17 Burst results for "Dr Tom Shives"
"dr tom shives" Discussed on Mayo Clinic Radio
"If you have bleeding and incision that isn't healing a red or swollen leg that's painful warm to the touch a temperature of 100.4 degrees Fahrenheit or 38 degrees Celsius or higher or a headache that just doesn't get better and talk to your health care provider about care after birth. A baby before that baby arrives for the Mayo Clinic News Network. I'm Vivian Williams. Welcome back to Mayo Clinic radio. I'm dr. Tom Shives and I'm Tracey McRae Tracy. We often hear about neurodegenerative diseases that strike the elderly like Alzheimer's disease, but there are some less common brain diseases that affect patients in their Prime of life. And one of these diseases is called Progressive supranuclear palsy or PSP PSP affects the brain cells that control balance walking coordination. I movement speech swallowing thinking almost everything. There is no cure for PSP. So treatment focuses on managing the symptoms and here to discuss PSP is the division chair of Behavioral Neurology at Mayo Clinic. Dr. Bradley Beauvais. Welcome to the program director of bovegas. Nice to meet you. Thank you. My question. We mentioned that it is a prime of Life disease. Meaning what's the most common age at which it strikes mainly forties fifties or sixties so indeed Prime of life and it's it can be a devastating disease. It is the usual. Course of the illness is two to five years on average some shorter some much longer, but it's relatively short course average survival less than 10 years. Yes. Once you get this disease, yes, and how common is it? It's about as common as Lou Gehrig's Disease most people have not heard of PSP before but the prevalence is about the same as ALS and they're just a few thousand people who have this disease in the US right? Some would say in the lower tens of thousands, but relatively uncommon what does Supra nuclear mean? It's an old fashioned term that is based on the clinical features and the I movement SAR a characteristic aspect of the illness. So the inability to look down also look up a dispatch to look down and it's because of the supranuclear involvement on the nucleya that control the movements and that's where the term came from aren't you? Glad you asked yes dead. Should Lou Gehrig's Disease? How is this different? How are the two different Lou Gehrig's Disease? It does affect the brain but it's more of an issue of the the spinal cord and the nerves go out to the muscles. So it's got central nervous system and peripheral nervous system involvement in Progressive supranuclear palsy. It's a primary brain disorder and there's more Parkinson's like features and cognition and behavior are affected far more than an LS, isn't it? Sometimes difficult to tell the difference between this disease and Parkinson's it is in early on it can be a real challenge, but the the early tendency to fall and fall repeatedly is different from typical Parkinson's disease the eye movements are quite different in the specific features of the parkinsonism are different than in typical Parkinson's disease also, so there are ways to differentiate but it can be challenging early in the course and the average age of onset for Parkinson's job. Is significantly older at least a bit older upwards of a decade older. What causes it is it a is your family history that's involved for the most part. There isn't much of a family history. It can run in families, but that's extremely rare and is due to a an accumulation of this protein Tau Tau Tau Parkinson's disease home office in Oakland. So it's a different protein and the parts of the brain that the towel protein missiles and then accumulates in the neurons..
"dr tom shives" Discussed on Mayo Clinic Radio
"Hi I'm Vivian Williams for the Mayo Clinic. News Network. Did you know your kid could have an eating disorder if he or she is extremely picky Dr Jocelyn Lebeau, a Mayo Clinic Child psychologist who specializes in eating disorders says it's called avoid into restrictive food intake disorder. It's basically extreme. picky. Eating the food repertoire of those who have it is so limited that they can't maintain their body weight and they have health issues she says it can be a fine. Line though between normal childhood behavior and extreme pickiness, she says, your kids weight goes on a curve. If they fall off their curve, that's when you start to worry and it doesn't matter by the way if they're curve is at the Fifth Percentile, the fiftieth percentile or the eighty fifth percentile as long as your kid continues to track where he or she has always attract that's healthy but it can be a problem if your kid loses weight and falls off his. Or her curve. In that case Dr Lee bow says, you don't WanNa make mealtime world war three. She says, if suddenly you're setting up a power struggle and demanding that they have to eat and you keep telling them, they have to eat they have to eat your kind of dooming yourself. It can be even trickier for picky teens. So she suggests getting professional help the meantime she says parents to do all they can to get their kid to eat more of. Anything Dutch Lebeau says parents should be challenging picky eaters to eat bigger portions of the foods that are on their list of what they want to eat. She says if your kid falls off, the curve nutrition is not as important at that point their bodies not using nutrition the same way. So it's really about getting their way back up before you start trying to get them to eat kale or something like that for the Mayo Clinic. News Network I'm Vivian Williams. Welcome back to Mayo Clinic Radio I'm Dr Tom Shives Mike, Family physician Dr Elizabeth Cozine Tracy mccray is away. Dr Nice to have with us. Thanks for having me with you. So we're GONNA talk about a very in cancer and we have previously talked about and we've talked about what a difficult disease it is to treat, and the fact that it is fortunately relatively uncommon only about twenty two thousand women are diagnosed with ovarian cancer every year the prognosis is sub optimal not as good as we'd like. It to be, and in fact, less than fifty percent of women live for five years after they're diagnosed, how do doctors decide the best treatment and what are some of the factors that influenced the outcome in patients with ovarian cancer joining us in studio today as Mayo, clinic, gynecologic oncologists, surgeon, Dr, a Monica Committee will come Dr Kumar thank you so much for having me. Good to have you back. So ovarian cancer. That many women present with late stage disease there. Wasn't diagnosed early on what it might have been more curable. Why is that? Yeah I mean it's one of the biggest challenges with ovarian cancer and part of it is because it's rare there's not a good screening test. So we've done lots of studies looking for screening tests similar to what we do for Mammography and breast cancer or colonoscopy for colon cancer pap smears for cervical cancer. But for ovarian cancer, there is not a good effective screening test and the second issue is there's not a lot of symptoms. So the symptoms that people have are really vague and I think this presents a really big diagnostic challenge for people like our primary care doctors. Where patients come in and they have a complains like abdominal pain bloating sometimes, they get full kinda early and who hasn't had that some over the last month. And trying to distinguish you know I I kinda in some ways have the easy part where they already come to the diagnosis. But if you're a family cared AKER AP- primary care and you're seeing this patient you have to figure out is this the problematic kind of abdominal pain or is this just normal daily dominant and when they come to see me they're usually pretty undifferentiated and read. About ovarian cancer because they do hear about this sort of statistic but you know fewer than fifty percent of women who are diagnosed with ovarian cancer live for five years after the diagnosis tells a little bit about those statistics. Why is it so grim yet? So at the end of the day, even though we do have some treatments that are effective and we can usually but not always get. Patients into remission because of the late stage of diagnosis, we have disease that's usually spread throughout the abdomen sometimes outside of the abdomen into the chest cavity or other parts of the body into treatment as challenging and cancer cells can evade the the traditional treatments of surgery and chemotherapy and the disease often recurs. So while I can get someone can get into remission with our traditional their babies. Their risk of coming back and then not being curable is quite high. Gotovina's has any woman female ever come into your office and and you said yourself, I, bet she's got ovarian cancer and if so what was it about the the history or maybe your examination that made you suspect that I've got it on my differential before actually I have yet to diagnose Ovarian Cancer I've thought about. Exactly although the the woman who's Postmenopausal, who is perhaps late fifties early sixties has new bloating or new early society that's being full shortly after eating and really hadn't had this symptom before. So that kind of raises my feels a little bit and the main thing that I wanna do is not ignore those types of symptoms and say, Oh, we should look into this while usually order, for example. Public ultrasound. Yeah and that's really important and like you said, I think it's becoming more common in the public discourse to know about these symptoms. But I think there's a lot of people who didn't even know there were themselves ovarian cancer a lot of pieces come to me and say, well, if I have so much cancer, I have pain or why don't I have more symptoms anything patients than The lack of symptoms. The lack of screening tests have shown anything. Then also lead to the sense of shock when they say well, I was just healthy and doing my normal life and turns out I have an advanced cancer, but there's plenty of room for the ovarian cancer to grow in the abdomen before it actually pushes on anything enough that it causes him right? Exactly. Right. So when you talk about treatment you, they come to you with a diagnosis. How do you outline the options and how do you and the patient decide what's best for them?.
"dr tom shives" Discussed on Mayo Clinic Q&A
"I'm Dr Tom Shives and I'm Tracy McRae a bone marrow transplant also known as the stem cell transplant is a procedure that transplants healthy blood stem cells into the body to replace damaged or diseased bone marrow, and the cells can come from your own body. They can come from a donor or they can come from umbilical cord blood. Stem cell transplants are often used to treat cancers most often cancers of the blood or immune system. Those examples would include leukemia lymphoma and multiple myeloma joining us in studio to tell us more is the director of the bone marrow transplant program at Mayo Clinic hematologist. That's blood specialist, Dr William Hogan Welcome to the program Dr Hogan Thank you very much revenue and good to have you here. So tell us about the the bone marrow and stem cells. So that's a very interesting question and oftentimes causes some confusion essentially when we're doing our transplant or a stem cell transplant, the idea is to try and replace healthy cells with. Our replaced the disease bone marrow with healthy cells. Sometimes we use the person's own cells. That's appropriate for certain diseases such as multiple myeloma or lymphoma where the cells that we collect are not usually contaminated by the underlying disease for other diseases such as leukemia and Milo plastic syndromes we have to use cells from different person because the cells that we collect maybe contaminated by the disease. So there's two different types. There's one which comes from yourself, autologous transplant and one which comes from somebody else an allogeneic transplant, and within that, we can collect either from the bone marrow itself in the pelvis with a surgical procedure or we can. Collect from the perfil blood from the arm by using machine like dialysis machine to try and collect the cells one where we collect you the dialysis machine called Nuku for Isa's is called propel blood stem cell transplant. The one where we collect from the policy is called a bone marrow transplant but sometimes, we use the term Bomar transplant colloquially to mean book. Now, what are these stem cells do? So the stem cells are Kinda like the seed cells. If you have a garden and you plan seeds, these are what produce all of the plants. In the garden, similarly for us, the stem cells produced a red cells that produced hemoglobin that help us function and allow us to supply oxygen to our tissues, the white cells, which US fight off infections and the platelets which help prevent us from leading. So they're the underlying cells that produce all of the important things that we need in our immune system and our blood choosing system to function you mentioned you're replacing Cells in someone's marrow with fresh good stem cells. Are Almost all of these patients who almost all of these patients have cancer or are there reasons why someone might need a transplant? Yeah. That's an excellent question. The vast majority of our practice are patients that do have a form of cancer usually blood cancer like them fomer multiple myeloma leukemia, my plastic syndrome by the way explained Myelodysplasia Syndrome. So Mine Otis Plant. Stick. Syndrome the old name. Used to be called Redo. Kimia, this is a condition of the marrow with a bone marrow doesn't work normally so it can result in two problems. One is where the failure of the production of the cells in the bone marrow or that they can convert into a form of leukemia. So it's an abnormal bone marrow problem where you can have either failure of production or transition to acute leukemia. How long have you been using stem cells to solve these problems? So this goes back to the original bone marrow transplant was done in nineteen, sixty, three, at Mayo, and since the late nineteen eighties early thousand, nine hundred and we've been using more blood stem cells. So you mentioned that the type of stem cell transplant by the way I think you were going to explain to us. Why do these transplants? Cancer is the most common reason but there are other reasons. In our practice, the vast majority are blood cancers, but there are other types of cancer. So for instance, germ cell tumors, which can affect a testicle sometimes can be treated with the bone marrow transplant, and then there are other variety of diseases like immune disorders, bone marrow, failure syndromes, diseases like sickle cell disease are fallacy Mia that can also be considered for transplant and then tell us a little bit more about the source of the stem cells you said that they could come from the patient themselves. That's one option. They could come from donor and then can't they also come from an umbilical cord. Correct. So it depending on the type of transplant. So for some people that can come from the person themselves and that can be either bone marrow or from blood, but almost exclusively now is perfil blood for that indication. For getting them from a donor, we have a number of options. The most common one that we would like to use is a matched sibling or brother sister donor but sometimes, we can use other family members and what's become more popular recently, and more effective is half matched transplants are happy to identify transplants, and oftentimes this expands the donor pool. So in a patient who doesn't have a matched brother or sister, then we may be able to consider another family member such is apparent in the case of a child that has disease or a child in the case of an adult that has the disease as a potential donor. With the recent technology that's allowed us to do half match transplants more safely. This has actually become a very significant. New Technology that's allowing access to a lot more. Transplants for patients so it would seem to me like if you had the opportunity, you would always use the patient as the donor because then you don't have to worry about rejection. and. So tell us again why it is you don't always do that. Right so I think for certain diseases we know that a person's own stem cells can be useful. So for instance, multiple myeloma lymphoma frequently because the cells we collect donations are not involved by the disease that we're trying to treat. Then we can give the chemotherapy to try and reduce. Our a radical, the underlying Myeloma Orlean former, and then use the stem cells as a way to just repopulate the bone marrow after the high dose chemotherapy. In that situation, most of the effect of the transplant is relying on the high dose chemotherapy and a stem cells dare to repopulate the bone marrow. Afterwards that's not entirely true because there there's some evidence. Primarily, generated at Mayo that suggests that there may be also an immune effect by the cells that we put back in. But in an allogeneic transplant, the cells that we collect are not feasible. One that we can collect enough because they have an underlying bone marrow disease that doesn't allow us to collect the cells or that they are impacted by the disease itself in the South we put back in would be malignant and therefore wouldn't be a very good option..
