Search for tag: "families"

Interviewer: How are your kids doing? Are they struggling with their mental well-being, or are they doing all right? Well, you might not even notice, because according to psychologist, Andrew Smith, in order to see how your kids are doing, you have to be honest with yourself and check in with how you're doing.

Dr. Smith: One of the things that creates problems and risk in families is when parents are struggling and they don't have the bandwidth, the emotional bandwidth to see and hear the distress of their adolescents and their kids. If you're listening to this, and you're struggling with your adolescents, and I'm hearing a lot of that in my clinic, reaching out and taking care of your own mental health needs is one of the answers. And having access to some sort of either online or bona fide psychotherapy is pretty critical to create that emotional health and bandwidth within a family.

Interviewer: You've had all the children you and your partner want. Your family is complete, and now you're considering permanent birth control. But how do you decide who gets it done? Is it the dad, and he gets a vasectomy, or is it the mom, and she gets tubal ligation?

Dr. Alex Pastuszak is a urologist and a fertility expert at University of Utah Health. What is your take on this question, tubal ligation or a vasectomy?

Dr. Pastuszak: So, Scott, I'm going to come right out and say that I would be strongly in favor of the vasectomy.

Interviewer: All right. But that's what you do, so I would expect that. Do you have some more support for it?

Dr. Pastuszak: Right, yeah. So, no, this has nothing to do with my pocket.

Interviewer: Okay.

Dr. Pastuszak: But it has everything to do with the safety and the cost of the two procedures relative to one another.

Interviewer: All right. Break that down.

Dr. Pastuszak: So I would tell you that vasectomy is the safer and cheaper option compared to tubal ligation. So let's go ahead and, just like you said, break that down.

So what are the risks of tubal ligation? So we know that, just like a vasectomy, it can include bleeding and infection. Unlike vasectomy really, though, it can include injury to other organs because you're dealing with the tubes that are inside a woman's pelvis, which are really close to a lot of other sensitive structures.

Tubal ligation requires general anesthetic or strong regional, so the anesthesia is already more significant, and the side effects from that can be more significant than that for a vasectomy. And then just in terms of pregnancy itself. So while tubal ligation is just as effective, effectively, as vasectomy, so more than 99 percent, you can still run the risk of an ectopic pregnancy or incomplete closure of fallopian tube which results in pregnancy.

Now, if you counterpoint those against the risks of a vasectomy, then you're really just talking about bleeding, infection, some pain, and maybe failure of that vasectomy as the main risks. Very few.

Interviewer: And recovery is also much quicker for a vasectomy versus tubal ligation.

Dr. Pastuszak: Right. Because tubal ligation, again, you need to make an actual hole in the abdomen, which by surgical standards in this case, it's a minor surgery, but it's still much more major than a vasectomy.

Interviewer: Gotcha. What about the cost? I think this'll be a short conversation because vasectomy is cheaper.

Dr. Pastuszak: Well, it's cheaper, and the reason it's cheaper is just because you can do it in the office under local anesthesia.

Interviewer: Gotcha, gotcha. Is there a reason why a couple might actually want to get a tubal ligation versus a vasectomy in spite of the reasons that you just gave? Is there anything that you're aware of?

Dr. Pastuszak: So unless there's an actual reason that a man cannot physically get a vasectomy, and I can't think of one off the top of my head, they may exist, or the woman is already undergoing another surgical procedure, like a Caesarian section, and at the time of that procedure wants to go ahead and have that tubal ligation, I don't see any reason why a tubal ligation would be or should be preferred over a vasectomy.

Interviewer: The difference is, though, a tubal ligation, a pregnancy could still occur that could be . . .

Dr. Pastuszak: That could be damaging to the woman.

Interviewer: Yes, exactly.

Dr. Pastuszak: In the setting of, say, an ectopic pregnancy.

Interviewer: Which means?

Dr. Pastuszak: Which means that the pregnancy actually starts in the fallopian tube, and since that fallopian tube is now closed, that fertilized egg can't get to the uterus, and so it starts growing in the fallopian tube, which becomes an urgent or emergent surgical situation for the woman.

Interviewer: And, as of right now, there are more tubal ligations than vasectomies in the United States, isn't there?

