Search for tag: "aorta"

Interviewer: You have a loved one and you've been told they have an aortic dissection. What does that mean for them in the short term, and more importantly, the long term? That's next on The Scope.

Dr. Jason Glotzbach is a cardiothoracic surgeon at University of Utah Health and if somebody's been diagnosed with an aortic dissection, let's kind of break that down a little bit and help them understand what that means. Generally, it's probably not going to be that person that had it that will be finding out this information because it's a serious thing.

Dr. Glotzbach: Absolutely. So the aorta, as we've talked about, is the largest blood vessel in the body and the aorta has several layers to the aortic wall. It's kind of like plywood where the layers should be stuck together without any space in between them and sometimes due to high blood pressure or other things, you can get a small tear in the inside of the aorta, which then allows blood to travel in between the layers of the aortic wall.

We call it dissection because it dissects into the aorta and then once that blood gets in between the layers of the wall and separates them, that can cause major problems with the aorta.

Interviewer: So when it's in between those layers is it going to break out eventually and you'll be internally bleeding or what happens at that point?

Dr. Glotzbach: It can proceed to that, although more that's rare. More commonly, the blood dissection inside the wall of the aorta will travel kind of along the length of the aorta and it can block off the branches coming off the aorta. So it can prevent blood flow from going to all the branches of the aorta which can affect any area of the body because of those arteriole branches.

Interviewer: Including the brain?

Dr. Glotzbach: Absolutely, so it can involve the carotid arteries. Obviously if the carotid artery blood flow is decreased or impaired and then it can cause a stroke. Similarly, the blood vessels going to the liver or the spleen or the kidneys or the intestines, if those are blocked off then you can have major problems in the abdomen. So it really is a critically dangerous problem once it develops.

Interviewer: And I understand that there are two different types of aortic dissections that somebody might be diagnosed with. For the understanding of, you know, a loved one that might have another loved one that's dealing with this, could you explain briefly what those two are?

Dr. Glotzbach: Absolutely, and we break it down anatomically by kind of location within the aorta and so the two types are type A and type B.

Type A aortic dissection involves the first part of the aorta coming right off the heart, so also known as the ascending aorta. And a type A dissection is a surgical emergency. Those patients need to go as quickly as possible to the operating room with a cardiovascular surgeon to repair that.

Type B aortic dissection involves the rest of the aorta, so from the aortic arch on down and including the abdomen. And so type B dissections are a little bit more complicated or nuanced in that they may require surgery or a procedure. They might not, but they definitely would need to be in the hospital.

So those two distinctions are critical for the initial treatment phase, although all aortic dissections really should be thought of as a chronic disease and so once this happens to the aorta, patients will need lifelong surveillance with imaging studies and follow up with an aortic specialist to make sure that problems don't develop down the road.

Interviewer: And what caused that to happen? Is it something that the patient did or did it just happen?

Dr. Glotzbach: It can be both. There are risk factors including smoking and high blood pressure. There are some genetic conditions or familial patterns that can predispose people to have this problem. One of the biggest risk factors for aortic dissection is developing an aortic aneurysm, which is an enlarged area of the aorta which gets thinned out and weakens, so that's more susceptible to a dissection. But a lot of times these are just bad luck and this happens to someone who's never had an aortic problem before and this just kind of happens out of the blue, so it can be a devastating problem.

Interviewer: Are there any sort of warning symptoms that would come before the actual emergency event?

Dr. Glotzbach: Unfortunately, there are not a lot of warning symptoms. A lot of, you know, an aortic aneurysm is largely asymptomatic. High blood pressure can cause a bit of a warning, and then obviously people that have known aortic problems. But most people who have a dissection have no warning sign or nothing that suggests this is about to happen until it actually does happen.

Interviewer: All right and once . . . How is it diagnosed?

Dr. Glotzbach: Typically it's severe pain and so patients who have a dissection have severe chest pain or back pain or abdominal pain or all three, and a lot of times it could mimic a heart attack or other kind of acute problems. So most people know something is going wrong and they have severe pain, which then usually people come to the emergency department with the symptoms and then it's diagnosed from there with an imaging study.

