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A baby that is wanted and planned for, a child by choice and not by chance, that is what modern contraception offers men and women. But you have to know what's out there, how it works, and where to get it. This is really important now more than ever.

This is Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah Health, and this is the "7 Domains of Women's Health" on The Scope.

Women and men all over the world have wanted to plan their families for thousands and thousands of years, but methods used in Cleopatra's time in ancient Egypt probably weren't as effective as what is available now. If no method of contraception is used, women in sexual relationships that would make them pregnant could expect to have more than 11 babies. That's in these days of good obstetrical and pediatric care, where women are less likely to die in childbirth and babies are much less likely to die in the first five years of life. Eleven babies sound like too much? One more baby sounds like too much right now?

Let's talk about contraception. It's an egg and a sperm problem. You need to stop egg production, stop sperm production, or stop the sperm from getting to the eggs. These are the main ways that modern contraception works.

About 50% of unplanned pregnancies happen to people who are "using" contraception but using it incorrectly. This is the most common reason that methods like abstinence or periodic abstinence, think natural family planning, or methods like barrier methods like condoms or diaphragms actually fail. They weren't used correctly or at all. Methods that you have to think about at the time of sex are more likely to fail because you're more likely to fail to use them. If you combine two methods, abstain during your fertile period and use condoms all the rest of the time, your chance of getting pregnant by accident is much lower. Two methods are better than one, and this is a combo where men can be the important user. You can get condoms most anywhere, and anyone with some smarts and gumption can figure out their fertile period.

So let's talk about hormonal pills, patches, and rings. They are considered moderately effective methods or ones that have an annual failure rate between 1 in 10 to 1 in 100. That means if women use them, the chance of getting pregnant is about 1 in 10 to 1 in 100 per year. Of course, you might be at risk for pregnancy for multiple years, so these chances literally add up. Considering a lifetime of contraception using these methods, it was calculated that women would have about two unplanned pregnancies. These methods work by blocking ovulation and by changing cervical mucus so sperm cannot get to the eggs, but women don't always take the pills, or patches or rings correctly. They miss some days or they stop for a week as directed, but they stop for longer than seven days, and they are very likely to ovulate. But you could team up with your sex partner and use a moderately effective method and condoms and get much more bang for your buck birth control-wise.

Hormonal methods aren't right for everyone, and you should know by reading up or asking knowledgeable clinicians if they're right for you. Now, there may be immense hormonal contraception on the horizon, transdermal hormones to block sperm production. If it has about a 10% failure rate per year, and women taking the pill as they will, not perfectly, have a failure rate of about 10% per year, if both members of the sexually active couple use the method not perfectly, the failure rate would be about 1 in 100 per year. The two methods multiply in terms of their effectiveness. If they both used effectively, if they both, men and women used hormonal methods effectively, it would be about 1 in 10,000 women per year, and that is effective contraception.

Now for highly effective methods, these methods have failure rates of about 1 per 1,000 women per year. They are so good because you don't have to think about them and using them correctly almost always happens. These include copper IUDs, hormonal IUDs, and hormonal implants under the skin. The hormonal implants' primary method of action is to work by blocking ovulation. The IUDs' primary method of action is by blocking sperm. Copper in the copper IUD kills sperm on their way up to the egg, and the hormonal IUD blocks sperm from getting through the cervix. The IUDs and implants are highly successful at preventing pregnancy but require a trained clinician to put them in. They last a long time, the copper IUD for 12 years, the hormonal IUD for 5, and the implant for 3, but they are immediately reversible as soon as they come out.

Now, all contraceptive methods have some side effects and risks, but none have as many risks and side effects as an unwanted pregnancy. Uh-oh, did you just say, "Oops?" Did you forget to take your pills? Did the condom slip off or stay in his back pocket? Was sex forced on you and you weren't using anything? Emergency contraception is for people who had unprotected or under-protected sex. They are pills over the counter or by prescription, that must be used in the first three to five days after the unprotected sex act, and the earlier, meaning the next day or the day after, the better. The copper IUD and hormonal IUD can also be used for emergency contraception, but they aren't FDA approved for that use, and you have to find a clinician to place one in a timely manner.

Using contraception means some work on your part. You have to know what you can use and want to use. You need to know where you can get them. You need to know how you can pay for them. All this information is available from many sources, but an overall good resource is bedsider.org. Many clinics around the country provide contraception on a sliding fee scale based on the ability to pay. Most insurance plans pay for a significant amount of the cost of contraception. There's a national family planning grant called Title X, that provides low-cost contraception to anyone who needs it, and it's available in most states. But you have to lace up your boots or put on your flip-flops and do it. Children deserve to be by choice and not by chance now more than ever. Thanks for joining us 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.

