Search for tag: "advice"

Dr. Tarbox: Hello and welcome to "Skincast." This is the podcast that helps you understand how to best take care of the skin you're in. You wear your skin your entire life. It is the most expensive garment you will ever wear so you want to take great care of it.

My name is Michelle Tarbox, and I am a dermatologist and a dermatopathologist. I'm an associate professor at Texas Tech University Health Sciences Center in beautiful sunny Lubbock, Texas, and I love helping people take better care of their skin. And joining me is my co-host...

Dr. Johnson: Hey, this is Dr. Luke Johnson. I'm a pediatric dermatologist and general dermatologist with the University of Utah.

Dr. Tarbox: So today we're going to go over acne basics. Acne is a common skin condition that affects most people at some point in their lifetime, and utilizing a few simple techniques you could really help minimize the impact of this condition on your skin.

Dr. Johnson: So acne is super annoying. I had pretty bad acne when I was a young lad. I still get the occasional pimple even though I'm 40. Really seems unfair. But when I, you know, became a dermatologist, we learned about what causes acne. And actually, I remember being a teenager sitting in my dermatologist's office and looking with fascination at the posters on the wall about the causes of acne.

So, in dermatology, we consider acne a disease of the hair follicle unit. So one of the first things that happens is that the hair follicle gets kind of blocked up with sticky skin cells. And the hair follicles are often connected to oil glands, and the oil glands produce oil. The special term for this kind of oil is sebum. And so since the sebum can't get out of the hair follicle because the hair follicle is blocked up, the hair follicle gets all kind of filled up with this sebum.

Dr. Tarbox: And one of the interesting . . .

Dr. Johnson: Who likes to eat sebum? Bacteria like to eat sebum. So bacteria come to eat it, and then that creates an inflammatory reaction from your immune system and that sort of really gets the whole ball rolling down the hill.

Dr. Tarbox: That's actually one of the things I like to think through as kind of fascinating that these bacteria, which are called Propionibacterium acnes — they're named after the condition that they cause — are almost like little farmers of the oil that they eat. So they actually make our skin cells more sticky to each other so it plugs up the hair follicle more, and that actually makes a little reservoir of oil that these bacteria can use as a food source.

Dr. Johnson: And you might wonder why this tends to get worse around adolescence. And hormones play a big role as you might guess. A lot of the hormones make your oil glands crank out more oil and they make your skin a bit stickier so it makes the whole thing worse.

Dr. Tarbox: Whenever you have that backup of oil, it can actually break open the edges of the hair follicle and then that skin oil and possibly those bacteria and the dead skin cells get into the part of our skin that's not supposed to have foreign bodies in it. So if you've ever had a splinter and it got inflamed and red and irritated, you know how much our skin doesn't like things that don't belong there. And that oil is just as inflammatory.

Dr. Johnson: I think it's helpful to understand why acne shows up because then we can understand how the treatments work. So the treatments for acne affect some of those factors that cause the acne to begin with. And our best treatments are those that can affect more than one of those factors at the same time.

Dr. Tarbox: Here on "Skincast" we are not sponsored, but we are going to mention specific trade products because it makes it easier for patients to find them and I think that it's a little bit less complicated than people scouring an ingredient list looking for a specific and very technical chemical name.

Dr. Johnson: Yes, we have no commercial interests. This is just stuff we found that is good for our patients. And if you've got some acne, then there is some over-the-counter stuff that's fairly helpful. One of my favorites is a medicine called benzoyl peroxide. Not hydrogen peroxide. That's something else. This is benzoyl peroxide. It's in a lot of over-the-counter acne treatment products. So if you stroll down the acne treatment section in your local grocery store, you'll find benzoyl peroxide in various concentrations. Usually it's something like 4% to 10% that's present in cleansers, in spot treatment pads, in creams, and in various other formulations.

Dr. Tarbox: Benzoyl peroxide can be a great help when you're dealing with acne. One thing you do have to be thoughtful about is that it has peroxide in it. So if you've ever bleached your hair or thought about bleaching your hair, you might know that peroxide can lighten things. And it's true that if you have a benzoyl peroxide product on and it gets on a bed sheet or a towel or clothing, it can lighten or bleach the clothing. If you have fine light brown hair, it can also lighten your hair color around the hairline.

Dr. Johnson: Yeah. So this is one reason why I like it as a wash or a cleanser. I figure most people are washing their face anyway. Might as well put some medicine in there so you don't have an extra step to do. I say wash your face in the morning with this stuff because then they're not immediately putting their face on a pillowcase and discoloring their pillowcase. You do want to use white towels though or you'll have some messed up looking towels. That's the main downside with this benzoyl peroxide stuff.

It can also be a little bit irritating to the skin. In general, the lower percentage, the less irritating it is. So how sensitive is your skin? If it's not that sensitive, just buy whatever's cheapest, like I do, the generic brand. But if it's a little bit sensitive, there's a couple brands out there that are especially gentle. There's one called AcneFree. All one word. You might have to get it online. It's 2.5%. And then CeraVe makes a good one called Acne Foaming Cream Cleanser. It's 4% benzoyl peroxide. Also, very gentle.

Dr. Tarbox: I really like that CeraVe product, and I think that patients can do really well with benzoyl peroxide. Some people can't tolerate it, and, in that setting you can potentially use a milder wash made from something called salicylic acid, which is actually a relative of aspirin.

Dr. Johnson: Yeah, I do prefer benzoyl peroxide, but salicylic acid doesn't have this bleaching property and is usually present again in the same sorts of products that benzoyl peroxide is found in. Usually it's 2%. And if the benzoyl peroxide is just too irritating or you hate that half of your clothes are discolored, then salicylic acid is a decent option.

Dr. Tarbox: If you are aspirin sensitive, you would not want to use salicylic acid, and if you're pregnant, you would not want to use salicylic acid as it is a derivative of an aspirin-like chemical.

There's another wash that I really like for patients who have very sensitive skin that can't tolerate benzoyl peroxide or salicylic acid. This is a product from Cetaphil that actually has zinc sulfate in it, and it's an oil control acne wash.

Dr. Johnson: So there's our cleansers. Something else that's really nice that's over-the-counter is a medicine called adapalene. The brand name is Differin, D-I-F-F-E-R-I-N. Differin the brand makes several products now I think. So you want the one that's called Adapalene, is the medicine.

Until about five years ago, this was a prescription product that cost about $220, and now it's an over-the-counter product that costs $12. So a rare example of medication costs moving in the right direction. It comes as a gel, and you put a little blob of it on your finger. I usually recommend that people do it at night. And then you get that blob on your finger and you kind of dot it all over your face and then you rub it in everywhere.

So neither of these approaches is a spot treatment. Both of them go over your whole face because they help prevent acne from showing up as well as treat acne that's currently there.

Dr. Tarbox: If you're looking for adapalene over the counter, there are a couple different brand names. Differin is the original brand name, but you also can buy it as a La Roche-Posay product. That's a French company that retails products across to pharmacies in the United States. And the name of that line is Effaclar.

Dr. Johnson: I did not know that. It can also be a little bit irritating. Usually not too bad. But I usually tell people if it dries you out, just give your skin a break for a day or two, let your skin recover and then come back to it. Most people's skin will kind of get used to it. If you find that you're using it every night and it's not irritating you at all, well, you could probably step it up to a prescription strength version of the same thing.

Also, this is a retinoid. So there are components called retinol that are in a lot of over-the-counter sort of anti-aging products. And they also work. They're pretty similar to adapalene. They tend to be a little bit higher priced though. But the reason that they are in these anti-aging products is because adapalene and retinol and all these things are good not only for acne but also for scarring, for wrinkles, for dyspigmentation, so pigmentary changes in your skin. Basically, anybody who's not pregnant or breastfeeding should probably be putting one of these things on their skin.

Dr. Tarbox: Yeah, I love my topical retinoid. I don't leave home without it. Speaking of irritation, sometimes people, when they have bad acne or acne that they're frustrated with, will really kind of go after it with everything and the kitchen sink and they can end up really stripping their skin and making it too irritated and dry, which can actually make the acne worse.

Dr. Johnson: Yeah. So just as important as knowing what to do, things like benzoyl peroxide and adapalene, are knowing what not to do. So your poor little skin doesn't need astringents, it doesn't need scrubs, and it doesn't need things that are just too expensive. So sometimes I have patients who come in and they bring their Ziploc bag full of products that they've been using and I love it when people bring them, but it kind of breaks my heart that they've been spending 20 or 30 bucks on a benzoyl peroxide cleanser because you can buy one of those for 4 or 5 bucks.

So things don't have to be expensive, in fancy bottles, and advertised on television for them to work well. You just want to look for these ingredients — benzoyl peroxide, adapalene, retinol, things like that.

Dr. Tarbox: Sometimes patients will also over exfoliate. There are products that are coming off of the market because they have microplastics in them with those little beads that sometimes were included in products for exfoliation. And there are also products that have ground up walnut shells and things like that, which are pretty abrasive to the skin and can do more harm than good. If you want to gently exfoliate, a gentle facial brush that you keep clean and use with minimal pressure is a great alternative.

Dr. Johnson: So those are pretty good things that you can do over the counter. But what if you've done those or your teenage kid has done those and they've still got acne? Well, it might be time to go to a dermatologist. Another reason to go is even if you haven't tried those things, if somebody's acne is moderate or worse and all of those over-the-counter things just aren't going to be good enough, come to one of us. There's really good acne medicines these days. Really the only downside for our acne medicines is that they take a little while to work. So I am sorry if you are getting married next week. There might not be a whole lot that we can do. So come early. It usually takes our medicines about three months to really kick in, but after that, modern medicine does a pretty good job of treating acne.

Dr. Tarbox: Yeah, I always remind patients if your acne is leaving footprints, if it's scarring, you want to seek professional help because scarring is permanent and while we can do a lot of things to help improve those sort of scars that are formed over the years, like chemical peels and microneedling, it's better to prevent than to treat those scars.