"dr tom shives" Discussed on Mayo Clinic Radio
"Mayo Clinic News Network. I'm Vivian Williams. Welcome back to the radio. I'm Dr Tom Shives. And I'm Tracy mccray cancer of the ovary fortunately relatively rare but it can be very difficult to detect very difficult to diagnose and some cases are diagnosed until the cancer has already spread to the abdomen or other parts of the pelvis. What do you do then joining us in studio to talk about newer and novel treatments for Ovarian Cancer is the chair of the Department of Gynecology at Mayo Clinic in Florida doctor. Matthew Robertson welcomed Minnesota. Thank you good to be here. It's nice to have you on the program. We know that ovarian cancer is one that that women don't WanNa have it's difficult to treat difficult to diagnose but I saw the number of women to being diagnosed with ovarian cancer is actually decreasing. That is true the according to statistics from the American Cancer Society. We are indeed seeing a slight decrease and know why. And we really don't the there are a lot of theories out there that were to Gatien's Hysterectomies on the protective factors. That we're aware of may be playing a role but at this point. We're not exactly certain. If you've had a hysterectomy you're less likely to get ovarian cancer. Yes Sir Enter. But we why that is well it? Hysterectomy itself is removal of the uterus. So you would think. How's that going to protect you? If the ovary and the Philippian tubes are still there but retrospective data looking at women who only had the uterus removed. They actually had a decrease incidents of ovarian cancer itself that it may somehow affect the blood supply to the ivory but we don't know that definitively what are the risk factors though is obesity and we hear every day that the obesity rate is greatly increasing in the country. And so then it surprises me that it doesn't seem to go hand in hand or some other risk factors some other women who are at higher risk. We'll we there's two If you will brawled overrate reaching themes Incessant ovulation the theory there is. There's some type of trauma if you will to the surface epithelium of the ovary. What's happening so in other words when the follicle ruptures in the ovary follicle is the egg coming out of the ovary when as the ovary tries to repair itself so in other words when who are ovulating more likely in their lifetime more may have a higher risk. Now that is one of the reasons that birth control pills were. Women don't ovulate pregnancy breastfeeding excetera. Wa these may be protective. The other theory then goes into some of the local hormonal concentrations. How that may be affecting it. And then certainly as we learn more and more about our Human Genome. We know that ladies who have unfortunately either a bracken mutation. Brca one or two a gene mutation gene mutation Lynch Syndrome. This familial colon cancer..
"dr tom shives" Discussed on Mayo Clinic Radio
"Clinic News Network. I'm Vivian Williams. Welcome back to Mayo Clinic Radio. I'm Dr Tom Shives. And I'm Tracy mccray tracy have you ever heard of an acoustic neuroma also called a distributor? Schwann? Oma Not not until just recently there is only about two or three thousand that are diagnosed every year in the US and Acoustic Neuroma or a dealer. Sean Oma is a benign. Usually slow. Growing tumor develops on the main nerve. That connects your inner ear with your brain here to tell us more about it. The symptoms the diagnosis. Why does it have to names? The treatment to is Mayo Clinic. Ear-nose-and-throat Specialist Dr Matthew Carlson. Welcome to the program Dr Carlson. Thank you for having me. So why does it have to names? So it's an antiquated term. The old term acoustic neuroma and that came from the idea that it came from the hearing nerve and that it was a neuroma coming from the nerve itself but neuroma is benign nerve tumor exactly in overtime. We've realized that when we as we say when we realized that actually comes from so the eighth nerve the hearing nerve actually has three parts to it has to balance nerves in one hearing nerve when you look at them more closely you you'll realize that most of these tumors are actually coming from the steeler portion of the eighth nerve so that's where the stigler comes in and they actually come from a growth on the outside of the nerve the Insulin. Tori fibers of the nerve. And that's what the Schwann cells are so the the technically correct name is the steelers Sonoma so all the nerves have surrounding sheath into installation on a wire and in that. Sheath are the sean cells and that's where the term comes from exactly now. Fortunately this is a benign tumor but rare. You must not even at the Mayo Clinic. See that many every year. So it's interesting you bring that up. Historically always said Acoustic neuroma service is very rare. But there's a lot of emerging evidence it says they're much more common than previously. That's probably been driven by the greater access to emory and also screen protocols race Metropol hearing loss. There's a recent study that we performed the Mayo Clinic. That actually determined that about one in five hundred adults over the age of seventy will acquire an acoustic neuroma during their lifetime in one and two thousand adults. So it's more common than we previously thought. It's just not being diagnosed you know. They're they are being diagnosed with greater frequency. The there's a lot of people are walking around with them That you wouldn't necessarily have them more particularly in recent years. They tend to be smaller at diagnosis with less symptoms and actually the age demographic is increasing so people are tend to be older diagnosed so it's not uncommon that a person might have headaches or something like that. And they get an emory scan and they get an incidental diagnosis so they weren't expecting to see that tumor there and actually about one in five or one in six tumors are diagnosed that way right now so if you do have symptoms but are those symptoms. The most common symptom is asymmetrical hearing loss. So one ear hears worse than the other ear and then the second. Most common symptom is ringing in the ear. Hearing loss and ringing kind of go hand in hand less commonly a person might experience inbalance even more commonly. You can experience Vertigo where you have the sensation of the room spinning around. And what about treatment wants you to discover this Does treatment depend on size and symptoms? Yeah exactly so. I'm probably the two primary things that determine the direction of treatment are the number one thing is size without question and the second thing is probably patient agent co morbidity and patient preference so when we better meaning other diseases other medical conditions. They might make it more difficult for them to have surgery or some other treatment and so when we talk about. The treatment of a of a steeler really have to kind of talk about three different size categories. The first is the very small tumor and the very small tumors typically something a centimeter or a centimeter and a half or less than size patients with tumor that size can either have observations. So he just gets serial imaging you get. 'em arise over time to see if it grows and if it doesn't grow you can just continue to watch it or you can get radiation treatment and typically radiation treatment is done through the gamma knife and that's a single out a single outpatient treatment with pretty low risk. Gamma knife gamut explain that. Yeah so GAM is a procedure that was actually originally developed in Sweden in the nineteen fifties and sixties and it's been really refined since that time and the United States Mayo Clinic has third gamut and Gamma Knife unit. That's ever been opened. Gamma knife uses static head frame so it's basically a small cage that's put on the head for very short period of time. And that allows you to triangulate the tumor exactly in three dimensional space in treat it with very low doses of radiation over an hour. So even when a tumor very small. It's really close to important things. We say it's an area of high real estate and so all the treatments are really focused to to treat the tumor and not affect surrounding structures. See you've got the smallest tumors which you do a lot of watchful waiting waiting a radiation or you can have surgery. The primary benefit of doing surgery on a very small tumor is if the person still has good hearing. You have an opportunity to intervene. And maybe remove the tumor and save hearing and that's a very controversial topic. But that's one of the main arguments for operating on a small tumor. All right. So what about the tumors? That are a little larger so once you exceed that one point five centimeter threshold in most situations. Then you're talking about some form of treatment not just watching it anymore. The ideas that once it starts getting much bigger than that then. You're starting to get into different area. More complications and things so at that point you either choose radiation or surgery and once you get about two and a half centimeters or three senators. We saved really. There's only one main strategy that surgical removal new ideas. If it's already two and a half or three centimeters if you treat it with radiation even radiation is successful. It often causes a little bit of swelling. Initially when it's treated a little bit of swelling can cause a problem. It's already that size. And so typically a tumor over two and a half three centimeter treating it with surgery. And when you I'm kind of making it sound very simple like it's just observation microsurgery radiation but in reality. There's all these different directions within those therapies. That you can actually go down so it's a little bit complex. Are you less likely to have hearing loss if you do the surgery? As opposed to the radiation. That's a really good question. That's really really controversial. It depends on whether you're a radiation therapist surge. Exactly Yeah Yeah. There's certain groups that believe different things and they published you different outcomes that might suggest one direction or the other. The general rule of thumb is if you have a smaller tumor and you have good hearing probably your best chance at stained the way you are the longest meaning having the hearing you have is probably just watching it but it probably will go down overtime or slowly over time in most situations if you get radiation. It's unlikely to develop a sudden hearing loss from the radiation you're hearing loss will also go down but probably a little bit faster than if you just observed it. So there's some radiation affects the tumor with surgery. It's kind of an upfront risk. If you win that gamble upfront. Then you're probably going to retain a longer but with surgery for a really small tumor. The odds are about fifty fifty for saving hearing on a small tumor. So if you if you if you do surgery you might wake up with nonfunctional hearing but if you do win that that that lottery then you're more likely to retain it longer than if he did Observation Radiation. At least that's what most people think to these tumors ever turn malignant into cancer by themselves so being untreated the chance of. That's very very low. There's probably a very very small risk that with radiation can change into a into a malignancy or cancer but even that risk is really low we put it in the category of about one in ten thousand risks so extremely low thirties. Laurie Ayton Acoustic Neuroma. Also called a vestibular. Sonoma it's a rare benign tumor the nerve. That connects your inner ear to your brain. But as we've just heard it may affect as many as one out of five hundred people over the age of seventy exactly the most common symptoms include hearing loss on one side Tinnitus or ringing in the ear on the affected side and balanced problems. Fortunately multiple treatment options most to put your successful our thanks to ent specialist actor Matthew Carlson. Thank.