Dr. Stoesser: Hi, my name is Kirsten Stoesser, and I am a family medicine physician. A question that a lot of new parents have is whether or not they need to supplement breastfeeding with formula. In most cases, this is not necessary but in some cases it can be helpful.

One of the times where we recommend that somebody supplement with formula is if the baby is not gaining weight appropriately, especially in those first few days to the first week. If we see that a baby has lost more than 10% of its birth weight and is not able to gain that back adequately enough and quickly enough with breastfeeding, then we will recommend to do supplementation with formula.

This doesn't mean, though, that you have to do a bottle feeding. There are actually some ingenious ways to be able to administer formula. One of my favorite ways is what's called the "Supplemental Nursing System," or the SNS system, and this involves sort of a drip line. There's a line that's taped over the mother's shoulder and then this line comes down and is taped across the breast and the nipple.

So a baby can still breastfeed and even if they're not getting much while breastfeeding, they are getting the formula that drips in and baby is still getting practice with breastfeeding so they're not losing that skill and mothers are still getting the stimulation at the breast, which helps to promote further breast milk production. Usually, when babies do the SNS system, they just need to do this for a few days and then they're able to catch up the growth and the weight that they need and are able to go back to breastfeeding.

There are different ways to supplement. Sometimes it can be because the baby's not getting enough nutrition, and sometimes it's because the mother's not producing enough milk. And so if the mother's not producing enough milk, having ongoing stimulation at the breast is important. So in addition to having the baby feed, one thing that I'll recommend to moms to do is to get a breast pump and after baby feeds to actually pump for five to ten minutes on both sides so that the breasts are getting adequate stimulation.

Another thing that's really important is for the mom to get plenty of sleep, which I know is hard, to make sure that she's eating regular meals, to drink plenty of fluids and to try to relax as much as possible. Another thing I'll recommend is that sometimes if just even one feed in the middle of the night, if somebody else can do that feeding, they can do a bottle feeding with either formula or with pumped breast milk, then that can allow mom to get a few hours more of uninterrupted sleep and sometimes that can help with breast milk production during the day because mom's not as exhausted.

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Interviewer: What should you do if you get a splinter? I know it sounds like a silly question, but maybe there's something we need to know. We'll find out next on The Scope.

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

Interviewer: Dr. Troy Madsen's an emergency room physician at University of Utah Health. And I think, you know, everybody's gotten a splinter at some point in their life. And normally, you'd grab a safety pin or maybe your pocketknife and you just start digging. Is that okay, or is that not so good?

Dr. Madsen: Probably works okay.

Interviewer: Okay.

Dr. Madsen: It hits home for me, because just a couple days ago I was picking up some stuff and got a splinter in my finger. And it's just one of those things where you get a splinter in there, it just drives you crazy. So the reality is you probably don't have to go digging for a splinter to get it out. It will work its way out on its own. It might take a couple weeks, but if you're like me, you get that splinter in there, it's all you can think about because it hurts and it stings and it's like, "I've got to get this thing out." So I probably did everything wrong. I grabbed a thumbtack off our bulletin board and just dug at it and got it out. That's probably not the best way to do it.

Interviewer: Yeah. Because I remember my mom whenever anybody would get a splinter, she'd either take a lighter and the safety pin and burn it, or alcohol. I mean. . .

Dr. Madsen: That's right. You know it's probably best to have something that's at least sort of sterile. So if you do take a lighter and you've got a safety pin or something and just run that over the lighter or, like you said, dip it in some rubbing alcohol. Something like that is going to at least get whatever germs are on there, get that off there.

And so that'd be probably the one thing I'd say is that if you can use something that's at least reasonably clean and reasonably sterile, you're going to reduce the risk of introducing some kind of infection in there. Because as you're digging for that splinter, you're sticking that thing in there, it might go a little bit deeper. It might push something down into the wound. And you don't want to then deal with some sort of a finger infection or something more serious just because you're trying to get a splinter out.

Interviewer: All right. What about, you know, as far as getting it out, do you just start digging? Or is there a method that works better than another method?

Dr. Madsen: I'm guessing everyone has their own method.

Interviewer: Nothing you learned in med school anyway, huh?

Dr. Madsen: Well, having . . .

