Search for tag: "healthier"

Interviewer: Five things to do to be a healthier you. That's next on The Scope.

You've decided you want to be a healthier version of yourself. We want to find out what are five things that you could focus on that would help you accomplish that goal because obviously, physical health is good but there are other aspects as well. So to help us kind of figure out the five things you can do to be a healthier you, we've got Dr. Troy Madsen. He's an emergency room physician at University of Utah Health Care. So what are five things that I could really focus on just to be healthier and happier this year?

Dr. Madsen: When we think about the New Year we often think kind of big picture things, and you always hear, "Eat better, sleep better, exercise more." We tell ourselves these things every year, like, "I've got to change this, I've got to do better." For me, I like to think specifics, so these are very, very specific things you can do to make a difference. Maybe you have other specific things in mind, but these are something you can do to say, "Okay, what can I do today to make a difference?" Something simple, some simple changes to improve in these areas.

Interviewer: All right. So we're not just talking about eating better, we're talking about something specific that's going to help you eat better?

Dr. Madsen: Exactly.

Interviewer: Oh, this is good. All right.

Dr. Madsen: Very specific here.

Interviewer: Number one, five things you can do to be a healthier you this New Year.

Dr. Madsen: So number one to eat better, eat fruit every morning with your breakfast. Very simple. Eat a banana, eat an apple, whatever it is. It's going to accomplish a couple things. Number one, you're going to actually eat breakfast which, of course, they say is the most important meal of the day. I don't know if that's true but I think it's an important meal. Number two, right there, you've already had a couple servings of fruit. Eat a full banana, that's like two servings. You're good, you're almost halfway there for the day.

Interviewer: So that's it. All right, yeah.

Dr. Madsen: See, you've already improved your eating.

Interviewer: Okay, I like that. Number two on five things you can do to be a healthier you.

Dr. Madsen: Number two kind of along the lines of this whole eating thing, is take a water bottle, a refillable water bottle, with you to work. Accomplishes a couple things. Number one, refill that bottle several times during the day, drink lots of water. It's going to get you up out of your seat, get you walking to fill it up. It's also going to get you out of your seat to go use the restroom. You have to use the restroom more.

Interviewer: Yeah, because a lot of us can just sit around at work all day and never get out of that chair.

Dr. Madsen: Yeah, and never get up and walk.

Interviewer: Getting up is super important.

Dr. Madsen: It is.

Interviewer: I mean, it seems so simple but it makes a big difference. It makes a big difference.

Dr. Madsen: It makes a big difference, and a lot of studies show that just sitting all day is a big risk factor for heart disease and problems down the road. So it gets you up, gets you moving around. It also helps you feel more full. It's also going to help you avoid going and getting sodas and high-calorie drinks because you already got water there, you're drinking it. It's going to help on a number of fronts.

Interviewer: Yeah. I know a lot of people that, when they start feeling hungry, they'll just take some water instead. A lot of times, that hunger sensation is actually caused by thirst, I've heard.

Dr. Madsen: Exactly, yeah.

Interviewer: Also, like you said, it fills your stomach. That's great. All right, number three.

Dr. Madsen: So number three is exercise. Don't just exercise but just tell yourself, "I'm going to something 30 minutes a day, three times a week." That's it. It doesn't matter what you do. If you can't run, walk. If you don't want to ride a bike, just get out, do something just to make yourself do it three times a week, 30 minutes each time. Don't hold yourself to super high standards, saying, "Okay, I'm going to go to the gym six times a week for an hour and workout." If you're doing anything right now, just say, "Okay, well, where can I start?" Three times a week, 30 minutes a day. Doesn't matter what you do, get out, walk, run, jog, ski, bike. Whatever it is, do something.

Interviewer: Just be active.

Dr. Madsen: Just be active.

Interviewer: All right, sounds good. Five things to do to be a healthier you, number four.

Dr. Madsen: So the next thing, of course, we talk about eating, we talk about exercise, and then there's sleep. Sleep makes such a big difference in terms of both our attitude, our general health, our diet. So to improve sleep, this is a challenging theme because sleep affects so many people, but a simple thing you can do is to improve your sleep hygiene.

Step one would be, if you have a TV in your room, take the TV out of your room. That's been something that's been shown again and again, that association of having that TV in your room can just make you sleep not as well. Either you're up late watching TV or you're thinking in the middle of the night, "I can't sleep, I'm going to turn the TV on." You're awake then, you're watching more of the TV. Take the TV out of your room.

Maybe it's something else, like just don't look at your phone an hour before you go to bed. Just don't look at that screen because that blue light coming from the screen can disrupt your sleep. But again, I think the simple thing would be to say, take the TV out of your room. That'd be the first step.

Interviewer: That's a great idea. All right, number five.

Dr. Madsen: Yeah. So the last thing would be to improve your psychological health. Something that's been shown again and again to improve psychological health is gratitude, just being grateful for what you have, looking on the positive side. A very simple thing you can do here is just jot something down every day that you're grateful for. Maybe it's on a little Post-it note, something you can stick on your computer, maybe it's just saying it out loud as you're driving to work. Something like that, just to bring it to the forefront of your mind.

You're grateful for the weather, you're grateful for your job, whatever, your family. Just something to focus on, rather than the negative. Studies again and again show that focusing on gratitude makes a huge difference in our psychological health, our general outlook and our physical health as well.

Interviewer: I've started doing that every morning at the beginning of the last year, and it makes a huge difference.

Dr. Madsen: Yeah.

Interviewer: Not only just gratitude, but also maybe celebrate your little victories.

Dr. Madsen: Right.

Interviewer: So for example, if you tried one of those other things and you did really well at it, like, "Wow, I really watched what I ate the other day and I've avoided the sugary stuff that I normally go to." Write that down, celebrate it.

Dr. Madsen: Exactly. Celebrate it, celebrate that you're eating a banana on the way into work because you're eating your fruit. You got your water bottle there, you didn't have your TV in your room last night. Look what you can be thankful for.

Interviewer: Right? As simple and as silly as that sounds, it really does make a big difference. It does.

Dr. Madsen: Yeah. It's amazing. It sure does.

updated: January 26, 2022
originally published: January 6, 2017

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. Jones: A good marriage makes people healthier. We know that. An abusive marriage is bad for your health, but what if you have good days and bad days and so-so days in your marriage? This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care, and we're talking about marriage and your health 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: Marriage is a good thing for committed couples, right? Well, whatever your feelings about the institution of marriage, there is substantial research about what's called "the marriage benefit." Now this isn't a tax benefit. This is a psychological and health benefit. People, particularly men, are healthier when they're married, and they live longer. The marriage benefit in terms of longevity is somewhat less powerful for women, but it's still there. Now, these studies are pretty easy to do. You look up birth and death records and find out how long people lived, delete the people who died too early to get married, and find out whether the person being studied was married or not, and that's how you do the longevity part.

But there is research that gives some insight into the marriage benefit. A person in an MRI who is holding the hand of a beloved, trusted spouse has their brain and their blood pressure calm down, and holding the hand of a beloved, trusted spouse works as well for pain as moderate painkillers. But what if the spouse isn't beloved or trusted, or maybe just not today?.

The behavioral research group at BYU made national news in the New York Times by their study titled, are you ready? "It's Complicated: Marital Ambivalence on Ambulatory Blood Pressure and Daily Interpersonal Functioning." This study wasn't about marriages that go from loving to abusive, but more about the feeling that your partner is unpredictable in levels of support or negativity. They studied 94 heterosexual couples in our own Salt Lake City with questionnaires about how regularly they felt supported and championed by their spouse and how reliably they supported and championed their spouse..

