Search for tag: "screening"

Interviewer: When you've been out and about, you may have seen it driving or in a parking lot in South Salt Lake, Ogden, Provo, Kearns, Glendale, or maybe some place else in the Salt Lake Valley. And you've always wondered, "What is the Wellness Bus and who can take advantage of this free resource?"

Nancy Ortiz is the mobile health program operations manager, which includes overseeing the University of Utah Wellness Bus. Nancy, let's just start off with what is the Wellness Bus?

Nancy: So the Wellness Bus is a mobile prevention and education clinic that is focused on really making communities healthier. So it's a 39-foot Winnebago that has been outfitted to travel around to different communities and provide free screening services for not only diabetes but other chronic disease.

So when you come to the bus, you can get . . . Everything is no cost. It's free. You can get a simple glucose test, and if your sugar is high, we can also do what's called an A1C test. Additionally, we can test your cholesterol, a whole lipid panel. We test your height, weight, your BMI. We test your waist circumference. And then, additionally, we have a registered dietician that offers free nutritional counseling or coaching on the bus.

Again, all services are free. And we go to the same locations because we want people to come back. We want to help people manage their diabetes or their pre-diabetes, or prevent pre-diabetes or diabetes, or help them with their high blood pressure. So we encourage people to come back and that's why we go to the same locations every week.

Interviewer: And the individuals that come and visit the Wellness Bus, what is the impetus? What inspired them to actually go into this bus, into this situation that they might not be familiar with? What got them there?

Nancy: That's a great question because as we found out, just because you build it or park it there doesn't mean they come inside, right? A lot of people just go walk by out of curiosity, like, "What is that?" But people, they do want to know, and we hope more people want to know. As we say, what are your numbers? What is your glucose? What is your blood pressure? What is your cholesterol? What do those numbers look like? Sometimes they can be a burden.

We don't diagnose on the bus because we don't have medical providers. We work with community health workers. So we say we identify. So the person that does finally make that decision to come into the bus, we do the screenings. And of course, they hope that their health looks pretty good. But in the event that it doesn't look . . . the numbers aren't ideal, we can help them find a provider if they don't have one.

And studies have shown that lots of times, people will not seek care because of the cost. They don't want to burden their family. Money is already tight. So we have services available where we can help people get either free or low-cost medical care. So we are there trying to help the person find affordable resources.

Interviewer: That would be a scary thing, finding out that you have a health condition, and definitely a reason why you just walk on by as opposed to finding out.

Nancy: Exactly.

Interviewer: So it's great that you're connecting people with community to resources that can help in their situation. Tell me about somebody. Walk me through somebody comes in, they find out, "I've got a high fasting glucose. I might have diabetes." You connect them with some resources. What's the journey like after that point?

Nancy: Right. Again, they've gotten this bad news, but we are there to encourage and say, "Through education and lifestyle changes," which is why we have a registered dietician on the bus, "you can really manage it."

We're here to educate you on ways to reduce your sugar levels or you're high cholesterol levels. And we highly encourage you to see a medical provider because it could be that you they need to be on other medication or insulin.

And once you've met with the provider, we encourage you to come back to the bus. We are here, again, for support. And a lot of times, Scot, it's just the social support.

We have an individual. He had diabetes when he came onboard. He comes to the bus pretty much every week. And his glucose levels are improving because I think that social interaction. He knows the people on the bus, like, "Hey, Alex. Hi, Maria. Hi, Veka." That really helps people, I think, pay attention more to their health and make them feel like somebody cares.

We try to make people feel comfortable. We try to break down on the bus as many barriers as possible.

People can come on the bus and remain anonymous if they want. We ask them general information, name, address, a little bit of medical history, but you don't have to fill it out. If people don't want to give their information, and some don't for fear that it's going to come back to them in some bad ways, it's like, "You don't have to give your real name. You don't have to give your address." We don't want that to be a barrier.

We have Spanish speakers on board, so we have that language, but we have an interpretation service that we use that we have access to 240 languages and dialects. We can get someone that speaks their language within a minute on the phone. So we don't want that to be a barrier.

We travel to communities that have high rates of diabetes and chronic disease, trying to make it easier for people to come to the bus. So just trying to break down those barriers of . . .

You asked me previously why someone would or wouldn't come on to the bus. We're just trying to get as close to them as we can and say, "Just please come on board. Let's just have a conversation. Let's look at your blood. It's just a finger prick. We're not doing blood draws out of the arm. It's just a simple prick on the finger."

