it a tough diagnosis to make?

    Dr. Shah: It is, to a certain degree. Unlike many other diseases that we think of, there's no single lab test or imaging, MRI or CAT scan or anything like that that really makes the diagnosis. So it's truly what's called a clinical diagnosis made in the room with the patient between the physician and the patient. So there can always be some uncertainty with that. I think that a lot of the evidence has shown that the more experienced somebody is in seeing patients with Parkinson's, the better they are at accurately diagnosing it or ruling it out. But in the absence of what we call a marker of the disease, it can be challenging at times, absolutely.

    Melanie: Now, when we talk about treatments, medication being what, the first line of treatment? And we will talk about some lifestyle things as well, but what is the first thing you do when you've discovered that someone has this diagnosis?

    Dr. Shah: Well, it goes to what our treatments are. Ideally, we would have treatments that both help the symptoms as well as slow or stop the disease progression. Unfortunately, where we are now is we have very good symptomatic treatment but not necessarily anything proven to slow or stop the disease. Of course, the ultimate goal is to reverse and turn the disease, but unfortunately, we're not there yet.

    Melanie: So it's really symptom management at that point.

    Dr. Shah: Exactly. It's really treating symptoms. When we talk about symptom control, especially early in Parkinson's, we can do that very well. And our goals then turn into well, what are the symptoms, how are the symptoms bothersome or problematic for patients, and what can we do to sort of treat those particular symptoms. So, it's a sort of multi-directional approach. If we're talking about things like the tremor and slowness and stiffness that we're looking at replacing a particular neurotransmitter in the brain, something called dopamine, which we can do fairly effectively with a number of different medications to help with, the most effective one being something called Levodopa that's available in a combination pill called Cinemet But there are many other options of other classes, including Dopamine agonists and another group called MAO inhibitors. But when we also talk about Parkinson's, we know that it's not simply a disease of motor neurologic features. There can be other things involved, including sleep disturbances, depression, or anxiety, and it's important to treat those things appropriately as well, particularly where they interfere with people's quality of life.

    Melanie: Now, what about surgical procedures, deep brain stimulation and such? What's being examined at UVA that can give some hope to people with Parkinson's?

    Dr. Shah: Well, I think it's an important thing to mention. When we talk about surgical treatments, our goal -- again, it's still symptomatic treatment, so we're still in the same phase where we're trying to improve patient symptoms. What we look for with surgery is to mimic the best effect of the medications. But when there may be limitations to the medication, either if they are wearing off too early or they don't last or they don't kick in early enough or there may be side effects due to the medications, we can use surgery to provide a baseline level of support, above which additional medication may be necessary, but hopefully, we can reduce that and provide sort of a smoother benefit throughout the day. The theory behind surgical treatments is there are abnormal neurologic circuits in the brain. Essentially, the brain can be thought of as clusters of cells where there are connections between them. In Parkinson's, we know that due to the degeneration, abnormal signals are being sent through these pathways. If we interrupt these abnormal pathways in particular areas, we could treat the slowness, stiffness, and tremor in combination or the tremor itself. We're targeting just another particular area. The FDA-approved treatments we have for doing this are deep brain stimulation, which involves going in through the skull and implanting an electrode into a deep part of the brain and running that down under the skin to a pacemaker-like device in the chest, and then we can program that stimulator. So we can kind of tailor effect to treat the symptoms that are really bothering patients. The other way is to go in and actually make a burn lesion rather than leaving in a stimulator. That's traditionally also involved making a borehole or making a small drill hole through the skull going in with the electrode, heating up the tip of that electrode, and then removing it when we know we're at the right spot.

    Melanie: Dr. Shah, in just the last 30 or 40 seconds, please wrap up Parkinson's for us. Give some hope to people listening for that symptom management and the work being done at UVA.

    Dr. Shah: Absolutely. Going back to the surgical treatment with focused ultrasound, we're experimenting with taking those burn lesions in the brain without needing to make any incisions in the scalp. We're going through the skull, and we hope that that will be a safer surgical treatment that will have just as good effectiveness for patients with Parkinson's and all their features. But that's not all we're doing, and that's not all that's being done in Parkinson's research. Really, finding what the underlying cause is is really what's going to help us find a cure for this.

    Melanie: And working on balanced and lifestyle management is all of what they do at UVA Health System. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
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  • Hosts: Melanie Cole, MS
Tagged under: Neurological Disorders]]>
Melanie Cole, MS Mon, 04 Nov 2013 19:00:00 +0000 http://radiomd.com/uvhs/item/15499-treatment-options-for-parkinsons-disease
Spotting and Treating Asthma in Children http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=15177-spotting-and-treating-asthma-in-children spotting-and-treating-asthma-in-children1 in 11 children has asthma, according to the U.S. Centers for Disease Control – do you know the symptoms?

Learn more about the causes, symptoms and treatments for this common childhood disease from UVA Children’s Hospital pediatrician Dr. Lynn McDaniel, who discusses the steps UVA has taken to improve outcomes for children with asthma.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 3
  • Audio File: virginia_health/1340vh5c.mp3
  • Location: Null
  • Doctors: McDaniel, Lynn
  • Featured Speaker: Dr. Lynn M. McDaniel
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Lynn McDaniel is a board-certified pediatrician at UVA Health System. She provides general pediatric care as well as caring for children with chronic and special health needs, including children with asthma, allergies, ADHD, acid reflux, ear infections, hearing loss and heart murmurs..