These folks were heroic research participants. They wore a blood pressure monitor throughout the day, had their blood pressures measured twice an hour for a day, and they had to take a brief questionnaire minutes after their blood pressure was taken to find out what they were doing and how they were interacting with their spouse. These were couples who either didn't have kids or whose kids had left the home, probably because it only takes one cranky teenager to upset the blood pressure applecart. The couples had been married for an average of 5 years from 1 to 41 years..

Twenty-three percent of the couples were in supportive marriages with low levels of negativity. Seventy-seven percent gave mixed responses. That's good and bad news. Good because mixed is normal, bad because the people in a marriage that had levels of negativity, that snarky comment you directed at your spouse, had higher levels of blood pressure readings than those who were supportive..

We don't know if that means these couples will die sooner or get sicker or get divorced, but it does mean that unpredictable or ambivalent support from your spouse isn't good for you. All of us who have been on the receiving end of that snarky comment from a friend, spouse, or loved one know that it doesn't feel good. By the way, the Oxford Dictionary defines "snarky" as "of a person, words, or mood which is sharply critical, cutting or snide." So this study adds to the research about supportive relationships. The University of Utah found that being in a marriage with a cold and controlling argument was as predictive of poor heart health as smoking or having high cholesterol..

Another study found that wounds healed more slowly in a person in a relationship that has hostile arguments compared to couples who solve their problems more equitably. So what do you do? There's an old nursery rhyme, "Sticks and stones may break my bones, but words will never hurt me." Well, that may work on the playground as a comeback, but it isn't really true. Being occasionally snarky and unsupportive to your partner is common, but it's a choice and it can become a habit..

Try this little three-card exercise. You and your partner fill in the blank on the following sentences, one on each card. One: I feel loved and supported when you (blank); two: I feel hurt and sad when you do (blank); three: I wish you would do (blank). Exchange the cards. Have a conversation. It takes a healthy relationship to do this exercise, but it can be the beginning of a dialog about both of you and how to be kinder and more supportive in your relationship..

If it's too threatening to do this little exercise, then your relationship may need someone to help you work through this. Your home should be a safe place, but even more, it should be an emotional shelter from life's storms, and giving or receiving snarky comments in the kitchen isn't good for the receiver or the giver. We should work on being kinder. Thank you for joining us on The Scope.

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: You're not feeling well. Did you ever consider for a second it could be the medication you're taking to try to feel better that could actually be making you feel worse? We'll discuss that 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. Mark Supiano is the Executive Director of the University of Utah Center on Aging. Sometimes medications can cause more problems than they can actually fix especially if you have multiple medications, prescription and non-prescription that are interacting badly with each other.

Dr. Supiano, let's talk about multiple medications and some of the things you've seen as far as how that makes you feel worse and what you would recommend.

Dr. Supiano: This is a particular issue in older individuals, because older people tend to have more medical conditions that we now have wonderful evidence basis of the benefits of medications to treat those conditions.

When we start to add up those conditions however, if you start to have three, four, five chronic conditions, and you're on three or five medications for each of those conditions, that multiplier effect increases your risk of having an adverse medical event or a side effect from the interactions between those medications.

So older people that we treat are more likely to be on more medications and are therefore at higher risk for exactly these kinds of problems.

Interviewer: So is it the raw numbers that's causing the problem or is it the actual what's in the medication doesn't like what's in another medication or both?

Dr. Supiano: The literature suggests that it's simply the number of medications that you're on. The magic number is if say you're on more than 12 medications, and as you mentioned earlier that is a combination of both prescription medications as well as any over the counter medications that you may be taking, if that number is above 12, there's almost 100% chance that there will be a drug-drug interaction.

Interviewer: Wow. So we're talking over the counter being any sort of pain killers you might take, cough medicine, what about like herbal?

Dr. Supiano: Sedatives or hypnotics or sleep aids that you might be taking over the counter, all of those.

Scott: What about herbal supplements and things like that?

Dr. Supiano: Absolutely and Utah is a hot bed of herbal supplements. So we are very aware of that and really need to be careful about the potential interactions between some of those supplements and prescription and other medications.

Interviewer: So if you are taking a whole bunch of pills, it might be good idea to have somebody professionally reevaluate. I would think that my pharmacist would know or my doctor would already know. Is that not always the case?

Dr. Supiano: If you're going to a single pharmacy, if they have an accurate record of all your prescription medications, there are systems now to screen for the most offensive drug-drug interactions. Most physicians are likewise aware of that but there are other subtleties that individuals trained in geriatrics are more likely to pick up.

Another component is the geriatrics is a team sport and as part of our medical home for example we have a geriatric Pharm.D who has additional expertise to be able to identify the appropriate medications for older people.

The other reason that your pharmacist or physician, if they lack that geriatrics expertise may not be sensitive to this, is that there are changes in aging in how the body gets rid of medications that can increase your risk of having the side effects. So if you're not adjusting the dose of the medication appropriately for that person's age or their kidney function that there may be toxic levels of the medication that accumulate and cause these side effects.

Interviewer: So you really can't set it and forget it? You've got a kind of reevaluate quite often it sounds like?

Dr. Supiano: So I tell patients if they have been on the same drug for many years and it can't be causing problems, well, if you're 20 years older now your body is metabolizing that medication differently and the levels are going to be higher than they were 20 years ago, so it now maybe causing problems.

Interviewer: What might be an indication to somebody that they are actually having some sort of adverse reactions through medication interaction?

Dr. Supiano: Great question and this is really a challenge and particularly since many of these side effects, someone might think, "Well, I'm just getting older, so of course I feel run down the next day or I'm having this particular symptom," say constipation. They may think this is just part of getting older and may not ascribe it to the medication.

So we're taught to teach our trainees that anytime someone has a new symptom, we need to first ask, "Is this potentially caused by an existing medication?" What we really want to avoid is treating that new symptom with yet another medication, because that adds further to this list of medications.

It becomes a vicious cycle and you just keep adding on more and more medications and you get more and more side effects, and the patient isn't getting any better.

Interviewer: So how big of a difference can it make if you identify that there's some sort of a medication-medication problem?

Dr. Supiano: If we can identify someone with side effects from a different medication and the term for this is Polypharmacy, if we identify what that side effect is and either reducing those medications or eliminate it, stop that medication and the patient gets better, that's a victory.

And I can tell you, Scott that in my career of some decades now I am confident that I've made more people better by stopping the medication that is causing one of the side effects, than I perhaps ever will by starting a medication to treat a chronic condition.

Interviewer: That's a powerful statement and a statement to probably keep in mind that more is not necessarily better.

Dr. Supiano: Particularly if it's causing one of these side effects, it's a very grateful patient if you can identify that offending medication and eliminate it from their medication list and their symptoms improve.

Interviewer: If I feel like I'm having this type of reaction, what will be my next steps?

Dr. Supiano: So a comprehensive evaluation to review those medications by someone trained to identify these problems would be the first step.

Interviewer: So my primary care physician not that person?

Dr. Supiano: It could be. I think the main principles, although we do this routinely, what needs to be is a medication chest biopsy. So this is a geriatric procedure. You need to go in and biopsy the medications and the way we do that is not with the needle but we ask people when they've come in for their initial evaluation to get a grocery bag and fill it up with all the prescription bottles, and it's called the brown bag technique.

And if one grocery bag isn't big enough, you load up two or, three, or four and bring them all in and our Pharm.D will sit down and look at each one of those prescriptions and review them and make sure that they're appropriate by with indication, by way of dose and review for these potential side effects.

Interviewer: As we've talked another podcasts, geriatricians, even if you're younger and you have a lot of multiple medications could help you. You don't have to just be an older person.

Dr. Supiano: Correct, so this syndrome of Polypharmacy is not unique to age and our team including geriatrician providers and our geriatric Pharm.D are skilled to evaluate patients for that potential problem.