So it's just about letting you know where you are, again, on the spectrum of good health versus ill health, and that's what we want people to know. We are not there to shame anybody. So, again, we want people to feel comfortable that we're not here to judge you on your weight or how you eat.

Interviewer: It's no reflection of a personal shortcoming at all.

Nancy: It's not. It part, lots of times, it's about education.

Interviewer: What would you say to somebody that might see the Wellness Bus parked some place and they're thinking about coming in but they're not sure?

Nancy: Don't even give it a second thought. Just open the door and come on in. Our staff is so friendly. They're going to make you feel like you're just sitting in your living room while you're getting your finger poked.

I mean, please, don't hesitate to come in. Just find out what your health looks like. Just get a baseline. And if it needs improvement, we can help you make those improvements. And if the numbers look good, that's even better. You can walk out of there feeling, "Hey, I'm even healthier than I thought I was," or, "There are little improvements that I need to make," or, "Wow, I do need to see a doctor or a provider at this point."

But again, we are there to help you on this journey not just today and say, "Oh, this is what your numbers look like," but, "Hey, come back. We are here every week whatever location we're at. We will help you on this journey to better health." So please, hop on board.

So you just had your Pap smear or your mammogram and it wasn't that bad was it? Or your colonoscopy. Okay, it really was that bad, but you didn't remember it. Are you wondering when you can stop doing these tests?

I asked a woman I know, who is in the health and fitness business, when she thought she could stop doing her cancer screening, you know, Paps, mammos, colonoscopy. She said, "Never," with a smile. She never wanted to stop her cancer screening, "It isn't all that bad, and it makes me feel safe," she said. I replied that cancer screening decisions about when and how often is a cost, risk, benefit analysis, and there are some data to inform that decision. She said, "You go with your brain, I go with my heart."

Well, let's go with the brain for a little while, okay? Let's start with Pap smears. The recommendations about Pap smears have been changing as we know more about what mostly causes cervical cancer -- the HPV virus -- and how fast it grows, usually not too fast. Cervical cancer does not increase with age for a lot of reasons. Sexual activity and the number of partners doesn't increase with age. Well, usually. And the cervix in postmenopausal women may not be as receptive to the virus. So there are good reasons to say that when you get to 65, if you've had normal Pap smears for the past 10 years, that means you actually have been having Pap smears in the past 10 years, and you haven't had an abnormal Pap in 20 years, you can stop testing. There's some pretty solid numbers to back this up, and the U.S. Preventive Services Task Force makes that recommendation.

Okay. How about colonoscopy? Well, colon cancer does not decrease with age. But if you don't have any family history of colon cancer and if your previous colonoscopies, that assumes that you've had some, have not shown any polyps or precancerous lesions, you can stop at 75. That's the recommendation of the U.S. Preventive Services Task Force and the American College of Physicians.

Lastly, mammography. Breast cancer does not decrease with age. It increases with age. The aggressiveness of breast cancer is less in older women than it is in younger women. But women still will get treated, which can be aggressive in and of itself. The U.S. Preventive Services Task Force said there's not enough evidence to recommend for or against mammograms at age 75 and older. But about a quarter of deaths from breast cancer each year are attributed to a diagnosis made in women after the age of 74. Women as they get older are less likely to get mammograms. About three-quarters of women 50 to 74 have had a mammogram in the past two years, but only 40% of women over 85. Of course, many women over 85 are in poor health, and mammography is just not on the list of things to do. And clinicians are less likely to recommend mammography if a woman is in poor health. The American Cancer Society suggests women should continue mammograms as long as their overall health is good and they have a life expectancy of at least 10 more years.

Well, how long am I going to live? I went online and Googled, "How long will I live?" There are lots of calculators because insurance companies and pension plans really want to know. Well, I tried a life expectancy calculator that was developed by the University of Pennsylvania and has been mentioned in the mainstream media. It asks sex not gender, age, height, weight, alcohol, smoking, diabetes, marriage status, whether I exercised, ate my veggies. I didn't fudge my weight or height. This calculator said I was going to live till 93 and I had a 75% chance of living to 85.

Another life expectancy calculator from confused.com asked me just a few questions, not my height or weight,or smoking, or alcohol, or diabetes. It did ask my relationship status, and options included happy relationship and married, but these were mutually exclusive. You could only pick one. Well, this one had my life expectancy of 97. And the calculator from Northwest Mutual, a well-respected life insurance company, cranked me out at 98.