Dr. Pastuszak: That's right.

Interviewer: Yeah. Even though the other one is the clear winner, it sounds like, to me.

Dr. Pastuszak: Yes.

Interviewer: So, in this conversation, is there anything else that you would recommend for a couple to consider while having it, other than just kind of the facts that you laid out?

Dr. Pastuszak: So I think the couple really does need to have the facts because, you know, guys are (a) afraid. I shouldn't say afraid, but guys do not tend to seek medical care, right. In the US, women are often the driver of their own and their partner's and family's medical care. So that is one barrier to more men having vasectomies. In fact, maybe not most, but a lot of the men I see in my office come because their partner, their female partner asked them to come, not because they have taken the responsibility.

You know, and I would kind of put this back in the men's court just to sort of say, well, how sexy do you think your woman thinks you are, you know, if you're sitting there and pushing back against this vasectomy? What do you think she would think if you said, "Honey, I'm going to go ahead and get this vasectomy, and I'm going to do this for us and for our family"?

Interviewer: Yes, because it's a safer and a more economically cheaper option. That's pretty sexy.

Dr. Pastuszak: I think so.

Interviewer: So I think, finally, if in spite of all this information, a guy still has it in about getting that vasectomy, what would you say at that point? Because, to me, the course of action seems obvious, but men can still be hesitant. What would you say at that point?

Dr. Pastuszak: So I really do think information is power, and I know that men are hesitant. You know, at the very least, go get the facts. Go see somebody who knows what they're talking about this. Go see your local urologist. Just talk to him about it. He's not going to commit you to having a vasectomy in the office that day. It's your decision, but at least know objectively what you're walking into. And I will tell you, most of you will go with the vasectomy after you talk to him.

Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source, straight from the doctor's mouth. Here's this week's listener question on The Scope.

Interviewer: All right, it is time for our listener question. Today, the listener question is from Renee. Her dad just had a stroke and he's going through physical therapy, and she wants to be sure that she's doing the right things to help him recover. She understands how important physical therapy is and she wants to know what to do, how to help. So we brought in an expert, Randy Carson. He is a new neuro clinical specialist in physical therapy. What can she do to help her dad?

Randy: One of the first things that we talk to people about, families especially, is to actually take care of themselves because they definitely need to be in a position where they could be helpful. So after somebody's had a stroke, they may need help with things like walking around the house, getting in a bed, and doing things like that. And while they're in rehab with us, they're in good care. So this would be the time for them to do things like get their house in order, make sure they've got the time when their dad goes home so that they can actually be in a good position to be helpful.

We do a lot of training with families right before somebody goes home to show them really great body mechanics and things like that so they don't get injured, a lot of good safety things that we teach them about how to assist, in her case her father, so that he wouldn't have a fall or put himself in more harm's way, and definitely, a lot of education on prevention of secondary risk factors so that you don't end up back in the hospital too.

Interviewer: Yeah. That surprised me a little bit. I guess I didn't see that answer coming. I thought your answer is going to be more along the lines of, "While he's doing his exercises, you can do this, this, and this."

Randy: People make tremendous progress while they're in the hospital. So if they're involved a lot and really early on, for one, they usually burn out by the end of the stay if they're there three or four weeks, because that's a long time to be on you're A-game the whole time. And then, the other thing is they're overwhelmed because who they see on the first day in rehab is going to be dramatically different on the person that they take home.

So we don't do a lot of training in the beginning, because that's when they're at their worst. They might need a lot of lifting assistance, they might be a super high risk for fall, and that's the best time to let us take care of them and try to improve them to a point where they can be very manageable to take home.

Announcer: Have a question? Ask it. Send your listener question to hello@thescoperadio.com.

Dr. Jones: How do you plan when and how many children to have? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care and this is "Making Babies or Not," on "The Scope."

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on "The Scope."

Dr. Jones: Most of us want children and most of us want to have them when the time is right. However, how much are we really willing to do to accomplish this goal of family? Some people prefer to take a more natural approach and some a more technical approach. Natural family planning provides contraceptive methods and a fertility method for creating a family of the right size at the right time.