"dr tom shives" Discussed on Mayo Clinic Talks
"If you're looking for special. Cme credits to fulfill controlled substance prescribing requirements we will be re releasing popular mayoclinic talks opioid edition on Thursdays these meet Arezzo Wisconsin and updated Minnesota state guidelines to claim. Cme credit for listening to these episodes visit C. E. Dot Mayo Dot edu slash opioid pc. Coming up on Mayoclinic. Uncertainty is something that we're all uncomfortable with mental health and coping during the Cova nineteen crisis social distancing is meant to be a health guideline but unfortunately limits a sense of intimacy that many of us need during uncertain. Times here ideas for finding comfort amid uncertainty. One thing that works very well is coming up with the schedule and advice about continuous news coverage. I think it's important to evaluate the sources of information that you're listening to any amount of time. You're spending on those sources learn strategies for managing worry amid a national emergency. If we're not handling stress while we can't expect our children to handle it very well question. How can you be better prepared for the cove in nineteen pandemic? It's important that we do that so that we don't spread our anxiety to other people. The answer next on Mayoclinic Q&A. I'm Dr Tom. Shives and I'm Tracy mccray during today's podcast on the covert nineteen pandemic. We'll share portions of a recent interview with Dr Beth. Rush a clinical neuropsychologist at Mayo Clinic. If you're feeling stressed out by the sweeping changes created in the virus outbreak. This discussion is for you. We'll find out why both structure and flexibility are needed in these days and Dr Russia's thoughts about connection and how it's possible even amid social distancing. Let's start with a wave of uncertainty. That's washed over our lives and Dr Russia's thoughts on dealing with that when people have to respond to change the best thing to think about is whether or not we need to fear what's uncertain uncertainty is something that we're all uncomfortable with and win we're uncomfortable. We tend to become anxious so if we can learn to embrace incertainty as something that we can handle. And we take the time to address then it becomes more bearable. It becomes something we can live through as for addressing that uncertainty. Dr Rush has several thoughts. I she says there can be comfort in structure. I think one thing that works very well is coming up with the schedule. We know from all of the literature that having his schedule being able to journal things having set times that we do things helps allay some of the fear and anxiety. We know what's coming up in our own home so maybe designing a households schedule and this is something had been considering doing with my own. Family is doing things at certain times during the day. Despite the fact that we're not in a structured school schedule or structured work schedule but I think having some structure in place or a schedule in place helps with the uncertainty. That's especially true in this crisis. Which could continue for a while. We're already at the beginning of the soft quarantine and we may be at it for several weeks at a time and we need to think about. How are we going to stay well? During that time and the structure the routine becomes really important being able to exercise on a routine basis being able to eat well and not just eat. What's available to us? Make sure you don't use all of the emergency oreos at once. I think that's really important. Take pause once in a while. And my feeling overwhelmed. Why am I feeling overwhelmed? And what do I have within me to be able to manage that? It's important that we do that so that we don't spread our anxiety to other people are children knowingly or unknowingly if we're not handling stress while we can't expect our children to handle it very well so make sure that you know you need to be checking in with yourself and monitoring your own stress and how it surfaces so that you can make sure you're setting a good example for your children that includes how you digest the news about the crisis. Dr Rush says one thing you might WanNa leave off your family's schedule or at least limit is time spent with news and social media. I think it's really hard to figure out how much news we need. And how much social media we need during a time of isolation such as self quarantining or being at home with our kids. I think you know yourself bass you know whether you're an introvert or an extrovert. You know how much information you need. I think it's important to evaluate the sources of information that you're listening to the amount of time you're spending on those sources for instance you may want to spend more time listening to CDC UPDATES and reference sake websites and less time on facebook listening to someone's reaction to a CDC update and remember. There's a difference between being in the know and obsessing about every alert that flashes across the screen at some point. You're GonNa feel totally overwhelmed and you're going to need a time out and you can respond to it with any of these things exercise. Meditation journaling a moment with your family or even a nap in those low moments. Dr Rush says it's important to be kind to yourself. Try not to eat a lot of fast food or a lot of carbs but I don't deprive myself if I wanNA cook. You ate a cookie. I think about it. Maybe donate ten for eight. The cookie I try to exercise regularly that becomes important for just managing my stress level and managing the way that I think. I try to make sure that I'm around people who care about and who don't introduce extra stress to me. I try to stick with my family. Tell my kids I love them. They try to be present for them. Dr Rush says the practice of being present can help replace the loss of intimacy and feelings of isolation that are happening in this pandemic social distancing is meant to be a health guideline but it unfortunately limits a sense of intimacy that many of us need during uncertain times. We can still have that intimacy but we have to go about it in a different way. We have to lock eyes with the person that we're talking to and be present. We have to listen actively to what they're saying and respond to them with true feeling when we do that were able to communicate the sense of constancy security that a hug creates and for healthy people in your own home Dr Rush says you can take it one step further. It's called the twenty second hug during times of uncertainty embrace someone that you love and hold them be still with them do nothing else for twenty seconds and that communicates a sense of calm and certainty. That wasn't president before the hug started. If you're healthy hug if you're not isolate heads up kids twenty seconds of hugging when I get home today this edition of Mayoclinic. Qna as part of a continuing series on the Cova nineteen pandemic other episodes delve more into the virus itself. It's spread in what you can do to protect yourself from getting it. We hope you'll consider listening to other conversations in this series. Meanwhile thanks to clinical neuropsychologist Dr Breath rush for her time and her stress reducing ideas until next time take Dr Russia's advice find some structure. Remember to be kind to yourself and be will mayoclinic. Qna is production of Mayo Clinic News Network and is available wherever you get then. Subscribe to your favorite podcast to see a list of all male clinic. Podcasts visit news network DOT Mayoclinic Dot Org. Then Click on podcasts. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to Mayo Clinic News Network at Mayo Dot Edu..
"dr tom shives" Discussed on Mayo Clinic Radio
"Coming up on Mayo Clinic. Qna The head of Mayo Clinic. Vaccine Research Group SEPARATES CORONA virus. Fact from Fiction Didi many if not the majority of Americans are going to get infected with this virus. What is coveted? Nineteen also known as the corona virus formally called Star Cobi to the disease that it causes is Kobe. Nineteen regularly infect human causing up to thirty percent of bi-zonal Cole. Who's at greatest risk of getting the virus so if you had traveled to an area where there's a known cases if you had been in contact with somebody who was shown to have the DVD older people who have flu like symptoms? When might vaccine be available? My guess is that it will be for the next outbreak. Not just one question. What can you do to best protect yourself? And Your Family Corona viruses are here to say the answer is next on. Mayo Clinic? Qna This is Dr. Tom Shives and I'm Tracy mccray with a death. Toll from the corona virus continues to climb and over a hundred countries have now reported laboratory confirmed cases joining us by telephone for an update on the corona virus is. Mayo Clinic. Infectious Disease Specialist vaccine expert. Dr Greg Poland after Poland. Good to talk to you. Mike Pleasure to be here. Is it fair to say that this virus is worse than we initially thought? Well no I don't I don't think so. In this regard we certainly saw before it hit here what it was doing in China and have not had the level of these or the severity that they had. We've watched In Fact Republic of Korea. We started this theater in Western Europe so I think we were ready for what was going to happen. I think there may have been people who thought well it won't happen here but of course infectious diseases. Do not respect borders. What is cove in nineteen? What is a corona virus? The virus is formally called stars Kobe to the disease that it causes is covert nineteen so corona viruses circulate the year round about four of them regularly infect humans causing about Five to up to thirty percent of just seasonal cold. It's when they're novel Cronin viruses like we saw with stars like we saw with merced like we're now seeing with SARS covy to these are zoo and no seat. These are viruses that jump the animal species from bats typically into a mammal intermediary and then into humid and because they're novel virus because of particular receptors. They use they involve the lung. And when you get to veer disease of the lung pneumonia Cetera you end up with severe disease and and sometimes critical illnesses. So the the symptoms. Tell us about those other than fever. We know that fever is one of the first signs. Yup comments a very good question because I think when people understand this fear levels go down because fear per se is not helpful the majority of people who get infected infected with this virus will never know majority like what percent majority maybe eighty percent eight. Oh they will have no or very minimal symptoms. This is in the average population healthy population. Yeah the healthy population so typical symptoms if you do develop them are really identical to influenza. It's fever it's a coffee It's it's that whole feeling. You have of a of a cold. It's not allergies. It's not a runny nose and itchy eyes. But it's Sore Throat Cau- fever shortness of breath. Those would be the typical symptom. And how long do they usually last? There's confusing information on this. So typically people become symptomatic about five days on average after they've been infected they may have symptoms that linger on for five to ten days. Depending on how severe the disease is in there. Now there have been a fair number of deaths from Corona virus and a lot of people are concerned that the death rate in a from corona virus might be higher than it is for the flu. Do you think that's not true is it? It is not true generally so if we look by age and people over the age of eighty which is the highest risk population at least in China. Fifteen percent of those confirmed cases died. Seventy two seventy nine. It was eight percent sixty to sixty nine three point six percent when you get to fifty and fifty nine one point three forty two forty nine point four and below thirty nine point two well. What's the what's the case fatality grades for influenza in general for the entire population? It's point one so you could look at it and say well the case fatality rate for Kovic nineteen is double that of influenza. But again it depends a lot on what other diseases do. You have what age you are. And what kind of access to medical care you have. It seems the biggest Determining the health of the long so I heard that in China where fifty percent of the men's smoke that is why so many men were dying of Corona virus. Is that correct? Is it the long that makes all the difference? You will not the only thing. But it is a key factor The hypothesis behind. Why more men die and The smoking rates in China relate to the fact that smoking up regulates the particular receptor that this virus uses presumably making people more susceptible to infection but other things are important too. I mean if you look at in China. Now that's where we have dad where the overall case fatality was around two plus percent. If you had cardiovascular disease it went up to ten and a half percent he had diabetes seven percent you had respiratory disease fixed percent. I- pretension fixed percent so it is very context dependent in terms of again age and other diseases that you have so on a public health level it does seem like. There's a lot of fear out there. Do you think it's appropriate events are being canceled? Schools are closing businesses. Are Closing people are not flying? Is that appropriate? What I have been Trying to explain to people as a concept that I call can textually appropriate layer of protection and the idea. Is You know if you're in a small town in the mid West where you don't even have a case in this state the level of protection that you need to take his very different than if you're in a city that's having widespread outbreaks so Trying to separate and and comment on what people are doing out of an abundance of caution and beer versus. What does the data show? We should do is difficult. I think it's worth taking what you might call sort of extreme precaution in a city where you're having an outbreak where you're trying to no longer just isolate a case or two but you're trying to contain an epidemic. That's that's a very different situation. Then than a state that has no cases. Why WOULD THEY CANCEL SCHOOL FOR EXAMPLE? I I don't really understand that one. So you mentioned that. The symptoms are very similar to the flu if there is a suspected case of corona virus. How do you confirm the diagnosis? The only way to confirm the diagnosis is through doing a diagnostic. Ask say the one that has done is what's called an RT PC are looking for the presence of the virus. We don't actually culture it because then you're putting all the laboratory people at risk by culturing a live virus. The key thing is and I've been trying to get people to understand. That is very important to get a flu vaccine and for our listeners. I would suggest that if you've not yet had a flu vaccine that's the number one thing to do on your priority list today. The reason being is that those symptoms will be confused with SARS Cova too. And it's going to cause you and your healthcare workers anxiety so let's remove that one off the table by getting a flu vaccine. Then what happens is depending on the context? Where did you travel? Who EXPOSED TO. We might look for one of the many other respiratory viruses that are circulating rhinovirus human Meta Numa virus influenza virus We have protested measles mumps all circulating in the US all of them causing respiratory type symptoms. So we have to do a lot of testing to find.