Well, I really don't want to hang around the planet all that long. But I really hope that my savings will take me up there, and I'm going to have to have mammograms for a while yet.

Thanks for joining us for the "Seven Domains of Women's Health" on The Scope.

Interviewer: Were you aware that lack of knowledge about colorectal cancer causes a significant percentage of adult deaths from colon cancer every single year? So that means just by listening to this podcast today you are going to reduce your risk of colorectal cancer.

Dr. Priyanka Kanth is from Huntsman Cancer Institute and here are the bullet points that we're going to talk about today to help inform you so you are less likely to get colorectal cancer.

So, first of all, it's one of the most common cancers, and it causes a significant percentage of adult cancer deaths. Colorectal cancer impacts men and women equally. You need to have screening even if you don't have a family history and by the time you have symptoms it can often be too late, that's why screening is so important. So let's start with the first one Dr. Kanth, colorectal cancer I didn't realize this, one of the most common cancers and causes a lot of deaths.

Dr. Kanth: That's correct. So colon cancer is the third most common cancer in the U.S. And so number one being lungs and number two being breast and prostate in the respective gender. And then third is colon cancer, and that's pretty high. And it is also the second most common cancer to cause death in the U.S. So the first is lung cancer, leading the highest deaths from a cancer, and the second is colon cancer. So it is surely that the burden of disease is very high.

Interviewer: Yeah. I think that surprises a lot of people. A lot of people don't realize that and, as a result, maybe don't take screening as seriously. Another misperception is that men . . . It's a man's disease, but it actually impacts men and women equally. Tell me more about that.

Dr. Kanth: Absolutely. So there is no separate recommendation for men and women. Both genders can get this cancer, and both genders should start at the same age. So there is no difference in recommendation. It is a disease for anyone. So anyone should get screened and now at age 45, yes.

Interviewer: And another perception is, well, my family, nobody in my family had colorectal cancer. So I'm probably going to be okay. Maybe I don't need to get screened at 45, which is the new recommendation. Maybe I can wait till I'm 60. But that's false too.

Dr. Kanth: Absolutely, you're very correct about it. A lot of time we don't think that it is a problem for us because we don't have anyone in our family, but that's not correct. It can happen to anyone. In fact, 70% of all colorectal cancer patients don't have a family history. So that's a big number. And that's why it's so important to have this screened because screening is the best prevention.

Interviewer: I also understand that there's a misperception that colorectal cancer just happens to older people, like in their 60s, 70s, and 80s, so I can put off my screening.

Dr. Kanth: Again, a very, very good point. It can happen to anyone. So age is a number. It surely can happen more in older age, but even young people can get it. And we have seen a rise in incidents in less than age 50. So it is not a disease of only old age. It is a disease for anyone to be worried about.

Interviewer: And then the other misperception that I've heard is, oh, I'll go in and get my screening when I start to show symptoms. But that's very dangerous and inaccurate.

Dr. Kanth: It is. It is very dangerous because colon cancer, especially early stages will not have any symptoms. Even sometimes late stages you'll have symptoms, very minimal symptoms. This is a disease where you don't produce symptoms, you don't think about it and it is inside you. So you have to be very, very aware of this. That don't wait for symptoms. Go ahead and get your screening.

Interviewer: And how difficult is it for treatment if a patient comes to you is at the point where they have symptoms?

Dr. Kanth: Absolutely. So if the symptoms are already there, we are worried it is a late-stage disease. And treating a late-stage disease when it has spread beyond colon is much more difficult compared to treating a stage one or two disease, when it is just in the colon. If it's just in the colon, we take your colon out. We all can live without our colon believe it or not. We can have some change in quality of life, but we can have same life expectancy. So treating an early-stage colon cancer is way easier compared to treating a stage four, late-stage colorectal cancer, yes.

Interviewer: And the two options you've got the stool test, or you've got a colonoscopy. Tell me the advantages and disadvantages of each one of those, because, you know, we know that 45 is the number we should be screened at, but some of us don't necessarily want to take, you know, the day off before and after to get a colonoscopy, so talk me through that.

Dr. Kanth: That's correct. So colonoscopy is gold standard. The reason we call it gold standard is this is the only preventive tool where we can go in, we can see a precancerous lesion, which is a polyp, and we can take it out.

Interviewer: And so it's a diagnostic tool.

Dr. Kanth: It's a diagnostic.

Interviewer: In addition too, if there's a problem at the same time, you can take care of it.