Interviewer: And how do they get fixed in the short term and then what's their long term look like?

Dr. Glotzbach: Absolutely. So for a type A dissection like we talked about, that's a surgical emergency so those patients go to the operating room and we will replace the ascending aorta at least and sometimes more. Sometimes the aortic valve can be involved or the coronary arteries need to be reconstructed. Basically need to stabilize that first part of the aorta so that the blood flow to the brain and to the rest of the aorta is preserved. So that's a type A.

For a type B, which is involving the rest of the aorta, the most critical thing is to keep the patient's blood pressure under control and then to determine if there is any problem with blood flow to any of the other organs. So we look at blood flow to the liver, the gut and the legs, the kidneys, all those things. As long as there's blood flow to those organs, typically we can manage those patients medically.

Interviewer: And what does life look like after somebody has an aortic dissection? Likely I'm talking, you know . . .

Dr. Glotzbach: Long term.

Interviewer: Three to five years.

Dr. Glotzbach: Absolutely. So once we've stabilized after the initial event, then it becomes kind of a chronic disease that needs to be managed and watched closely like any chronic disease. And so the way we do that for aorta, number one, is blood pressure control so we have to . . . most patients are on one or multiple blood pressure medications and then we do long term follow up with imaging studies. And typically that's a CAT scan or a CT scan, which is a three-dimensional X-ray that gives us a very good picture of the aorta and tells us exactly what's going on.

And so we'll have the initial imaging from when it first happened and then we'll get every, between six months to a year or so and every year after that we'll get CT scans watching how that aorta is changing or not and if things start to change then sometimes we need to do procedures in the future and sometimes not, sometimes people just remain stable and we just keep watching them.

Interviewer: So what I'm getting is that it's something that could happen again to somebody who's had one.

Dr. Glotzbach: It could, and once you've had an aortic dissection your aorta's at risk for life and so this is something that is, you know, can be managed and stable and people can go on living with it but it's not something that will ever heal completely and so people just have to be aware that they need lifelong surveillance and I think that's where a true aortic program comes in where you have a dedicated team of physicians and nurses and radiologists and people that are used to watching these over long term so that we can pick up on problems as they begin to develop, before they turn into big problems, we can intervene.

Interviewer: And what about quality of life?

Dr. Glotzbach: I think that this is a very serious emergency. When these happen, they're life threatening and should be taken seriously and treated immediately at a hospital and so the quality of life after that, once you've stabilized and treated from the initial event, people can go on living normal lives and do almost anything that they want to do provided they have good follow up care and we keep an eye on things and make sure that that aorta remains stable and doesn't develop complications down the road.

updated: August 25, 2021
originally published: August 23, 2017

Interviewer: What is abdominal aortic aneurysm, how did you end up with it, and what can be done about it? We'll talk about that next on The Scope.

Dr. Claire Griffin is a vascular surgeon with the University of Utah Health and one of the things that you deal with on occasion or often—I guess we'll find out—is an abdominal aortic aneurysm, also called "AAA." So what is that?

Dr. Griffin: Well, an aneurysm is when a blood vessel becomes larger than it should be. So we define in medicine an aneurysm as any time the blood vessel is one and a half times the normal size.

Now, normal is different depending on the patient, how big they are, if they're a man or a woman. But in general, we have an idea of how big blood vessels should be, and when they're larger than that, we call them aneurysmal.

Interviewer: All right. You get a little bit concerned about it. Let's go back for one more step. What exactly is the aorta? Where is this happening in my body?

Dr. Griffin: Okay. So you can get an aneurysm in any blood vessel in the body but the most common location is in the abdominal aorta. So the aorta is the main blood vessel in our body. It actually starts in the chest where it comes directly off of the heart and it gives branches to the arms and the head before traveling through the chest and going into the abdomen.