"dr tom shives" Discussed on Mayo Clinic Radio
"The Mayo Clinic News Network. I'm the Dean Williams. Welcome back to Mayo Clinic. Radio I'M DR. Tom Shives and I'm Tracy mccray Tracy we have talked about the heart valves before as you recall there for them and just like the valves and the plumbing in your house they open to allow blood to flow forward and they close to prevent blood from flowing backward now the valve between the two chambers on the left side of your heart that is the left. Atrium the left ventricle. That is called the mitral valve. Now there are two things that can go wrong with the mitral valve. The opening is too narrow and that restricts the flow of blood to the rest of the body or it doesn't close the way it should and blood leaks. The blood flows backwards and here to tell us about repairing the mitral valve with the help of a robot is Mayo Clinic. Cardiovascular surgeon Dr Rocky Daily. Welcome back to the program Dr Daily. Thanks for having me back in the good to see you. So the buzz word for any kind of surgical procedure is minimally invasive. So tell us about the techniques that are minimally invasive in the field of heart surgery. So when we're talking about that we're talking about different incisions. We're not talking about doing different surgery on the heart. We do the same surgery on the heart. We just use different incisions than their smaller incisions in a different location and we think that that helps with the time to recovery does seem to help patients recover and get stamina back sooner so you can do those minimally invasive surgeries with or without the robot right. Well that's true we can. I think the robot helps us in a lot of ways and makes it a little bit easier actually and tell us how that system works so the robot really moves the surgeons hands inside the chest and we can put the hands or the arms of the robot and through little incisions and then they they work just exactly what the surgeon wants them to do. while a surgeon working on on the robot sits at a console that's remote from the patient So you're not even at the operating table. One surgeon is at the operating table. Okay should understand because we do want somebody right there. That's working on the patient. And they do their work through a little incision that's about an inch long Or as little as an inch long and then the other surgeon sits at the robot console and controls the arms or the hands of the robot to work inside the chest So that at the Console. The surgeon moves their hands and and the movements are replicated exactly inside the robot. The robot doesn't decide what to do or do things automatically. The surgeon is actually moving things he said that for the patient minimally invasive robot assisted surgery They can recover more quickly because they're not being opened up so much. Is it easier for you as the surgeon or is it harder? It was harder for me at first I had to learn these minimally invasive techniques Current surgeons finishing training. Today are much more adept at the minimally invasive techniques and But once I was doing enough of these now I feel comfortable both ways. Both ways are equally Easy for me how did you? How did you practice? Do you have a simulator you you have a simulator and and initially we would practice as a team so both surgeons would go and practice one working at the bedside at the simulator and the other working in the console so we would get to be a team and then we'd switch and we'd so we could Fill in either way and it takes a lot of teamwork to be efficient with this and not to waste time. What's on the console? What does that look like? You're controlling the robotic arms at the console. So it's it's got to I guess arms. That insurgent inserts fingers into and then as the surgeon moves their hands and their fingers. Those movements are very exactly replicated by the robot. The only thing we can't do as we can't get a sense of touch or feel like how harderwijk grasping something so we need vision to be able to do that and the robot provides good three dimensional vision. It's which gives us all we need and I assume the patient is asleep. When you put the robotic arms and now they're asleep okay and then are they then on the day on a bypass so the heartland right so the surgery on the heart is exactly what we would do with an open surgery It's on a heart-lung machine. We have to stop the heart. Open the heart and work directly on the valve. We can see the valve much better with a robotic approach because the hands of the robot than inside the heart really and the camera goes almost inside the heart and the view is perfect. And how do you get the heart to stop? And how do you get it restarted? So we do that the same way. We do with open technique We stop it with a solution called. Cardio pleasure that stops the contract. Tilleke of the heart and then once we give the heart normal blood it just be hearts like to beat just goes back to his old job. Yep It's good to know so tell us about the mitral valve. Is that the one that there is most often a problem with. And what can you fix? Well most often we see problems with the left side at heart. Valves either the valve leading in which is the mitral valve leading out which is the aorta valve and we can all of those two valves. The mitral tends to be easiest to apply repair techniques. We don't have to replace it for certain types of lesions we can repair it. And how do you figure out what's wrong in the first place that what? How do you know what you have to fix well? Echo is usually the most reliable way of seeing it and that's an ultrasound that ultrasound done from outside and it shows you the function of the heart and what may be wrong and how the blood is flowing and even the structure of the valves now we can see very with high resolution with Echo. It's pretty amazing. And what's the most common problem you see with the mitral valve leaking in the United States? The biggest problem is leaking of al which is called insufficiency or regurgitation. And you can fix that with the robot ninety percent of the time we can fix it and if you fix it. Do you have to replace the valve? And can you do that robotically? Yes and yes we we would have to replace it and we can do that robotically and then if you have to replace it what. What do you use a mechanical valve? Or do you use it in. Yeah there's two types of valve either mechanical valves tissue valves. The mechanical valves will last forever but they require a blood thinner in the tissue. Valves don't require the blood thinner but they might wear out and what the recovery like this minimally invasive surgery versus when you have to crack the chest open the Jesse so it's still a surgery. It's not like a catheter. Based procedure and the patients do need time to recover after a full stern Adamy. It probably takes six to eight weeks to really get their stamina back and feel good again and stern out meeting. You have split the chest the breast bone to get exactly and with The minimally invasive technique. It's more in the neighborhood of four weeks. Everybody's different of course and some people need more in less with approaches. But it's just a little bit sooner. I think getting the Stamina backs the most frustrating thing to young people recovering from surgery. Let's say you have decided that you need to replace the valve and you're going to use a mechanical valve. I assume that's about the size of a what a grape walnut grape. It's it's about the size of a half dollar okay. So how'd you get it in there? Well actually it's interesting because getting the valve through the incision is sometimes challenging when we have to replace it. The incision has to be big enough to which the valve through right so wing it. We have the arms in the sewing is fine but And then how do you get it into the heart We have an incision in the heart that we're working the muscle. Yes yes the upper chamber the Atrium all right and you've done how many of these over nine hundred now and you've got a couple of guys that you're trying to take over. Should you ever decide to this up there? And they're very good. They're great aright robotic assisted heart surgery. The surgeon sits at a council looking at hard on a video monitor. And I think you have a magnified three d. view of the whole thing don't you yes. And you performed the procedure with robotic arms and sense. What.
"dr tom shives" Discussed on News Radio 810 WGY
"They had a hard hat for protection and legal protection as well. In some cases, the law gives an inter construction worker entitlements above and beyond worker's compensation. I'm Vic mazzetti Eloy at Martin Harding, Ms Oddy, and I know construction law and special benefit call one eight hundred law ten ten to find out if your injury qualifies it's worth it to talk to the heavy hitters. Newsradio. Wait ten and one zero three one WG y. Welcome back to male Clinic Radio. I'm Dr Tom shives, and I'm Tracy McCray. Well, thanks to better awareness and screening cancer of the colon and rectum rates have been declining in recent decades overall, but alarmingly cancers of the colon and rectum are on the rise in younger adults kids adults in their twenties thirties in their forty s. Well, this past may, the American Cancer Society changed their recommendation about screening they now say you should get your first colorectal screening at age forty five that's down from age fifty. So why there is and what can be done about it. Joining us on the phone from Jacksonville, Florida to discuss as mayoclinic hematologist oncologist, Dr Pashtoon Cassie welcome to the program. Dr Kelsey, it's nice to meet you. Thank you for having me get gas. You. Thanks for joining us. So overall rates of cancer of the colon and rectum have been declining. That is true. Indeed. If one of the few cancers were creating. In the late nineties with the advent of corn ask has been what has allowed for cancer to be caught. At the earliest stage few Kansas. That follows a pattern of becoming something that is it can't. Venables into cancer were period of time in the order of years, which allows for an intervention beaming bureau tests, that can detect cancer can prevent it overall has resulted in the decline, but you've been removing the polyps that would otherwise ultimately turned into cancer and. Your screening colonoscopy or some form of to look at five colon. I is one of the ways, but there are other tests as well, which are relatively non invasive that can also be employed to help diagnose, the why are the numbers rising when it comes to younger adults, you know, the the the most intriguing question right now observation was something that was noted earlier last year by researcher that was funded by the American Cancer Fadi while indeed you see the decline in the curve and the individuals that the fifty sixty seventy. Beauty. If you look at the decade, go to both around the time when colonoscopy the inning interventions were introduced, but the thing is why individuals in their twenties, thirties and forties. You're seeing to the millennial age groups that our own after the eighties as opposed to somebody who was born in the fifties of sixty the risk of cancer, depending on the location was up to four fold in some instances, which is not yet the plane and there's an ongoing research unexplained. Then you know, what's being tweaking is the only thing that recurrently coming up with a team surprising. Even though we think of colorectal cancer as one entity or just pretty much interest. Speaking a long piece of tubing is derived from different parts of the body. So even the right side of the colon is is completely different organ when it comes to compare and get to the left. Of the colon in a patent that had emerged as the team played it rectal cancers and the cancers on the left side of the colon. That are more often being in in individuals who are diagnosed with these young on. Now, we know because they are derived from different parts of the embryo. Of the colon is different biologically the mutation than patterns that we be as compared to the left side of the colon and the rectum that being a recurring theme. There was initially noted in the study by the American group at meal, we published our findings last month as well. And again the same team pretty much. A colon as well as rectal cancer more. So the rectal cancer was increasingly being in the individuals twenty thirty forty by definition would not have met this guideline. Granted the recent guidelines have led to the age being moved from fifty to forty five or what we call the average risk individuals that by definition in all those individuals would not have met any criteria for screening so often the problem is because they're not getting fiend by the time. They're diagnosed with cancer often at most young adults don't think that they're gonna get colon cancer. But what are the symptoms that they ought to look for back to where the cancer originates? Whether it's in the rectum was the left side of the corner. Versus is the right often some of the symptoms are not necessarily something that one would consider a threat the diagnosis bleeding is one thing an fifty with current. Situation with them not meeting guidelines if somebody has ongoing leading that would be one thing to consider unexplained weight loss changes in the about habit of constipation or changes in the caliber of school. Or if things that persistently getting worse unexplained is definitely worthwhile bringing it to the attention of the doctor now often leaving is not necessarily profound, especially if the cancer originated on the right under team bloodwork or visit to a primary care physician, especially in the meal, if anemia which is low blood counts that should always signal wreck back because anemia fifteen meals and even females in addition to mental blood losses is often bleeding from the garden one otherwise that would be fine to look for and obviously in advanced advance. It can present the abdominal pain and liver and lung. The common type of metastasis so often somebody gets scanned for some.