Dr. Kanth: You've taken care of it. It will never turn into cancer. Stool test are very, very, very good tests to detect colon cancer. They may not detect polyps, but they will detect colon cancer at a very high sensitivity. So it is a very good option for patients who are worried about colonoscopy. Now, colonoscopies are not without risk. It's an invasive procedure. We give you sedation. You have to go through a prep as well. You have to take time off, like you mentioned, and yes, some risks associated with the procedure itself, like bleeding or perforation. Those risks are very small, very, very small, but can happen. Stool tests on the other hand, are very safe, can detect colon cancer readily, may not be polyps, but it's a very good tool, once we find that you have blood in stool. Now remember this, if your stool test is positive, you have to get a colonoscopy. That is the next step. So just to keep in mind, any screening test result like we said, best screening test is the one that gets done. So we should consider screening whatever option works for you.

Interviewer: And the advantage of a colonoscopy too, is once you have that done, if no polyps are discovered, you're good for another 10 years.

Dr. Kanth: Absolutely. If your prep was good, if you did a good exam and no polyps were found, you have no family history, you don't have to repeat it for 10 years. So even with small polyps now we don't have to repeat it for 7 to 10 years. So the recent recommendation has changed and become more relaxed for even if you had one or two small polyps, you're okay.

Interviewer: And the stool test is yearly.

Dr. Kanth: So stool test, there're a couple of stool tests. One stool test, where you have to do pretty much yearly is called fecal immunochemical testing. The other stool test is called FIT-DNA, which is commercially called Cologuard which you may consider doing it every three years. But it is surely more frequent to do it than getting a colonoscopy done.

Interviewer: And let's talk briefly about barriers that keep people from getting either one of the two screenings. So maybe we can help talk them through and encourage them, you know, if they have average risk to get screened at 45, because that is really the best way of preventing death from colorectal cancer. So what are some of the barriers and how can people overcome those?

Dr. Kanth: Absolutely. So the biggest barrier, I think, is the knowledge. They should know that they have to get screened. So there is a provider and patient education involved either away. So if no one told them, or if they did not hear it on the radio, say they don't know. So that's the biggest barrier. So education is very important from both aspects. The other barriers are, I would say another very big barrier is, of course, insurance coverage, if you don't have insurance. But there are other tools, there are other ways, like I said, stool tests, they are very cheap. So things can still be done even if you don't have insurance. Apart from that, other barriers are just being worried about getting a procedure. A lot of people think colonoscopy is painful. I have to go through this. It's not true. Colonoscopy is a very smooth, painless procedure, honestly. So those kinds of things that this is going to hurt me, that's not correct. So those are the main things. I would say if I have to pick any, I would say education. If you're aware you're going to do it, you will do it.

Interviewer: And sometimes it's just getting it on the calendar, right?

Dr. Kanth: Absolutely.

Interviewer: Whether it's the colonoscopy or whether it's the stool test, just talk to your primary care provider. Have that discussion find out where it works out for you.

Dr. Kanth: Absolutely. Yes. And that's for average risk screening, you can choose anything, colonoscopy or stool test. There are other tests, other modalities too, but these two are the most common. If you've family history, we recommend colonoscopy, that's the usual tool is recommended. So the best way is to contact your primary care provider, talk to them what's best for you.

Interviewer: It used to be 50. Now it's 45 and there's a good reason for that. Huntsman Cancer Institute and University of Utah Health says more lives can be saved if men and women who are at average risk of colorectal cancer get screened at 45 instead of 50 years old. Dr. Priyanka Kanth is from Huntsman Cancer Institute. Why the change? What happened?

Dr. Kanth: Over the years since mid-'90s to early 2000, we have noticed an increased risk, increase incidence, and mortality. Actually both. So increased cases and people dying from colorectal cancer. And that was the main reason people started looking into it, researchers started looking into it and came up with this studies, modeling studies. And that's why this recommendation was changed.

Interviewer: Yeah. And the reason that's so important is because unlike other disease that perhaps might show symptoms, and then you would go get treatment. That's not how colorectal cancer presents. It really is screening is the best way to save lives.

Dr. Kanth: Absolutely. You're very right about it. So most of the early onset cancers or any colorectal cancer, early stages do not produce symptoms. Polyp usually starts with a polyp, which is a little bump in the colon and it changes into colon cancer. These polyps do not produce symptoms and they grow slowly, and you will never know you have one. So that's the biggest problem with colorectal cancer. And by the time you have symptoms, it's fairly late. So screening is the best strategy to prevent this cancer.