Interviewer: Or not a procedure you use in the ER.

Dr. Madsen: It is a procedure. You know, we do occasionally have people who come in for that sort of thing. And . . .

Interviewer: Like big splinters, I mean . . .

Dr. Madsen: Usually bigger splinters or much deeper foreign bodies. And those can be just so frustrating because I'll have people come in that say, "I know I stepped on something. I know it's in there." Sometimes I'll use an ultrasound just to see if I can see anything that jumps out on there. Sometimes I'll just go right over the point where they say, "This is where it hurts." And I'll numb it up and cut in there. But, usually, these are much deeper than anything you're going to be doing at home.

So my technique for home is to say, "Okay. I see the end of the splinter kind of sticking out right here. Or I can see kind of the tip of it there." I'll go right in that spot, try and lift up the skin a bit and just open it up along that line. And then, you know, as I'm in there, scrape around with that thumbtack or that safety pin to try to feel it and work its way out. And wash it off really well, see if I can just wash everything out. And it's kind of like what I'm doing in the ER. You know, in the ER, it's a little bit deeper. Again, I'm feeling around with some forceps as I'm going in there, hopefully feeling something that I can pull out or wash out.

Interviewer: And what is the risk of infection, really? I mean, you know, I . . . we don't want to give advice, we don't want . . . but, I mean, is it a high risk, low risk?

Dr. Madsen: I would say, if I had to put a number on it, the risk of infection with having a splinter in there is less than 5%.

Interviewer: Okay. But it is a possibility.

Dr. Madsen: There's a possibility.

Interviewer: Yeah.

Dr. Madsen: And usually, when it's infection, you're going to see a little, sort of a blister formed there, something that has what looks like pus in it. Even then, quite honestly, you're probably okay taking the safety pin, running it over the lighter, whatever to sterilize it, popping that thing open, opening it up a little bit and getting it to drain.

The biggest things I'd watch for, in terms of infection, are the hand. We always get concerned about infections in the hand. If you start to get a lot of pain along the finger or pain that's tracking up into your wrist, that's a really serious thing, because then we're worried about infection actually in the tendons. That'd be the number one thing I'd say you really need to watch out for, especially, you know, if you're digging in there with a pin or safety pin, or you start to get an infection from a splinter.

Interviewer: Got you. But otherwise, however you're doing it is probably fine.

Dr. Madsen: It's probably fine. Exactly.

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Dr. Gellner: Every year, it seems more and more children are coming in to see me and other pediatricians because of anxiety issues. And the kids are getting younger and younger. So what do you do if you have an anxious child? I'll give you some tips on today's Scope. I'm Dr. Cindy Gellner.

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

Dr. Gellner: A lot of parents have concerns that their child is developing anxiety. Their child will stress over everything and no matter what they say, nothing seems to be able to calm their child down. Some anxiety is okay. We all have fears. But when this anxiety starts causing a lot of problems, that's when they should come to us.

Some parents want anxiety medications for their children. Others do not. Medications really should be a last resort, as many are not really safe in young children, often not approved use until age 12. And like any medications, they come with their own set of side effects.

So how can you help your anxious child before things get out of hand? There are some things you can try before resorting to medication. I'm going to give you some suggestions that could help change your child's fear-based thinking on both the conscious and subconscious level.

First, let your child know it's okay to feel afraid at times. But don't act too worried. Anxiety gets worse if your child feels anxious about being anxious. Remind your child how strong they are. This will help them believe in themselves. Explain that their anxiety is their body's automatic response to fear because their body thinks they're in danger. Sometimes the body gets tricked and it thinks it's in danger when it really isn't in danger. And that's just the brain's way of trying to protect them.

Have your child close their eyes, focus in the moment. Have them tell you what they're hearing or smelling and pay attention to their breathing. Tell them slow, deep breaths remind the brain that they are safe.

Give them a pillow or stuffed animal or even a box of tissues and tell them to grab it and throw it as far as they can. This can help release the high energy they have. Teach your child that panic attacks are temporary and they have the skills to make it through them.

Remember, if you make a big deal about it, this will make it bigger for them and it only serves to increase the anxiety. Figure out what your child is really afraid or anxious about. Once you understand this, you will understand what they need to help feel better. You will be able to better explain the difference between fears that help and keep us safe and fears that hurt and only cause more anxiety.