    Organization: UVA Children’s Hospital
  • Transcription: Melanie Cole (Host): One in eleven children has asthma, according to the U.S. Centers for Disease Control. If your child is exhibiting certain symptoms, would you know what they are? Would you know the difference between seasonal allergies and asthma in your children? My guest is Dr. Lynn McDaniel, she is a board certified pediatrician at UVA Health System. Welcome to the show Dr. McDaniel. So, explain a little bit about asthma and what makes a child more likely to develop it.

    Dr. Lynn McDaniel (Guest): Well, we’re not really sure what causes asthma. We do know that certainly genetics play a part. So, it can be inherited…if there is a family member that has asthma, it is more likely that a child will develop asthma. We know that the immune system plays a role. We know that environmental factors, like cigarette smoking in the home or air pollution. We also know that viral infections play a role in children developing asthma. Asthma is a disease of the airwave and the smaller airwaves of the lung can become very inflamed and clogged with mucus, making it very difficult for a child to breath.

    Melanie: Let’s talk about some of the symptoms, because certainly at this time of the year, with the leaves falling and things, you know, kids develop all kinds of sniffles and coughs and little dry sounding coughs. How do we know what we are hearing, as parents, is something that we really need to take them to the doctor about and look into asthma?

    Dr. McDaniel: You know, sometimes it can be very difficult to tell the difference when you’re a parent and your child has a cough and a sneeze and when they breath sometimes it does sound whistley or wheezy. I think if a parent is certainly concerned that it is something more than a cold, they should always take them to their pediatrician and have them evaluated. Some of the common signs children will have will be coughing, a lot of times, even in the evening at bedtime. Shortness of breath, they may complain that their chest feels tight, they may have trouble sleeping, because they cough. All of these things should trigger a parent worrying whether their child may have asthma or not. The other thing is a cold that seems to linger for a long period of time or a cough that seems it should have gone away if it were a typical cold – those are things a parent should look at and go “Perhaps I need to have a doctor evaluate them.”

    Melanie: OK, if we take them to the doctor and they are diagnosed, this is something a little bit more chronic we’ve caught, that it kind of doesn’t go away, it’s not really the same as a cold, which comes and goes, maybe lasts a week or whatever and you’ve determined that it is asthma, what treatments are there? Because, people and parents, we are panickers of course and we worry about ongoing medications and what that’s going to do to our child at school and is it going to make them lethargic? Speak about treatments that are out there right now.

    Dr. McDaniel: Absolutely. Asthma is the most common chronic disease of childhood. We see a lot of this. It’s responsible for so many office visits, so many missed days of school, so we do want to treat them appropriately. A lot of things that parents want to stay away from medications, is to eliminate any triggers. If they are allergic to dogs or they’re allergic to dust mites, do the kind of things in the household that’s important…try to eliminate the things that will trigger their asthma. Get a flu shot – great time of the year to think about that. Everybody in the household needs to be immunized because, influenza and colds can trigger them. But, when it comes to medication, it is incredibly important to understand that asthma is a chronic disease. It really does need to be treated. Your child will not become hooked or dependent on these medications, but they can help to calm down the inflammation in the lungs and allow them to be a normal kid and not be limited in their activities. One of the big things that we rely on is what we call “quick reliever medications” and those are medications like Albuterol. Generally, they are delivered in an inhaler or a puffer. They are inhaled medications. And those are important for relieving symptoms. Parents should know, that if their children are having to rely on those quick reliever medications really frequently during the week, several times during the week, then perhaps they need more…a medication that they take every day to keep their asthma symptoms down, so they don’t have to rely on that quick reliever medication. Some of those long term controller medications are things like Inhaled corticosteroids. A lot of times with parents and steroids they are like “oh no, that’s a bad thing.” But, inhaled steroids can be great. It is not the same kind of antibiotic steroids you hear about in sports, this is a medication that really calms down the inflammation of the lungs and really helps the children to be active and grow normally without being restricted by their asthma.

    Melanie: So, if they are on these controller medications, the Inhaled corticosteroids and their at school, is there any restrictions? You know, back in the day, children with asthma would have to sit out from gym. We understand there is a difference between exercise induced asthma and asthma that is normal. Do they have to sit out? Is physical activity limited? Do these controller medications help them be able to partake in the physical activity at school?

    Dr. McDaniel: Great question. The whole purpose of treating asthma is so it doesn’t limit them. We want them to be active, because, actually exercise in children with asthma is shown to be very helpful. We want to be able to manage their medications in such a way that they are not limited in their activities. We want them to play sports, we want them to be active in gym class. Certainly having those quick reliever medications available them at school or at play is important, so if they have an attack, but it should not limit their everyday activity.

    Melanie: Dr. McDaniel, when do we turn over care of this kind of thing to our children themselves? When do we put them and say “you know what, you know what your symptoms when if you are about to have an attack and you keep that rescue inhaler with you, but, make sure you’re taking your meds when you are supposed to.” When do you begin to give them a little autonomy there?

    Dr. McDaniel: A lot of it depends on the maturity of your child and whether they truly are able to sensor symptoms. Some children are much better able to go “I’m having trouble” and others are sitting there coughing and wheezing and saying “I’m fine.” A lot of it is knowing your child’s ability. Generally, we start talking about turning over some of their responsibility too them when they are around 10, 12 or 14 depending on your child. Schools will allow children, with a written note from their doctor, to carry their reliever medications with them in their backpack at school, which is really important, because getting to a nurse sometimes is difficult in larger schools. I think that teaching and coaching your children to know when and how to deliver their medications. Most children when they’re using puffers may need a spacer device attached to the puffer to help them deliver all of the medication. Some of them want to stop using that if they get to be older and teenagers, but they need to continue to use that spacer device to get all of the medication in.