Today in "The Scope" studio, I'll be talking with Dr. Joseph Stanford, professor in the Department of Family and Preventative Medicine. Dr. Stanford has a special interest in natural family planning and in natural procreative technology. Dr. Stanford and I have spent our careers in helping people have the children they want, but we take different approaches and we're going to talk about that today. Welcome, Dr. Stanford.

Dr. Stanford: Thank you, great to be here.

Dr. Jones: So let's just throw it out there, what is family planning to you?

Dr. Stanford: Family planning, to me, means couples being able to choose how many children to have, and when and how to have them.

Dr. Jones: I agree with that 100%. So there is a large domain of knowledge and practice around natural family planning.

Dr. Stanford: There's some considerable science and there's also . . . my interest is a lot of things we're still learning, but yes, there's a considerable body of science behind it.

Dr. Jones: Okay. So tell me a little bit about your counseling couples or your practice of natural family planning. What does that mean?

Dr. Stanford: So natural family planning means couples understanding when the woman is ovulating, when the days are that intercourse would result in pregnancy, and then making choices to either have intercourse or abstain. Or we can talk about the various choices they might make around that time to decide to either try to get pregnant or not.

Dr. Jones: So how well does it work?

Dr. Stanford: If a couple understands the days that they may get pregnant and does not have intercourse on those days, it's highly effective for avoiding pregnancy. The controversy about effectiveness comes when couples take chances or say, "Well, maybe I'll see what happens." That's where the gray areas and the controversy come for effectiveness.

Dr. Jones: Right. Well, so, for me, I would say I take a more technical approach. I certainly was raised as a reproductive endocrinology with the science of contraception in terms of birth control pills, birth control hormones, IUDs and shots, because my training told me that people are the least predictable about their behavior when they're thinking about sex and that the difference between what they intend to do and what they really do is kind of big. We know that people want to take their birth control pills and they . . . 10% of them screw up and they don't take them right. Well, what about the natural family planning? You must be looking at a very unique group of people who are motivated, highly motivated.

Dr. Stanford: Yes and no. I would say that successful users in natural family planning are highly motivated for a variety of reasons and find a way to make that work, and find it beneficial to their relationship over time. So in that sense, yes, they're highly motivated. I would also say that they, on average, tend to have a little bit different view about when they want to have children. I think natural family planning users, on average, probably have a few more, one or two more children than the contraceptive users, and that's because of their worldview of how many children they want and what methods they want to employ to get there.

Dr. Jones: So I think the people who provide this service may have a unique worldview. That would be you versus what mine might be, and the people who come to practice this method reliably and successfully may have a little bit of a different worldview, so I think . . .

Dr. Stanford: But I would also say there's a spectrum of reasons people use natural family planning or what we might call fertility awareness methods. Some are coming at it from a religious point of view, some are coming at it from an ecological point of view, they don't want hormones, some are coming at it from a point of view of not wanting to have a barrier or they like that idea of understanding their bodies. So there's a spectrum. It's not a monolithic group that use natural family planning.

Dr. Jones: Right, and I understand that, having grown up sort of in the granola culture, that a lot of women didn't want to put anything in their body or take anything unnatural and preferred -- they were well-educated women -- to make their own personal choices, and I can see that that might be very useful for them if they practice it reliably through a lifetime of contraception.

Kids who might be sexually active, when they're still not reliably ovulating or women postpartum, or women in their 40s, are there special tools that you have to use for women who aren't reliably ovulating?

Dr. Stanford: Let's talk about the women in their 40s or women who are not reliably ovulating. Those are cases where I think we do need more research, but I do think we have adequate tools to make it work for those who want to make it work. Is it always the easiest thing? No, sometimes it requires a little more patience. It can work for that group. I hope we have better ways in the future to make it work a little more smoothly or easily.

The teenager, that's another question of motivation and the whole social context of . . . . I believe that teenagers should all be educated in their sexuality, including their fertility and their fertility cycles. Whether or not that means we rely on that as the only way of them not getting pregnant, I would think you need to look at social context and social norms, and other issues. And in some social context for some teenage populations and families, they may think contraception's part of that, but I think that for all teenagers, they should understand their fertility.