Dr. Johnson: I would like to have a little myth-busting section of our podcast here because I think there's a lot of myths out there around acne. One of the main things that gets bandied about is diet. So there's been a fair amount of research into diet and acne, and I will admit that, before I read some of this research, I just didn't think diet mattered at all. Now I think that diet matters... just a little bit.

So the research says that if you have a high glycemic diet — so that's a diet where you eat a lot of like sugar and fat and carbs and things — that can make your acne a little worse. And for some reason, skim milk specifically has been associated with acne. Again, I think the effect is pretty mild. So if you have a high glycemic diet and you drink a bunch of skim milk, instead of having five pimples a month, you might get seven. So it's not really going to make or break things, but there is some data out there. So if you want to listen to your grandma and not eat that bag of Doritos, it might help your face a little.

Dr. Tarbox: Yeah, the skim milk connection is really fascinating, because when you have skim milk, it's had the fat taken out of it so more of that product is protein. And our hormones are proteins. Animals that aren't raised organically sometimes have extra hormones added to make them big and strong and overproduce milk, and those can affect some patients. If you are sensitive to that, going for the organic alternative or going for a vegan alternative may help you.

What about cleaning the skin, Luke?

Dr. Johnson: Well, I don't think cleanliness is as important as a lot of, well, to be honest, mothers and grandmothers seem to tell their children and grandchildren. Obviously, you should do something, but blackheads, for example, are not black because there's dirt in there. That's the sebum, remember the oil, and it just gets oxidized when it's exposed to the air and it turns black. So it's not dirt in the skin. And you don't need to be overly vigorous, as we've discussed, with these scrubs and things. So I think washing your face once a day with something gentle, especially with something with some acne medicine in it, like we've discussed before, is probably all you need to do. But having acne does not mean you are an unclean person.

Dr. Tarbox: That is such a good thing to tell people because sometimes there is a stereotype that goes along with bad acne especially. If I have an active young person that's a student athlete, I do like for them to cleanse their skin after exercising, and the product I really like for this is something called Simple Face Wipes because they're little pre-moistened towelettes in a little convenient packet that can go right in the gym bag and the patient can just wipe their face down after exercising or sweating and it helps to decrease that kind of post-exercise gunk that sort of stops up the hair follicles.

Dr. Johnson: When we think about acne, we're often thinking about teenagers, but acne can show up in other people too. It can show up in adults, especially women, in which case it's often hormonal and we do have hormonal treatments. So there is hope out there if you are such a woman. Come in and see us. We can do stuff. And then I can see it in fairly young kids too. So, from hormonal standpoint, puberty supposedly begins around age eight. And, you know, having a couple of little kids of my own, that's rather terrifying. But I have seen acne show up in, you know, eight years, nine years. Usually, it's pretty mild, but I have had some significant acne in kids as young as about 10.

Dr. Tarbox: There's another special form of acne that can happen in young women called acne excoriée, and it actually has a French name. It's acne excoriée des jeunes filles ,which means 'the picked-on acne of the young woman'. And this is usually occurring in young women who are a little bit stressed out, often successful, intelligent, driven young ladies that sort of express a little low-level anxiety by picking at the acne lesions often sub, kind of, consciously. So bringing that to your attention, if you are a person that picks at the skin lesions, is a good idea and you should remember that the little scars and the marks that are left behind after manipulating or picking at an acne lesion are going to last longer and scar worse than the acne lesion itself.

Dr. Johnson: Don't pick at your acne. There. You heard it from some dermatologists.

There are some other sort of special forms of acne. Most of the time, when we see acne, it's standard acne or what's called acne vulgaris. But there's a form of acne called acne mechanica. So if you're wearing something like a mask, for example, on a part of your skin, then that can further occlude those little hair follicles and make acne a lot more likely. So maskne is a form of this acne mechanica stuff. People who wear a lot of sporting equipment, you know, goalie masks and things or fencing masks, I've seen it or surgical caps. I've seen that in surgeons because it occludes their forehead and they get acne there. I see it in military recruits who have to wear backpacks a lot. They get it on their back. That kind of thing.

Dr. Tarbox: You can also get acne from products that are put on other parts of your body. So if you use heavily oil-based products on your scalp, over the course of the day the heat from your body will melt those products and it just sub-clinically trickles down from the hairline to the eyebrows and patients can have a flare of acne on that forehead region because of their hair care products.

Dr. Johnson: Apparently, according to the textbooks, acne is also worse if it's really hot or humid. I live in Utah, where it's really hot, especially today, but it's not humid. But it has its own special name — tropical acne. So if you are a military recruit in some tropical place, I hope your back does okay.

Dr. Tarbox: There's certain medications that can also cause acne. Steroids, either steroid hormones, like the male and female type hormones, or steroids such as glucocorticoids or prednisone can cause acne to worsen as can other kinds of medications that are sometimes used to treat seizure disorders.

Dr. Johnson: But if you are taking one of those medicines and you get acne, we can help. So, you know, if you need to take testosterone or you need to take other hormone replacement therapies and things, then it makes sense to come see one of us if the acne is giving you trouble.

Dr. Tarbox: And especially if it's an anti-seizure medication. Those are not medicines you want to mess around with. So, you know, you would continue to take those based upon the recommendation of the doctor that takes care of you for those and then seek the expert advice from a dermatologist.

Dr. Johnson: I hope that you guys found this helpful. And we want to thank our institutions. Thanks to the University of Utah and to Texas Tech. And if you are a real dermatology nerd, you might be interested to know that Michelle and I co-host another podcast, which is really targeted at people practicing dermatology, but hey, maybe you'll find it interesting as well. It's called "Dermasphere," D-E-R-M-A-S-P-H-E-R-E.

Interviewer: We're talking with Dr. Michael Good, who is the CEO of University of Utah Health. And here at thescoperadio.com, we got word that Dr. Michael Good was spotted in the hospital, so we wanted to find out what was going on. Now, I don't know but is it common for a CEO to be in the hospital late at night rounding?

Dr. Good: I don't know what other hospital and health system CEOs do. I hope they do that. Taking care of patients is both a real privilege and also a great responsibility. And we have great people here at University of Utah Health, and it was really a pleasure to get to meet and chat with many of them last evening.

Interviewer: Well, tell me more about why you were there, what you saw, and what happened.

Dr. Good: Last evening, I spent over three hours with our mobile nursing supervisor walking the hospital, checking in with our charge nurses, and just seeing the hospital at work in the evening hours. The daytime shift gets a lot of attention and focus. A lot of things happen in the hospital during the day that's really important. But I can tell you at 10:00 p.m. last night, there was really impressive health care happening, and that's where I wanted to spend my time last evening.

It was just really impressive to see our people at work. Many of the patients' care was following routine protocols, but I also saw our people really called into action. There was an infectious disease exposure, and Jared, the nursing supervisor that's one of his responsibilities is to see if the patient will consent for a blood specimen so we can help sort out the health of our healthcare provider. We had a patient sign out against medical advice last night. And health care is intense and it's challenging, and there's a lot of emotional discharge, if you will, from our patients. And particularly our nurses are on the frontline of that.

We had a behavioral emergency, where the team also included security and really having to help a patient understand what is acceptable behavior in our hospital and what's not.

And then really where I was most proud, pretty late into the evening, we have a rapid response team. It's where a patient on the medical ward, where their vital signs, their heart rate, their blood pressure, their oxygen saturation, their breathing rate crosses certain thresholds and the team rallies. It really was a multidisciplinary team that came together, physicians, both general and specialty physicians. There were nurses, both the nurse that was taking care of the patient, but as things became urgent, the charge nurse came in and also participated. As things became more urgent, the nurses that are part of our rapid response team came. An EKG technician came and performed that. As blood cultures and other laboratories tests were needed a member of our phlebotomy team came. And it was really like a great orchestra.

It's really hard to describe the sophistication, the teamwork, and the level of care that quite honestly you'll observe every night happening over and over again here at University of Utah Hospital.

Interviewer: Were there any takeaways from last night that is going to change anything that you do?

Dr. Good: You spend an evening in the hospital, and I was supercharged. It makes me want to come to work in the morning and work even more so to make sure our staff and our faculty have the tools, have the resources, have the things they need to do to excel in their work. I couldn't help but notice last night, as we moved through the hospital, how many of our team members were wearing their top 10 for 10 Patagonia vests. Last year for the 10th year in the row, University of Utah Hospital was recognized by Vizient, a national organization, as being in the top 10 for inpatient quality of care and being in the top 5 for ambulatory quality of care. And, of course, those Patagonia vests are now a year old.

And while a year ago, we were 10 for 10, one of the things that got lost, if you will, in the fog of the coronavirus pandemic was that this year University of Utah Health was number 1 in the country for inpatient care 11 for 11. So there was a lot of pride of ownership. One way that people display that is with they're proud to wear the vest, if you will.

It was just re-energizing to see great care being delivered late at night when there's not a lot of attention or not a lot of spotlight, but really special people taking great pride in their work and knowing that they made a difference in the life of their patient last night.

Interviewer: You had an opportunity to interact with some of the great providers and people that make all this possible, but you also, were not able to interact with everybody. So I'd like to give you an opportunity as we wrap this up to deliver a message to everyone, all the great individuals working at U of U Health. What would you say?

Dr. Good: I want to say thank you to each member of the University of Utah Health team. What you do is so impressive, so meaningful, so impactful, so often life-changing and life-altering for our patients. I couldn't be prouder of you. I couldn't be prouder to be a part of this team. And I am very optimistic about what you will do in the year ahead.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

If you've ever looked up your medical symptoms online, it can seem like every website assumes the worst possible scenario. These results can be alarming to say the least. So where can you find reliable health information online?

Dr. Troy Madsen has dealt with the stress of trusting bad online information personally and professionally with his patients. He's put together a list of websites he uses and has found to be the most reliable to find information on any medical topic.