    Melanie: I’ve seen that spacer device and it does help the children. In the last minute and a half, tell us a little bit about the steps you’re taking at UVA to improve asthma care.

    Dr. McDaniel: We have the joint commission, which is the governing body of hospitals has asked that children’s hospitals look closely at how they handle inpatient asthma. It’s very important that we do three things; that we give them reliever medications to relieve their symptoms, that we treat them with steroids and that we give them a very detailed plan when they’re discharged to help them manage that asthma at home, so they don’t need to come back. As a team of doctors and nurses and respiratory therapists, we’ve worked very hard to make sure that we are able to do those three things and for the past five quarters, UVA has been a top performer in what we call UHC, which is a university health system consortium of leading academic centers. We are very proud of all the work that everybody has done. But, more importantly, teaching our families what they need to do at home, what kinds of things they can do to stay away from triggers, to get their flu shots, so that they don’t need to come back to see us. That parents can manage and their doctors can manage their medication at home.

    Melanie: That is very exciting. For you parents listening, you can work with your pediatrician at UVA to control your child’s asthma, maybe turn over just a little bit of it to your children, so they understand their symptoms, signs they might be having an asthma attack. Teach them how to use their meds properly, make sure they get all of the meds in. And work with your school system. You’re listening to UVA Health System Radio. For more information you can go to uvahealth.com, that’s uvahealth.com. This is Melanie Cole, thanks for listening…have a great day.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Children's Health]]>
Melanie Cole, MS Mon, 28 Oct 2013 17:00:00 +0000 http://radiomd.com/uvhs/item/15177-spotting-and-treating-asthma-in-children
Identifying Patients at High Risk for Pancreatic Cancer http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=15497-identifying-patients-at-high-risk-for-pancreatic-cancer identifying-patients-at-high-risk-for-pancreatic-cancerThe fourth leading cause of cancer death in the U.S., the symptoms of pancreatic cancer often don't appear until most treatments are no longer an option.

Learn more about the risk factors and how UVA is working to more quickly identify patients at high risk for pancreatic cancer.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1342vh5b.mp3
  • Location: Null
  • Doctors: Bauer, Todd
  • Featured Speaker: Dr. Todd Bauer
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Todd Bauer, a surgical oncologist, is part of the multidisciplinary team at the UVA High-Risk Pancreatic Cancer Clinic. His specialties include surgical treatments for pancreatic and liver cancer; he also leads a laboratory research program in pancreatic cancer that is seeking to develop personalized treatments for patients.

    Organization: UVA High-Risk Pancreatic Cancer Clinic
  • Transcription: Melanie Cole (Host): The fourth leading cause of cancer death in the US, the symptoms of pancreatic cancer don't often appear until many treatments are no longer an option. My guest is Dr. Todd Bauer. He's a surgical oncologist, and he's part of the multidisciplinary team at the UVA High-Risk Pancreatic Cancer Clinic. Welcome to the show, Dr. Bauer. Speak about pancreatic cancer a little bit for us. Why is it considered such a deadly disease?

    Dr. Todd Bauer (Guest): Well, there are several factors that contribute to that. For one, pancreatic cancer is a cancer that behaves very aggressively. The second problem is we don't have very effective chemotherapies to treat this disease like we do in many other types of cancer. I would say the third challenge in pancreatic cancer is that when patients find out they have the disease, the tumor is usually already advanced to a metastatic stage or to a stage where we can't offer surgery. In that setting, it's very difficult to treat.

    Melanie: So what would put someone at risk for pancreatic cancer?

    Dr. Bauer: Well, there are several risk factors we know of. They would include smoking, obesity. Diabetes has recently been shown to be a risk factor. We also know that patients that have two or more family members with pancreatic cancer are at a higher risk. Also, some patients with certain types of pancreatic cysts, we know that they're at higher risk. There are a few other genetic mutations, notably the BRCA gene, which most commonly is associated with breast cancer but we now know that these patients are also at higher risk for pancreatic cancer.

    Melanie: Well, that's fascinating. So what symptoms would people have? I know that typically sometimes you don't have symptoms until it's a little bit advanced and, as you say, metastasized, but are there some symptoms that might pop up that people can give them a little bit of a warning sign to get in?

    Dr. Bauer: There are. One of the more common symptoms is jaundice, so the patient's eyes and skin will turn yellow. Skin may start itching. Their urine may get real dark. That's the sign that the tumor has caused an obstruction of the bile duct. But in a lot of patients, the early symptoms are very subtle—maybe loss of appetite, maybe some very subtle abdominal discomfort, things that patients could attribute to just an indigestion. So that's part of the challenge is unless the patients get jaundice and turn yellow, the symptoms tend to be rather subtle.

    Melanie: How is it diagnosed? Because I know that if you've come up with some of these symptoms, you're looking at a lot of things first. Is it tough to diagnose?

    Dr. Bauer: Well, usually early in the course, particularly if a patient gets jaundice, then they'll end up getting an ultrasound and, quite often right after that, a CAT scan. That's really how we make the diagnosis is eventually, the patient gets a CAT scan, and then we can see that there's a mass in the pancreas and possibly some obstruction of the bile ducts to the liver.

    Melanie: What treatments are available? If it's caught early, obviously maybe you have more treatment options available. But what are the treatments for pancreatic cancer?

    Dr. Bauer: Well, you brought up an important point. Catching it early, it makes all the difference. So if we catch it early, before the tumor has had a chance to spread, then we're going to offer surgery, and that could be potentially curative. The most common operation we do is called the Whipple operation. Even when we do surgery, we're still going to recommend chemotherapy and radiation after surgery, because we want to give these patients the best chance for a cure.