There are actually two main branches that come off of the aorta right after it gets into the abdomen that give blood to the liver and the intestines and then another branch goes to each kidney. Once those branches have come off there's a relatively straight section of the aorta before it divides into two around the level of our belly buttons to give blood flow to our pelvis and our legs. So that's the aorta in a nutshell, the main blood vessel or the superhighway for blood to get from the heart to everywhere else in our body.

Interviewer: So then piecing together what you've just told us, an abdominal aortic aneurysm is when the aorta in the abdominal area is larger than it should be?

Dr. Griffin: Exactly.

Interviewer: All right. So can you explain that a little bit further?

Dr. Griffin: Sure. So the normal size of the aorta depending, again, on if you're male or female or how big you are is normally about 1.7 centimeters to 2.5 centimeters. Which given that we don't use centimeters very often, really means about the size of a nickel.

When we see somebody who has an aorta that is bigger than three centimeters, so around the size of a half dollar, we consider that to be an aneurysm. Now, having an aneurysm doesn't mean that you need anything done about it. It really depends on where it's located and how big it is.

Interviewer: All right. And what caused this aneurysm to happen? Was it something that I did or does it just happen?

Dr. Griffin: So we know that there's definitely some sort of genetic component aneurysm disease but there's not one gene that causes them to happen. It's really multi-factorial.

We know for example that smoking is like fertilizer for aneurysms and causes them to grow really fast. So the number one thing we can do is avoid smoking to prevent them from happening. But even if you've never smoked, you can still have aneurysm. And if your parents or grandparents had one or uncles or aunts had one, that is a risk factor for you.

Interviewer: So how is it diagnosed?

Dr. Griffin: Because we know that smoking is the most common risk factor, there actually are screening programs that if you are a male over the age of 65 and you've been a smoker in your life, you can get an ultrasound to look at the size of your aorta. Although the most common way this is diagnosed is because people get a CT scan for something completely unrelated and it's found by accident on a CT scan.

Interviewer: So it doesn't really present any noticeable symptoms that . . . like shortness of breath or something like that. It just . . .

Dr. Griffin: No. If they're quite large, they can present symptoms because of their size or if they grow rapidly, sometimes patients will have pain associated with that, but they are most commonly asymptomatic.

Interviewer: All right. And kind of found by mistake.

Dr. Griffin: Exactly.

Interviewer: Because you're looking for something else. So when does it become a problem?

Dr. Griffin: So as the blood vessel, in this case the aorta, stretches it doesn't get any thicker. So the wall just becomes thinner and thinner. Sometimes that growing can cause abdominal pain but usually it's asymptomatic. Once it gets to a certain size, we worry that that thin wall can actually become so weak that the blood leaks out of it and that can be an emergency, considered a rupture. So we like to fix them before it gets to the size where it would rupture.

Interviewer: Yeah. And if it ruptures, then like you said, that's an emergency. That's your blood gushing out now at this point.

Dr. Griffin: Correct.

Interviewer: Pretty quickly, I'd imagine.

Dr. Griffin: It can be what we would call a contained rupture where you have some sort of symptom and pain, but even if it's a contained rupture it's still a surgical emergency to fix it.

Interviewer: So if a patient is diagnosed with one, what then? You mentioned not in all cases do you have to do something but . . .

Dr. Griffin: Depending on the size of it dictates what the next step is. So if we diagnose it and it looks like it has already met the threshold for repair, in other words, if we think that continuing to live with it is more risky than fixing it, we go ahead and do surgery to fix it. But if your aneurysm is small, it might be that you never need it fixed and so we continue to watch that or place it in surveillance and do serial imaging with either ultrasound or CT scan to keep an eye on it.

Interviewer: And then how and when do they get fixed? You'd mentioned you kind of keep an eye on it, right? If it gets stretched so far, that's when it gets fixed. So then what do you do, is it surgery?

Dr. Griffin: There are no medicines that fix aneurysms. The only thing that we can do is reroute the blood somehow so that the high blood pressure isn't touching this thinned out wall. There are two different ways that we can fix it:

1. We can either open up the patient in the operating room and replace that thinned out blood vessel or the enlarged area of the aorta or
2. If the anatomy is right, which is something that we can tell on a CT scan, we can actually travel inside the blood vessels through specialized IVs and re-line the blood vessel so that the thinned out wall is no longer getting the pressurized blood.