• Centers for Disease Control and Prevention (CDC)
• The Mayo Clinic
• The Cleveland Clinic
• University of Utah Health
• MedScape.com
• UptoDate.com

Each of these websites are from reputable health organizations run by professionals. Dr. Madsen highly recommends using these sources over a basic web search to make sure you're getting the best information possible. How Can You Tell if a Health Article is Valid?

When it comes to research you see in your news feed, it's easy to get bad information. There are a lot of potential problems with online health journalism. Media groups often write articles about science and medicine in a way that can get them clicks. Due to limitations, the story is not always able to go as deep into a topic as is necessary to fully understand the complex nature of scientific studies. And finally, most journalists lack the medical or scientific background to accurately present the findings.

Dr. Troy Madsen has a list of tips that he suggests everyone follows when reading any study to help you decide if it's true.

• First and foremost, make sure the article links to a published scientific study. If there's no study, there's a good chance the information in the article is misleading.

• Make sure the linked study actually claims what the article says. Most scientific journals will give access to the abstract or short summary of the research for free. Read through to make sure the journal isn't twisting the findings.

• Make sure the study is published in a reputable scientific journal. There are "predatory journals" that allow any group to pay to publish research in official sounding publications. To be safe, only trust journals like The New England Journal of Medicine, The Journal of American Medical Associations, The Lancet, or The British Medical Journal.

• Avoid studies that make bold and definitive claims. Science is nuanced and seldom makes hard and fast claims about anything.

• Make sure the claims are backed up by multiple studies. For example, if chocolate really did cure cancer, multiple studies would be looking into it.

• Be sure to check the sponsor of the research. It's not uncommon for companies to back skewed research that shows the positives of their products.

Be a skeptic! Next time a scientific story comes across your feed, keep an eye out for these elements to make sure you really are getting reliable information. What Makes a Good Scientific Study?

Troy also suggests a few things to look out for when judging the validity of a study. A good scientific study should have the following:

1. Low "P-values." A p-value is a statistic that describes the likelihood of the collected data having errors. As such, a lower p-value means a more reliable study. Look for data with a p-value less than .05. That means there is less than a 5% chance of the data being wrong.

2. Large numbers of subjects. A scientific study about health should include over a thousand subjects minimum. Ten thousand is even better.

3. The best type of studies use "randomized control trials."

4. The gold standard for medical research are "prospective studies," where the scientist actively follows the patient and their behavior rather than rely on anecdotal information.

Maybe you didn't chew as well as you should have. Now you have a piece of food stuck in your throat. It's not obstructing your airway, but it's definitely uncomfortable or painful. The food won't come up, it won't go down. ER or Not?

First, make sure the food isn't obstructing your airway. Any blockage of the airway needs to be seen at an ER immediately.

If you can't get the piece of food up, you may need to go to the ER to get it removed by a professional. But first, there's a trick you can try at home that may save you a trip and the cost of an ER visit.

Take a drink of a soda, preferably a cola. Try to get a swallow of the cola down your throat and let it sit there for five minutes or so. Carbonated cola has some properties that will help the esophagus relax. It may be able to relax your throat enough to swallow the food the rest of the way. Repeat a few times if necessary.

If the cola trick works, it is important to go talk to your doctor afterwards. There are some conditions that can be related to getting food stuck in your throat that would be important to catch to diagnose and treat.

If the cola didn't help push the food through to your stomach, you will need to go to an ER. You will need to be treated by a gastroenterologist immediately. An urgent care will not have that kind of specialist on hand. Try to go to a larger ER that would have an oncall specialist. Housekeeping - Hello Ladies.

This podcast is called "Who Cares About Men's Health." The goal of the show was very focused and very singular. Create a podcast by men, for men. Yet our our most recent statistics surprisingly show that about 40% of our listeners are women.

Guess this just goes to show that women also care about men's health.

Listener Danielle recently gave us a shoutout on Facebook.

"I love listening to bits and pieces of this podcast Who Cares About Men's Health. You don't have to be a man to find it interesting."

Women, if you are listening, be sure to share it with the men in your life. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Troy would rather have a broken finger than a long-lasting cold, because he can't get sympathy. Scot has a moment of honesty about his personal health struggles and he reminds us that health is a practice with ups and downs, not a linear journey. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Dr. Chan: What is it like to move away from your family in Utah to attend Harvard University? How do you choose which college activities to be involved in with your limited time? How does one create a community or second family while far away from home? What's it like to be part of The Arts Board for the "Harvard Crimson"?

Today, on "Talking Admissions and Med Student Life," I interview Ha, a first-year medical student here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world. This is "Talking Admissions and Med Student Life," with your host, the Dean of Admissions at the University Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Well, welcome to another edition of "Talking Admissions and Med Student Life." Great guest today, Ha.

Ha: Ha.

Dr. Chan: Ha. All right. Start med school next week.

Ha: Yes.

Dr. Chan: How does it feel today with less than two days to go?

Ha: I'm very excited, but I'm also very nervous. So I think they cancel each other out and I just feel maybe Zen about it.

Dr. Chan: Zen. That's a good way to do it. What plans did you have this weekend? How are you going to . . .

Ha: So I hope to watch some movies, read a lot of books. I have a huge pile of books. And a couple of my friends from high school want to do archery. So I'll just be going to the archery place down at Sugar House for that.

Dr. Chan: Oh, fun. I've seen that place. Do you do archery?

Ha: When my friends want to, I come along with them. But it's been a while.

Dr. Chan: Do you help spot them? Do they need spotters? Does that exist in archery?

Ha: I don't think you need spotters, but definitely, it's just fun to have someone there with you to watch and congratulate you when you hit the target and things like that

Dr. Chan: Yeah. Especially if it makes that sound, like thwap.

Ha: Yeah. A lot of fun.

Dr. Chan: Cool. All right. So let's start in the beginning. At what point did you think about becoming a doctor? Was it when you were your young or was it more in college? When did that decision start solidifying?

Ha: So I started becoming really interested in medicine maybe when I was about around 10 or so.

Dr. Chan: Ten? Okay.

Ha: And that came from my experience with my grandparents. When I was growing up, my grandparents lived with us and they often had a lot of different health concerns and various issues. So the hospital just became a really big part of our lives. And even though I was too young to be brought along with them, I would hear a lot about their visits afterwards.

And for me, I think the thing that interested me in medicine was that it was a very scary time. I remember there was this particular moment like seventh, eighth grade, around that time, when my grandpa got diagnosed with melanoma. And then on the day that he got surgery for it, my grandma fell, fractured her spine. And then a couple of months later, we also found out that she had cancer too. And so, during those months, medicine was just really prevalent.

And I think that there was a lot going on, like factors outside, that could have caused a lot of troubles for my grandparents. They didn't really understand English. There are always concerns about the cost of treatments and everything, but my grandparents always loved seeing the doctors and they always respected them.

And seeing that, it just made me really think, "Wow, what is it about medicine that can take something that can be so raw and so hurtful, but transform it into something that makes people somewhat excited and can find hope?" And so that launched me into looking into medicine more.

Dr. Chan: Did you help translate or were you just . . .

Ha: When I got a bit older . . .

Dr. Chan: Technically, you're not supposed to use 10-year-olds to translate, but I know it still happens. Yeah.

Ha: Yeah. Basically, my mom would translate a lot more. But when I got older, sometimes if my mom couldn't go to the appointments, I would go in their stead and help translate.

Dr. Chan: This is in Salt Lake City?

Ha: Yeah.

Dr. Chan: And how are your grandparents doing?

Ha: So, during college, my grandpa passed away and my grandma moved back to Vietnam. But she's doing pretty well in Vietnam.

Dr. Chan: Okay. All right. We're going to talk about that. All right. You're 10 years old, and then you grow up in Salt Lake, and then you attended West. Correct?

Ha: Yeah.

Dr. Chan: So let's talk about West. IB program, I assume. I assume it was a really positive experience?

Ha: Yeah. I really liked West. I enjoyed being a part of the IB program because it gave me a lot of exposure into things that I don't think I got to do a lot. It's somewhat annoying when you're there in the moment, which is writing the extended essay, which is where you choose a topic of interest and research it. But it was actually pretty cool getting to get into it and to do that. And I met a lot of great friends there that I still keep in touch with and I'm still pretty close with. So West was definitely a very fun high school experience.

Dr. Chan: And then West helped prepare you for the next experience.

Ha: Yeah.

Dr. Chan: So let's talk about . . . how did that play out? Did you have a really good college advisor? How many schools did you apply to? What did that look like?

Ha: Yeah. So, for me, I just ended up applying to two schools.

Dr. Chan: Two schools?

Ha: I applied to The U and then I applied to Harvard Early Action. And so Early Action rules you can only apply to your state school.

Dr. Chan: So you're locked in.

Ha: Yeah. So those were the two schools that I applied to. There was definitely some advising, but I think that I just stumbled into a lot of things. I would reach out to counselors when I had specific questions and they would give us a lot of resources, but I sometimes go about things a bit confused, which is fine.

Dr. Chan: Why Harvard? Why early decision, early assurance?

Ha: Early Action I think it's called.

Dr. Chan: Early Action.

Ha: Yeah. When you take the SAT and everything, a lot of people . . . the schools start sending you information packets and everything like that. Harvard made a pretty good impression on me because I remember there was one moment, they sent us stuff about, "Oh, if you have questions about financial aid, feel free to fill out this form." And I did. And a few months later, the financial aid office actually called me and said, "Hey, we saw that you had some questions. We're happy to explain the Financial Aid Initiative, what we're trying to do here."

Similarly, the admissions office has this Undergraduate Minority Recruitment Program, and over the summer before senior year, I got an email from a student there and she was really willing to answer a lot of my questions. And what struck out to her answers was that she really loved the community there. And Harvard has a really nice built-in community system with their house system.

Dr. Chan: Interesting.