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Interviewer: Fat-free, reduced-fat, sugar-free, whole grains, gluten-free. It seems impossible to hash through the different labels and figure out what is actually the healthiest. Get help and learn to eat this, not that, 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: Grocery shopping can be stressful these days. There are so many different labels on foods. Luckily, we have Ashley Quadros, a health educator from the University of Utah Department of Health, here to help us figure out what to look for when we're shopping. Hey, Ashley. How are you doing?

Ashley: I'm great. Thank you.

Interviewer: Awesome. So, walk us through a typical nutrition label. What will we find there?

Ashley: You'll find an abundance of information on a nutrition label. I would start at the top, and the first would be the number of servings in that particular container, and also what the serving size is. So how much the label tells you about that serving size. That's at the top. Then it will go through a number of different nutrients in the food, vitamins, minerals, fat, carbohydrates. And then at the very bottom you'll see the ingredient list, so everything that's in that product.

Interviewer: Okay, what are the most important things on that nutrition facts label we should be looking out for when comparing different products?

Ashley: By far and away, the first thing you should look at is the serving size because that's going to tell you, a teaspoon of the product, which is a tiny amount, or I get to an entire two cups of this product for what the label is telling me. So that's the first and foremost thing to look at. And then, what you look at all sort of depends on what your focus is. So if you're trying to lose weight, calories might be important to you. If you have Type 1 or Type 2 Diabetes, carbohydrates would be really important to you. If you're trying to minimize sodium, you would look at the sodium content. So, it kind of depends on what your goals are, really.

Interviewer: I can definitely see what you're saying in regards to looking at the serving size. You may think, "Hey. It's only 15 calories. This is great." But that might be a teaspoon instead of what you might think it might be. So, you could really add up really quickly.

Ashley: Yeah, and my favorite example of that, actually, is a pint of ice cream is four servings, but who really only eats a fourth of the pint?

Interviewer: No one.

Ashley: No one.

Interviewer: Absolutely. So what are some misleading labels we should be looking out for that we'll see on foods?

Ashley: Well, I think what's most misleading is what's on the front of the product, especially when you think about something like a bread product. They'll put a lot of different marketing claims on the front, so it could be made with whole grain or it could be gluten-free or 100% organic, and you might have different ideas about those things being healthy. But, they're not necessarily true, or they could be misleading you to think that they're healthy when they might not be. So that's what I think is most misleading, so you really need to look at the label itself and read it and make a judgment based on what you know.

Interviewer: So say that you are looking at a bread. What would be the healthiest option after reading all these different types of labels?

Ashley: When you're looking at the bread, you would look at the label, and you would want to see the first ingredient to say 100% whole-whatever the grain is. So that could be rye, or it could be wheat, or whatever you're looking at. That is the first thing to look at. So just on that alone, you would know that the bread a reasonably good choice.

If you read further along in the label, and somewhere you saw enriched wheat flour, then you would know that there is some refined flour in it, too. It's not 100% whole grain even though the first ingredient is. So you would know that there is some white flour, so still a good choice but not perfect. If you saw another label that just said 100% whole grain wheat and nothing else, except for maybe some salt, water, oil, that sort of thing, then that would be the best option because it's 100% whole grain.

Interviewer: Okay, so look out for the 100% whole grain and have a very basic ingredient list.

Ashley: Yes, and don't trust what the front of the bread package says.

Interviewer: Any ingredients, in general, that we should avoid if possible?

Ashley: I think probably the most important thing to avoid is the partially hydrogenated oils, which many of the listeners may have heard of before. But those are what trans fats come in. They come in partially hydrogenated oils, so that would be the most important thing to avoid in most processed foods. Also, anything with added sugar, and there are some controversial ingredients that people choose to avoid. Things like MSG or artificial sweeteners. So depending on what your concerns are, you would look out for those.

Interviewer: And then finally, what are your best tips for grocery shoppers trying to stay healthy? I know I've heard things like, "Walk the perimeter of the grocery store because that's where all the natural foods are." Are there any overall tips for someone walking into the grocery store, you would say, "This is what you should do."

Ashley: Yeah, I think that there are different tidbits of advice that work for different people. I do like shop the perimeter of the store. I also really like promoting things that don't have labels because if it doesn't have a label, it's not processed. Things are only required to have labels if they have a certain amount of processing. That's probably your best bet.

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: The general perception is that we all need eight hours of sleep. True or false? That's coming up next on The Scope.

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

Interviewer: We're talking today with Kyle Bradford Jones family physician at the University Utah. How important exactly is sleep?

Dr. Jones: Boy, sleep is huge. You know, if you get too much, too little, it severely impacts your health for the negative. It's been a big debate for years. How much sleep do we need? Currently the average American gets a little bit less than 7 hours. And so the question is, is that enough? Is that too much? Is that too little? So the National Sleep Foundation got together a bunch of sleep experts. They reviewed all of the scientific literature on sleep and came up with some recommendations for certain age groups.

Interviewer: And what are those guidelines?

Dr. Jones: So first of all for adults 18 and over. They give the range of seven to nine hours. So I mean that kind of fits the perception that we've had of roughly eight hours. But the nice thing is they give a little bit more of a range, because sometimes we need more sometimes we need a little less.

Interviewer: Right so there's that seven to nine buffer zone.

Dr. Jones: Exactly.

Interviewer: How about elderly people?

Dr. Jones: It's a similar amount. However with the elderly they tend to sleep a little bit less at night and nap a little bit more during the day. And that's okay. That's more of a natural rhythm for them. And so that's healthy for them.

Interviewer: So my grandma, bless her heart, always comes up with these crazy myths in the world. She always told me that the older you get, the less you need. I guess her way of saying that you can't sleep as much as you used to. That seems to be the case with this review.

Dr. Jones: Absolutely. As you get more into those elderly years like we said, it's a little bit less at night and then a little more napping during the day.

Interviewer: My grandma is not that crazy then.

Dr. Jones: Not on this aspect anyway.

Interviewer: And what about school age children? How much sleep do they need?

Dr. Jones: So this has been a big topic for years as well. How much do they need? We're talking about nine to 11 hours a night. Many kids don't get that. But it really impacts how they do in school. If they get that amount of sleep, they're going to do better, they're going to behave better and they're going to learn it better.

Interviewer: Does bedtime and waking up time have a difference or does that matter?

Dr. Jones: As long as it's consistent and you're getting the adequate amount, that's the most important thing.

Interviewer: Does school age children also include teenagers?

Dr. Jones: No. So for teenagers it's slightly different. We're looking at 8 to 10 hours. Parents of teenagers know that they like to sleep in. They like to do those things. Getting 8 to 10 hours is important because they are growing their bodies are changing, they need that rest in order to optimize their physical health.

Interviewer: What if you are a mother caring for a newborn, let's say?

Dr. Jones: So with a newborn its 14 to 17 hours a day.

Interviewer: More than half the day.

Dr. Jones: Exactly. They are growing so rapidly. Their brain is developing so rapidly. They really need that much rest in order for their body to grow.

Interviewer: So I'm not a mother yet, so I don't really know the answer to this, but is that in one nap or is it separated?

Dr. Jones: It's separated. So getting as much sleep during the night as you can which is easier said than done as any parent knows. But also includes a few naps during the day and letting them get their rest as much as they can really.

Interviewer: Does that also apply to adults as well, like little naps in the afternoons or something like that when we're free. Does that add up to the seven to nine buffer zone?

Dr. Jones: Actually for adults naps can be detrimental because it actually can worsen your sleep during the night. So ideally you want the seven to nine hours all in one chunk overnight.

Interviewer: Any final thoughts?

Dr. Jones: Just try to individualize this to yourself. So some people do better with seven some might do better with nine. You know you want to try to get within that range as much as possible to optimize your health. But the most important thing is making sure you get enough rest.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.

Interviewer: Why buying a new pair of skis should also change the way you prepare for your ski season. That's next on The Scope.