And depending on how we fix it, it has a lot to do with how fast the recovery is and when you can get back to your normal life.

Interviewer: After you've been diagnosed, is it . . . are you pretty good for the most part in your specialty at being able to know, "We need to do some about this right now or we have a couple of weeks?"

Dr. Griffin: Yeah. So the Society of Vascular Surgery actually has some really great guidelines that help us make decisions about patients and every patient is different. So I mentioned before how there are branches that come off the aorta. If the aneurysm includes those branches, that can make it a very complicated surgery to fix it. Or if the aneurysm is away from those branches, it can be a very straightforward repair.

So the CT scan that we usually get to diagnose it and to surveille it is critical in helping us decide how to treat it.

Interviewer: Okay. I guess what I was trying to figure out is if I was told I have an aneurysm, to me, that's an emergency, like right now. But you have a pretty good body of evidence that kind of helps dictate how dangerous you are at any given time.

Dr. Griffin: Exactly. And since this is something that I treat all the time, as a vascular surgeon, when I hear that somebody has an aneurysm, that is part of what I take care of every day. So I don't think that patients should be scared or think that it's an emergency to fix it right away. On the other hand, it is important to get plugged into a vascular surgeon so that they can tell you when and how and what the next step was going to be.

updated: August 13, 2021
originally published: August 22, 2017

Interviewer: Coming up next on The Scope, learn more about a specialized clinic that treats just diseases of the aorta. 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: Dr. Jason Glotzbach is a cardiothoracic surgeon, and Dr. Claire Griffin is a vascular surgeon, both at University of Utah Health, and they're both part of the Aortic Disease Program at University of Utah Health. And today I want to get a better understanding about that specialized clinic, why somebody might be referred there, and the advantage for the patient versus other options.

So, first of all, why is it necessary to have a clinic dedicated to the treatment of aortic disease?

Dr. Griffin: So the aorta is one of the major blood vessels in the body, and any pathology associated with it can be very complex, and it's often not something that regular doctors have a lot of familiarity with. So our training gives us the opportunity to understand not just focused pathology in one particular area, but the whole aorta. And working together means that patients can come to one place and have a variety of opinions that really helps get the full scope of treatment options, natural history of the diseases associated with their aorta, and the full gamut of specialists to help take care of everything in one place.

Interviewer: So what I'm getting is it's a pretty complicated part of your anatomy and you need some pretty specialized people to take care of it?

Dr. Griffin: Yes.

Interviewer: Let's go back to anatomy class, Dr. Glotzbach. Where is the aorta? I know it's somewhere near the heart and it carries blood, but beyond that I don't remember much.

Dr. Glotzbach: Absolutely. That's a good place to start. The aorta is the largest artery in the body. It starts at the heart. So the aorta is the first stop of blood. As it leaves the heart, it goes into the aorta, and then from there it goes up and around the aorta and, through all of its branches, goes to every part of the body.

So the aorta is literally the kind of main superhighway for blood as it travels through our body. And so given that, obviously diseases of the aorta are very critical to the entire body, and so we have arteries in the chest, the abdomen, the legs, all that feeds off of the aorta.

Interviewer: Dr. Griffin, you'd mentioned that it takes, you know, a specialist to kind of understand this. In your general four years of med school, how much of this part of the body is really covered?

Dr. Griffin: So the understanding of most medical students coming out of medical school is probably exactly what Dr. Glotzbach just highlighted. It's the superhighway for blood, it's what takes blood everywhere else, but the understanding of the diseases that are in the aorta and how to treat them, and the thought process behind the approach to them is all something that is specialty training.

Interviewer: And what's the advantage for the patient to come all the way to University of Utah Health, I mean, other than the experience part which, I guess, is a pretty big advantage, right?