Dr. Jones: Right. I thought that if they had sex, they were reflex ovulators like cats, meaning, yes, grown-up women ovulate on a schedule and teenagers only ovulate when they have sex because it seems like it only takes once, at least that's what they've told me.

Dr. Stanford: Well, you know, that's an interesting question that I actually think we need a little more research on, but it's not true that . . . there's no evidence, let's put it that way, that women can go from no mature follicle to ovulating based on one intercourse.

Dr. Jones: Even I know that. Well, so I take it . . . I come at contraception from a perspective of wanting to have a very low failure rate with almost no input.

Dr. Stanford: Right.

Dr. Jones: So for those of us who are interested in what we call long-acting, reversible contraception, or highly effective reversible contraception, we want something that's highly effective and reversible, and you don't have to think about it, that has some side effects, though. It has some downside and women, the tradeoff for highly effective and reversible is some side effects, but I guess . . . what is the failure rate if you follow the rules? Did we talk about that?

Dr. Stanford: Yeah, 1% to 2%.

Dr. Jones: One to two percent, that's pretty good, per year?

Dr. Stanford: er year.

Dr. Jones: Per year.

Dr. Stanford: So I would say that is a fundamental difference in philosophy. Natural family planning is, in some ways, the complete opposite of long-acting, reversible effective contraception in the sense that the goal is to have as little user input as possible, make it completely independent of the user.

Dr. Jones: Right.

Dr. Stanford: Natural family planning is the radical opposite of that. The user, and not just the woman, but the woman and the man together, need to cooperate and understand what's going on and cooperate to make that happen for both of their intentions. So it is a radically user-dependent method, which I think some people see as a weakness, but it is also a strength.

Dr. Jones: I think it is for strength and what I really want is for women to have their choices.

Dr. Stanford: Right.

Dr. Jones: And for couples to have their choices.

Dr. Stanford: Right.

Dr. Jones: And I think that's important to both of us, and whether you choose a very technical approach to your personal contraception, or you want a, what I call radically . . .

Dr. Stanford: User-dependent . . .

Dr. Jones: . . . user-dependent method, meaning your control and your body

Dr. Stanford: Right.

Dr. Jones: We want to have both people to be successful.

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Interviewer: Genetic discovery is allowing a family to outlive their family history. Up next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope.

Interviewer: I'm talking with Deb Neklason. She's Program Director of the Utah Genome Project. Dr. Neklason, tell me about this family. What sets them apart from others?

Dr. Neklason: This family is a family that had a lot of colon cancer going on and a lot of people dying at young ages, in their 40s and 30s and 50s, and the family was very impacted by this. So the family was engaged in research to be able to try to piece together the genetics and the history and try to determine what was causing colon cancer in the family.

Interviewer: How did scientists go about discovering what was causing that disease?

Dr. Neklason: The clinicians and the researchers, geneticists at University of Utah worked very closely together on identifying individuals that seemed to have a clinical . . . they had a relative who had had colon cancer or they themselves had had multiple polyps. And they engaged these individuals in research, obtained a blood sample that they were able to look at the DNA, and tried to piece together some part of their genome that they are inheriting that is shared by all the people who are affected by either multiple polyps or have had colon cancer or a parent with colon cancer, and try to piece that together and rebuild that puzzle.

Very early on they identified a gene that's involved in a similar condition called familial adenomatous polyposis. These individuals have hundreds and thousands of precancerous polyps. And so they were able to associate it with this gene and then eventually over time to be able to sequence through and actually find the specific genetic change. And in fact, everybody who had had colon cancer or had multiple polyps did have this genetic variation.

Interviewer: Right. So as part of your journey in helping this family, you went back to patient zero. You did kind of investigative work to figure out where this variation came from. Why was that important?

Dr. Neklason: Well, that's really important because it demonstrates the breadth of the impact of this genetic variation. It's not just a little two or three generation family. We actually traced this back 14 generations to a Pilgrim couple that came to America in the 1640s, and it tells us there's a lot of families and a lot of individuals in this country that potentially have this genetic variation, and we're trying to still continue to piece together these families.

Interviewer: How many of those descendants do you know of have this genetic variation?