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

Interviewer: Dr. David Rothberg is an orthopedic surgeon at the University of Utah Health Care, and the new type of parabolic skis actually mean that you might be opening yourself up to a different type of injury that you are not used to before, and mean that you need to get back to the basics of skiing. Talk about that a little bit. What are you seeing with the new parabolic skis, which are great, they give you so much more control and make it more fun, but they also can make it more dangerous.

Dr. Rothberg: We absolutely love the new ski shapes we are seeing because they allow us to do things that we weren't able to before. We can turn more quickly, we can navigate steeper slopes, and do so with a shorter lighter ski. But one of the problems that we think we are seeing with this is because the ski is shorter and we can turn more quickly we're actually putting more force on our knee. Because of that when you buy your new pair of skis you need to think about your knees fitness and how you're training for the season. As we know to prevent injuries you both need to be fit, and aware of your surroundings but also battle fatigue. When you get fatigued your technique becomes poor and you set yourself up for knee injuries.

Interviewer: So it sounds like if you get a new set of these skis and maybe you are going from an old style you may be in far a little bit of a surprise and you may want to reevaluate your physical condition.

Dr. Rothberg: Absolutely, at the result of some pretty serious knee injuries. The most common thing we see is an MCL strain which really is more of a beginners knee injury, which you have been stuck in the pizza pie, or snow plow position all day long and just strained the inside of the knee. Further more we start to see more ligament injuries, like an ACL tear which is so common. Both in non-ski athletes and skiers alike where the ski continues down hill with the lower leg, but your body is going backwards and puts that anterior-ly directed force on your tibia and tears the ACL ligament.
Then to a higher level of trauma, what we see so frequently here at the University of Utah is the tibial plateau fracture, or the top of the tibia, base of the knee fracture. We think that a lot of these are coming because you are able to put so much force on the knee with your shorter tighter turn radius.

Interviewer: So even experienced skiers might be a little surprised if they switch to this different type of ski. They're going to get what are typically considered beginner injuries maybe.

Dr. Rothberg: Absolutely, it is all related to how much force you can put on your knee.

Interviewer: You mentioned the importance of being more aware of your surroundings if you switch to this type of ski. What exactly do you mean there and how does that affect what I'm doing on the slopes?

Dr. Rothberg: Being aware of your surroundings is a combination of knowing what is physically around you as in the slope and snow conditions, weather conditions, visibility, and also it is really just as important to know what your own limitations are. Being aware of where you should be on the mountain and when you should be there, and what time of day it is, are you tired and is it time to take a break.

Interviewer: So what is your advise to somebody that if they are switching to a parabolic type ski to maybe help prevent these types of injury that you might be seeing as a result of better control, faster more torque on the body?

Dr. Rothberg: Well control is really going to come from about two or three muscle groups in your body. The obvious ones are your quadriceps and hamstrings, muscles around the knee. But secondarily, the hip stabilizing muscles, the abductors, and then thirdly the core strength. All these things are going to play into your body awareness and balance and ability to manipulate uneven surfaces and abnormal body angles so you can recover from variations as you turn and navigate the slopes.

Interviewer: How do I know before it's to late that maybe I shouldn't be pushing myself as hard as I think I can? Is there a way to determine that?

Dr. Rothberg: That's the hardest question to answer because it is always the last run of the day you get hurt.

Interviewer: Oh, is that because of fatigue?

Dr. Rothberg: No, it's because once you got hurt you're done.

Interviewer: Oh okay, is it last run of the day you get because of fatigue?

Dr. Rothberg: Yeah, probably. In addition to fitness and awareness comes in hydration as well. So one of the important things about being on the mountain is staying adequately hydrated.

Interviewer: Do the new parabolic type of skis actually tire you out more quickly?

Dr. Rothberg: It may not be that the ski itself tires you out more quickly, but your ability to navigate more difficult terrain and push yourself because of the tighter turn radius may in effect cause the fatigue.

Interviewer: So what would your final word of advice be to a skier putting on a pair of parabolic skis?

Dr. Rothberg: I think the most important thing is to know your skill level, be aware of the terrain you are on, and be aware that you are going to be able to make much tighter turns which are going to make you have to react more quickly to the slope that you're on.

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Dr. Miller: Heartburn, when does that become a concern, next on The Scope Radio.

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.

Dr. Miller: Hi, this is Tom Miller, and I'm here with Dr. Kathleen Boynton, and she is a doctor in the Department of Medicine and she is a gastroenterologist, a specialist in gut disorders. And she is also an associate professor. She is here today to talk about heartburn.
Kathleen, when is heartburn... everybody gets heartburn, right? I mean, you have that big chili cook-off and a couple of hours later you're really resenting that and you're reaching for the sodium bicarbonate, or you're going for Tums. How often would one have heartburn and not be worried about it? Or conversely, when should somebody worry that they're having heartburn too often?

Dr. Boynton: Well the truth is nobody has ever done the study where they say this frequency equals a severe disease. But generally I tell people, if you're having it two to three times a week that's probably enough to see your physician. The other concern of course is if you come from a family with a history of esophageal cancer, perhaps any degree of heartburn is enough to see somebody.

Dr. Miller: I know a lot of patients will have heartburn maybe three times a week, and then they just have gone to the store and they've bought several different kinds of antacids. If that works, do you still think they need to see a physician?

Dr. Boynton: I think that they do, because we know that the way you feel doesn't necessarily match what's going on inside your gut. And your concern is to prevent the complications that are irreversible, that are related to heartburn.

Dr. Miller: Long-term heartburn, what are those complications?

Dr. Boynton: You can get scar tissue in the esophagus. The esophagus is made to be elastic, so if you inadvertently swallow a big piece of food it can still distend, stretch the esophagus and pass down into the stomach. If you get scar tissue it cannot pass, and we see obstructions all the time when we're on call, where somebody has a piece of meat, say, that's stuck in the esophagus and won't pass.

Dr. Miller: Then long-term heartburn can lead to scarring of the esophagus, the narrowing of the esophagus so that you can't pass food and is a dangerous situation.

Dr. Boynton: Right.

Dr. Miller: Now what about this term called Barrett's esophagus? Some patients will come in and they've read about it on the Internet or heard it on TV shows about Barrett's esophagus and its relationship to heartburn.

Dr. Boynton: Yes. Barrett's is a concerning change in the tissue and it develops as a result of exposure to acid, which causes inflammation. Inflammation means that the tissue has to regrow. And sometimes the tissue makes a mistake and it grows to look more like the tissue we see in the stomach, and then duodenum. And the problem with that is a small percentage of those people that have that Barrett's tissue will go on to develop esophageal cancer. So our question is when we see a patient with heartburn, are they somebody that may have Barrett's? How do we decide whether or not to investigate that?

Dr. Miller: Now there are age cutoffs I think; the older a person is the more likely a physician is likely to recommend diagnostics. Can you talk a little bit about that and when you decide as a gastroenterologist that a patient might in fact need a study, or a look down to see what that tissue looks like, to see if they have Barrett's esophagus?

Dr. Boynton: In medicine we have what are called guidelines, and they are in part based on associations, because we want to be efficient and not do unnecessary testing on patients. The recommendation is that in a white male over the age of 40 who has a history of heartburn that we do an endoscopy, and the endoscopy helps us. We can see the Barrett's tissue; it looks different from normal tissue.

Dr. Miller: Now the endoscopy, can we just clear that up for some people. That's a tube that goes down with a light on the end of the scope and they can actually see the tissue in the esophagus. They could even take biopsies.

Dr. Boynton: Right. And based on those biopsies we can tell someone whether or not they have Barrett's disease. If they have Barrett's then we recommend that they be monitored with endoscopy and the frequency can be in a year, or it could be every three years, depending on the profile.

Dr. Miller: Now the physician might also decide there's treatment, and are there effective treatments for heartburn that can make it better?