Interviewer: And this new research has just really shown that people between 45 and 49 because catching it early is the best defense that a lot of good can be done by having it at 45.

Dr. Kanth: Absolutely. Absolutely. There are certain research which has shown that there was a drastic increase even between age 49 and 50. So one study showed that there was an increase of almost 46% between age 49 and 50. So if we decrease it from 50 to 45, we are really hoping to capture that colon cancer patient. And this would be very, very beneficial between that age group.

The other thing I would like to say that this is also an incentive, an added benefit to increase screening from age 50 to 55, 50 to 54. But traditionally, it has been on the lower side if you do it from 50 to 75. There's slightly decreased screening rates in screening uptake between age 50 to 55. So this will help patients who are thinking about it at age 50, but did not get it till age 55. Now they're like, "Oh, you have to get it done at 45, let's get it one at by age 48." Something like that. So this will be very helpful at that point.

Interviewer: Is there a perception that colorectal cancer is an older person's disease?

Dr. Kanth: Yes. I think a lot of us, a lot of our patients in general public we think cancer is an old person's disease, especially colorectal cancer. That's not the case anymore. This is still true. Most colorectal cancer will still be diagnosed when you're older, but there has been a rise in patients who are younger than age 50. Some of it is because of genetic causes, but the rise has been in the average risk. So this perception should be changed. We should consider 45 as new 50 to start screening now.

Interviewer: And really that number, age 45 is the most important number. It's not do I have a family history? It's not do I have symptoms? It's not am I a man or a woman and think I'm less likely to get it. Really as soon as anyone hits that age of average risk of 45, that's the trigger you should go get it checked.

Dr. Kanth: Absolutely. Very correct. So 50 was . . . the same recommendation was for anyone, any gender, male, female. Any person who hits 50, you should get a colonoscopy. Now that has changed to 45. So it doesn't matter if you have symptoms, you should get it checked, especially if you don't have family history. If you have family history, that's a different story. If you don't have family history or average risk, please go get checked at age 45.

Interviewer: How is this going to impact those that do have an increased risk? Not an average risk, an increased risk? Does that also drop their age that they should go in down or do we know?

Dr. Kanth: So, at this point, if you have a family history, we usually start screening early. Most of the time we start screening at age 40. Or if somebody had colon cancer, I'd say whatever age, 10 years before they had colon cancer. So that may not change so much. It's possible we can look at the data and that may change again, but at this point, this recommendation is only for average risk. So family history is a different cohort of patients. That is still a very good point for primary care physician for all of us to ask that history from patients, "Do you have a family history of colon cancer?" Because your risk might be very different from the average risk.

Interviewer: So have that conversation if you're above average risk with your physician, your provider is whether or not you should get it earlier.

Dr. Kanth: Absolutely. Yes.

Interviewer: All right. And for the recommendation, is a colonoscopy okay? The home stool test, is that impacted by this age going down to 45?

Dr. Kanth: The best screening is the one that gets done. So that's another message which has to be delivered by providers. Colonoscopy is not the only screening test. Colonoscopy is gold standard because you can see the polyps you can remove it before it turn into cancer. But there are other very, very good stool tests which can detect colon cancer easily. They are non-invasive, you stay at home, you don't have any logistics around it. And those are good tests to be done. So that's a big message which everyone should know that colonoscopy is not the only way to detect cancer. There are other very good stool tests, which everyone should consider. If you're declining colonoscopy for any reason, do go for a stool test.

Interviewer: So if it's a stool test or if it's the colonoscopy, it doesn't matter. Average risk needs to be 45 now.

Dr. Kanth: Absolutely.

Interviewer: All right. And also, I understand with the new recommendation that Medicare, Medicaid, and also your commercial insurance will cover either one of those screenings starting at 45.

Dr. Kanth: That is correct. And that's what we believe after the new recommendation which has been endorsed by pretty much all the societies that all these should be now covered under preventive care just that how we had it at age 50. Even now, some insurances are already covering at age 45, but that was more sporadic. So now we expect this to be 100% covered.

Interviewer: What is the fine line between a few drinks to relax or blow off steam and a potential alcohol abuse problem?

Dr. Troy Madsen is an emergency room doctor at University of Utah Health. Dr. Madsen, I hear that doctors have a series of questions that they ask patients, and it's pretty accurate at indicating if somebody has a potential alcohol use problem.