    Melanie: And the Whipple, that's quite a big surgery, right? It takes a quite a while and, really, it's an in-depth surgery.

    Dr. Bauer: It is. It's about a 6- to 8-hour operation, and it's probably one of the bigger operations that is done in surgery. So it is a real undertaking for the patients to undergo this surgery and then the recovery. And the recovery from that operation, it can be two to three months until the patient is fully back to their normal status.

    Melanie: So Dr. Bauer, describe what makes UVA's high-risk pancreatic cancer clinic different from other pancreatic cancer clinics.

    Dr. Bauer: Sure. Well, our goal from the onset was to build a clinic that would really pull in and identify all patients that we know are at a substantial increased risk for pancreatic cancer. So this comprehensive nature to the clinic is really what makes this unique. So we include patients with family history of pancreatic cancer, patients with a pancreatic cyst—usually that's caught on a CAT scan done for another reason—patients that have the BRCA gene mutation or one of several other gene mutations, patients with familial pancreatitis, and lastly, those with chronic pancreatitis. The other feature we thought of was while we had this group of patients that we know are high-risk, we're going to screen them very intensively with MRI and endoscopic ultrasound on an annual basis. The goal would be if they were to develop a cancer, we would hope that we would catch it earlier by screening them before they have symptoms, and then we'd be able to cure a greater proportion of those patients.

    Melanie: That's fantastic, Dr. Bauer. Now, what about after surgery and after treatment? Are they now at risk for diabetes? Do you keep a pretty careful watch afterward?

    Dr. Bauer: We do, and that's an important point to discuss with the patients. As it turns out, only about 20 percent of patients become diabetic after the surgery. In those patients and all patients after the surgery, we keep an eye on their blood sugar. If they need medication to help control their sugars, then we institute that early.

    Melanie: Now, can you speak just a little—we only have a minute or two left—about your research into pancreatic cancer?

    Dr. Bauer: Sure. That's something I'm very excited about. We have a team of over 13 researchers from nine different departments across the university, and the whole focus of this research program is how we can study human pancreatic cancer, tumors that we take out of the patients, put them into mice, and we ask the question: how can we come up with a therapy that we can take back to the patient and improve their outcome? With this model, using tumors right from the patients with the patient's consent, and studying them in mice, we've come up with some new treatment therapies that have not been tested before in pancreatic cancer, and we hope to put these into clinical trials in the near future. So we have great hope that we're going to make strides in treating this difficult disease.

    Melanie: That's amazing. I certainly applaud your research. Keep up the great work. Now, in the last minute and a half or so, wrap it up for us. Give some hope to people listening about pancreatic cancer and really what's going on out there.

    Dr. Bauer: Well, I have great hope for this disease. While the statistics have been quite grim over the past several decades, the understanding that we now have as to what makes these tumors grow and how we can target those pathways with newer drugs, I'm very hopeful that over the next 10 years, we're going to make a significant impact. Right now, we know we cure some patients with surgery and chemotherapy, and I see that number going up substantially over the next 10 years. And I think we're going to be making great progress in some early detection scans that will help us find the disease earlier.

    Melanie: Thank you so much, Dr. Todd Bauer, surgical oncologist at the UVA High-Risk Pancreatic Cancer Clinic. You're listening to UVA Health System radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
Melanie Cole, MS Mon, 28 Oct 2013 17:00:00 +0000 http://radiomd.com/uvhs/item/15497-identifying-patients-at-high-risk-for-pancreatic-cancer
Detecting Breast Cancer Sooner http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=15176-detecting-breast-cancer-sooner detecting-breast-cancer-soonerEarly detection is the best defense against breast cancer.

Learn about Tomosynthesis, a 3D breast scan that helps UVA doctors detect breast cancer sooner.

UVA radiologist Dr. Carrie Rochman explains how Tomosynthesis works and discusses which women may benefit most from this 3D scan.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 2
  • Audio File: virginia_health/1340vh5b.mp3
  • Location: Null
  • Doctors: Rochman, Carrie
  • Featured Speaker: Dr. Carrie Rochman
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Carrie Rochman is a member of the UVA Breast Care Program, which offers advanced screening options for women who need mammograms and personalized care plans for women who need breast cancer treatment. Dr. Rochman specializes in breast imaging and is board certified in diagnostic radiology.

    Organization: UVA Breast Care Program
  • Transcription: Melanie Cole (Host): Early detection is the best defense against breast cancer, and we're going to learn today about something called tomosynthesis. My guest is Dr. Carrie Rochman. She's a member of the UVA Breast Care Program, and she is also a specialist in breast imaging and board-certified in diagnostic sadiology. Welcome to the show, Dr. Rochman. Let's speak a little bit about tomosynthesis. What is it, and how does it differ from standard mammography?

    Dr. Carrie Rochman (Guest): Hi. Good morning. We are very excited about breast tomosynthesis. It's also known as a 3D mammogram, and it's basically a different way of taking a mammogram image. The mammogram machine moves slightly during the test, and what we are able to create is the 3-dimensional image. And the great benefit of tomosynthesis is that we're able to see through the different layers of normal tissue to get better detail of the breast.

    Melanie: Wow. That is exciting. Women, especially first timers, are sometimes afraid to go for their mammograms. Would you do tomosynthesis on somebody right from the get-go, or is it used diagnostically?

    Dr. Rochman: Tomosynthesis is showing benefit across all groups of women, all ages, all different types of breast density. The benefit is that it's more sensitive, which means that we find more breast cancers. It's also more specific, which means that we find fewer things that turn out not to be cancer. So it's an overall more accurate test, and the benefits apply to all women.