Dr. Glotzbach: Oh, we like to think so. I think we like to look at the patient as a kind of individual and tailor the treatment to each individual patient's needs, and I think that that's one of the things that we can do well here, is that we have specialists from multiple different disciplines so that we can think about the disease process in many different angles or from many different perspectives.

Interviewer: When you say "from the patient's needs," what does that mean exactly?

Dr. Glotzbach: Because the aorta is such a complex organ and aortic diseases are very complex in that they are very unique to each person, so one person's disease may not be the same as another person's disease, which is a little bit different than other problems that we focus on. So it's really important to take each patient as an individual and look at exactly what kind of treatment they need, and then hopefully we can provide that in a very targeted, individualized way.

Dr. Griffin: We just have very different thoughts when we approach the aorta. The training that I received, I spend a lot of time thinking about complex endovascular or minimally invasive ways to treat the aorta and its branches. And the approach that Dr. Glotzbach might have from a CT surgery perspective comes more from a major open perspective, and having the two of us working together means that we really constantly open each other's eyes about different ways to approach the same problem.

Interviewer: Yeah, you might be able to do something a little less invasively, perhaps?

Dr. Griffin: Exactly.

Interviewer: Or you might be able to talk to each other and go, "Well, actually we do have to be a little bit more invasive in order for it to be successful?"

Dr. Griffin: And talking about those cases together and making sure that there's open collaboration means that there's never a time that Dr. Glotzbach doesn't weigh in on something or I don't weigh in on something, and so we really get the benefit of both training backgrounds for every patient.

Interviewer: Two heads are better than one.

Dr. Glotzbach: Absolutely.

Interviewer: And you have even more than just the two of you on the interdisciplinary team. Who are some of the other members, and how do they contribute?

Dr. Glotzbach: We have basically the entire division of cardiothoracic surgery and vascular surgery are both committed to making this collaborative effort work. So my division chief, Dr. Craig Selzman is very committed to this, and so he's involved in all these collaborative discussions, and all of my partners on the cardiac surgery side have weighed in on all of these cases and, you know, individual cases and also as programmatically as a whole.

Dr. Griffin: Similarly, from the vascular division we have Dr. Larry Kraiss who's our division chief, and then the remaining members of the vascular division all are involved in the collaborative discussion of patient care. And because of other collaborations between our two divisions, as well as the Cardiovascular Center as a whole with cardiology and intervention radiology, there really is a lot of expertise at the University of Utah for this kind of disease pathology.

Interviewer: That's pretty cool. How old is this clinic? It's fairly new, isn't it?

Dr. Glotzbach: You know, we've had this expertise in kind of individualized divisions and aspects of care for years, but the collective pursuit of this as a multidisciplinary thing is really within the last year, we've been trying to build this up. And we've had a lot of buy-in from the leadership of the hospital in the cardiovascular service line, and so we're starting to really get some momentum with this.

Interviewer: One call, and you don't have to look around for all the experts, you're still in one spot.

Dr. Glotzbach: That's the goal. We're really trying to streamline things for the patient and for referring physicians who want to send people here for us to help out with. I think that it can be very complex to navigate a system like University of Utah, these large academic medical centers, and so our goal is to make it kind of a one-stop shop for the patient to come in, and we bring whatever expertise we need for the individual patient. We bring that to the table.

Interviewer: How do patients generally end up in the clinic? I don't imagine that's their first stop.

Dr. Griffin: That's a great question. There are a couple of different ways to find our program, and it really has to do with the kind of problem the patient has. So some of the aortic diseases are picked up by primary care doctors with routine screening evaluations or as incidental findings on CT scans that patients have for other purposes, and those patients really come through the referral process. There's a whole other section of diseases that affect the aorta that are really emergencies or acute findings that take patients to the emergency department, and they would come to us through emergency transport.

Interviewer: Let's talk about the referrals. If there is a patient that has been diagnosed with some sort of aortic issue and the physician doesn't know about the clinic or doesn't make a referral, is there a way a patient could find their way to you in that instance?