"dr tom shives" Discussed on News Radio 810 WGY
"Radio, I'm Dr Tom shives, and I'm Tracy McCray. Trophy lateral sclerosis or a L S is a progressive neurological disease that destroys nerve cells slowly gradually causing more and more loss of function. LS is sometimes called Lou Gehrig's disease after the famous baseball player who is diagnosed with A S often begins with muscle, twitching and weakness in a lamb or in slurred speech, eventually LS affects control the muscles needed to move speak. Eat and breathe while there is no cure for a LS. There are treatments that can help to slow the progression of the disease in here to discuss a LS and how it can be treated. As mayo clinic neurologist, Dr Jennifer Martinez Thompson, welcome to the program. Dr martinez. Thompson is nice to meet you. Nice to meet you. Thank you for having me Detmer tina's Thompson, so nice to have you on the program a neurologist who treats people with a S, do you? Enjoy this job. It's it's a difficult job. But there's a lot of things that we can offer these patients, and so it's a very rewarding experience to work with these patients and their families and be able to help them along the course of their disease. So it's very valuable so explain the term amyotrophic lateral sclerosis to us if it's possible. Yeah. So I mean, it's really based off how clinicians initially described disorder so thinking back to the nineteenth century and the initial clinical descriptions of patients with LS the trophy term comes from the loss of muscle bulk, which we term atrophy of muscle, meaning must meaning muscle trophy. Meaning shrinking exactly shrinkage of the muscle, and then the lateral meaning that it tended to be lateral is on the side of the body. So it might start on the right side of the body and a limb versus the left side and then spread from there. So lateral ice in that sense and sclerosis meaning that when they looked at the pathology of the nerves it seemed like there was loss. Of nerves at different portions of the spinal cord and other areas of the body. So that sclerosis component loss of the actual nerves would that be amenable to scarring? Yes. Courtly nerves. Yes. Anyone get this disease? That's a really good question. We don't really understand the cause. At this point. We can talk about that a little bit more later on. But really looking at. What it is that underscores this disorder? We don't know of US Pacific trigger. So really can affect anybody can affect men and women about equally. It can affect people of different ages. There's not really an ethnic or racial predisposition. And so it really anybody in society can be affected. Does it run in families at all it does? So we do understand some of the genetics about the disorder and actually in the last five to ten years. There's been a lot more degenerotic discoveries. So there's a small percentage about ten percent of cases of Ahah less that do run in families. And so there are multiple members within the family that manifests with this weakness in the symptoms that you discussed earlier on what exactly is happening to the nerve is dying. Or is it malfunctioning or what's happening? That's a good question. So it is actual degeneration of the nerve itself. We don't know what the initial trigger is that causes that initial degener-. Ration-? But once a start we think it's almost like a domino effect. And so if it starts in our region of the body, and they're does their degeneration, then it breads from that point to other points in the body. And then it almost takes a life of its own is there in associated gymnastic abnormality that you can actually actually test for or do, you know, what the gene Eber melody is? So there has been more recent genetic discovery with Jean that's called or add mutation specifically that's called c-9 ORF seventy two that's on a specific chromosome chromosome nine, and that seems to be responsible for the largest proportion of cases of genetically based ale Astle those that run in families, but beyond that there's about thirty genes at this point that have been discovered all with similar mechanisms similar pathways involving different families that have been identified, but the c nine ORF seventy two is the most common. One that we've identified so Tracy kind of alluded to the usual presenting symptoms but expand on that for us. The most patients that you see how do they present? So typically, it starts with weakness. It's weakness without any associated pain or sensation change. It may start in an arm or it may start in a leg and over some period of months that weakness can then progress to involve other muscles within that limb. And then spread to involve the other limb. And then from there continue to spread to involve the remaining limbs or the muscles that involve facial contraction swallowing function speech and breathing function. But it can vary from person to person in the way that it presents. So we do see a lot of variety in terms of how the symptoms initially manifest in people. And then how do you nail down the diagnosis? So that one it can be a very difficult diagnosis to make. Because as you know, there's not a specific blood test. We. Do have genetic testing where we suspect, but they're not there's not a specific blood tests that we can test for that says, yes, you have the disease. No, you do not have the disease. So it's a clinical diagnosis in the sense that you have to combine what you see on the neurologic examination so based on the symptoms that patients have and then combine that with testing specifically electro myopathy and nerve conduction studies where you look at the way that the electricity 'electricity actually conducts through the nerves and then with a different portion of that test the electromagnet look for signs of nerve degeneration within the muscle and look for specific findings, and how that g generation patterns happening that may give you a clue as to what's going on. You have to put all of that together for a diagnosis that does not sound like a quick process. Sounds like it must be quite an ordeal during this time for the patient. It is it is and it can be very anxiety provoking and frustrating for the patient because early on. It may be very difficult to diagnose if they have specific findings that are confined to an arm or leg. And sometimes we do have to continue to follow closely to see how things change over time to help us come up with a more definitive diagnosis. So it does create a lot of anxiety for the patients and their families. It would make sense that the first thing that you would do I guess maybe to ease their mind. I mean, it wouldn't be a good diagnosis. But would just be to do the genetic test straight away to see if you have that malfunction in your jeans? That's a that's actually a interesting point that you raise in. It's a tricky one because there are a lot of other disorders that can overlap with similar features as you might CNA less, and so, you know, testing for genetics upfront it can be an expensive ordeal. Not one that's always covered by insurance and see where we want to balance that with how high we think the likelihood is. That somebody has the diagnosis certainly in those that have a family history of us. We may be testing for the genetic tests, specifically sooner in their course. But it is a very detailed discussion upfront about the repercussions of genetic testing results might mean for them and their families. So it sounds like it might very well oven is very much a a diagnosis of exclusion that you can't really tell necessarily early on what it is. And how for example, do you tell the difference between LS an MS? That's a good question as well. So, you know, you're looking at the central nervous system disorder, and so the findings that you see when their central nervous system function are things like stiff muscles, or what we call specificity weakness or slowly slowness of movement of the muscle and reflex us that are hyperactive so very jumpy reflexes. Whereas in LS it. It is a disorder that affects the motor nerves specifically that travel from the brain to the spinal cord, and then the connections from the spinal cord to the muscle. And so you get a different pattern of findings there in the sense that you get not only that upper motor neuron dysfunction. But also that lower motor neuron component. And so there are some additional findings like you were mentioning the atrophy or loss muscle bulk sometimes loss of reflexes in combination with increased reflexes another parts of the body the muscle twitching or facilitations, and you have to look at that pattern carefully in that mix pattern. There's not really another condition that gives you that type of mixed pattern of findings are a good thing. There are experts like you. All right. We're talking about a LS. With a mayo clinic expert neurologist, Dr Jennifer Martinez. Thompson time for short break. When we come back. We'll talk about treatment options and living with.
"dr tom shives" Discussed on News Radio 810 WGY
"WG y. Welcome back. To Mayo Clinic Radio, I'm Dr Tom shives, and I'm Tracy McCray. John Brayson Rome is a rare disorder in which the body's immune system attacks nerve your own body, damaging your own nerves strange disease. The first symptoms are usually tingling and weakness in the arms and legs. And these sensations can quickly spread eventually paralyzing your whole body. So most people with John beret need to be hospitalized for supportive care. The exact cause of Gambari syndrome is unknown. But it is often preceded by an infectious illness such as respiratory infection or the stomach flu. And here to discuss is mayo clinic neurologist, Dr James dick, welcome to the program. Dr is nice to meet you. Thank you very much better. Nick good to have you on the program. This has to be one of the more interesting intriguing diseases out there. Yeah. No, I think neuropathies in general are very intriguing and yonder is absolutely one of the more intriguing of the neuropathy, neuropathy means disease of the peripheral nerve damage to perform John beret syndrome is an inflammatory performer opposite, meaning it's caused by inflammation. Meaning it's caused by inflammation, and autoimmune causes an attack by your immune system, as you mentioned, John berry syndrome is an example of that CIP chronic inflammatory demolished. Any polling Araba is an example of that. And necrotizing vascular Itis is an example of the all of those things 'cause inflammatory neuropathies that one of the things about John is that we don't know why. I have this conversation frequently with patients from my perspective. We know why I'll say to patients your immune system's attacking your nerves that is the mechanism of damage to your body. You know, we know why this is what's happening. And they'll say, yes. But why does that right? And so what triggers that how that happens? We don't really know that you're right there is this concept of molecular mimicry, meaning that there are things in the nerves that look a bit like the infectious organisms the viruses. And so your body is fooled if you will it's trying to fight off that bad infection. And this is why it's often a post viral rightous that you get an infection your body mounts an immune attack to that infection. And instead of just attacking the virus it starts attacking its own. But the interesting thing is people recover from there. So does the body finally figure out that it's wrong? It's a good question. So yes, so the body attacks its nerves for a while John very syndrome that immune mechanisms gets turned off and people recover that is in opposition. To see DP, John beret syndrome is a IDP acute inflammatory demolished getting neuropathy. I is chronic inflammatory demolished ending up where the immune mechanism does not get turned off, and those people continually need treatment for their neuropathy is that like MS it is somewhat like MS, but it's in the purple nervous system. So MS is a central the mile and aiding condition. CIP John beret syndrome or peripheral. Conditions. Now Mylan is the insulation around nerve fibers does I've ever die of this. It does everybody's body. Finally, figure it out that this is the wrong thing to be doing. And they get better. Everybody gets better know people. So we have gotten much better and looking after people, and you mentioned this originally a lot of the treatment for this is supportive care. So people may need to be intimated and put on respirators they need to have aggressive physical therapy. And so people used to die of respiratory deaths or they would get deep venous, thrombosis and pulmonary embolism. And we've got much better. But it's still occasionally people will die. L? How do you know? That's what they have. What it what are the symptoms? First of all you start with numbness, prickly entangling, and then you often have ascending paralysis you get weak. And so and it happens fairly quickly. So by definition on beret syndrome occurs over the course of a month or less often will occur over the course of a few days in contrast occurs, at least two months, if not greater so that that's one way you differentiate these conditions there often is an elevated spinal fluid protein. And then there are dating changes are nerve conduction. Studies EMC test in which you shock the nurse to see how they respond to can't be too many things that are more frightening to a patient. Their body is becoming parallel. I think it's terrifying. And it, and it is very dramatic. Sometimes I mean, you'll see a person on occasion who in the morning is fine. And by that afternoon is completely paralyzed. And. On a respirator, and that is very dramatic. When that happens, but the treatment there is no specific treatment for this disease supportive care because there are no kind of antibiotic or drug that you can give people to help them. That's not entirely true. So both plasma exchange where you remove the blood within that plasma are all those nasty antibodies and things that your body is making to attack itself. And then you throw that away and you give them new protein is one way of treating it or alternatively giving other people's immune system to the patient. I the I g intravenous immunoglobulin giving that extra approaching from other patients often will suppress your own immune systems, immune response and both of these treatments have been shown to be effective treatments and John syndrome, meaning the patients recover faster than they would without them. But it's still largely supportive as you say in most patients do recover fully. And how long does it normally take complete? Depends on the extent of their. So if they have a milder case, they'll recover more completely and more fully if they have a very severe paralytic case, they will I've seen patients on respirator for six months to a year and recovery taking several years that is the very severe cases and sometimes not complete recovery. Again. This is theoretically a knitting or oppa the meaning it's the insulation. So have you we insulate you don't have to regrowed fibers. But in some cases, you will actually get exonerate loss where the nerve fibers themselves degenerate, and they have to regrow than those cases, it may not be complete recovery. Why is it when I'm getting my flu shot? Do they ask if I've had gamma-ray syndrome? I don't like that question personally. And I don't think there is good evidence to that effect. But if you're a person who had a flu shot after the flu shot developed yamba race engine, you probably don't want to get other flu shots. But by and large. I think most patients given everything it's better to get a flu shot once is bad enough. But you can actually get beyond beret more than once. Can you? Absolutely have recurrent, John. How are more likely to get it a second time? Once you've had at once. Yeah, you're probably more likely than the average population. It's still for most people. They're not getting it recurrently. However, I've seen people who've had multiple toxin. And I think those people are than at risk to develop more all alright everything you always wanted to know about John beret. And hopefully, you never get it. We've been talking with mayo clinic urologist actor James dick, Dr dick thanks so much for being with us. Thank you for inviting me, and that's our program for this week. Find more information on the mayo clinic news network.