Ha: So it was something that really excited me because I care a lot about communities and I care a lot about creating second homes and things like that. So I think with all of that . . . like, the academics is definitely very important, but I think the community and all those other things pushed it over the edge for me. And also, they just felt a lot more approachable compared to some other communications I had.

Dr. Chan: Have you ever visited Boston before?

Ha: No. It was risky.

Dr. Chan: Okay. And did they interview you for Early Action, or how does that look like?

Ha: So anyone who applies for college gets interviewed and they do alumni interviewing.

Dr. Chan: So here in Utah?

Ha: Yeah. So I went to an alumni's home and we talked for an hour.

Dr. Chan: Okay. And so, you got in and I assume you got into The U, too, for undergrad.

Ha: Yeah.

Dr. Chan: And any conflict there or, definitely, you were committed to Harvard?

Ha: I guess, for a moment, we were trying to see if it worked financial wise, but after we realized that it did, I was pretty committed to going there.

Dr. Chan: So let's talk about Harvard. How was that? How was it going from Salt Lake City, Utah, to Boston to Cambridge where you've never been before? How was that jump? How was that experience?

Ha: It was an adjustment. I will have to say that. I definitely had . . . because I really was always in Salt Lake beyond sometimes traveling a bit out. So it was weird being really away from my family, which I was also very close with. And it was a very different environment than a lot of what I was used to. And it was really cool. I remember the first few weeks I was wide-eyed, very excited. But eventually, the excitement at the beginning dies down and you have to get serious, and it is a bit hard not having your family there.

Dr. Chan: I went to Stanford, similar to Harvard, but I would argue better weather.

Ha: I would not argue against that.

Dr. Chan: And I remember coming out of high school . . . I went to Skyline, and I took a lot of AP tests. We didn't really have the IB program back then. And I thought I was hot stuff, but then I get to Stanford and my dorm, it's like, "Oh, here's someone that took three times as many AP tests. Oh, they not only play violin, they can make a violin. They can construct one." And it was just overwhelming and intimidating because all of a sudden, all these people are really accomplished, really smart, really driven, really ambitious. And they're all just right there. So, yeah, it sounds somewhat similar.

Ha: Yeah. It definitely can get a little bit under your skin if you don't learn to realize that everyone has their own path and everyone has their own goals.

Dr. Chan: So talk about your path. How'd you find your path at Harvard? Because you did a bunch of activities. I mean, how'd you end up picking those and how'd you find your passion, I guess?

Ha: I think it just came to what . . . I think part of it was a lot of my values do come into community. So a lot of my activities were involved with being a part of a community and really getting to experience people's different perspectives.

For instance, one of my more memorable activities was being part of the Harvard Vietnamese Association. And that was really important to me because a lot of times . . . and a lot of people there also said the same thing. A lot of times at Harvard, when you do activities, it's for your resume or it's for an end goal. But at the Harvard Vietnamese Association, it was just really to be there for each other and to give support. And so, that's what I really enjoyed about it.

And so I definitely loved being part . . . I definitely tried a lot of different activities and dropped a lot of different activities. But the ones that stuck were the ones where I enjoyed the people that I was around.

And then secondly, I think when I came there, I knew that I was premed and I knew that eventually I'd end up in medicine, but I felt that I would never have four years to really explore things outside of medicine. So that was also where I took a lot of my passions, was to focus more on the arts, which was a field that I had a lot of interest in, but not something that I would want to make a career out of.

Dr. Chan: There's a lot to unpack there. So, going back to the Harvard Vietnamese Association, what kind of activities did you do and how many people attended? It sounds like a really cool group.

Ha: Yeah. It's a very small group because the Vietnamese community within Harvard is actually pretty small. So sometimes it would just be like only 10 or so people would attend activities, but we would do retreats where we would just go off for a weekend or a weekend night to just spend time with each other, cooking food with each other, playing games.

We also liked to do a lot of educational activities or to do activities that show the different types of Vietnamese food. One of the popular ones was in Halloween, we would do a fear factor where we would do different Vietnamese foods that look a bit gross, but are somewhat delicious.

Dr. Chan: Okay. I'm nodding my head. Yeah.

Ha: And so we would do that. And it would always be really funny just seeing different people reacting to different things.

And then during my junior year, one of the co-presidents of the Vietnamese Association decided to start this program called HVIET. So, at Harvard, there were a lot of different programs where students could go to countries in Asia and teach seminars for a week or so, and really help those students in those countries learn about different things. But they didn't really target Vietnam.

And so the co-president really wanted to have that because she felt that a lot of the education system in Vietnam can sometimes be pretty rigid as it is in a lot of Asia. And she wanted to introduce a lot of the liberal arts spirit to a lot of the students. So she started that and I joined along and helped with it. I never could go to the summer camp because of a lot of other different priorities, but I helped interview the students in Vietnam. I helped choose seminar leaders for it. And that was also a great experience.

Dr. Chan: The Vietnamese-American population, is it larger in Utah, or is it bigger in Harvard, or is it tough to say?

Ha: It's tough to say. It's also just because I think it is a lot larger than you would think in Utah. But then I always think about Texas or Southern California, particularly Orange County where it's really big. But I would definitely say that I feel that it might have felt maybe a lot bigger here compared to at Harvard.

Dr. Chan: In a way, it sounds, and correct me if I'm putting words in your mouth, like going off to Harvard, doing that jump from Salt Lake City to Boston, New England, this started to become your family away from . . . since you couldn't be as home as much if you had attended The U for undergrad.

Ha: Yeah. And that was definitely one of my families. I made a lot of different families there.

Dr. Chan: Yeah. Let's talk about the other families. Because I know you're being very modest, but I know you've done a lot. So I am just trying to . . . yeah, what else did you do?

Ha: So the other big thing I did was being a part of the "Harvard Crimson." So the "Harvard Crimson" is the independent college newspaper at the school and I was a part of the Arts Board. So that meant that we covered art-related events happening on campus in the greater Boston area. And we wrote a lot of book reviews, music reviews, film reviews.

Dr. Chan: So you got to get paid to go to art shows, and movies, and plays. Am I characterizing this right?

Ha: It wasn't a program that did get me paid, but for majority of the students it was more like we got in for free to all the things, and we got advanced copies of books that we might want to read that people haven't gotten yet.

Dr. Chan: Did you get to interview artists and authors?

Ha: Yeah, I did. For instance, when they had a special Boston Calling feature article, I got to interview a lot of the people playing at Boston Calling. So it was pretty cool.

Dr. Chan: Yeah. And I assume you've got lot of cool stories and met interesting people along the way.

Ha: Definitely. Yeah. Maybe not in the way that people think because I know that Hollywood and the media likes to portray things with the arts very crazy. But definitely, it was very interesting because even though I really liked the arts throughout high school, I was very much more focused on the sciences, and the arts, sometimes I would go support a friend when they were dancing.

And so it was really cool getting to meet all these artists and to talk about their passions, what drove them, what they were interested in, how they saw their art within the greater society. And so I really enjoyed it.

Dr. Chan: How did you get into the "Crimson"? I mean, did you do high school journalism?

Ha: Yeah.

Dr. Chan: Okay. All right. Because I just have this image of, again, this media, like "All the President's Men" or "Spotlight," which is a newer movie. Got deadlines, you have editors, and trying to make sure people aren't trying to censor you, and trying to have . . .

Ha: So, in high school, I wrote for the "Red and Black," which was the high school newspaper. Though actually, when I started college, I didn't want to do journalism. I thought four years of high school journalism was enough. But one of my entryway mates in my dorm got into the "Crimson" and he really loved it. And he kept telling me about the wonderful community and everything.

And then I guess there was a part of me that actually did miss getting to just sit and interview people and talk with them about their lives and their passions. And so I joined.

Dr. Chan: Before I turned on the pod, we had this conversation. Usually, the tables are turned. How am I doing so far? Would you rate me pretty okay as an interviewer?

Ha: No, I think you're doing wonderful.

Dr. Chan: Okay. All right. I try to be approachable. All right. So, the Harvard Vietnamese Association, the "Crimson." Anything else outside of class? Because again, there's just this image of studying, and doing all the premed recs, and then all these activities on top of it.

Ha: I also danced. So I primarily danced for Harvard College Bhangra, which was very fun.

Dr. Chan: Teach me about that. What is Bhangra?

Ha: So Bhangra is this dance from the Punjabi region, which is a region in India. A lot of times it's like . . . I don't quite know the exact history of it because whenever I would ask some of the captains about it, they would say something that was jokey. So I don't know if I can completely trust them with it.

Dr. Chan: No one really knows. It's a mystery.

Ha: But I'm pretty sure it sometimes was related to celebration, because it's a very joyous dance. And the thing I say about they would always make it very jokey is because whenever we danced, the captains would get very angry that we weren't smiling big enough. Because they would always say to us, "You guys are celebrating that you're getting crops. You are so happy that you are going to be fed for the next year. So smile like it."

It was really fun. It's very dynamic. A lot of jumping. A lot of squats. And a lot of yelling sounds halfway through to get the spirit up.

Dr. Chan: Any orthopedic injuries?

Ha: No. Though I guess now that I think about it, I do have a lot more ankle and knee injuries from hiking than normal.

Dr. Chan: Sounds really intense.

Ha: Yeah. It was definitely . . . I remember the first time I started it, it was because my block mate wanted . . . it was an open house, so she convinced us to go with her. And the first day I came out I was really sore. But after a while, you get used to it.

Dr. Chan: Awesome. So you're having a great time and you're still thinking about medicine. What was your strategy with graduation? Because you graduated and then you had a gap year or two, right?

Ha: Yeah, I had a gap year.

Dr. Chan: Okay. Yeah. So let's talk about that. What was your thinking?

Ha: So, I think, in the medical path, I decided to major in biomedical engineering because I felt that was a really . . . I really like to see science applied, and problem-solve, and design solutions. And I felt biomedical engineering could give me that background, and it also helped fulfill all the premed requirements within the course itself. And so I decided to do that.