Dr. Boynton: Absolutely. And they are even available over the counter. The most effective are what we call the proton pump inhibitors, and there is a whole bunch of those. But the one that's over the counter is omeprazole, or Prilosec, and that's probably the most frequently used drug.

Dr. Miller: When you go you grab the omeprazole and it's probably cheaper, right?

Dr. Boynton: Yes.

Dr. Miller: And taking that daily, I think, is pretty much what's prescribed for people who have heartburn three or more times a week. And I've found most patients do very well with that; it's very effective.

Dr. Boynton: Yes.

Dr. Miller: And it stops heartburn in its tracks.

Dr. Boynton: Yes, that's correct.

Dr. Miller: Now what happens if a person is taking one of these medications and they're breaking through?

Dr. Boynton: Well in the doctor's brain, when they see those patients, what they are wondering is first of all do I have the diagnosis correct. Is this still acid? But assuming that it is still acid, we will increase their medication. If that doesn't work there is even surgery that will fix the underlying mechanical problem that causes reflux.

Dr. Miller: Now how often in your experience would a patient not respond to medication to reduce or to eliminate heartburn and need to go on to surgery? How often does that happen?

Dr. Boynton: I don't have exact numbers, but it's under 10% of patients. Sometimes patients will elect to have the surgery for lifestyle reasons. They just don't want to be on a medication long term, and that's a valid consideration.

Dr. Miller: So it sounds like the take-home points are; one, if you're having heartburn more than three times a week, you should probably see your physician and have him decide if additional diagnostic studies should be done; or if they would just go ahead and prescribe a medication, such as omeprazole that would eliminate the heartburn. And if you're having heartburn and you're taking a medication for heartburn, you really should probably see your physician about it for additional diagnostic studies.

Dr. Boynton: Right.

Dr. Miller: Thank you very much.

Dr. Boynton: You're welcome.

Dr. Miller: The ScopeRadio.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: So, juicing, is it really better than nothing, or should you be actually eating the fruits and vegetables raw? We're talking with Kary Woodruff, registered dietician with the University of Utah and she's going to tell us all about that today 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: So Kary, I am a big believer of fruits and veggies in my diet but I am also a really big believer in the fact that my diet needs to taste good and some of the vegetables just don't taste good to me. And so, I choose to just blend it all up and if I don't see it, I can just chug it all down. Am I doing it right? Am I still good?

Kary: Yeah, it is, as you identified, it is probably better to eat the whole fruit and the whole vegetable. That being said, juicing would be a better option than not getting any fruits and vegetables at all.

Interviewer: Okay.

Kary: And I would say not all juices are created equally. So there's some ways of juicing fruits and vegetables in a way that retains the pulp.

Interviewer: Oh, okay.

Kary: Some of the more pricey juicers. They are more expensive, but they do give us more benefits like the Blendtecs or the Vitamix, because they actually retain the whole fruit and vegetable. They don't remove the pulp.

Interviewer: Okay.

Kary: Which is the really nutritious part of the fruit and vegetable.

Interviewer: So it's a . . .

Kary: So if we can retain the whole food, and not remove the pulp, then we'll be retaining more nutrients.

Interviewer: Okay. Is that seeds, everything, that's included as well, right? So like an apple?

Kary: Correct.

Interviewer: Okay. When I juice my orange, obviously the juice of it comes out, but the pulp of it still stays there because I'm juicing it by hand. From what you've just said, that's not really healthy then, is it? Or it's not as healthy.

Kary: It's not as healthy, yeah, because you're losing some of the fiber. And so when we eat foods with fiber, like the whole orange, it'll actually last longer versus something that has the fiber removed we'll feel energy pretty quickly. But then we actually feel hungry again pretty soon thereafter.

Interviewer: All the juice cleanses then out there, do you recommend those?

Kary: I do. Yeah, again, I would try and juice it in a way that's retaining the whole fruit and vegetables.

Interviewer: Okay.

Kary: And so they're juicing in a way that's retaining the whole form of the vegetable and fruit then that would be a better option.

Interviewer: Gotcha. Okay. But most of them, from what I've seen, are just the juice and that's, so stay away from that if you can.

Kary: Yeah, I would rather see people eat fruits and vegetables.

Interviewer: Okay. And then are there any kinds of fruits and veggies that are just, not only taste good together, but can really benefit your health when you put them all into a blender and you mix them all up?

Kary: Yeah, I mean I think really the more the better. There are some nutrients that do tend to help the absorption of other nutrients. But really when we see when we get a good combination of fruits and vegetables we tend to see good absorption, and good nutrient utilization. So I wouldn't get too caught up in trying to focus on two particular fruits and vegetables, and just to get a variety.

Interviewer: Okay. And then I also, there's this new trend where, when you're juicing something, when you're making a smoothie or a fruit juice or a veggie juice, they're putting in like proteins and whey and all these other products. Is that okay?

Kary: Well it depends on what the purpose of the juice is. So if it's a meal, if it's going to be a meal replacement, then there should be some protein with it.

Interviewer: Gotcha. That's okay then, to do juice as a meal.

Kary: Yeah, I mean I'd rather, again I'd rather see someone eat the fruits and vegetables and get a food source of protein, but I do understand that sometime there's a convenience factor to being able to make it and have it on the run. And so there's that, again I think when we can juice it with something that will retain the whole fruit, the whole vegetable, and then getting some protein with it. So whether someone uses a protein powder, or they could actually use a food source of protein like some Greek yoghurt, or some milk, or soymilk, could be good ways of integrating in some protein.

Interviewer: Gotcha. So what I'm hearing is its fine. It's fine to juice your fruits and veggies. It's okay.

Kary: It is. You have to make sure you're also eating them as well.

Interviewer: Okay. Is there a reason why juicing would not be good for you?

Kary: Well, it would be like if you are going to Jamba Juice and getting these extra-large Jamba Juices that have added juices for sweetness. And that's going to be simply added sugar. That's really what that translates to. And then what we see that happens with that is those can be pretty high in calories, high in the sugars, and those forms won't be healthy.

Interviewer: Gotcha. All right. So juice all you want, just make sure that the raw, the source material of the juice is still there and don't add anything bad that can cause harm to your health in the juice.

Kary: Yeah, like added sugar.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Interviewer: Men and women are very different. Nobody would ever argue that, but up until recently, in the eyes of researchers, they're exactly the same and that's a problem. We'll discuss that 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: It might shock you to find out that when it comes to research, a lot of times, women aren't even considered in research and we're going to find out more about that now from Jean Shipman. She's the director of the Spencer S. Eccles Health Sciences Library. Let's talk a little bit about this what is it called, gender bias in research?

Jean Shipman: Sex and gender differences in research.

Interviewer: All right. So explain a little bit what that means.

Jean Shipman: Well, sure, sex and gender. Sex means male or female, the biological difference between the two, and gender is more who you identify with. So you can be male, but have more feminine tendency or desire or understanding of the world. And so, lately, researchers are becoming more aware that there is a need to look at these populations differently.

Interviewer: Okay. And, what, give me in real terms what that means.

Jean Shipman: Yeah, let's say I'm a researcher and I'm looking at the population. Most of the time, I'm referencing the male population. Historically in literature, that's who has been documented. Now, I need to pay attention that there are differences physiologically between men and women and it could affect dosage, it could affect physiological uptake of medications, but there is a difference that has to be recognized.

Interviewer: So wasn't there a story on 60 Minutes recently about this very thing?

Jean Shipman: There was. It was Ambien, the common drug is diagnosed, they found, double the dosage for women. And who knew, but they found out that everyone was being given the same dosage, but the uptake of it is twice as much in women, so they were being double dosed.

Interviewer: So if I understand correctly, they were just looking at, you give this much per body weight, and it was all based on men, but women actually process it differently, so that was inaccurate.