Dr. Glotzbach: Absolutely. We have a kind of dedicated administrative pathway where we have one phone number that we can . . . you know, both patients, or physicians, or doctors' offices could call and get an appointment with us. And it doesn't matter whether they end up needing a cardiovascular or cardiac surgeon, vascular surgeon, or both of us, you know. We can streamline that process, and our goal is to have it. So as soon as we hear about a patient, we will get them into our system and get them plugged in with the appropriate providers that can help them with their specific problem.

Dr. Griffin: One of the things that is helpful about our system, and having as much expertise as we do, is that a lot of times people can have really rare disorders of the aorta or its branches, and their primary care doctor or maybe the physician taking care of them doesn't see it enough to feel comfortable managing it, and that's one of the benefits of having such a collaborative effort that it's not rare to us. We're familiar with it, we're comfortable with it, and we're happy to help take care of it.

And in addition, I think that one of the things that's unique about our effort right now is that it's very collaborative, and so we're not competing with each other to take care of these patients. We're working together, and I think that creates an environment not just for the physicians and the patients, but also for all the support staff that really can be focused on patient care and patient outcomes instead of trying to be competing with each other.

Interviewer: And make sure that the patient gets exactly what the patient needs to get back to their life, however it may have been before they ran into the problem?

Dr. Griffin: Exactly.

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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.

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Dr. Miller: You're pregnant and you're uncomfortable. Do you really have to sleep on your side? We're going to talk about that next on Scope Radio, and I'm Dr. Tom Miller.

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Dr. Miller: I'm here with Dr. Howard Sharp. He's a professor of obstetrics and gynecology here at the University of Utah. Do women really need to sleep on their side when they're pregnant? What's the story there, Howard?

Dr. Sharp: Well, it is recommended, and the reason for that is the big vessel, the aorta, comes off the left side and it's the higher pressure.

Dr. Miller: The aorta is a blood vessel that brings blood down to the lower part of the body and to the baby.

Dr. Sharp: Exactly. And then on the right side there is the vena cava, which is the return pipe. Ideally, sometimes when a pregnant patient is more than 20 weeks pregnant, there is a little bit more compression against that vena cava. So if you can have them kind of pressing against the aorta, which is the high pressure side, it's not as big a deal. It's easier for the blood to get through.

Dr. Miller: But does that matter or is that just an old wives' tale that you have the sleep on your side?

Dr. Sharp: Well, there is one study that was relatively good, but not fantastic, that did show improvement in outcomes where patients slept on their left side. But the truth is everybody wakes up on their back, and there's rarely a pregnant woman that I see who doesn't ask that question.

Dr. Miller: So the key thing is if the woman starts out lying on her side and wakes up on her back, which is pretty common, that's probably just fine.

Dr. Sharp: Yes, because this has been happening certainly for centuries and centuries, so probably not a huge deal. Now, I'll tell you one funny thing. I did have a really sweet patient who taped a tennis ball onto her back with duct tape. You do not need to do that.

Dr. Miller: To keep herself from rolling onto her back?

Dr. Sharp: Exactly. But I thought, well, that is a dedicated mom. But what you can do, and the truth is even the right side is probably okay, it's mostly just that you're not flat, you could also prop yourself up with wedges, and that helps if you just can't sleep on your side.

Also, a lot of people get these body pillows where they're able to take this really long pillow and they're kind of able to clutch that, put it between their thighs, and that kind of helps them stay on their side. So that's another option.

Dr. Miller: Well, so one of the things you talked about was compression of the major vessels in the body, but what would potentially be the bad outcome?

Dr. Sharp: The worry is that if the blood is not flowing back to the baby, could that deprive the baby of oxygen and nutrients. I think it's really more of a theoretical concern. I don't think it's the end of the world if one ends up on their back.

Dr. Miller: So it sounds like women that are pregnant beyond 20 weeks should start out lying on their side, try to sleep on their side, but if they wake up and they're on their back, don't worry about it.

Dr. Sharp: But if they're on their back, they shouldn't lose sleep over it.

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updated: July 12, 2018
originally published: April 7, 2015