And I did look into a couple of . . . I volunteered at a primary care clinic for a summer. And then I also did research. And so I did those little things, but definitely, I got really busy with the other activities that, by the time I graduated, I knew that there were still holes and that I might still need to do a lot more exploration to really figure out my place.

Dr. Chan: Holes in your application?

Ha: Yeah.

Dr. Chan: Or would you say holes in your desire? You weren't 100% sure you wanted to go down the medical path or what?

Ha: Well, I feel like a lot of moments you sometimes face a lot of self-doubt with medicine because it's so competitive and you sometimes wonder, "Am I good enough for this?" And so there is always that that you feel about it.

But it was more holes in my application and I felt that I didn't really quite understand what I wanted to do with medicine yet. All I knew was that there was something about it that really drew me in. And whenever I was in the clinic, or working, or hearing about medical problems, it made me really excited in ways that a lot of times a lot of other things didn't. But I knew that I needed more experience to really understand for certain about it.

Dr. Chan: So, when you graduated, did you decide to stay in Boston or what was your . . .

Ha: I was ready to go home. Yeah.

Dr. Chan: Okay. So came back to Utah.

Ha: Yeah.

Dr. Chan: How did that go? I mean, you're living in Boston, and I know it's a jump, and then you get used to the art scene and the restaurants. Yeah. So coming back . . .

Ha: I think the hardest adjustment was that when you graduate from a school like Harvard, a lot of people go their separate ways. And a lot of people end up focusing in Boston, New York, Bay Area, and D.C. And those are the main hubs. And so, going back to Salt Lake City, I felt a lot farther from all of these people who I had made a lot of wonderful memories with, a lot of people who I refer to as my sisters essentially. So that was the big adjustment.

It was definitely that these were the people that I would go every week to watch films and discuss the way that they were getting shot and making critiques about the film with. And suddenly I wasn't doing that anymore, so it was weird. It was definitely isolating for a while.

Dr. Chan: Because your high school friends, a lot of them are probably still around here, but they have their own lives and they're doing their thing.

Ha: So a lot of them also went out of state for college and then also stayed out of state after graduation.

Dr. Chan: Thus is West's high school's reputation. Yes. West High School does a great job of placing students around the country.

Ha: Yeah. So I did have a couple of friends here and they definitely helped, but as you said, they were very busy with their own lives. But I will say I was really happy to just be home.

There's one thing . . . you never really appreciate seeing mountains all around you until you leave to a place that's sea level and you don't see mountains anymore. And I really missed my family. A lot had happened in my family while I was gone and it was really hard for me to realize that I was thousands of miles away and couldn't be there for them when they needed me most. So I really wanted to just be home with them again.

Dr. Chan: So you come back to Utah. And how do you start plugging those holes in your application? What kind of stuff did you start doing?

Ha: So I returned to the research . . . well, I was working remotely for the research lab. I started throwing myself back into the research lab that I worked with in Utah.

And then I also started looking for more volunteering opportunities because I definitely realized I was a bit more . . . I did a bit of volunteering here and there when I had the time for it, but it wasn't something very longitudinal. So I started volunteering at Primary Children's Hospital. I started volunteering at the Utah AIDS Foundation. And then I also found another part-time job that I really enjoyed at the Hope Lodge.

Dr. Chan: Oh, okay. What were you doing there?

Ha: So I was a coordinator, and basically, it's when there's off hours so that the full-time staff isn't there, I'm there to make sure that the guests have all that they really need. And if there are any concerns, I deal with those concerns.

Dr. Chan: For the people who don't know, what is the Hope Lodge? What's their mission?

Ha: Yeah. So the Hope Lodge is . . . basically, it's cancer patient housing. And what it does is it serves people who live within a 40-mile radius away from Salt Lake City and have to come into Salt Lake to get treatment. So, for this Hope Lodge specifically, it was a lot of people from rural Utah, Nevada, Montana, Wyoming, and Idaho.

Dr. Chan: Interesting.

Ha: And they would come down here and it was completely free. And so they would be able to stay there and have a place to go to while they were getting their really long treatments. So, as a coordinator, I just made sure that if they had any issues with their rooms or any medical concerns, I referred them to the right person. I also just helped them. A lot of them had never been in Salt Lake, so I would help them find out where the markets are, and give them tips about restaurants, tell them about things that they can do.

And sometimes every month I liked to organize a food-related event for them. So most of the times, because I would work weekend shifts, there weren't that many people there because some people would go home for the weekends. Other people didn't have appointments, so they didn't need to be there. And so I would just typically just have cookies out or donuts or things like that. But sometimes I would make smoothies or cook waffles, which was always a hit with the guests.

So that was the Hope Lodge. And I really liked that because both of my grandparents dealt with cancer. So it had a really big personal connection to me.

Dr. Chan: It sounds like you did some really amazing experiences after you came back here.

Ha: I felt they were very important to me, yeah.

Dr. Chan: So you're doing these and I assume you have your eye towards the application process. What was your strategy going in? It sounds like you had a strong pull to stay in Utah. And they say for interviewers, you should never ask a question you don't really know the answer to, but I'm going to ask you a question. Did you apply broadly, or did you, again, put all your eggs in one basket?

Ha: Well, actually, if I had felt comfortable with it, I would have liked to have just applied to Utah early and make it my one school. But I did realize that in some cases my application wasn't the strongest. And so, when I talked with my advisor, they recommended that I just apply broadly because they felt it was just better to get into a med school than to not . . .

Dr. Chan: Not get into med school.

Ha: . . . get into a school. Yeah.

Dr. Chan: Like a good advisor would . . . all right. So how many schools did you apply to?

Ha: Over 30.

Dr. Chan: Thirty? Wow. Okay.

Ha: Yeah. A lot.

Dr. Chan: Okay. MD and DO, or just MD?

Ha: Just MD.

Dr. Chan: Just MD. All right. And then I assume, because again I've done this job long though, the secondaries started to roll in, and that in and of itself could be like a full-time job, right?

Ha: Yeah.

Dr. Chan: So how did you deal with that? What was your strategy? Bang them out as soon as they came in, or would you let critical mass and then . . .

Ha: So I ended up submitting my application a bit later than I wanted to, but that was also good because it took about a month for them to process my application and have the secondaries roll in. And during that time, secondaries were rolling in for people who had gotten them in earlier. So I would check Student Doctor Net, which this is the only time I would typically say to check Student Doctor Net.

Dr. Chan: Yeah. I know Student Doctor Net.

Ha: And I would look up all the secondary questions at the schools I was applying to that got posted and I'd start pre-writing. So that helped when the secondaries started rolling in. But there was a point where things were getting a bit overwhelming and I had to take some vacation time off of work just to lock myself in a cafe and write secondaries 24/7.

Dr. Chan: Yeah, you're on deadlines like "Crimson" time, right? Deadlines, you've got to get this stuff in. Yeah.

Ha: I will say I'm appreciative of all the writing deadlines because I got really good at cranking stuff out really quickly.

Dr. Chan: So all these medical schools are asking similar questions. Similar, but little different questions, and yeah, you just have to be careful. So 30 schools, how many interview offers did you get?

Ha: I got five interview offers.

Dr. Chan: Okay. Good.

Ha: But I only went to four of them because I got into The U before the fifth one came up.

Dr. Chan: Okay. You were able to save some money.

Ha: Yeah.

Dr. Chan: All right. And you go out and start interviewing. What did you pick up on the interview trail? What did you learn? I assume different interview techniques were being administered.

Ha: Yeah. It was really interesting seeing the different vibes from different schools and also . . . even schools that would do MMIs had a very different approach to it. And then similarly, the traditional interviews also very different. So it got interesting trying to figure out how to adjust to all of those.

Another thing was it was interesting seeing what each school would emphasize, and when you'd go there, you would definitely see what a school was passionate about, what they were driven with.

What I was really interested in was the interviews that I went to, I found that they all had very common chains. They were all very interested in community service and they were interested in really integrating yourself into the community. And I guess that made me think like, "Well, I guess my application must have said something that made those specific schools interested in it." Yeah.

Dr. Chan: It resonated. Yeah. Did you apply to Harvard Medical School, HMS?

Ha: Yes.

Dr. Chan: Okay. We had a joke at Stanford that you had to be really, really good to . . . they didn't like their own graduates. It was very rare for someone to graduate from Stanford undergrad and also enter Stanford Med. There's a handful of people to do it, but it was very . . . yeah.

Ha: Yeah. My advisor was just like, "Yeah, maybe." I just kept pushing it. And finally, I was like, "Okay." But at Harvard, they do take in a lot of Harvard grads too.

Dr. Chan: All right. So you're out interviewing, you're learning about the different schools, you're getting the vibe, and seeing what they emphasize. It's interesting because I think we try to emphasize certain things, but there are still students . . . applicants still . . . it's all about their perception, right? So sometimes there's a disconnect.

And then you got into The U. Were we your top choice or did you have this struggling period like, "Oh, I don't know"? How did you navigate that?

Ha: No, it was definitely . . . the moment I got into The U, I was like, "Good. I'm set." Because I was just really hoping that I would get into The U. It was where I really wanted to be.

Dr. Chan: Why did you choose the U?

Ha: Because first, definitely, I wanted to stay close to home. Four years away made me really just realize a lot of what you miss when you're not close there. And so I really wanted to be close, especially since now it's just my mom without my grandparents. So I wanted to be with her.

But also, I think . . . so a lot of the reasons, like the people and the reasons why I got into medicine, were here at this hospital system because my grandparents were always at The U, or the Huntsman. And I also had a lot of doctors that I really loved and that I got a lot from were also from The U.

When I was in high school, when I was still thinking about, "Would I be premed or not?" I did a hospital internship at the VA and that was what really solidified my decision to go into premed. The research that I really fell in love with and enjoyed was at The U. And so I think the things that brought me to medicine the most were always in Utah.

Dr. Chan: I do remember when I called you, you were a little shocked, but also very happy. I could tell.

Ha: Yeah.