Jean Shipman: Exactly.

Interviewer: And I'd imagine that happens in a lot of other instances as well.

Jean Shipman: I'm sure we're just starting to uncover how often that's happened.

Interviewer: Yeah. Wow. So is it really that widespread that research, so when we're researching any of our health concerns, we really just look at men for the most part?

Jean Shipman: Well, I think in the study design, people are asked to look at all kinds of subjects - men, women, children, and document, but when you're actually looking at tissue or specimens, I think male tissues have been used and not so much women. And, also, I think we're seeing that women's needs are very different as far as the healthcare that they receive.
Another example is in developing medical devices. With surgical staplers, who knew that there would need to be a difference between men and women, but women have less pressure...

Interviewer: Yeah, like hand strength.

Jean Shipman: Yeah, hand strength so...

Interviewer: And smaller hands many of the times.

Jean Shipman: Exactly. So they have difficulty getting the stapler to work in surgeries and yet more women are becoming surgeons, so. We need to take that difference into account.

Interviewer: Wow. It's kind of shocking, isn't it? That nobody has really done this before so...

Jean Shipman: Yes.

Interviewer: You've received a grant from the NIH. Tell us a little bit about that grant and what it hopes to do.

Jean Shipman: Sure. The Office of Research of Women's Health and the National Library of Medicine have recognized this need to encourage more researchers to think about the differences between men and women and gender differences. So they have solicited about ten libraries across the country and given us subcontract money to make our university personnel a lot more familiar with this issue.

Interviewer: Yeah.

Jean Shipman: And we've gotten two rounds of funding and we've looked at social media as a mechanism for making people more aware of this need and the differential research. We've looked at videos. We're looking at the podcast that we're doing today as a way to educate people about the importance of this. We also will be having a symposium on campus in September.

Interviewer: Okay and all the goal is to just get people to start thinking, researchers, specifically, to start thinking in terms of gender, not sex.

Jean Shipman: Or both.

Interviewer: Or both.

Jean Shipman: Yeah. The idea that you do need to account for the physiological as well as the social, economic, cultural differences.

Interviewer: Yeah, that, that there are differences, just to be aware of that. Ultimately, what's the goal of this program then? What do you hope would come out of it at the end of the day?

Jean Shipman: The ultimate goal would be everybody I talk to would understand that there is a need to think about these two things differently. Personally, I didn't realize the difference between sex and gender until getting this contract money.

Interviewer: And you're a woman. You should...

Jean Shipman: I know.

Interviewer: ...be more sensitive to this, right?

Jean Shipman: I know. I had the inkling that we weren't be represented equally but let me just say that it did surprise me that sex was biological and gender was more of a cultural.

Interviewer: Yeah.

Jean Shipman: That I always heard them being interchanged and, if you look at the literature, it's misconstrued a lot of times as being one in the same, and they're not, so.

Interviewer: So I think an important thing is if you are a researcher, you now know a little bit better. If you're not a researcher, you know somebody that is, share this podcast with them. And you're just looking for at, first for a paradigm change.

Jean Shipman: Right.

Interviewer: Just to start considering it.

Jean Shipman: And, as a consumer, I would say you could ask your doctor, "Well, you know, I am a woman. Does this make a difference in how I should be taking this medication that you're treating me with," or you know, be a little more assertive in asking that question.

Interviewer: Yeah. And just talking about it in general, I think...

Jean Shipman: Right.

Interviewer: ...would be a good idea.

Jean Shipman: Right. And I think we'll see more and more in the news about this. I know NIH is starting to require researchers include tissue samples from women as well as men in their basic science studies. So there'll be more governmental, kind of, endorsement, of encouragement of this use of the difference in the terms.

Interviewer: Who knew that women were still being discriminated against? We thought we thought we got past this whole thing didn't we?

Jean Shipman: Oh, I think we have a long way to go. But, but I'm pleased to hear that there is more awareness being built about this and that libraries, particularly, were addressed as a unit that could be the educators within their universities, being neutral and central.

Interviewer: And because you have a contact with a lot of researchers that use you as a resource.

Jean Shipman: Exactly, and that we can help to shape the evidence of the future.
Announcer: We're you're daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.

Interviewer: How dangerous is skin cancer, really? We'll examine that next on The Scope.

Man: 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: Let's face it, we all love the feeling of the sun on our skin and maybe even a little bit of a golden tan, but then we hear things like skin cancer and you should wear long sleeves and big hats. We're with Dr. Glen Bowen at Huntsman Cancer Institute. How do I balance that kind of desire to want to be out in the sun and yet the desire to do what guys like you tell me I should do?

Dr. Glen Bowen: Well, the first thing I would say is somebody dies every hour in the U.S. from skin cancer. It is an epidemic problem, so you can't really minimize that fact, not to mention the fact that there are people every day that come to the Huntsman Cancer Institute. I'm removing either part of their nose or most of their nose or eyelids or lips or ears. It's very devastating for people. Almost all of them, not all of them, but almost all of them are avoidable.

Interviewer: Yeah.

Dr. Glen Bowen: So, yeah, the sun's okay, but, you know, people just aren't really exposing themselves to the sun in what I would say moderation.

Interviewer: Okay. So it's just a matter of people are trying to get too much, laying out there for hours on end or going into the swimming pool without any protection. Bad idea.

Dr. Glen Bowen: That's right. And a really, really bad idea are peeling sunburns. There's no question that peeling sunburns have a very big impact on our risk for skin cancer. The interesting thing about swimsuits is that they used to cover the torso. If you look at photographs of Saltair, the swimsuits for both men and women covered the torso. Well, most melanoma occurs on the torso.
So when the swimsuit style changed, there was an incremental jump in melanoma incidence because they tend to occur in areas where we get peeling sunburns, which is usually the torso. They're spring break cancers.

Interviewer: And it's really young people that really need to be the most careful, right?

Dr. Glen Bowen: Yeah. So it's thought that about 80% of the sun damage to our skin that causes skin cancer probably happened before we graduated from high school. And it doesn't mean that the sun after high school doesn't matter. It just means that most of the switches that were flipped to cause cancer happened when we were young. So it's critically important that young people try to avoid peeling sunburns.

Interviewer: Yeah. Tell me about the genetics of skin, because what the sun does is it actually genetically alters a cell, and these peeling skin cancers are some of the worst at doing that.

Dr. Glen Bowen: That's right. You could think in a way of the ionizing radiation from the sun like bullets from a machine gun. I mean they literally are. They pass through the skin, and they poke holes in the DNA. The DNA has a beautiful spellchecker like our word processors that can kind of correct for the mistakes, but the problem is you can simply overwhelm it, and that's exactly what happens particularly in light-skinned people, Caucasians. With chronic sun exposure, the spellchecker simply can't correct the mistakes in the DNA as fast as the mistakes are being made, and the result is skin cancer.

Interviewer: So tell me how do I balance then this desire to want to be out in the sun and maybe get a little color to my skin in the summertime versus the dangers of melanoma.

Dr. Glen Bowen: So what is it? Well, people don't dress like they used to, and if you want to do an interesting experiment, just look at the photograph of the Golden Spike when it was pounded in, and you look at the people in that photograph. They all have long-sleeved shirts. They all have trousers, and they all have hats. And that's how people used to dress.
Of course, the style of the swimsuit as it went from one piece to two piece, there's a very direct correlation of increased melanoma rates. So the trick is to go ahead and enjoy yourself outdoors but dress the part. You know, wear clothes. It's not a good idea to go trouncing around in a speedo with nothing else.

Interviewer: For a lot of reasons.

Dr. Glen Bowen: Yeah, it's a great idea to wear a hat, especially a hat with a brim. I remove a lot of portions of men's ears because we don't have hair that covers our ears. So hats with a brim on the side. A baseball cap won't help you in that regard, but a hat with a brim is hugely helpful, and, of course, sunscreen.