"dr tom shives" Discussed on Mayo Clinic Health Minute
"From the studios of the mayo clinic news network. This is Mayo Clinic Radio, exploring the latest developments, health and medicine, and what they need to. You welcome everyone to make radio dot to Sange caca and I'm Tracy McCray being told you need a transplant can send you and your loved ones on a challenging and uncertain journey. One with physical, financial, emotional hardships, the gift of life transplant house at mayo clinic aims to ease some of those burdens. The goal of this nonprofit organization is to provide a home that helps and heals for transplant. Patients on today's program will learn more from the director of the gift of life transplant house and a current resident also on the program. Dr Tom shives will join me as co host, and we'll hear about the latest treatments for erectile dysfunction few stories from flying the friendly skies. All that along with this week felt in medical news right after this. Welcome back to male Clinic Radio to Sange Kako and I'm Tracy McCray in nineteen Seventy-three. Ed pumping received the gift of life a kidney from his mother, no less Helen. As personal experience at mayo clinic led him to believe that the health and wellbeing of transplant patients and their families would be better if they could live in a home, like setting during their treatment. The goal was to provide mayoclinic transplant patients with high quality, affordable accommodations that could offer the support that transplant patients need in ninety four. That goal became a reality when the gift of life transplant house open. That's right gift of life. Now has two houses in Rochester on either side of second street. They provide services for solid organ bone marrow and stem cell transplant patients and their families. Patients of all ages come to mayo clinic from all over the world and gift of life offers transplant. Patients a home away from home inherited discuss is the director of the gift of life transplant house Mary wilder and joining her is the husband of a stem cell recipient. Jon Royce to share the experience of life at the transplant house. Welcome both of you to the program. Thank you so much for having us. We're just delighted to be here. It's going to be here. Fun show. Tell us first of all, Mary, how long have you been the director at the gift of life transplant high have not even been there a year yet. I started on may twenty second. I actually was a kidney donor from my father forty years ago, and I was so connected instantly to the mission and what I found gift of life transplant house. And that's what brought me here. Elvis deal passion is an infectious. When you walked in the dole, tell us about the culture what you noticed about the gift of life transplant house. The very first thing I noticed was the warmth that was they're very, very supportive feeling. It was just like walking into your own home and feeling that that the patients and the caregivers that were there were very welcoming with one another. You know, I expected to find situation where I would be incur. Urging individuals where I would be the one thing. Oh, it's going to be okay. We'll be praying for whatever it was instead. It's exactly the opposite. And that was from the very first air walked in that I was being encouraged. I was being inspired by the courage. I saw of guests who were dealing with very, very difficult situations and yet living in a home like environment where they could discuss all this with others, how many patients are families do you usually see each year? Well, with last year in two thousand seventeen. We were able to accommodate four thousand six hundred twenty five guests and caregivers the year before that it was right around four thousand. So we are continuing to grow and continuing to accommodate more and more. And of course the need is getting greater and greater as mail is expanding as well. How often does the patient usually stay? You know, the average stay is completely dependent on the type of transplant than an individual has. So our kidney recipients will be with us. Yes, for two to three weeks, whereas our stem cell patients can be with us for their whole one hundred day journey through getting that stem cell transplant and John. That's that's where you kind of come in because, yeah, your wife, Susan is in that position. Tell us her story. Two thousand eleven. Actually she had a stem cell transplant in September and went to Dr. She's a, we're gonna stay with said, well, we'll stay at a hotel someplace I've ever thought about the gift of life as what is that? She's what's the place where transplant people can still as well that the interesting over and took a tour which you must required to take one. And we saw the people just like Mary said, such a friendly, warm atmosphere, and we were in the older house on north side. I, we stayed there and the people were just great. And so that's began are stained gift of life house in what was her diagnosis. She was multiple myeloma, and so she was here. We are six weeks in September, two thousand eleven, and then she was on continuous chemo from that didn't really work that. But so she just completed the car T-cell transplant, which was five weeks ago. And so we're back here again. It's a first place. We wanna stay a gift of life house. So John going through a diagnosis like this can be emotional and trying when when you came to the gift of life house, tell us how that chain. Things for you, made it easier to adjust the treatment of Susan receive? You know, it's kind of like when I got drafted an army infantry during Vietnam, none of us wanted to be there, but we're all there and so we can make the best of it and that's kind of without was because everybody there had some issue that they're dealing with some major issue. And so you just stick together. People are saying how we pray for you, like Mary said, we'll help you. What can we do to help you? And we're on the same boats.
"dr tom shives" Discussed on Mayo Clinic Health Minute
"From the studios of the mayo clinic news network. This is Mayo Clinic Radio, exploring the latest developments, health and medicine, and what they need to. You welcome everyone to make radio dot to Sange caca and I'm Tracy McCray being told you need a transplant can send you and your loved ones on a challenging and uncertain journey. One with physical, financial, emotional hardships, the gift of life transplant house at mayo clinic aims to ease some of those burdens. The goal of this nonprofit organization is to provide a home that helps and heals for transplant. Patients on today's program will learn more from the director of the gift of life transplant house and a current resident also on the program. Dr Tom shives will join me as co host, and we'll hear about the latest treatments for erectile dysfunction few stories from flying the friendly skies. All that along with this week felt in medical news right after this. Welcome back to male Clinic Radio to Sange Kako and I'm Tracy McCray in nineteen Seventy-three. Ed pumping received the gift of life a kidney from his mother, no less Helen. As personal experience at mayo clinic led him to believe that the health and wellbeing of transplant patients and their families would be better if they could live in a home, like setting during their treatment. The goal was to provide mayoclinic transplant patients with high quality, affordable accommodations that could offer the support that transplant patients need in ninety four. That goal became a reality when the gift of life transplant house open. That's right gift of life. Now has two houses in Rochester on either side of second street. They provide services for solid organ bone marrow and stem cell transplant patients and their families. Patients of all ages come to mayo clinic from all over the world and gift of life offers transplant. Patients a home away from home inherited discuss is the director of the gift of life transplant house Mary wilder and joining her is the husband of a stem cell recipient. Jon Royce to share the experience of life at the transplant house. Welcome both of you to the program. Thank you so much for having us. We're just delighted to be here. It's going to be here. Fun show. Tell us first of all, Mary, how long have you been the director at the gift of life transplant high have not even been there a year yet. I started on may twenty second. I actually was a kidney donor from my father forty years ago, and I was so connected instantly to the mission and what I found gift of life transplant house. And that's what brought me here. Elvis deal passion is an infectious. When you walked in the dole, tell us about the culture what you noticed about the gift of life transplant house. The very first thing I noticed was the warmth that was they're very, very supportive feeling. It was just like walking into your own home and feeling that that the patients and the caregivers that were there were very welcoming with one another. You know, I expected to find situation where I would be incur. Urging individuals where I would be the one thing. Oh, it's going to be okay. We'll be praying for whatever it was instead. It's exactly the opposite. And that was from the very first air walked in that I was being encouraged. I was being inspired by the courage. I saw of guests who were dealing with very, very difficult situations and yet living in a home like environment where they could discuss all this with others, how many patients are families do you usually see each year? Well, with last year in two thousand seventeen. We were able to accommodate four thousand six hundred twenty five guests and caregivers the year before that it was right around four thousand. So we are continuing to grow and continuing to accommodate more and more. And of course the need is getting greater and greater as mail is expanding as well. How often does the patient usually stay? You know, the average stay is completely dependent on the type of transplant than an individual has. So our kidney recipients will be with us. Yes, for two to three weeks, whereas our stem cell patients can be with us for their whole one hundred day journey through getting that stem cell transplant and John. That's that's where you kind of come in because, yeah, your wife, Susan is in that position. Tell us her story. Two thousand eleven. Actually she had a stem cell transplant in September and went to Dr. She's a, we're gonna stay with said, well, we'll stay at a hotel someplace I've ever thought about the gift of life as what is that? She's what's the place where transplant people can still as well that the interesting over and took a tour which you must required to take one. And we saw the people just like Mary said, such a friendly, warm atmosphere, and we were in the older house on north side. I, we stayed there and the people were just great. And so that's began are stained gift of life house in what was her diagnosis. She was multiple myeloma, and so she was here. We are six weeks in September, two thousand eleven, and then she was on continuous chemo from that didn't really work that. But so she just completed the car T-cell transplant, which was five weeks ago. And so we're back here again. It's a first place. We wanna stay a gift of life house. So John going through a diagnosis like this can be emotional and trying when when you came to the gift of life house, tell us how that chain. Things for you, made it easier to adjust the treatment of Susan receive? You know, it's kind of like when I got drafted an army infantry during Vietnam, none of us wanted to be there, but we're all there and so we can make the best of it and that's kind of without was because everybody there had some issue that they're dealing with some major issue. And so you just stick together. People are saying how we pray for you, like Mary said, we'll help you. What can we do to help you? And we're on the same boats. We find out their diagnosis and what they're doing. We encourage one another, which is so good. What is cartesian cartel. It's a clinical trial that they're doing their good FDA approval for a mile. I'm sorry, some forms of them foam in some forms of Kimia, but they do not from open my Loma. So they take your t
"dr tom shives" Discussed on WZFG The Flag 1100AM
"May is american stroke months a campaign to help us become aware of signs of shokhin others and to know important steps we can take to prevent a stroke from happening in the first place on today's program will discuss stroke awareness and prevention with the mayor clinic expert also on the program dr tom shives will join me as co host will learn how pain rehabilitation centers can help those struggling with chronic pain and we'll learn about treatment and therapy that's necessary offer an amputation all that along with districts south and medical news right after this shop local why painful price when you can save with big deals what is big deal it's am eleven hundred the flight online store we have lots of different fields for you from automotive restaurants health and wellness to snow removal you can even hire temporary help for your home or office all you have to do with goethe am eleven hundred the flag and click on big deal am eleven hundred the flag dot com and click on big deals central steel building and construction is your premier source for gsi grain bins gsi grain dryers and gsi grain handling equipment central steel also offers livestock water welding supplies and a variety of gears pulleys plus bulk bolts and nuts call central steel today for your gsi grain storage material handling and grain drying needs seven zero one six five to twenty eight eighty six central steel building and construction in carrington online at grainstuff dot com this is colonel denny gilan those two frontlines of freedom your military talk radio show.