    Melanie: Is it something that you can foresee that we're going to be switching to over standard mammography, or is there still a place for that?

    Dr. Rochman: We're gaining more data all the time. The data that has come in so far really shows that it is a more accurate test. In my opinion and with our experience so far, I think that we will be using more and more tomosynthesis in the future, absolutely.

    Melanie: Is there anything different that women do? We're told not to use deodorant for our mammogram, and we're told soap, that sort of thing. Is there anything different that you do?

    Dr. Rochman: No. For the patient experience, it's actually quite similar. The machine looks identical to a standard mammogram machine. There's just a subtle movement in the top part of the machine during the test, but the test is about the same length of time, and it should be very similar from a patient's perspective.

    Melanie: Pain-wise, does it compress the same?

    Dr. Rochman: Yes. There is some compression of the tissue. The benefit of that is that it really helps the tissue spread out so that we can see through and find those cancers when they're very small and the earliest detection possible.

    Melanie: So you know the dreaded sit and wait, Dr. Rochman, that every woman just really, really hates. You have your mammogram, and then you go sit in the lobby and you wait to make sure that they got the pictures all proper, then you can go home and wait for the results. Is this the same, or do you have results a little quicker? Can you tell right there in the room? Any difference there?

    Dr. Rochman: The waiting time is about the same. For a screening exam, the patient will have the pictures taken, and then the patient goes home and the screening exam then is read within a day or so. In the diagnostic setting though, those are for women who have had an abnormal screening or if they have any kind of a breast problem, those are read immediately, while the patient is still there, and all the results are given to her before she leaves our department.

    Melanie: Now, because you specialize in breast imaging, tell us what the difference is. I've gone around after my mammogram and stood there with the tech and looked and seen. I can't really tell what's going on there; you look around, you see a bunch of dots and you say, "Oh my goodness," they say, "No no, that's not anything." What would you see that looks different than the standard mammogram? What's the picture like for you?

    Dr. Rochman: The picture is that the normal tissue is almost blurred out, and so the normal structures melt away into the background. The abnormal structures, the breast cancers, stand out as a very mass-like finding. As well, what tomosynthesis is great is to see any kind of architectural distortion, where the normal architecture of the breast has been disrupted. Tomosynthesis is just superior at letting the imager see that.

    Melanie: That's so exciting. What about radiation? Is there any more or less than standard mammography?

    Dr. Rochman: Tomosynthesis or 3D mammogram does have an increased radiation dose relative to your standard digital mammogram. It's about two times the dose, but it's a very low dose. Even though it's two times, it's still two times a very tiny dose, and it's still well within what the FDA allows for screening mammograms. The levels of radiation are similar to what we used to have with mammography about 10 or 15 years ago when we were using analogs. When we switched to digital, we got the dose down, and now, tomosynthesis brings it back up to those levels that we had several years ago. Now, there's a lot of research, though, being done about how to get that dose back down, and I really think within about the next year or so, we'll get it back down to the levels we're at with a standard digital mammogram.

    Melanie: And this is something that you can have once a year, just like our standard digital mammogram, and you're hoping, maybe, that this will be what we're using?

    Dr. Rochman: Yes, once a year screening. I do. I really think that patients will benefit. I recommend it to all of my friends, family members, and patients. It's just a great test.

    Melanie: Now, let's speak about women doing a self-exam. If you're teaching women how to do this and you're telling them, "I really think it's important," when is the best time for women to check their own breasts and to kind of get to know them?

    Dr. Rochman: The best time is to do it the same every month. We want to check your breast when your hormone levels are at their lowest. If a woman is still having a menstrual cycle, the hormones are at their lowest in the week after her period, not the time when there'll be fewer areas that are tender, fewer things that are a little bit slow and just because of hormonal influences. So that week after your period is the best time to check your breast, and do it consistently that same time every month.

    Melanie: Some of us have dense breasts and cystic, and it's hard to know what you're feeling.

    Dr. Rochman: Absolutely. The best thing to do is kind of get an idea with your healthcare provider when you go in for a clinical breast exam and have them help explain to you the areas that feel normal, why they feel normal, and then get a good idea about what you're looking for. And then once you have an idea of what your own baseline exam is, how your normal tissue feels, it gives you a starting point to then look for something that's different.

    Melanie: Because I think that's the hardest point that women don't actually do a self-exam is because they don't know what they're supposed to be feeling for, plus we all dread feeling that pea-sized bump if we were going to feel anything. Would it be something that moves around in there? Would it be something that is stationary on the back wall? What would we feel?

    Dr. Rochman: The things that we're looking out for on a physical exam is we're looking for an area that feels hard. Breast cancers tend to feel hard like marbles. The other thing that we're looking for is that the tissues around the lump don't slide around it very easy, so we call it a fixed lump. The skin doesn't slide easily back and forth across it, or the tissue doesn't slide back and forth against your chest wall very easily. The other things that we look for are a change. Somebody might say, "You know, this spot was always soft, and now it just feels a little bit thicker." Any of those things would be a red flag. There can be changes on the skin. If there's redness or swelling of the skin or any kind of dimpling of the skin, all of those things should be evaluated. I want to stress, too, if there are ever any concerns that a patient feels or that her doctor feels and that she is concerned about, always come in and get it checked out. We're always happy to see women if there's any concern.

    Melanie: The UVA Health System is the first hospital in the region to use tomosynthesis. In the last minute or so, 30 seconds or so, Dr. Rochman, please wrap it up for us about tomosynthesis and the advantages in using this 3D type of screening for breast cancer.