Dr. Neklason: We went through and very rigorously investigated three branches of the family that looked like they had more colon cancer than usual. Two of those three branches have the genetic variation, the mutation that leads to high colon cancer risk. And in those two branches we have identified, let me think, 186 individuals with the mutation, and 819 individuals who do not have that mutation, and we've been able to go back and provide that information along with genetic counseling and education to these individuals. A hundred and forty or so of them chose to pursue genetic testing and education and so they know the mutation. The remaining individuals, some of them are deceased.

Interviewer: That's the important part here is that there actually are preventative screening and preventative measures that these people can undergo to slow or stop the disease, right?

Dr. Neklason: There are, and that's definitely the amazing thing about it. We've been able to look at the family and the cancer rates in the family over the years and see what sort of impact did genetic testing have on this family. What sort of impact did it have on cancer prevention? And so we are able to look at cancer rates using the Utah population database that has the genealogies, and overlay the Utah cancer registry, cancer records on top of that. So all cancers diagnosed in the state are reported. When we went and looked at the numbers of cancers in the two affected branches, we found that when we initially engaged them in research, which was about from the mid-80s to the mid-90s, we saw that cancer rates dropped in half in the family.

Interviewer: Wow.

Dr. Neklason: Their incidence was about five times higher than the general population, and they dropped down to about two times higher than the general population by just knowing. That is in the absence of genetic testing, but knowing that they have something going on in their family. So that's the impact of communication and knowledge and education on these individuals. And then we see again after we started to do genetic testing and return results to the family, we see another drop, about 30%, in this family for cancer rates.

Interviewer: How are they made aware of this inherited condition and what the risk is to them?

Dr. Neklason: All of these individuals that I had mentioned we've done genetic testing on, about 180 of them that were mutation positive, we've enrolled them in research and their successive generations. So whenever the children turn 18 we give them the opportunity to enroll in research, and through that we're able to extend this knowledge and the information.

We also encourage the families to communicate with their family members and work with the parents to say, "Okay. You need to talk to your children about that. When they're at the age where they can make their own decisions, you need to look at pursuing genetic testing." And then if they don't carry the mutation then they don't need to undergo colonoscopy like past generations did until they're age 50, the average population risk. If they do carry the mutation then they need to start having colonoscopies in their early 20s and prevent and remove these precancerous polyps before they can become cancer.

Interviewer: So you have this long-term relationship with this family. What do you hope to do going forward?

Dr. Neklason: We would really like to try to piece together some of these other families that are across the country and figure out how they relate to each other, and a lot of that's just engagement of the existing research participants. Do you know your family history? Do you know the names of your great, great grandparents, and then all of a sudden you can start to piece together these families. And that's important because some of these other 15 families, odds are you can expand that family, just like we did the Utah family, to include hundreds of individuals who are at risk and don't know that they're at risk. It flies under the radar and sometimes it's very hard to pick out in the general population that colon cancer is not just bad luck in your family, you actually do have this genetic mutation that's leading to your risk.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

Interviewer: Family dinners, holiday parties, jingle bells and presents. It's that joyful time of the year again. But you go feeling depressed and moody. Coming up on The Scope, how to deal with holiday depression.

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

Interviewer: We're talking with psychiatrist Dr. Jason Hunziker from the University of Utah. Jason, the holidays are here and you're supposed to be happy. But why are some people depressed?

Dr. Jason Hunziker: Have you ever been to one of those holiday parties before? They can be very stressful, and often we think about families, and we think about our childhood, growing up, and all of those things that are very nostalgic to us. However, as life goes on families change and traditions are thrown away. And some people have a hard time changing those traditions and moving forward.

Additionally, you see family members that maybe you don't see all the time; you have work parties, and you have to buy Christmas gifts. You have to plan meals and entertain and clean house and everything has to be just right. And it gets very overwhelming, particularly if you don't stop and take time for yourself.

Interviewer: And this might seem like a silly question, but how can you tell if it's getting stressful?

Dr. Jason Hunziker: I think when you can tell that things are getting too overwhelming is when your sleep starts to get disrupted; you are shorter with people in your family or others at work. You start to dread Christmas altogether. You're finding yourself sitting in your room crying occasionally. You are more emotional when you're interacting with others. I think that the time that you need to really pay attention so that that doesn't turn into something else.