"dr tom shives" Discussed on Mayo Clinic Radio on Transplant
"Twenty fourth twenty seventeen to Mayo Clinic. Radio I'm Dr. Tom Shives and I'm Tracy McRae Tracy. The Mayo Clinic Liver Transplant Program There's three different sites. All three sides do liver transplant Arizona. Florida and of course the mothership Minnesota and the three of them combined perform over three hundred liver transplants. Every year now unfortunately like other Oregon's the number of people who are waiting for liver transplant far exceeds the number of available donors because the human liver regenerates and returns to its normal size. Shortly after part of it is removed living donor liver. Transplant is an alternative to waiting for a deceased donor liver to become available. Isn't that interesting the liver can actually regenerate itself? Make more of its up. The only organ in the body can do it. Here to discuss liver transplant. Is the division chair of transplant surgery at Mayo Clinic? Dr Charles Rosen. Welcome back to the program. Dr Rosen thank you the pleasure to be here. So Dr Rosen. Nice to see you Mayo Clinic Rochester. One of the sites that does liver transplants. So tell us why someone would need a liver transplant a liver transplants done for anybody that develops liver failure. It can happen rather suddenly and we call it acute liver failure and that can be from Drugs such as tylenol overdose can be from a an acute hepatitis caused by a virus or a couple of real rare conditions. And sometimes it's just a drug interaction that we don't totally understand Also people can have what's longstanding liver disease or chronic liver disease that over a period of yours develops into cirrhosis and that can be caused by alcohol a lot of viruses that can cause psoriasis as well as some diseases that we have fancy names for. What really don't understand all that well. So psoriasis basically means that the liver scarring of the liver. That's right and the liver Delivers an organ. As you mentioned it can regenerate and grow back but for some reason when it gets diseased. It grows back and develop sees fibrous scar tissue. That keeps it from regenerating to its full capacity and Results in problems did did I hear you say that? If you take too much tylenol you can get acute liver. Failure is that over a long period of time. No It's if you take too much once. Unfortunately in some countries like the United Kingdom. It's a a form of suicide occasionally. It can be that done here or can be inadvertent and if you also drink alcohol with tylenol. The two of them together is not a very good combination. Really quite a lot if there is a lack of liver livers available for donation. Why aren't more living donor? Why isn't that happening? More often Well first of all A. It's kind of exciting. Two Thousand Sixteen was a wonderful year for transplantation it was the highest number of donors ever in the United States There were over almost sixteen thousand donors and thirty three thousand six hundred people got transplants last year. Both those numbers are up about ten percent or nine percent from the year before an organ donation is actually up about twenty percent over the last five years so we're fortunate in the United States that the deceased donation has gone up and we would much rather do that rather than a living donor transplant When you get the whole organ with the larger vessels in the bile ducts Things go well. A living donor. Transplantation is a way around it for people that can't get a deceased donor because their position on the waiting list there are more problems in the recipient with the bile duct. 'cause it's shorter and smaller in the same with the blood vessels going to and from the liver And of course. The donor has to undergo pretty major operation in involves taking out up to almost seventy percent of the liver in some situations. The liver grows back find. But just the course of the operation dividing the blood vessels and dividing the liver. is composed some risk to the and the risk to the donors. Life is actually about somewhere between one and two hundred one and three hundred. So it's it's not insignificant to one to two percent chance that you'll die being a living liver donor of one in two hundred one and three hundred so about point five. Yeah well but still. It's a big risk. What's the average? Wait how long do people typically wait for a donation ever? Since the early two thousands they changed the allocation for liver based on the The government's Kinda directive to the transplant community to transplant the sickest patients first so it isn't How long that someone would wait for transplant? But how sick that. They have to get so waiting. Time doesn't really matter unless you have a condition where the scores adjusted because of a tumor something but unfortunately now many of our patients are getting far more sick than they were years ago. Oftentimes they're in the intensive care unit or even on dialysis for Kidney Failure. That results from the liver failure. So I heard you say I think that you would prefer to do a deceased person's US that Their liver as opposed to a living donor correct. We would always prefer to do a deceased donor liver transplant over a living donor transplant. If we can get the liver and the only reason that you would do a living donor. Transplant is if the person On the waiting list Couldn't you couldn't find a deceased liver donor for that person? That's right and the reason we wouldn't be able to find it as that. They're not quite as sick as the other people that are on the deceased donor waiting list. So their score which we call a MELD score model for end stage liver disease and that scores lower because they're not as much risk of dying although they're still pretty sick so in those situations where we can't get a liver until they get more sick we consider living donation. I think the last time that you were on the show with us you had just on your one liver surgery. That might be true so that was one thousand ago so tells about the day you did five in one day. Well it wasn't just me. It was our entire team and There was a day About a year and a half ago and we did do five transplants in one day in Rochester living and deceased donors. They were all deceased donors except for one was a heart liver transplant. And the liver. That patient had Disease called Familial amyloidosis where the liver is normal but it just makes too much of a protein in order to get rid of it you have to get rid of the liver and so you replace the liver with the transplant. And they also needed a heart transplant but deliver that we took out of that patient can be used for another patient and we pick patients that are a little bit older in their upper fifties to sixties or older and they get that disease when they get that new liver but it might take twenty thirty or forty years before it causes trouble. So that day we did do five transplants. One was what we call a domino transplant. The other were four deceased donors. That must be unusual to have that many deceased donor organs become available on one day. And we've actually done the math and for a program that does about one hundred transplants per year over three hundred sixty five days the chance of when we do one transplant chance of doing two or more is about forty three percent. Tell us about pig liver and other organ donation. Are we close to the point in time where we can take up a pig liver and transplanted into a human? We're not very close. But working out with pig cells. Dr Scott Nyberg has a lab and is developing techniques to use pig cells to support human particularly the kind of patients that might be an acute liver failure and just need temporary support with an artificial device Intel. Oliver becomes available or even if their own livermore recover but to actually use a whole organ from a from a non human Is Still on our future more fiction than fact? Yeah so far so you do one hundred a year at Mayo Clinic in Rochester. Three hundred a year system-wide terrific. We actually did a hundred and thirty one in two thousand and sixteen with about twenty one living donors and the rest were deceased donor. So it was an all time high for us as well. That's a Lotta lives saved isn't it? It is liberal. Let you live. That's correct Mayo. Clinic transplant surgeon. Dr Charles Rosen time for short break when we come back..
"dr tom shives" Discussed on Mayo Clinic Radio on Cancer
"Mayo Clinic Radio. Presents conversation about gynecologic cancers with gynecologist Doctor Jaime Gomez the show hosts? Are Dr Tom Shives? And Tracy McRae. This podcast was recorded on September thirteenth. Twenty sixteen. Welcome back to Mayo Clinic. Radio. I'm Dr Tom Shy. And I'm Tracy mccray Tracy the PAP test you've heard of that. Probably had fewer near day should have and that was developed by a Greek physician by the name of George Patton Nicolau. My wife is Greek. And she's going to really like me for this. So it came into use around the nineteen forties. But actually he had discovered that you could find malignant cells under the microscope. Actually in the twenties or early thirties but nobody never got credit for it. Nobody believed him. Dull around the nineteen forties when it finally came into use. And of course that test is called the PAP test or the PAP smear and is now used worldwide for the detection and the prevention of cancer of the cervix and other diseases of the female reproductive tract. What he did what he showed. Was that by gathering just a few cells from the vagina inside the vagina vaginal tract and looking at them under the microscope. You could actually tell whether or not a woman had cancer of the cervix pretty amazing breakthrough. Absolutely the PAP test changed the lives of millions of women and now researchers are working on a screening test for endometrial cancer. Also known as uterine cancer research funded by the National Cancer Institute and Mayo Clinic is developing a screening method using DNA from a Tampon for early detection and screening of endometrial cancers now unique is that DNA from Tampa. How so and and we're talking about uterine cancer as opposed to cervical cancer and the two are connected but the cervix is just the opening of the of the uterus with baby-boomer is now in the age risk category for endometrial cancer. The number of women diagnosed each year is increasing here to discuss this new minimally invasive screening method for endometrial. Cancer is the woman leading the research. Director Jamie baucom Gomez. Welcome back to the program. Dr Beckham Gomez thank you. Dr baucom Gomez Pretty Exciting stuff and truly unique tell us about this using a Tampon to diagnose endometrial uterine cancer absolutely. We're very excited about this. We've known for decades that abnormal cells from inside the uterus can be picked on picked up on PAP smears but it's not very commonly picked up that way there are other markers that are not naked That are not necessarily visible under the microscope. Such as molecular markers that we can actually now test for these are changes in DNA so DNA mutations DNA methylation which is where the gene is actually turned off because of a change to. What's kind of hanging onto the DNA called methyl groups And we can pick those Those changes up not only in the actual cells that are the cancer cells but when those cancer cells shed and flow down through the cervix into the vagina they can be picked up Those those signals can be picked up on PAP smear and we're actually taking it to the next level of Trying to pick them up on the fluid in the vaginal canal because it's in that fluid it's in that fluid and And the reason that we're focusing on detecting this using a Tampon is data. Tampon is a common hygiene product that most women use in fact The tampon business in the United States in two thousand fifteen one point five billion dollars so we know using using that as a surrogate that this is a very common while accepted collection prod collection device. It's not a special Tampon by any means the kind you just buy it the convenience store. Well we're doing from from the research standpoint we're just using the common over the counter regular about Tampon As we develop this test further a likely be something a little bit more specialized so tell us how this works a you you tell the woman To use a Tampon put a Tampon in and then take it out when and then bring it to you is that how does it work so right now. We have clinical trial open In which we are collecting Tampon samples from women who are coming in with abnormal uterine bleeding That are paramount of puzzle or postmenopausal. So it's still in the research phases And before they have a biopsy to determine whether or not there is what the cause of that admirable pleading is on. We're asking them to collect a Tampon They're doing that in the clinic. We time how long it's been in the vagina because that's also part of the test need to figure out exactly how long it It needs to be in the. What's the minimum amount of time? And then the then the Woman goes on to have her clinically indicated biopsy in. How's it doing so far Well so far we've enrolled almost a thousand patients to that to this clinical trial And we're working on the combination of markers DNA methylation mutation Markers a table a test in prospectively in those in those samples with this sounds were some somewhat similar to Coa guard where you take a stool specimen and look for abnormal DNA DNA. That will tell you whether or not the patient has colon cancer. Same principle absolutely. So guard is a combination of mutations. One mutation and Three methylated genes. And they're all they also look for fecal called Hemoglobin so much a colt hemoglobin doctor. Yep exactly so fecal a call him Gordon. They're looking for blood as well. So but it's a multi target DNA test that is self collected and exactly. That's exactly what we're trying to To do with this type of a test. is develop something that is highly patient accepted something that provides women with high access meaning. They could collect the sample at home and potentially mail it in. That's our ultimate view or ultimate vision. I should say that would make I would imagine. Make a big difference for anybody could take part in that. I mean it could be that someone notices that they're not feeling writer. They've got some symptoms but they don't end up going to see a physician. This would be a good step to get that ball rolling absolutely. We know that decreased access to healthcare Does worsen survival in certain cancers. So that's that is something that we are hoping that ultimately we impact so uterine cancer itself. What are the symptoms? Who's WHO's at risk for this particular problem? Yes so there are very well known. Risk factors for uterine cancer. Obesity is probably one of the largest risk factors for wearing fur and mutual cancer Also having diabetes hypertension Those are also hyperloop. -demia those are risk factors having a family history of Uterine Cancer Colon. Cancer Stomach Cancer Those symptoms those cancers tend to If there are families where you can actually see high numbers of those cancers and that's consider Lynch Syndrome are some families are diagnosed with Lynch Syndrome? Which is a genetic condition that puts women at higher risk for uterine cancer? You don't hear about very many women. Dying of uterine cancer. I know it happens but it must is not all that common so it must be very treatable if you can. Just make the diagnosis right. It is It is fairly treatable especially in early stages early stages typically the treatment surgery alone Even in advanced stages There are potential cures but usually it requires extensive surgery radiation and chemotherapy and the side effects of those are oftentimes long lasting. And what are some of the symptoms of endometrial cancer? Yes so symptoms. Ninety percent of women with endometrial cancer will present with some sort of abnormal