Dr. Chan: Again, I got the vibe from you that you were going to stay here. But then again, with your Harvard background, like, "You probably got into other places," like Boston. So I said, "Okay." So, in my mind, I think you were leaning towards us, but I felt like, "Oh . . ." You know?

Ha: I was definitely very joyous. Actually, I was walking from a room where I was processing western blots to back to my lab and I passed by the VA, the building to VA lobby, as the call came. And I burst into tears afterwards. So I had to find a little corner in the lobby and just cry.

Dr. Chan: So sweet. So glad you're here. You're going to make me cry. Yeah.

So school starts very soon. And I'm not going to hold you to this, but where do you see yourself going? What kind of doctor do you think you will want to be? To be honest, I love this question because I'm going to have you come back on the pod, and I'm going to ask you again. But just to see, as you get more experience, if that starts changing. Because you have a wealth of experience already, so I'm just . . . where do you think you're headed right now?

Ha: Specialty-wise, I'm going to leave it open because I know that once you actually get into the rotations, you figure out which vibes with you a lot more. But I really want to work with underserved populations. I can't imagine not being involved in the community or doing some aspect of community health in the future.

And a lot of doing with my research lab, I've gotten exposed to a bit of academic medicine and I do really like teaching and mentorship. So, if I can somehow do that into it, that would be ideal.

Dr. Chan: Would you even touch . . . like global health, would you do a rotation back in Vietnam?

Ha: I would love to actually do a rotation in Vietnam.

Dr. Chan: How's your Vietnamese?

Ha: Proficient, but my mom always tells me I need to get better. So I guess not good enough.

Dr. Chan: All right. If you were to go to Vietnam right now and start talking, would people say, "Eh, you have an accent"?

Ha: They know I'm an American.

Dr. Chan: Okay. They would pick up that you're . . .

Ha: Yeah. Yeah.

Dr. Chan: Okay. All right.

Ha: Yeah. So I definitely need to get on that, but I would love to do either a health project with Vietnam or to go and rotate at a hospital.

Dr. Chan: That'd be so cool. Yeah. That'd be awesome. Well, last question. If there's anyone listening out there who's thinking about going to med school or might have some doubts, what would you say to them? What advice would you give them?

Ha: That's a tough question because I feel like I could go off for five hours with thoughts. But I think the thing that I would say is that a lot of times, choosing this path, it can be very scary, and there are a lot of times where you're filled with self-doubt. But if you're ever facing self-doubt and uncertain if it's the best path for you or if you're going to make it, I would just really think about why you love medicine. Follow that "Why medicine?" and do activities that really ground you in it.

Because I also do know that sometimes you're looking like, "Oh, I have to do 1,000 hours of this, and this, and this." But it's easy to get caught up in those numbers, in those statistics. But if you just figure out what drives you and really follow that, you'll eventually stumble into your own form of medicine that's really you and really personal. And you'll be very happy with it.

Dr. Chan: That's fantastic. Thank you for coming on.

Ha: Thank you for having me.

Dr. Chan: And we'll have to have you come back. I don't know if we have a student newspaper, but maybe you should help get it off the ground. I don't know if you'll have time.

Ha: I will say, even though I didn't do news, which was the most stressful, I did arts, which was very chill.

Dr. Chan: We do have an arts magazine. It's like an annual edition.

Ha: That sounds cool

Dr. Chan: Rubor. Am I saying that right? The Rubor people will talk . . . yeah, you'll learn more about Rubor when the school picks up. All right. Thank you, Ha.

Ha: Thank you so much.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio, online at thescoperadio.com.

Dr. Campsen: If you are being evaluated for an organ transplant, you're going to come in to the University of Utah for a full day workup, and one of the people that you'll meet is our social worker. Today, we're going to talk about that part of the organ transplant visit.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Dr. Campsen: My name is Jeff Campsen. I'm a transplant surgeon at the University of Utah and I'll be talking with Melissa Morales, one of our social workers at the University of Utah Transplant Clinic.

So we have people that come in who are in organ failure and need an organ transplant and we try to have them come in during a full day visit to meet a medical doctor, to meet our financial advisors, but also to meet you as the social worker. And I'd like to talk to you a little bit about what that visit's like and what is your role in that visit?

Melissa: Anytime I've kind of explained to patients what I do, I sort of start with, "I'm here to make sure that they are a good candidate and I want them to not be at risk." I take a detailed social history and some of the things that we talk about is their mental health history. We talk about having adequate support, this is family support, emotional support, making sure that they have sufficient resources. A lot of our patients are from out of state and so they have to stay here for up to four weeks.

And overall, it's about compliance. It's about making sure that they are going to be a good candidate, they're going to follow the medical team's recommendations so they have excellent results after transplant.

Dr. Campsen: So that's what they can expect from your visit. Is there anything else that they should be prepared for when they come in?

Melissa: I think it's important for them to know that the reason why we're here is because we want successful results. This isn't necessarily to rule someone out or to find out anything negative about them but it's really to see who they are and what resources they already have in place and what's available to them, how we can further help them if they need to be.

Dr. Campsen: So once you see them, you're going to give them recommendation to the Transplant Selection Committee on whether or not they should receive an organ transplant. And based on what you're saying, have you ever actually said no to somebody? And if you have, are there avenues for them to change and then proceed with their organ transplant?

Melissa: So I actually haven't ever said no. I would say that most of the patients are doing well. Again, they have this support, these resources in place. There are times where patients come in with unmanaged mental illness and they need additional support from either an individual therapist or a psychiatrist, and we help make those referrals to community services and get the help that they need.

Dr. Campsen: So as part of the transplant team then, how does your interview really affect the transplant process?

Melissa: So I sort of serve a dual role. I am there to evaluate and to assess how I think that they would do post-transplant. But I also am there to advocate, to link them to these community resources, to refer them out if they need to be. You know, we see these patients about once a year, and so there are times where I have to follow up with them more than that if there are any concerns on my end. So we get to build a connection, a relationship throughout their listing, and it's great.

Dr. Campsen: But this dual role is interesting because not only are you an advocate for the transplant program and helping the transplant program select the right people to give organs to, you're also a member of the team of the patient. And how do you navigate that dual role?

Melissa: You know, my goal, my purpose is to make sure that patients are successfully transplanted in a safe way and that they have the resources and support that they need, making sure that they're linked to exactly what they need that will help them have successful results.

Dr. Campsen: Well, I know what advice you've given me. What advice would you actually give a patient that was coming in to clinic to see you?

Melissa: I think something really important that I like patients to know is that their mental health really affects their physical health. If they are depressed or have anxiety, all those things are going to exacerbate especially after transplant, and I want them to know that we have these resources, we have ourselves, and we're available to help them through any sort of difficulties that they might have from an emotional, psychosocial side. You know, I really like making these connections with patients. Sometimes I do wish that I had more interaction with them than just once a year. But just seeing how successful they are, see how different their lives can be, a lot of them go back to work after several months and, you know, they talk about how grateful they are for our team and really for this process and having gone through that.

Dr. Campsen: I know that I always like to say that basically, once a patient gets listed and they get an organ, they're always a member of our team and they always have medical resources. But they also have social resources, correct?

Melissa: Right. Yeah, so we're available to them post-transplant. You know, we usually say for about a year after but we're happy to meet with patients any point whether it's been years out or, you know, within a few months.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Announcer: Health tips, medical news, research and more, for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Are you considering a career as a nurse, but you don't quite know where to start? Matthew Anderson is a nurse at University of Utah Health Care, and we're going to ask him how he got to where he is, what kind of education it took, his experience with finding a job, and what he's learned about being successful. First of all, thank you very much for taking time to give us an insight into you, and your life and your career.

Matthew: Absolutely. I'm glad to do it.

Interviewer: What made you decide to pursue this path, to become a nurse?

Matthew: Yeah. So I was actually born with a congenital heart defect called coarctation of the aorta. At six days old I was life-flighted and had a surgery, and so I've had frequent contact with health care since. You know, I've a yearly check-up with cardiologist and everything and had a few procedures throughout my life, and as part of those was in contact with nurses. And having that right nurse that just demonstrated appropriate compassion, responded to you appropriately, made all the difference. And that's kind of where my desire to become a nurse, again, was just from those nurses that I had that made a difference in my care.

Interviewer: So you knew you wanted to do that. You had some very specific reasons why. What was the next step at that point? Was it to start looking at schools, or was there some preparation to do before that?

Matthew: Well, actually what I did was when I was in high school, my school offered a CNA course, Certified Nursing Assistant course. And so I said, "You know, that's the bottom of the food chain. I'll take that course." And because I wasn't quite sure if I wanted to do nursing. You know, there's kind of the stigma of a male nurse and everything on that. So I said, "Hey, I'll take this course. If I enjoy that, I'm pretty sure I'll enjoy nursing." And I did, and I really liked it. I love having a personal contact with people, you know, and just being able to help people in their time of need, in that really vulnerable state.

And so that's kind of what started it for me, and then I guess for it to continue on with education and everything, I actually did a little bit longer of a route. I went to community college first and got an associate's in pre-nursing, but then I transferred to Brigham Young University, and their nursing program once you get in, is three years long, as opposed to most universities it's two years once you're in their program. And so it actually took me about five years to get my degree.

So a little bit longer than most paths, but you can get an associate's in nursing. That's what my wife did, which it took her about three years. Usually it takes about a year of prereqs, and then two years in the program. Or if you get a bachelor's, you do about a year to two year prereqs, and then two to three years once you're in the program.

However, the Institute of Medicine recommends that all nurses get their bachelor's. So whether you start with an associate's and then go back and get your bachelor's, it is recommended that you get that higher degree. It just gives you more, kind of, a global training, and helps you kind of see a bigger picture than just direct patient care.

Interviewer: Yeah. So it sounds like you could get a career or a job in nursing, and then continue your education if you wanted to continue it that way.

Matthew: Absolutely.

Interviewer: And so, how difficult was it to get into nursing school? I'm of the impression that I've heard that it's difficult.