Teach your child to ask, "Will worrying about this do any good?" If the answer is no, then it's a fear that hurts. Finally, teach your child relaxation and self-calming skills. I call this their toolbox for when they get anxious. Once they learn how to calm down their fears, remind them that they can do anything.

If your child's anxiety is still keeping them from enjoying the things that children should enjoy, talk to your pediatrician about helping to find a good therapist. By coming to a pediatrician, we can help with figuring out some things to help your child initially. But if things are too complicated, we can find exactly who you need to see and get you a referral to a mental health specialist that will work with your child and do exactly what your child needs.

Tell your child that this is someone that they can talk to that will help with their feelings. And remind your child every day, "You can do this." Empowering them to be in charge of their feelings will give them the courage they need to face their fears.

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Interviewer: Three alternatives to handing out candy on Halloween, 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: All right, here's the deal. You've decided you want to make Halloween a little healthier for the trick-or-treaters that show up on your door stoop, how can you do that? Well, we're going to find out right now. Registered Dietician Theresa Dvorak is from the Department of Nutrition and Integrative Physiology at the University of Utah College of Health and, first of all, I've got to know, as a dietitian, what are the gInterviewers and goblins getting at your door stoop on Halloween?

Theresa: A combination of things, I usually do, kind of, a bucket that they can choose out of.

Interviewer: So like, apple slices, oranges, I mean, are you handing out candy?

Theresa: Well, I guess I do more non-food things and then maybe some candy things.

Interviewer: All right, so here's the premise, you're thinking maybe you might want to make Halloween a little bit healthier for the kids in the neighborhood and not get your house TP'ed at the same time. So, let's start with number one here of, like, three candy alternatives, what's your first one?

Theresa: Things like school supplies, so pencils, erasers, that have a Halloween theme to them, keeping within . . . you know, you don't want to send out just a boring pencil or something of that sort, but maybe get ones that are decorated with a Halloween theme.

Interviewer: All right, that's pretty good, I like that. How about a second alternative?

Theresa: Another alternative would be things like trinkets or toys, you know, things like the spider rings or . . .

Interviewer: Ooh, I like that.

Theresa: . . . items of that nature that might be fun to play with.

Interviewer: And what are you going to recommend for candy-alternative number three?

Theresa: And then, third could be something of a healthy choice, a healthy snack like a string cheese or apple slices, prepackaged, healthful foods. Interviewer: Yeah, because that's another one of the tricks, right? Like, I think, well, you could hand out apples, but no you can't because of the safety concerns.

Theresa: Right, just like candy, you want to make sure that it's fully packaged and sealed, so even if it was just those miniature boxes of raisins, those are great things to hand out as well, those dried fruit, individual packages.

Interviewer: Like, what about granola bars? Are those better than candy? Like, little, small granola bars?

Theresa: It depends, a lot of them, honestly, have about the same amount of sugar that a candy bar would, so incorporated into a balanced diet, maybe, but that certainly could be a choice that looks different than, say, a Snickers bar.

Interviewer: And you said that you, kind of, give out a mix of things, so why is that?

Theresa: You know, I like to let the kids choose.

Interviewer: Do they choose the apple slices ever?

Theresa: They do.

Interviewer: Do they?

Theresa: They do, honestly, yeah. I think part of it is just that it's something different that they're not getting at all at the other houses, so it's that unique piece. Yeah, and you know, Halloween too is really just about the experience, right? Going out and trick-or-treating, going door-to-door and dressing up, and out with their friends or family. And so it's the fun of the trick-or-treating and then often, too, the sorting of the items when they get home, right? Putting them into different piles and "What am I going to choose first?" or what have you. That's really the fun of Halloween is the trick-or-treating and the sorting.

Interviewer: So as a registered dietitian, it sounds like you do give out . . . do you give out candy at all?

Theresa: I do, I do a combination.

Interviewer: Yeah but kids will go for the healthier stuff?

Theresa: They do, yeah.

Interviewer: And does your house get TP'ed every year?

Theresa: No, thankfully. Interviewer: No, everything's good, all right, that was very helpful, some, maybe, alternatives to giving out candy or, I like your idea, maybe even giving a mix or giving kids the choice.

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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: Can you test for the flu and should you ask for it when you go visit your physician if you think you have the flu? We'll examine 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: So wouldn't it just be easier if you could get a test for the flu to know if you have it or not? Well, we're going to find out right now. Dr. Tom Miller is internal medicine at the University of Utah Healthcare. First of all, is there a test for the flu?

Dr. Miller: There are tests for the flu, yes.

Scott: Okay, I want one.