Interviewer: When is it to the point where you say, okay, this is getting serious? I have to go see a doctor.

Dr. Jason Hunziker: I think the best predictor of how we're going to do over the holiday season is how we've done during all the holiday seasons. And I think if you know that holidays are very stressful for you, get in early and go see the doctor early so that you can start to feel better and enjoy your holidays rather than feel miserable and can't wait until they're done.

Interviewer: So we'll say it's Christmas; I'm depressed and I don't want to see anyone, which means I obviously don't want to see you. I don't want to go see a doctor. Am I going to get worse?

Dr. Jason Hunziker: It's really important to recognize when you are feeling that way and not pretend that these emotions don't exist and that you are supposed to be happy so you're going to be happy. You need to acknowledge those emotions and those feelings and then get in and do something before it gets to the point where you don't want to do anything. If it gets to the point where you're isolating, that you're contemplating hurting yourself, that you're drinking alone in your bedroom so that you can avoid contact with anybody, those are things you really need to look at and get in and get some help.

Interviewer: Usually I feel like when you're depressed, you don't want to admit that you're depressed. What are some signs and symptoms that close friends and family members can look out for in case someone around them is getting depressed?

Dr. Jason Hunziker: I think one of the big things that families notice is that change in your personality where if you're the type of person who is readily engaged with people, you're always wanting to be at parties, but you start to isolate and you start to avoid conversations; you're not answering your phone; I think people will recognize that, and that's a danger sign. If you're sleep pattern is disrupted, your significant other often will recognize that and be able to say, hey, you were up all night, what's going on. I think that's important to pay attention to.

A lot of people during this time of year will eat more than they normally do when they start to feel depressed. And then they feel guilty about eating so much and that becomes a problem. Alcohol is a huge problem during this time of year because there is alcohol at all of these parties and people who tend to drink more during the holiday season could be somebody who is feeling depressed or sad and that could be the time to get in and talk with somebody.

Interviewer: Okay, so how do I avoid all of this? I'm aware of my problems, but I'm not at the point where I need to go see a doctor. How do I get better and avoid getting worse?

Dr. Jason Hunziker: I think reaching out to other people is really important. I think often times people feel left out during the holiday season, but there is so much going on in the community that you can go volunteer somewhere at a soup kitchen and just giving back to somebody and helping and getting that human contact is very important to help you feel good during the season. I think you need to be realistic about what you expect from the holiday season. You can't expect everything to be the same as it always was, and you can't expect all those traditions to be the same. Traditions change; families change; change your traditions with your family. If your kids are grown and they're out of the house and they're scattered all over the place, have a cell phone conference with them. Enjoy the holiday that way so that you can have a new tradition rather than longing for the old tradition and doing nothing at the same time.

Interviewer: What are some other common issues that could lead to holiday depression?

Dr. Jason Hunziker: Another problem that happens during the holiday season is we don't stick to a holiday budget. We tend to spend a lot of money that we don't have, charge up a lot of credit cards; and then right after Christmas we have this huge remorse. And right in January when we get our first bill from Christmas it gets even worse. So stick to a plan. I think planning ahead is always a good idea as well.

If you're going to entertain or you're going to have a party, plan way ahead so that you're not rushing around at the last minute because you forgot a certain spice that needs to be in your pie. If you have it all lined up and it's all laid out, then the stress level will go down.

And don't abandon your healthy habits. We tend to do that all the time. We stop exercising, and we start drinking more; we eat all the junk food. All of that stuff is going to make you stressed. You're going to be unhappy. You're going to be depressed, because you just ate a whole pie last night.

So be careful to keep exercising; that's another way to keep yourself happy as well. That will help you feel better.

And I think the last thing to do is to make sure you have time for yourself. It goes back to the exercising, but maybe even take in a moment, ten minutes, to meditate and think about why the season is important to you and what is most important about the season so that you don't feel stressed and overwhelmed. And you can remember why it is that you're putting yourself through all of this in the first place, and the importance of that to you and your family.

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