    Dr. Rochman: Again, I just really want to stress that it's more sensitive, that it finds more cancers, and then also that it's more specific, that there's fewer recalls for things that turn out to be nothing, so there's fewer false positive. We have a more accurate test, and it's overall just great news for women.

    Melanie: And it can certainly help the UVA doctors detect breast cancer sooner. You are listening to University of Virginia Health System Radio. That's UVA Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Women’s Health, Cancer]]>
Melanie Cole, MS Mon, 21 Oct 2013 17:00:00 +0000 http://radiomd.com/uvhs/item/15176-detecting-breast-cancer-sooner
Identifying and Managing Fibromuscular Dysplasia http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=15496-identifying-and-managing-fibromuscular-dysplasia identifying-and-managing-fibromuscular-dysplasiaFibromuscular dysplasia, or FMD, can cause arteries throughout the body to either narrow or bulge.

FMD often occurs in arteries in or near the brain.

Left untreated, FMD can lead to aneurysms or a stroke.

Learn more about how to identify and manage this potentially dangerous condition.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1342vh5a.mp3
  • Location: Null
  • Doctors: Sharma, Aditya
  • Featured Speaker: Dr. Aditya Sharma
  • Guest Name: Null
  • Guest Title: Null
  • Organization:
  • Book Title: Null
  • Guest Website:
  • Guest Bio: Dr. Aditya Sharma is a vascular medicine specialist at the UVA Heart & Vascular Center. He specializes in conditions such as aneurysms, deep vein thrombosis, peripheral arterial disease and fibromuscular dysplasia.

    Organization: UVA Heart & Vascular Center
  • Transcription: Melanie Cole (Host): Fibromuscular dysplasia or FMD can cause arteries throughout the body to either narrow or bulge, and if it's left untreated, it can lead to aneurysms or stroke. My guest is Aditya Sharma. He's a vascular medicine specialist at the UVA Heart and Vascular Center. Welcome to the show, Dr. Sharma. Tell the listeners a little bit about FMD, if you would.

    Dr. Aditya Sharma (Guest): Sure, Melanie. Thank you for inviting me over to your show. Fibromuscular dysplasia is a condition of the blood vessels where we see narrowing as well as enlargement of the arteries in different parts of the body. Interestingly, the narrowing and enlargement are right next to each other. So the blood vessels appear like a string of beads when we look at it on a CAT scan or MRI. When the narrowing is too bad or too narrow, then it can actually cause decreased blood supply to whatever organs that area is supplying, which can cause problems. If the enlargement is too enlarged, then of course, there's a risk of rupture and having more problems from that.

    Melanie: Are there certain people that are at higher risk for this, for FMD?

    Dr. Sharma: Yes, certainly. In fact, nine out of ten times, we see FMD in women specifically in their thirties to fifties. So relatively younger women are more affected by this disease. It is not a very common disease. In fact, it is seen in probably less than one percent of the entire population. But we think one of the reasons of it being so uncommon is the fact that we are perhaps not diagnosing it as frequently as we should.

    Melanie: Okay. So what would be the symptoms, even if it is rather rare? If somebody was subject to this, how would they even know?

    Dr. Sharma: The symptoms depend upon which blood vessels in the body are affected. One of the most common locations is the arteries supplying the kidneys, which are the renal arteries. If fibromuscular dysplasia occurs in those particular blood vessels, then frequently, people suffer from severe hypertension, especially which would be very uncommon typically wouldn't see a 30-year-old lady suffering from severe hypertension, but this would be one of those presenting features. The other thing is that they may sometimes complain of low back pain around the area of the kidneys. Now, if it occurs in the blood vessels of the neck, which are the carotid arteries and the vertebral arteries, which are, again, a very common place to have fibromuscular dysplasia, then these people suffer from migraine headaches and in fact hear a squishing sound in their ears. They may have ringing in their ears that occurs all the time. The biggest problem that they frequently see is that people with fibromuscular dysplasia are at risk of tearing their arteries spontaneously, which can -- if it occurs in the neck blood vessels, then it can lead to stroke.

    Melanie: Wow. So if you have any of these symptoms and the back pain near the kidney, or you hear that squishing sound that seems to be pretty telltale, you go to see a vascular medicine specialist such as yourself. How is this diagnosed? It's MRI, you mentioned a little bit, before?

    Dr. Sharma: Exactly. A lot of times, we start diagnosing or look for --first of all, we make sure that there are not other causes that could be leading to these problems. However, sometimes, some of these symptoms appear very classic for this particular disease and in those situations, we may start with an ultrasound first, as it's the most non-invasive form of imaging. And eventually, for final diagnosis, though, after getting an MRI, for some areas, a CAT scan is better. At times, we have to proceed with doing a conventional angiography, which is basically putting a catheter through the blood vessels and shooting some die to look in the blood vessels. Typically, we will see the string of bead up here in the blood vessels which are affected.

    Melanie: It sounds that this is also similar to atherosclerosis which is quite, quite common. So when you're looking, you're really discerning between the two, correct?

    Dr. Sharma: Right, exactly. In fact, it's very interesting because it occurs in the same blood vessels and arteries as atherosclerosis, but the location is quite different. That's one of the reason we actually are able to identify or separate this disease from atherosclerosis. Atherosclerosis, typically, in these blood vessels, would occur at the origin of the blood vessels. So when these blood vessels—like for instance, the renal arteries, the kidney blood vessels—the common location where atherosclerosis would occur is right when the renal artery gets off the main aorta. So it's right at the origin, so to say. However, fibromuscular dysplasia occurs more at the end of the blood vessels, so distally, where we typically will not see atherosclerosis. That's one of the ways we differentiate it. Plus, with atherosclerosis, you tend to have more of this narrowing at one area with a lot of cholesterol plaque around it. With fibromuscular dysplasia, we do see narrowing, but there are multiple narrowings most of the time with sort of this bulging up here, which we won't see with athero. That's sort of another way we differentiate it. Also, what they don't notice with that is it is very unlikely especially to see women in their thirties and forties to present with such severe atherosclerosis. So, those are one of those differentiating factors, how we figure out one from the other.