Matthew: It is. Yes. And it really depends on the program you apply to, but it's pretty competitive nowadays. It's one of those careers that's been growing. It's expected to continue to grow. The average GPA for the program I applied to at BYU was 3.88 to get in. So it's pretty high. And I think that's probably the highest in the state, but you know, I work with CNAs who've worked in the hospital for 10 years and they haven't even been able to get into nursing school. So it can be difficult. So you have to prepare and do really well in your prereq courses, kind of the GPA. Some prefer work experience. It kind of depends on the school. They all have a little bit different criteria, and that can be difficult for training people as well.

I have a co-worker who took classes here at the U, and then she's trying to apply to SLCC's program, but they didn't accept her classes at the U because it didn't have a lab. Even though they weren't different credits, it didn't have the lab, and so that can be really frustrating as well. And so, you kind of have to do your research in advance, know where you want to go and figure out, and talk to people who they're advisors, everything like that, really figure out what you need to do.

Interviewer: If somebody doesn't have that huge GPA, are there other routes that you are aware of? Or is that really kind of a roadblock right there?

Matthew: Well, for some programs. So BYU, that's a big part of theirs. It just kind of depends on the school. Some weigh in work experience more as part of their application. There are, you know, service and leadership components that kind of help with the application. Also, some schools will let you buffer at the SAT and your GPA. So if you do really well on the ACT or SAT or something, that can kind of buffer your score as well. So there's different things you can do. Really, just knowing your school, you know, your target market if you're trying to get into.

Interviewer: Yeah, and maybe talking to an advisor and just saying, "Hey, my GPA is not that strong, but I'm really passionate about it. What can I do here?"

Matthew: Absolutely. And it really depends on the semester too, because you know, as the average . . . I had friends at BYU that had a 3.4 and got in. And so it just depends on the year as well. Even not as many applicants apply this year, and there's a number of factors that go into it as well.

Interviewer: How hard is it then to get a job?

Matthew: It really goes . . . it fluctuates. So you know when there's nursing shortages, it's not hard at all. You can pretty much work wherever you want. They'll hire new grads to ICUs and EDs where they don't typically hire new grads to, and so it really just depends. You know, back in 2008, when there was kind of a hiring freeze on nurses, really hard to get a job initially.

When I got out of school, it was a little bit harder. So it took some of my classmates a few months, which really is not long. We took a few months to find a job, but in that hiring freeze, it was difficult to find a job. And so, it just kind of depends. Right now is a pretty good time. You can find a job pretty easily.

Interviewer: So there are opportunities then to move up and move around. I mean, what does that kind of look like then?

Matthew: Yeah, absolutely. It really . . . I mean, there are so many avenues. I remember when I graduated, one of my instructors gave us a list of things you could do in nursing, and it had like over 200 different positions. But just here, I work at the University of Utah here, and you know, on each unit you have your nurses, but then you also have charge nurses.

Also, they have clinical nurse coordinators, who are kind of are quality or scheduling, nurse managers, nurse educators. And there's quality nurses, there's infectious disease nurses. As far as advancing, leadership is a big thing as well. Education is a big thing. Research is kind of another field. Procedural areas, all kind of different areas you can go.

And so sometimes people are like, "You know, I did this for five years, and I got tired with this. So I went over here." And I love that flexibility in nursing.

Interviewer: It's also kind of cool that there are so many opportunities I think. A lot of people just think of the bedside nurse as the nurse, right? But there's a lot of responsibilities and roles that nurses will play and that's . . . continue to expand from what I understand as well, in health care. Yeah.

Mathew: Absolutely.

Interviewer: So what advice would you give somebody, you're at a party, somebody is talking about that they're considering becoming a nurse. What advice would you have for a person considering that career?

Matthew: I guess going back to that, just remembering your "why," remembering why you're doing it, because you'll have times you're like, "This is not what I signed up for. This isn't what I want to do," you know. Every program of study has their challenges, and in college you're like, "What did I do?" But I think sometimes, you really also kind of have a spiritual journey as well because you're working with people who are near death. And sometimes that can be really taxing, especially when it's somebody young or somebody who's close to death.

Or if I take care of a child who's the same age as my child, and maybe they pass away, that can be very difficult to deal with. And so those things that you don't really think about, that can be emotionally taxing, and so you have to just remember why you did it, and that you're there regardless of the outcome. You're there to care for them the whole way.

But also again, just going . . . If you're preparing to go to nursing school, just do your research. You work hard, but you've got work smart as well. Because I've known people who've worked really hard, and they've gone the wrong direction, and so they have to retake all these prerequisite courses to try and get into nursing school. And it's taken them much longer than it has to have.

Also, sometimes it's better just to plow through things. And we all have different circumstances with families and different things, where you have to take care of needs, but sometimes it's better just to get it done. I've seen people who have stayed in school for far too long, as well. They take the 10 year route, as opposed to a 2 year route.

Maybe work part time, and go to school full time, as opposed to working full time and going to school part time. And get through school, because the difference between HCA pay and RN pay is a big difference. And so just get it done, get it out of the way, and then also it opens opportunities further for advancement once you're a nurse, much more than when you're an HCA if that's kind of the route that you're doing.

But really, like I said, know your schools you're going to be applying to. Know what they need. Know what kind of sets them apart, especially if you're GPA is not as strong. Know what can set you apart, leadership things you can have, everything like that.

Interviewer: It sounds like try to get through school as quickly as possible, if you can work in the field while you're going to school. I'd imagine that there are a lot of advantages to that.

Matthew: For sure.

Interviewer: Not only, you know, being able to pay for your education as you go, but really, making what you learn in the classroom stick because you're using it.

Matthew: Absolutely.

Interviewer: And then just remember that "why."

Matthew: Yeah. Absolutely. Remember that "why." It makes a big difference.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com, and click "Sign me up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: You had kidney stones once in your life, what you need to know going forward. That's next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: So you already went through the process once, the excruciating pain, then the re-passing of the stone or the operation to remove the kidney stone. Does that change how you need to look at your life from that point on? Well, we're going to find out right now. Doctor Gary Faerber is a urologist at University of Utah Health Care. If somebody has a kidney stone once, are they inclined to have another one?

Dr. Faerber: Yes, they are. If you have a kidney stone and you make no changes in your lifestyle or anything else like that, you have a 50% chance of forming another stone within five years.

Interviewer: So I suppose the general advice would go, regardless of the stone, you need to drink more water, you need to watch your diet, the salts, the sugars, reduce that kind of stuff. Does that apply across the board?

Dr. Faerber: That really applies across the board and of all of the things that you've mentioned there, keeping yourself well hydrated is the most important aspect of prevention of kidney stones. And I think in patients who have risk factors, for example, if they have a family history of stones, if this isn't their first stone and they've had several others, or if they have on their imaging studies more than one stone, those people really need to have an evaluation to figure out why they may be forming stones and what can we do to prevent them.

So in those patients, they'll get some blood test to look at their overall kidney function, we'll get serum calcium levels and if that's elevated we may get a parathyroid hormone level. And then above that, we'll also have them collect urine over a 24-hour period and look at the chemical composition of the 24-hour urine. And that will help us direct what medical therapies and dietary therapies would be appropriate for the folk.

Interviewer: So you might prescribe some sort of medication to help as well?

Dr. Faerber: Yes, absolutely.

Interviewer: Yeah. And would you prescribe a very restrictive diet more so than just eating healthy?

Dr. Faerber: I often will tell patients that a really good, healthy, what they call the DASH diet, which is used for patients who have cardiac disease, the DASH diet is a good diet to prevent kidney stones. It's made up of fruits and vegetables, low sodium, limitations of red meat, mainly poultry and fish, legumes and whole grains. Eating a diet like that, especially if you manage your calories and you're not eating too much compared to your activity levels, that's a great way to start limiting or restricting your incidence of forming stones in the future.

Interviewer: So you do the analysis, the tests, based on that result, you might prescribe a medication. Is there anything else that you would tell somebody that just had a kidney stone going forward?

Dr. Faerber: Well, if they have a family history, where their mom or dad or grandfather or grandmother or a brother and sister have a kidney stone, I often tell them, "Listen, you can't run away from your genes and you're sort of stuck with who you're with." And in that case, I will really push them to make sure that they keep their fluids up. I think the only other thing that is really important is to limit the amount of salt intake that you have, watch the potato chips and move that salt shaker away from the kitchen table.

Announcer: Thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Dr. Gellner: No more flu mist means another shot for your child. How can you help your child prepare for this and other vaccines? I've got some advice today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: You've probably heard that the Centers for Disease Control and Prevention is dumping FluMist. I know, my kids are disappointed too. But a CDC advisory panel found that the spray is so ineffective at protecting from the flu that it shouldn't be used anymore. Vaccine experts aren't sure why the mist isn't working but none of that really matters to parents who are now wondering how to prepare their children to face the flu shot needle.

There's definitely a lot of hype when it comes to those dreaded shots. Needles strike fear into the hearts of many people, no matter how old they are. The most important thing a parent can do is to keep calm. If you're freaking out, your kids will follow suit.

Honesty is most important when it comes time to get any shot. Explain to your child that it may hurt for a second and tell them why the shot is important to protect them. Ask them to think about how strong their body is going to be, and how well the good immune systems cells will be able to fight the bad germs that this vaccine is protecting them against. Kids will be more receptive to shots if they understand why it's important for them to get them.

However, while honesty is key, don't give your child too much time to stew over the fact that a shot is coming. They may get more worked up, or they may be cool with a shot, it all depends on the child. And if they are going to be extremely anxious during the entire visit, I recommend telling them at the end of the visit. If they're older kids or kids that are not too afraid, then being honest with them before the appointment is best.

Once at the appointment, present a united front with the person who is giving the shot. Don't let your child cower, kick, or hide in your arms. That could end up hurting them more than the shot and may also result in an injury to the person giving the shot. Instead, help the person giving the shots put your child in the position that is the safest for administering shots, while still being there to comfort them.