bleeding or abnormal vaginal bleeding Postmenopausal women I About Even though ninety percent of women with cancer will present with abnormal vaginal bleeding. Only ten percent of women who come in with postmenopausal bleeding will actually have a cancer. Well that's a good thing. It is a good thing it is but also all of those women undergo an Mitchell biopsy which is an invasive procedure and. We're looking to try to help void that as well. It's it just as interesting just as an exciting just as incredible caller of art so We wish you all the success in the world. But now we'll expand our discussion to other reproductive system cancers because September is gynecologic cancer awareness month so Dr Gomez why Why is Ovarian Cancer? The the worst of all of these so ovarian cancer has kind of a long standing nickname. And that is that. It's the silent killer The signs and symptoms of ovarian cancer can be very vague. Despite the fact that it's already in its advanced stages the signs and symptoms of ovarian cancer typically fall into four categories or for For symptoms and that as abdominal bloating distension Change in appetite or society basically getting full fast when you eat Bowel changes Whether it's swinging constipation or diarrhea And then bladder changes Frequency a frequency of urination or urgency. So let's go over those. What's more loading Just WanNa make sure that that all of our listeners have. These bloating is one but that everybody has that at one time or another and you sort of write it off yet. We're talking about something that's constant that's persistent for. You know. Probably more like two weeks or so rather than an intermittent type of process But you're right. That's why these scientists. These symptoms are quite vague. All right and then you had bowel changes Bladder problems and a number two and I had to do with eating society full fast. So is ovarian cancer in a sense somewhat. Like cancer of the pancreas in that because the the ovaries are so deep-seated that tumor has to get fairly large before it does cause any symptoms and by that time it has often metastasized or spread elsewhere. Yeah there are different patterns As far as the spread of ovarian cancer but most often the GI type of symptoms the bowel changes and even the early Feeling full early in a meal. are probably related to the Matassa metastatic deposits that are on the surface of the small intestine large intestine and sometimes even the stomach. So what's this a five year survival rate now for women with ovarian cancer and compare that to? Let's say a decade ago. Are we better? We're better yeah. We've definitely made a lot of progress. I think it's it's hard sometimes to go through to actually dissect what the Five Year. Survival is for ovarian cancer in general because most ovarian cancers are diagnosed at an advanced stage One of the most important prognostic aspects is thorough surgery In the beginning of the diagnosis out. Good you can get it all out. That actually improves five year survival And some studies have actually shown that at five years More than fifty percent of women are still alive who were diagnosed with advanced stage disease. Where is it usually go to from the ovary it starts there? Then where does it spread? it likes to go to an organ that's inside. The abdomen called the mental It is an organ that hangs down off of the stomach and large intestine. So it surgery if you can if it's a metal to the surgery hasn't spread to too many places or too far away from the ovaries chemotherapy. And what about radiation is it? Ever part of the regimen radiation used to be part of the regimen for ovarian cancer but it has It has fallen out of favor. Because we've shown that chemotherapy is actually more effective so treatment for ovarian cancer is a combination of surgery and chemotherapy. Sometimes we give chemotherapy first and then surgery in between two courses of chemotherapy. And what's the average age of the woman diagnosed with ovarian cancer most often? The woman that segments with cancer is going to be in her early sixties so it is yes. September being gynecologic cancer awareness month. We've talked about endometrial cancer and ovarian cancer What's up next cervical while cervical cancer? Also one of our specialties. How deadly cervical cancer so cervical cancer actually the mortality in the United States as well as in other developed nations has dramatically decreased with the introduction of the PAP smear Back in the nineteen forties We also now have the vaccine against the Human Papilloma virus which causes most of most cervical cancers That vaccine or those vaccines. I should say because there's actually a series of them that are that are available those vaccines. We don't think we've seen the impact of them yet. because those are vaccines that are currently indicated for For Young Women Ages Eleven and twelve and men too and Manitou. Yup exactly if enough people love of young people get vaccinated weekend pretty much. Wipe out cervical. What percentage of cervical cancers are caused by this virus ATV? Almost all of them are caused by high risk type of virus. Seventy percent are caused by two specific viruses. Hp Sixteen at HP eighteen in the vaccine. Good against both of those. It is all three. Vaccines that are available are include. Hp Sixteen Eighteen. What's hard to believe but women can also get cancer the vagina often. Do you see that so vaginal cancer is much more rare than than cervical cancer but it is also most often caused by those same viruses the HP viruses the key of that HP. It's it really is a cancer vaccine. I think people tried to diminish it a little bit saying Oh it's a sexually transmitted disease thing but it's it really is a cancer vaccine. Yes it is all three of the vaccines that are available are against The include HP sixteen eighteen As.
"dr tom shives" Discussed on Mayo Clinic Radio on Neurosciences
"Mayo Clinic Radio presents a conversation about functional neurological disorders with psychiatrist. Dr Jeffrey Stab. The show hosts are Dr Tom. Shives and Tracy mccray. This podcast was recorded on August. Thirty First Twenty sixteen. We'll come back to Mayo Clinic Radio. I'm Dr Tom Shives. And I'm Tracy mccray according to the National Institutes of health what was once called conversion disorder. But his I'm now more commonly known or maybe better known as functional neurological disorder. That's a condition in which you show a logical stress and physical ways. Your mind affects your body. In unusual ways sometimes conversion disorder or functional neurological disorder can present his blindness paralysis or other nervous system symptoms symptoms. That really can't be explained by physical illness or an injury. It's frightening symptoms may occur because of emotional distress or psychological conflict and they usually begin suddenly after after a stressful experience or traumatic event here to discuss conversion disorder need. Stop calling it that. It's functional neurological disorder and how it can be treated is. Mayo Clinic Psychiatrist Dr Jeffrey Saab. Welcome to the program. Thank you thanks for having me. Okay why did it have to get changed? Well there's really a couple of reasons but the main one is because the idea of it being related to psychological stressor which really dates from the time of Freud and others. One hundred years ago isn't something that holds up all the time. People can develop functional changes after a medical event and sometimes for reasons that we can't pin down so we certainly look for people who have undergone difficulties either in their present life or past life and sometimes find them connected but other times we find a medical trigger a fainting spell or or a medical. There are medical illness. Sometimes we really can't sort out what what triggered it so there. There's the there's the common. There's the unusual and there's the rare but then there's the really curious curious and peculiar and maybe confounding and this sounds like it's in that category right. It's it's so all of us that practically any doctrine in in Practice right now is trained to think that when a patient presents with a symptom whether it be spell of passing out or a movement of the arm or lack of movement of the arm is that we look for neurological causes. We look to see if something more with their brains their muscles their nerves and and if we don't find anything then we presume that psychological The problem is that we can't always find the psychological and so that's been a sort of an either or way of thinking that is isn't always put us in our patients in the best spots so as we go through evaluating people who present that way we certainly look for the psychological things but sometimes we don't find anything in particular and neither do the neurologists and neither does anybody else but it's still a treatable condition and that's the best part of this as even though it's sometimes mysterious we can do something about it so you've seen I'm sure In in fact we mentioned at the beginning that these people can have blindness or they can have paralysis or other nervous system disorders or symptoms. So how do you go about evaluating somebody and ended up putting them in this category but functional neurological disorder? Well we have to work as a team so we can't psychiatrists do it alone. We work together with neurologist and sometimes bringing a general internist to help us as well and so we. The first thing we do is listen to the story. Listen to how this is developed and how it's changed over time. And sometimes that gives us the clues the the triggers or something it to patients and their families might have picked up and if we give them some time to tell us about it we can see that and look in Lynn. Listen to the patterns and then we do have to evaluate the the parts of the nervous system that could be affected gaining of the brain any EG to look for seizures laboratory tests to make sure. There's not infections or other things like that. That's a part of the the evaluation and then from the psychiatric standpoint to look at person's past history. How they developed recent things that may be going on in their in their life. We look for all of those clues to try and put the picture together. Last thing about this is not either or there are patients who have both a stroke and a functional problem together or Epilepsy and functional spells together. And so that's another thing that we're all taught was thinking in either or ways and that That feels a lot of patients who have one thing triggering another and then both exist together. I can't imagine for the patients. This has to be incredibly frustrating and frightening. Well well it is for a couple of reasons one is that some of these symptoms are very dramatic. I mean people can have completely lose consciousness. People can have what looks for all the world like an epileptic fit. People can have a loss of memory that goes on for hours or days and so they're very frightening symptoms and and And the way that they present All of us think well this has to be something wrong with the brain of possibly be something That that comes from a psychological process or can't be my mind doing this to me and again we can't always say that that's the case but and so as a result a couple of things happen. Patients oftentimes get very extensive neurological valuations for tough things for strokes for for LS for problems for Mathis from multiple sclerosis problems like that. We're very very frightening to go through an evaluation where somebody thinks that. That's maybe going on. And then when they get to the end of the road and their doctors are not left with answers. Then they're starting to say well you know this has to be something going on with you and that's when it's very difficult to shift gears do well. What would you do to help these patients right? So there's there's a couple of things first of all if we do happen to find something that's gone on in the person's life Then we have to address that I've encountered many patients who have a sudden event occur everything from a woman who became paralyzed after an earthquake because she was over well mainly frightened that something bad had happened to her family to people who go through stressful times in their life. So we look for those. And if that's present we can address those if there if we can't find a specific caused there. There are a number of different behavioral strategies that we can use our physical therapists work closely with us so somebody's having paralysis problems or or movement abnormal movements or or walking difficulties the physical therapist can can rehabilitate them using techniques that they've been taught over over many many years. So it tells you about one of the most unusual cases that you've seen with unusual presentation. Sure I used to teach patients about this is is when I was in the Navy. I was stationed in Guam and earthquake. Eight point two magnitude earthquake so pretty big And it was a woman who was from her family at the time she was visiting and other village and she was brought to the emergency room about a half an hour after the earthquake deaf dumb blind mutant lane. No Yes yes abso absolutely nothing. So of course. We wondered if she'd been injured because she was by herself. And she hadn't been medically neurologically. She was perfectly fine and in that particular case what had happened was she became at. The time of the earthquake became so overwhelmingly frightened that her sons daughters or grandchildren had been had been injured that literally her body shut down the old sort of see no evil hear no evil walk to no evil experience. No evil is what happened with her. And when one of her family members came to the hospital to find her and said that you know the house is a mess. But everybody's okay. We give her that information and kind of help to coax her back to walking again and then seeing again in an hour and a half she was able to leave the hospital perfectly fine so that's an example of how intensely overwhelming sudden fear can be but we've also seen circumstances in which just as dramatically people have things like headaches migraine headache that produces some change in vision or some change in movement that we know migraines can do but then goes and gets elaborated into a much bigger picture and they're trading treating the headaches as the solution so most of these Resolve spontaneously in. What your role as a psychiatrist and helping the patient get better well. Some of them resolve spontaneously so sometimes people have distinct spells. And they go on for Awhile and then go away. But but Left untreated some functional. Disorders can continue for years and years. So if somebody's getting better and you know we can help them understand what happened and continue the process of recovery. We don't have a lot to do but if they're not getting better than we do have to work together. Again with neurology. Physical therapy and art our team of therapists to address all the pieces. That might be part of the part of the picture. We have a truly interesting job. Don't you it's fun? How how often do you see one of these people? We we see about three to four day every day my team. Yes with functional neurological so movement problems persistent dizziness or Vertigo Spells. Fainting or other similar spells. Yeah our team. Our team has specialized in this This type of a of a problem over the last few years. Well you know certainly. Some things in medicine are difficult to explain it very unusual and and some of the people that you see some of the most unusual things we've heard about on this program Dr Jeffrey. Stop the psychiatrist at the Mayo Clinic. Talking about functional neurological disorders. Thanks so much for being with us. Well it's been a pleasure. You're quite welcome. Glad to be here for the latest in health and medical news go to news network DOT Mayoclinic Dot Org..