Troy: We do have a screening tool we use. We all learn this in medical school, and it is something that we will then use in our practice, is a quick screen to say, "Does this individual potentially have an alcohol use disorder that we should look into further and ask some more questions and see, 'Well, how much are you drinking? Do you need some help?'"

This is a tool that's called the CAGE questionnaire. So the first C, the C stands for cut down. Have you ever felt you need to cut down on your drinking? The A is annoyed. Have people annoyed you by criticizing your drinking? So, for each of these, you get a point if you answer yes. G is for guilty, G of CAGE. Have you ever felt guilty about drinking? And E is for an eye-opener. Have you ever felt you need a drink first thing in the morning or an eye-opener to steady your nerves or get rid of a hangover?

Now, if you answer yes to two of those questions, so if you have a score of 2 or higher, it has a 93% sensitivity for identifying excessive drinking and a 91% sensitivity for identifying alcoholism. That means it's a pretty good tool for potentially identifying individuals who may be needing some help, again, just answering yes to two of the four CAGE questions.

Interviewer: When you say over 90% accuracy that that person may have a drinking problem, this is research supported?

Troy: It is. Multiple studies. This CAGE questionnaire has been around for many, many years, decades. They've got studies going back into the '80s on this. So it's something that's been studied over many, many years, many, many people.

If you're answering yes to two or more of these . . . let's say you've had people tell you, "You really should cut down," and let's say people are critical of you, you get annoyed by it, if you've got two of those four, that's potentially a sign that maybe you need some help. Maybe you do have an alcohol use disorder.

Interviewer: What if you just have one? Is that supported by the research? Does that necessarily mean anything?

Troy: So that's considered a negative screen. So, if you just had one . . . let's say you felt guilty about your drinking, so you got the one point there, but you didn't answer yes to any of those others. It's like, "Well, no one has ever told me I should cut down. I've never really felt annoyed. I don't really need an eye-opener in the morning to take care of a hangover," so if you just get the one, technically, that doesn't get you a point.

Obviously, there are a whole lot of other variables that play into this, like who you are hanging out with. If you're hanging out with people who are drinking a lot, they're probably not criticizing your drinking and you're probably not getting annoyed by it. So it's one of those tools where it's not a perfect tool.

The advantage of this tool is just something quick that we can do as healthcare providers. It's a quick screen. Just talking through those questions took us maybe 30 seconds. And if you're getting a score of 2 or higher, it doesn't mean you have an alcohol use disorder. It just means, "Let's do some additional screening to see if that's potentially an issue."

Interviewer: It's pretty amazing how accurate the CAGE questionnaire is, but is that where doctors stop, or are there some additional questions that a doctor might ask, or is there an additional resource that a patient could go to on their own to find out a little bit more information?

Troy: There's something called the AUDIT questionnaire, and if you search for that, you can find it online, but that goes through in more detail about getting into exactly how many drinks you have per week, how many you have at once, and getting into the whole binge drinking thing.

And some of those CAGE questions, it kind of goes through some of those again as part of it, but it's a 10-question questionnaire and that really then breaks things down by a score to say "Are you a medium risk? Are you a high risk? Are you at a point where addiction is likely?"

So it's an additional questionnaire. We don't need to go through all the questions on it, but I think that can be helpful as the next step to potentially see, "Is there an issue that I should get some help for, or where are things right now?"

Interviewer: And if somebody has taken the test and they're thinking, "Wow, maybe I should look at getting some help or I would like to get some help," what would the next step be? Because that seems like it could be intimidating.

Troy: If you're looking for inpatient treatment where you need inpatient detoxification and you need medically-assisted treatment to be able to just reduce your drinking or cut off from drinking, it's something you can talk to your doctor about. I think, regardless, I'd talk to your doctor, but they can help set those things up for you. There are many community resources available for that as well.

In some people, it's just the sort of thing where they just reach a point and they just say, "I need help, and I need it now, and I need to make this happen, and I don't have time to wait on that." We see those individuals in the ER on a regular basis. You can come in. We can talk to you about options. In some cases, we admit people to the hospital for this if they are in withdrawal and they have severe symptoms. I'd say I admit people for this . . . it's a weekly thing for me where I'm admitting patients for this.

So, with any substance use disorder, I think the important thing is just reaching out for the help. And I think that's the hardest part, taking that initial step, but if you can reach out to family and say, "Hey, I've got an issue. I need help," I think that's . . . it's a huge thing just to be able to do that. Then you take it from there and you'll get the help you need as long as you just keep pushing forward.