Interviewer: So what type of sunscreen should I be wearing?

Dr. Glen Bowen: Well, sunscreen, in general, if you get to a sun protection factor, SPF, 30 or higher, the incremental gains from a higher SPF are pretty small.

Interviewer: Okay.

Dr. Glen Bowen: But there's a huge difference between a 15 and a 30. So, in general, you want to be wearing something 30 or higher. The other problem with a sunscreen is people kind of see it as the seatbelt. It's not. It's the airbag.

Interviewer: Okay.

Dr. Glen Bowen: So clothing is really your seatbelt.

Interviewer: Okay.

Dr. Glen Bowen: But sunscreen in addition to that is very effective. It has to be reapplied, and that's another problem. People tend to put it on once. But golfing, for example, you need to apply it before the first nine, and then you want to reapply it after the first nine because after about two hours, the particles are pretty much dissipated on the skin and it's dilute enough where it's not working very well.

Interviewer: And that's very effective in preventing melanoma, is that correct?

Dr. Glen Bowen: Yeah, it's thought to be.

Interviewer: Okay.

Dr. Glen Bowen: The science is really difficult to do in that case, but we just think that it'd be like a filter on a cigarette, you know . . .

Interviewer: Sure.

Dr. Glen Bowen: . . . the more you filter out the tar and nicotine, the less likely you're going to get lung cancer, and the same with ultraviolet light. The less that gets through to the DNA within your skin cells, the less likely you are to get skin cancer.

Interviewer: Prevention's also important, meaning like to examine yourself. What would I be looking for?

Dr. Glen Bowen: Yeah, that's a great question, and the answer is you look for exactly two things. One is a sore that doesn't heal. So most of the skin cancer is not melanoma. It's called a basal cell carcinoma or a squamous cell carcinoma. Most people, especially young people, they will dismiss it as a zit.

Interviewer: Really?

Dr. Glen Bowen: So it's a little blemish on the skin that does not go away after about a month.

Interviewer: Okay.

Dr. Glen Bowen: So I just had three patients this morning that I operated on. They said, yeah, it was a sore that wouldn't heal. So little sores on the skin, especially the face, that don't heal after about a month, they could be a skin cancer.

Interviewer: Okay.

Dr. Glen Bowen: Sometimes they'll heal temporarily and then they'll break down again like a rollercoaster. So if a sore seems to get better but then it breaks down again, gets better, breaks down again, that's another warning sign that it might be skin cancer. The melanoma is almost always from a mole, and it's simply going to be an ugly duckling. So if you look at the moles on your skin and there's one that just stands out from the others, it's the ugly duckling, it's the black sheep, it doesn't look like the other ones, that's the one to be concerned about.

Interviewer: How important is early diagnosis? How big of a difference does it make?

Dr. Glen Bowen: It's everything. I mean, it's everything. Just to give you an example, I had a patient today with a melanoma that was what we call in situ, which means it's very superficial. Their survival is predicted to be close to 100%. Whereas another patient with one that, say, is down to the fat, they have less than 50% chance of surviving their cancer.

Interviewer: Wow.

Dr. Glen Bowen: So it's like Charles Dickens-it's the best of times and the worst of times. If it's caught early, it's one of the best cancers to have. If it's caught late, if not the worst cancer, it's certainly one of the worst cancers to have just because there are very few good treatments for melanoma that has got into the internal organs.

Interviewer: So it can spread to other organs?

Dr. Glen Bowen: Melanoma is a terrific hitchhiker. It's incredibly good at getting into the bloodstream or the lymph vessels and traveling to internal organs. A lot of cancers, they don't do well out of their neighborhood. Melanoma does exceedingly well. It can set up shop anywhere it wants to-bone, brain, liver, lungs, small bowel. I've seen it in every organ in the body. It's kind of amazing that way.

Interviewer: And once that happens . . .

Dr. Glen Bowen: It's very tough to treat. I mean, we do have some newer treatments at the Huntsman Cancer Institute that are very promising, but you just don't want to be one of those patients on experimental therapy.

Interviewer: Sure. And why go that way, because it sounds like this is a totally preventable cancer.

Dr. Glen Bowen: Well, you know, there are cancers out there, pancreatic cancer, for example. There are these terrible cancers out there that there's not much you can do. It's a little bit of the lottery. Most skin cancer is very easily preventable. That's the tragedy of it, but it's also the good thing about it. You could easily prevent most of the skin cancers that I operate on every day at the Huntsman Cancer Institute.

Interviewer: Is there a takeaway message that you would have our listeners leave with?

Dr. Glen Bowen: I would say for the parents, concentrate on your kids because it makes a huge difference. Those peeling burns we got as children, they make a huge difference for when we're adults and getting skin cancer.
Get a rash guard, you know, those little swimsuits that are spandex or Lycra that they just wear as a T-shirt. It'll protect their skin. It's got a tight weave. They're comfortable. They dry quickly.
So I would say, you know, just be careful to avoid those sunburns. And then it's a good idea for any person to just look at their birthday suit the first day of each month and make sure that there's not an ugly duckling or a nonhealing sore.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Interviewer: It's New Years. A lot of people make New Years resolutions. My New Years resolution this year was just live healthier, and I'm here with Dr. Tom Miller from University of Utah Hospital. As I started thinking about that simple statement I thought well, "What does live healthier mean?" So, I thought I'd ask you.

Dr. Miller: I think it's pretty straightforward:

1. Don't smoke.
2. Don't drink. Or if you drink, drink just a little.
3. Get plenty of exercise. Eat right and manage your weight.

Interviewer: All right. Do you feel that get plenty of exercise and eat right are self explanatory in your experience?

Dr. Miller: I think most people understand that. I think we all should be eating less protein, less meat and eating more vegetables.

Interviewer: So, you've basically boiled it down to three things.

Dr. Miller: Yeah, three things: Don't smoke. Don't drink. And if you drink, just drink a very little bit, that's less than an ounce of pure alcohol a day. Workout an hour a day and maintain your weight. That is, keep a body mass index between 18.5 and 25.

updated: January 5, 2022
originally published: December 30, 2014

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

Host: Did you know that you could get hypothermia when it's 40 degrees outside? I'm with Dr. Troy Madsen, emergency room physician at the University of Utah Hospital. Let's talk about hypothermia. Is there a comparison to be drawn between heat exhaustion and heat stroke here?

Dr. Troy Madsen: Absolutely. Heat stroke is when the body temperature gets really high. Hypothermia is when it gets really low.

Host: Okay.

Dr. Troy Madsen: Neither of those is good. So think about it this way. Probably the easiest way to compare this is to your car. If your car's really hot, it doesn't run well. But then think about these cold mornings we're having now, going out there, trying to start your car up. You're just trying to get that engine going. It just starts to turn over a little bit, and once it gets going, it doesn't work well.

Host: Yeah. And then even you try to shift it into gear, the transmissions sloggy.

Dr. Troy Madsen: Exactly. It just does not work well. That's exactly what the body does. You know, your heart's kind of the engine of your body. If it's cold, it does not work well. You know, at high temperatures, same thing with your heart. Absolutely. There's definitely a comparison there.

Host: So 40 degrees, it could start happening. Is it normal at 40?

Dr. Troy Madsen: Not normal at 40. The big thing in the 40's is if you're in damp weather, if it's raining on you, you've got cold clothing, you can get hypothermia. So people who are outside maybe. You know, it's a little late in the year for people to be hunting, but maybe for outdoor activities, you may think, "Hey, its 40 degrees outside. I should be fine." But you could or your children could be experiencing hypothermia if you start to get cold or you just don't have the right clothing on.

Host: What temperature does it normally happen? When do you really need to start worrying about it?