    Melanie: That's true. It is. Dr. Sharma, once you have diagnosed FMD, what are the treatments? Are medications similar to atherosclerosis? Are we doing blood thinners for the narrowing? How does that work?

    Dr. Sharma: That's a very good question. Some of the treatment is very similar to atherosclerosis, but then there are actually some major differences, and this is why it is very important that these patients with fibromuscular dysplasia come see a proper specialist. For most Asians with fibromuscular dysplasia, we will keep them on a blood thinner, which primarily is aspirin but sometimes we may use other blood thinners, still. If the narrowing is too severe and it is affecting that particular blood vessel area that it's supplying, this could be -- if it's the kidneys and the narrowing is so severe that it's leading to severe high blood pressure, then what we do is we do an angioplasty, where we put in a catheter and basically, the catheter has a balloon on it, which opens up and dilates those areas of narrowing. The main difference in those terms is that with atherosclerosis, you typically tend to put a stent in these patients. We actually differ from putting a stent in, as that area where this narrowing occurs is very flexible, and a stent can actually cause more problems by getting broken or fractured in those areas. So those are the sort of the small differences that we look at. If the bulging is too large, then there's all this risk that that area could rupture, the blood vessels could break down and cause bleeding. So in those situations, we actually repair them, either by surgery or by putting a stent to that area.

    Melanie: Dr. Sharma, what is UVA's experience in years with treating FMD?

    Dr. Sharma: UVA has a lot of experience in treating FMD. I know that physicians at UVA had been seeing patients with fibromuscular dysplasia for over two decades. We have publications coming out of UVA almost 15 years ago, and we frequently see those. In fact, in this particular area, UVA is considered one of the major centers of excellence for fibromuscular dysplasia. I know that we have seen over 200 to 250 patients with fibromuscular dysplasia in the last, maybe, five to ten years, which is a whole lot for a rare disease like this. And we frequently communicate with other areas or centers of excellence with fibromuscular dysplasia, so we try to be up to the standards of care that is being performed all over the world for this disease.

    Melanie: That's really amazing. In 20 seconds, Dr. Sharma, wrap this up and give your best advice about FMD.

    Dr. Sharma: If you have any of these symptoms that we just talked about, such as squishing in the inner ears, ringing in your ears or severe hypertension at an unusual young age, talk to your doctor about this disease and have them check it out. If you are diagnosed with this disease, I think it's very important to see a particular specialist who specializes in this particular disease. One of the best websites to go to is fmdsa.org, where you can find the major centers of excellence closest to you.

    Melanie: Thank you so much. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Neurological Disorders]]>
Melanie Cole, MS Mon, 21 Oct 2013 17:00:00 +0000 http://radiomd.com/uvhs/item/15496-identifying-and-managing-fibromuscular-dysplasia
Treatment Options for Aggressive Brain Tumors http://newsroom.uvahealth.com/about/news-room/radiomd-podcasts/radiomd-medical-podcasts-from-uva?segitem=15175-treatment-options-for-aggressive-brain-tumors treatment-options-for-aggressive-brain-tumorsGlioblastomas are the most common – and most aggressive – type of brain tumor.

What treatment options are available for patients with these fast-growing tumors?

Dr. David Schiff discusses the comprehensive treatment options available at UVA Health System, including Gamma Knife surgery, TomoTherapy, chemotherapy and clinical trials investigating potential new treatments.

Additional Info

  • Group Segment Topic: Null
  • Segment Number: 1
  • Audio File: virginia_health/1340vh5a.mp3
  • Location: Null
  • Doctors: Schiff, David
  • Featured Speaker: Dr. David Schiff
  • Guest Name: Null
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  • Guest Bio: Dr. David Schiff is the co-director of the UVA Neuro-Oncology Center. His specialties include clinical trials for malignant brain tumors and the management of neurological complications of cancer and its therapies.

    Organization: UVA Neuro-Oncology Center
  • Transcription: Melanie Cole (Host): Glioblastomas are the most common and most aggressive type of brain tumor. What treatment options are available for patients with these fast-growing tumors? My guest is Dr. David Schiff. He is the co-director of the UVA Neuro-Oncology Center. Welcome to the show, Dr. Schiff. Tell us what is a glioblastoma, and what makes this tumor so harmful to patients?

    Dr. David Schiff (Guest): Melanie, glioblastoma is a type of cancer that originates in the brain substance] itself. Many brain tumors are secondary, meaning they've spread from other organ sites in which the tumor originated. For example, people with lung cancer, breast cancer, kidney cancer can have tumors spread to the brain, and we call that brain metastasis. But glioblastoma is a cancer that arises from the supporting cells in the brain itself. There's roughly 10,000 to 12,000 diagnosed each year in the United States, and there is a number of things that make them very tough to treat. One, of course, is the real estate, the location in the brain, because there are many parts of the brain that are absolutely crucial to our functioning. Another very important reason these are such difficult tumors is that even when the tumors look well localized or circumscribed on the brain, and if they're favorably located, perhaps the surgeon can remove the visible tumor, the problem is that these tumors invariably put out little microscopic fingers or tentacles into the surrounding healthy brain. These tentacles are invisible, the surgeon can't see them. And unlike some other parts of the body where the tumor can take some extra tissue around the tumor—a margin, as we say, try to be on the safe side—it's just not feasible on the brain. So even when these tumors are favorably located and the surgeon is able to do a great job with it, there's always tumor cells left behind after surgery.