Talk to your child while they're getting the shots. Make eye contact with them. Let them know you're right there and you'll give them the biggest hug when they're done because they've been so brave. I've sung to my boys when they were younger and had their kindergarten shots. That seemed to help.

Taking steps to help with the pain from shots can help as well. Give your child acetaminophen or ibuprofen but not until after the shot to reduce inflammation that may cause pain. We don't recommend giving anything beforehand anymore since some studies show that blocking the fever response may interfere with the immune system response.

With some shots, the pain, redness, and swelling may last for up to 24 hours. Pain may occur when medicine in the shot goes into the body and then again over the next few days as the body's immune system does its job building up antibodies. When all else fails, it may be time to make a deal with your child. One word: bribery. It goes a long way with kids. A special treat after the appointment for their bravery is always a hit.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: Five tips for family caregivers of advanced cancer patients. That's next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: You find yourself in a situation where you have to provide care for a family member who has advanced cancer. It can be a very, very difficult time. And today we've got Dr. Lee Ellington. She's a clinical psychologist. She has five tips to help maybe make that process better not only for yourself but, more importantly, for the cancer patient as well. What is your first piece of advice for somebody that has found themselves in the situation?

Dr. Ellington: Number one is to communicate openly with the patient or other family members about the remaining days. It may be uncomfortable, but it's an important conversation to have.

Interviewer: And why is that conversation important? What does that do? What does that accomplish?

Dr. Ellington: It helps people prioritize what's important in their life, things that may have gone unsaid that they might have regrets about later. It helps open up some understanding and I think, in general, just talking about how we want to live in our final days needs to be an open conversation.

Interviewer: How about number two?

Dr. Ellington: If you have a patient with advanced cancer, then I think it would be important to learn about hospice before you need it. So explore hospice and what hospice offers and how not only will it help the patient that they're caring for but they may have many resources for the family. So hospice is a team approach. There's a chaplain, a social worker, a physician, nurse, hospice aids and other resources, and the unit of care is for the family.

Interviewer: So it's not so much necessarily always for the patient, but it's also for those that are caring for the patient in the family?

Dr. Ellington: They will encourage about the caregiver to take care of themselves, but sometimes the caregiver will say, "No, no, no. I can't do that now." But to be at their best, to really take care of the patient and themselves, they need to do both.

Interviewer: All right. So it's a good idea to have an idea what hospice can do, what kind of resources will offer you. What's number three?

Dr. Ellington: Consider yourself a hospice team member. So hospice is a team care approach and the family caregiver and the patient are part of that team. Caregivers have valuable information about the family, about the home life. They know a lot about the cancer and the disease and values and preferences and they should empower themselves to voice that and see themselves as a team member.

The fourth thing is to take care of themselves, self-care. So maintain their health the best that they can. Be sure they get the rest that they need and the resources to provide rested if that's necessary. So kind of pace themselves.

Interviewer: So don't abandon all the other things in your life. You still need to keep maybe exercise routines or give yourself some breaks away from caring for that patient. Again, I would imagine a lot of people are like, "No, I can't do that. That's selfish of me."

Dr. Ellington: Absolutely. That's the most common statement, I think. The other would be to seek support, whether from the hospice team, from families, from friends. People don't know what to do. They want to provide support to you, to both the patient and to the family and to take people up on that and ask for it, meals, a friend to talk to, a break. So seeking that support.

Interviewer: Yeah. And so often in that situation, you'll find people will say, "You know, if there's anything I can do," and then how often does that conversation just end right there? You're recommending that that family member should say, "You know what? It would really help if you could cook a potluck dinner for us tomorrow night or whatever."

Dr. Ellington: Absolutely.

Interviewer: Is there a big bottom-line takeaway when it comes to you're the caregiver, how can you care for yourself for the benefit of not only yourself and your loved one as well?

Dr. Ellington: Death does not just one person's experience. It's everyone's experience. There's loss, there are goodbyes. And so I think the takeaway is that to come together and decide how the family or the support ties want this to occur, want it to happen and be clear about that. So that means maybe taking a break so that they can be present for important conversations or can be present to provide the care they need. Or it may be taking a break to reflect on, "What just happened here?"

Interviewer: Do you find that that uncertainty of the person that is giving care not exactly knowing what the person that they're caring for wants can cause a lot of undue stress and that's why these conversations are important?

Dr. Ellington: Yes. People are afraid to talk about it and, certainly, the patient drives the course of the conversation. If they're not comfortable about talking about the final days and you've gently tried to make that occur, then you need to talk about with someone the final days and what you want and how you can make that happen for yourself and for the patient, but definitely, these conversations are difficult in our current culture.

Announcer: TheScopeRadio.com is University of Utah Health Sciences radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: Recovering from a concussion, what you need to know is next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Greg Hawryluk is a neurosurgeon at University of Utah Health Care and a concussion expert. Help me understand what steps are involved for recovering from a concussion.

Dr. Hawryluk: It's important to know that any concussion needs to be seen by a doctor. These days even if there is a suspicion that you may have had a concussion, it's important to see a doctor. Some people have trouble recognizing the signs. It can be things like headache, dizziness, confusion, blurred vision, and just feeling funny. Sometimes those symptoms aren't apparent until maybe the next day. That's the first step is making sure you see a physician.

Interviewer: So don't self-treat. You wouldn't fix your broken arm. Don't try to fix a concussion.

Dr. Hawryluk: That's right. Don't try and fix your brain yourself.

Interviewer: Okay.

Dr. Hawryluk: The biggest advance that we've had in concussion over the last 10 years or so has been the recognition of the need for a gradual return to normal activities and the importance of rest. That's both mental rest and physical rest. This is one of the rare times where we'll counsel young patients not to do homework. In fact, even things like video games, we think can be a little too taxing for a recovering brain.

Interviewer: Really? When the brain is recovering it needs to rest like any other body part might to heal.

Dr. Hawryluk: That's what we are starting to learn.

Interviewer: Okay.

Dr. Hawryluk: That's really step one, it is to get to a doctor and get started on this pathway of greater recovery. We do talk about six steps in terms of recovery and it's really tailored towards athletes. Again, we start with complete mental and physical rest, and then if that goes well you can basically progress through these steps at one step a day. It means the very fastest you're going to get back to your sporting event is going to be about a week.
Once your symptoms have totally resolved or almost completely resolved, normally the next step is going to be resumption of light activities. That might be something like an exercise bike or a brisk walk or something that is not too taxing.

Interviewer: Let me back up. Step one, nothing, mental and physical rest. How many days is that?

Dr. Hawryluk: For sure, one day.

Interviewer: For sure, one.

Dr. Hawryluk: Yeah, it's really based on the symptoms. Once the symptoms have resolved, or almost resolved.

Interviewer: Then step two.

Dr. Hawryluk: Then you're ready to try step two.

Interviewer: Which is light activity, okay continue.

Dr. Hawryluk: What's interesting about concussion is that symptoms can . . . even though at rest your symptoms are gone, once you push your body a little bit it actually can bring on the symptoms. Really the goal of step two is to see if you can do some light physical activity and see if any symptoms happen. If that goes well, we step it up. Step three would be a return to sports-specific activity. For instance, if you're a hockey player, well, we'd say okay, you can go back and skate at this point. We certainly wouldn't want you participating in regular drills. We wouldn't want you participating in body contact. Step three would be return to sports-specific sort of activities.

Interviewer: At this point, could you start feeling those symptoms again?

Dr. Hawryluk: What we want to see is if at any one of these stages, you do have a recurrence of symptoms. We say well, we need to back up. Some doctors would recommend starting back at square one. A lot of people like myself also advised just taking one step back and seeing where you can get to with no symptoms and eventually trying to work your way back up the six steps.
Once you can do sports-specific activity without symptoms, the next step is going to be to participate in practices without body contact. If that goes well for a day, usually we will give the green light to participate in practice with body contact. Ultimately, the last stage is return to gameplay and normal activities.

Interviewer: This is very sports specific. What about someone that has suffered a concussion for some other reason that's not an athlete, and doesn't have practice. Do they go through the same steps?

Dr. Hawryluk: They do. This six-stage process is really built for athletes that most of whom are really keen to get back to playing. It's designed to get people back as fast as we think is safe. We apply the same principle to people that aren't athletes. The principles of rest and greater return to normal activities has been associated with the most efficient recovery, the least chance of setbacks. We think it may be associated with a reduced chance of the so-called post-concussion syndrome.

Interviewer: For an athlete, what is the danger of returning to full gameplay before you go through these steps?

Dr. Hawryluk: To be totally blunt, one of the biggest things we worry about is death. I say that with a bit of drama on purpose because as physicians, that is the biggest thing we want to prevent in concussion. Some very sad occurrences over the years has taught us that players that return to the sport while they're still symptomatic, in fact, even players that return to the same game, you're at risk of for something called Second Impact Syndrome. We don't fully understand what that is. Fortunately, it's rare. But there's something about an injured brain that it's quicker to swell. We've seen patients that get hit a second time that have dramatic and fatal brain swelling and there have been a number of deaths
So that's the single most important principle for us as physicians in managing concussion. The biggest principle we need coaches and players to be aware of is that if you're concussed, you can't go back to play that game or in any other games until you've been seen by a physician and you work through that greater return.

Interviewer: When it comes to the recovery process, what is the most important piece of advice you would have for somebody?

Dr. Hawryluk: What I often find is true both of athletes and people with jobs and things like that. People are dying to prove to themselves and they want to prove to other people that they are okay. They want to shake this off and they want to be normal. The challenge is that for a lot of patients, that's not a good approach because what happens is you find that you actually are having trouble. And getting back to your activities, if you do it too soon, it doesn't go very well. It kind of becomes a negative experience. Ultimately that can delay an ultimate successful return to what you're doing. The importance of going slow really is key here.

Interviewer: TheScopeRadio.com is the University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.