Dr. Troy Madsen: This last winter, I saw several cases of it in the ER because we had some really cold days. But usually, once you get these temperatures down in the teens and the single digits at night, we see it a lot in people who are homeless, who are out on the streets, who don't have any place to go or may have not gotten into the place, into some of the resources that we have available. Or people who may be intoxicated, who may not be aware exactly what's going on, that their body temperature's dropping. That's where we really start to see some serious cases in the ER.

Host: So generally, it's not somebody that's doing some outdoor activities such as snow shoeing, skiing, that sort of thing?

Dr. Troy Madsen: Typically not. You know, I think most of us, we know when we're getting cold. It's not, like, you're walking out to your car in the morning and you get overcome suddenly by the cold. It's usually people who are in some other situation. They may be out skiing. They may be out in the back country where they just can't get to where it's warm soon enough. But for most of us, in our day-to-day activities, it's not a big issue.

Host: So frostbite's probably a little bit more predominant though? Because I can be out doing an activity and not have gloves on.

Dr. Troy Madsen: Right.

Host: I could be warm enough, but my extremities are not?

Dr. Troy Madsen: Exactly.

Host: Okay.

Dr. Troy Madsen: And that's one, too. You know, the big thing with skiing is usually these temperatures are in the single digits, and those can be some pretty cold days. When you're snow shoeing or hiking or whatever, when it kicks up, you've got part of your face exposed. You can get some frostbite on your face or on your nose. Certainly on your hands if you don't have the right equipment on. And when it gets cold like that, your body's going to pull blood from your hands, from your feet to your core to keep it warm. That's when you get some issues in your hands, some frostbite in your hands and fingers.

Host: So if my face gets frostbitten. What does that mean?

Dr. Troy Madsen: Basically, what it means is you got dead tissue there. You got tissue where there's just not enough blood supply there because the blood has been pulled away from it, and the temperatures have gotten so cold in that part of the body that the tissue actually dies. So, real cases of frostbite, that's dead tissue. Oftentimes, if it's severe enough, you know, we'll have cases of people who come in with frostbitten toes. I've seen cases, interestingly, of just people who are just out working, just out shoveling their snow. I've had a couple cases of that. They had some other medical problems that I think made things worse, but they've had amputations of some of their toes because of that, because the frostbite was so bad.

Host: So frostbite can cause things to have to be amputated?

Dr. Troy Madsen: It can. It can. You know, usually, it may cause some cosmetic issues. Certainly if it's on your face, that can be a problem. But in some cases, you actually have to have an amputation.

Host: What are the symptoms of either one of these that I need to watch out for? You know, because I've been really cold before.

Dr. Troy Madsen: Yeah.

Host: So cold that I think, "My toes are going to fall off."

Dr. Troy Madsen: Right.

Host: But was I really in danger?

Dr. Troy Madsen: I think the first one with hypothermia, you know, if you're shivering, that's a good sign. So you think the normal body temperature's 98.6. Once it starts to drop down around 97 or 96, you're going to start shivering. And that's just your body's way of trying to produce heat. You shiver. It produces heat. It tries to warm up the core. But the really concerning thing is if you stop shivering. That's when your body temperature gets less than 90 degrees, and that's where it becomes life threatening. Your heart just starts to do weird rhythms. It gets really slow. And certainly, if you're with someone and they just are not shivering and you're really cold, and they're just not shivering at all, and they are not really responding to you, those are signs of severe hypothermia.

Host: Is there anything that you could do for them at that point if you can't get them to help?

Dr. Troy Madsen: It's not everyone's ideal scenario or consideration, but if you have to, the best way to get someone warm is number one, make sure they're dry. Number two, if you've got a sleeping bag or something to insulate you, strip them down. Strip yourself down. Get your body heat next to them. That's the best way to warm them up.

Host: And that's about all you can do at that point?

Dr. Troy Madsen: That's about all you can do besides trying to get help. You know, obviously, if you can make a fire or whatever resources you have there, but that's going to be the quickest way to warm someone up.

Host: Any other thoughts?

Dr. Troy Madsen: Yeah. I think the number one thing is just preparation. Make sure you know where you're going. Know what the temperatures are. Make sure you're prepared for that, so that doesn't happen to you.

Host: And bundle up when you're shoveling your driveway.

Dr. Troy Madsen: Exactly. Stay bundled up.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.

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: It's time for another From the Front Lines with Dr. Troy Madsen, emergency physician at the University of Utah Medical Center. As an emergency room physician you see things first-trends, what is happening right now? What is it we need to be aware of?

Dr. Madsen: So right now the big thing we're seeing and the big thing people are talking about is air quality. As the temperatures go up in Utah we get ozone that develops. This is stuff in the air that can then get in your lungs; if you have lung problems like asthma or emphysema, it can really make things worse.

Interviewer: So in the E.R. you're seeing increased cases of this?

Dr. Madsen: We are. We're seeing more cases of people coming in who are having trouble breathing, definitely just in the last few days.

Interviewer: And that's attributed to air quality? No doubt about it.

Dr. Madsen: It is. I hadn't seen the numbers we've had recently until just now and just looking at the ozone levels and the fine particulate matter, this is all the stuff that's released from forest fires and different range fires. We are seeing our numbers up, associated with that.

Interviewer: So what's going on exactly, you've got the bad air, somebody breathes it in, and what's going on at a physiological level?

Dr. Madsen: Yeah, so the big thing that's going on, for people who have asthma or emphysema, there lungs are already sensitive, so when you get this stuff in your lungs, if you get this ozone in there or these particles in the air, it just causes the lungs to get inflamed. They produce more mucous, they just get really inflamed and red, if you were to look at them and see them, and then they get really tight. So these are people who already are more likely to have their lungs just tighten up, where their airways just can't get air through them. This just makes things that much worse.

Interviewer: So what can you do for a person like that?

Dr. Madsen: So the big thing is if you already know you have asthma or emphysema, make sure your medications are refilled, make sure your inhalers are full, and make sure you're using them. Do you have preventive medications? Be sure to use those on a daily basis. If you start to have trouble breathing, use your Albuterol or whatever you're using to help you out. And if things get really bad, come to the E.R. A lot of these people we're having to keep overnight on breathing treatments and on steroids to try and get their lungs opened up.

Interviewer: What about healthy people, is it going to affect somebody that's healthy as well?

Dr. Madsen: So the big thing we're seeing with healthy people is a lot of times they're getting what feels to them kind of like allergies or a cold, clearing their throat a lot, having a lot of congestion maybe runny nose, stuff that feels kind of like allergies, maybe their eyes are watering a little bit, so it's causing some of these issues with them as well. So I would say if you're younger, if you're healthy, get outside, exercise, enjoy it but try and do it more in the morning when it's not quite so hot, because as the day gets hotter, that ozone, that stuff in the atmosphere builds up more and can be more of a problem.

Interviewer: How long are we going to have to endure?

Dr. Madsen: Hard to say, yeah, in terms of what we have in line and in store for us, I think it's really going to depend on what happens with fires. I sure hope that we don't see forest fires and issues like we had last summer. I can say I've never seen a summer in the E.R. like last summer, in terms of the number of cases we had of people with trouble breathing. It was worse than what we see in the winter, which is usually pretty bad, so let's just hope it doesn't get to that point.

Interviewer: So it's really the fire particulate matter more than the heat and the ozone that's causing the problems?

Dr. Madsen: Well I think what happens, the ozone is there, it's always there with the heat, we know about it, people who have asthma kind of know what to watch out for but then you throw that smoke in on top of it, for the bad forest fires, and that's when things really get bad. People usually aren't prepared for that and that's when we start to see a lot of problems. It kind of pushes people over the edge who already have some issues.

Announcer: We're your daily dose of science, conversation and medicine. This is The Scope, University of Utah Health Sciences Radio.