    Melanie: Now, Dr. Schiff, people, they get headaches, and right away this is the kind of thing that they worry about when they get headaches. Tell us some of the symptoms, something that might send somebody to the doctor to check for such a thing. It's pretty scary, and people want to know what might they feel.

    Dr. Schiff: Well, fortunately, almost everybody in the world has had a headache at one time or another, and many of us get headaches pretty frequently. Fortunately, only a miniscule fraction of all the people with headaches have headaches related to brain tumors. Probably about a third of patients with glioblastoma initially come to medical attention because of headaches. So headaches certainly can be a sign of brain tumor, though as I said, in the world of people with headaches, brain tumor's a very uncommon cause. I think the big thing to keep in mind is that a change in a long-standing headache pattern or the new development of headaches in an adult, particularly someone who's middle aged or elderly, may warrant some attention. Headaches are one symptom. Other symptoms include things like personality change. People just sort of losing interest in their favorite activities and kind of being a little bit like a bump on a log, withdrawn. Sometimes people present to medical attention because of some weakness or clumsiness on one side. They may have some facial drooping or slurred speech. They may start dropping objects with a hand. Sometimes vision on one side is impaired so that people may bump into objects on one side or the other. These can all be -- and occasionally, related to that, people may start to have driving accidents because they're not seeing things on one side of the road. Those are the sorts of stories that patients in our clinic typically come in with.

    Melanie: So maybe loss of vision and changes in personality, behavior. So now they've come to see you and you've diagnosed them. Now, what are some of the treatment options that are available—surgery, chemotherapy, radiation? Because you've described those fingers, and maybe margins are not able to be gotten. Explain what the surgeries are like and then what they can expect after.

    Dr. Schiff: Right. The first thing is typically, as a patient, by the time he or she comes to us, they've had a CAT scan or an MRI that shows something that looks like a lump in the brain, and they come to me and my neurosurgical colleagues and we have to figure out what the next step is. Sometimes we suspect that the lump is a glioblastoma. Sometimes we're honestly not sure. We usually have an idea whether it's a tumor or not, but there are other types of tumors, as I mentioned. So the first step is to make sure there's no obvious sign of tumors elsewhere in the body. So if somebody has a history of cancer, we examine them, and sometimes we may get a chest x-ray or a CAT scan of the chest and abdomen to make sure we don't see any tumor there, to make sure that isn't, what with the lump in the brain, it doesn't represent spread from elsewhere in the body. Once we've done that—and we are assuming we don't see anything suspicious below the neck—then the next step is to make a diagnosis to get tissue from the lump in the brain. And there, it really boils down to should the surgeon make an attempt to remove as much of the tumor as can safely come out, or is the tumor located in such a delicate place that only a biopsy can be done. That's a decision ultimately that's up to the surgeon in discussion with the patient, because sometimes, if there's potential risk of doing a more aggressive surgery, obviously, patients need to be involved in the discussion as to how much risk they're willing to tolerate.

    Melanie: So at the UVA Neuro-Oncology Center, what treatment options are you offering?

    Dr. Schiff: Well, the tumor neurosurgeons and the medical neuro-oncologists like myself, we don't do surgery but choose from the other therapies available. We generally see the patients together at the same time in-clinic, and we figure out first what the surgical approach should be. Now, if the patient has undergone total or partial removal of their tumor or has only had a biopsy, the next step, we generally have to wait a few days for the pathologist to do their work with the specimen to render a diagnosis, and then we meet together with the patient and the family to discuss the diagnosis and to discuss treatment options. A couple of things about the surgery, there are some bells and whistles that can be done to make the surgery safer and more effective. Among the things we do at UVA include, first of all, we have an operating room suite that has an MRI in it so that during the surgery, the surgeons can have the patient undergo an MRI to see if they've gotten everything that they want to get out of the brain before putting the skull back on and closing the skin and sending the patient to recovery. That can be very helpful in maximizing the amount of tumor that's safely removed. The other thing our tumor neurosurgeons do is they do functional mapping of the brain so that they can record signals from the brain while the patient is asleep in the operating room to make sure they're not taking out areas that are important for movement or sensation. They also have the ability to do what we call awake craniotomy—in other words, a surgery where the patient is put to sleep initially to have the skull opened, but the patient can be awakened for parts of the surgery so that the surgeon and psychologist and physiologist can test the patient while the patient is awake to make sure that areas of brain tissue that the surgeons would like to remove are not performing vital functions that the patient is not going to be happy about missing when he or she wakes up.

    Melanie: Now, Dr. Schiff, in just the last 20 seconds, if you would, wrap it up about the center and give some hope out there to people listening.

    Dr. Schiff: Right. Well, while glioblastomas are very aggressive tumors, our clinical focus has been on doing clinical trials of novel therapies to improve the outcome. In fact, two of the therapies tested here in the last five or six years, one of them being a vast.. one of them being the Novocure TTF device, have been approved by the FDA, so we have seen some real progress during our time here.

    Melanie: Thank you so much. You are listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
  • Length (mins): Null
  • Internal Notes: Null
  • Hosts: Melanie Cole, MS
Tagged under: Cancer]]>
Melanie Cole, MS Mon, 14 Oct 2013 17:00:00 +0000 http://radiomd.com/uvhs/item/15175-treatment-options-for-aggressive-brain-tumors