Dr. Miller: You don't get one.

Interviewer: Why don't I want one or get one?

Dr. Miller: You don't need one. First you don't have flu symptoms, and if you do have flu symptoms and you're not severely ill, we would just treat you empirically. Meaning, if you have symptoms, you have a high fever that starts suddenly, shakes, chills, cough, you basically would have the flu until proven otherwise during the middle of the flu season.

Interviewer: So you're saying that the flu for a physician is a pretty obvious thing to diagnose. You don't need a test.

Dr. Miller: Should be, but everybody loves a test Scott.

Interviewer: Okay.

Dr. Miller: Everybody loves the test.

Interviewer: They like to know for sure.

Dr. Miller: So we've talked before on the program about being treated for the flu. So there is a treatment, an antiviral that you can give, but you should give it within the first 48 hours. So if one obtains a test to prove whether you have the flu or not it might be longer than 48 hours before you get the test results back, while in the meantime you're feeling miserable.

Interviewer: Oh. Yeah, so I come into the doctor and they're like, "I'll give you the flu test, if you want it," and then by then it's too late.

Dr. Miller: The decision is made based on a clinical presentation, so looks like the flu, smells like the flu, it's probably the flu. And we go ahead and treat it. We start the treatment.

Interviewer: What do I do if I'm convinced I have the flu, and you're not?

Dr. Miller: I guess we have a problem.

Interviewer: Do you get that? Do you get people that you say, "Oh I'm sorry you don't have the flu."

Dr. Miller: No, I generally don't. I mean it's pretty clear when people have the flu. They feel awful. Now they might have a cold, just a common cold. And I can usually explain to them that, "No, you don't have a high fever. It didn't start suddenly. I think this is a cold, which is due to a virus, but it's not the influenza virus." And basically when they are without a fever, that's something that they just get over after several days, and we really don't have effective treatment for that anyway.

Interviewer: That's the tell-tale sign, is you might feel completely miserable, but if you don't have a high fever above 101 then you likely don't have the flu.

Dr. Miller: Then if you have shaking, chills and you just feel awful and two hours ago you didn't feel bad, that's pretty much flu. Those are flu-like symptoms, and could be something else. The main thing is you want to get started on the therapy that could actually reduce the severity of the symptoms and turn the thing around, and cut it back by a day or so.

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Dr. Miller: How worried do you need to be when you receive your lab results in the mail or online before your physician's had a chance to talk to you about them? I'm Dr. Tom Miller and we're going to talk about that next on Scope Radio.

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Dr. Miller: Hi, I'm here with Dr. Jerry Hussong. He is a clinical pathologist and also the Director of ARUP. He's also Medical Director of ARUP and we're going to talk about abnormal lab results that a patient sees and how important those might be and what guidelines a patient might have so they don't worry too much about it before they talk to their physician.

Now, Jerry, I'll have patients call me before I have a chance to talk to them about what I would consider normal lab results, but they will get those lab results and if any of the values, and there are many values that come back with a series of standard lab results, if any of those values are outside the normal range, they're usually marked in red. And sometimes they're barely over the limit. But patients can be very concerned about that and worry that the world is about to end. Do you have any comments about how patients should look at those lab results and think about them?

Dr. Hussong: Sure. I think to start with, it's really important for patients to realize that all laboratory test results are going to come with a reference range attached to them. And basically, really, reference ranges are ranges that we establish by looking at normal patients and we establish the reference range by looking at 95% of the normal population or having that as our criteria. So the range will include 95% of the total normal population and that's really . . .

Dr. Miller: But 5% could be outside that range.

Dr. Hussong: But 5% could be outside the normal reference range.

Dr. Miller: Normal is not always normal.

Dr. Hussong: That's right. And so it's really important to realize that you can be slightly outside that reference range and still not worry or be alarmed. It's important to realize a laboratory test should always be interpreted in the context of the reference range, but also in the context of many other things that are going on with the patient. So we put this in context with the physical examination that you're going to be doing with the patient, other laboratory test results and how far outside the range is that result.

Dr. Miller: That's one of the things the patient can look at if they have the ability to do that, is to look and see if the number's very far outside the reference range. If it's two or three times the outside limit then there may be an issue. But if it's just a little bit outside perhaps not such a big deal.

Dr. Hussong: And it may mean that there absolutely is nothing underlyingly wrong with the patient at all and they just have to realize that. In some context, this is why we're doing the test to see if there's anything abnormal with those laboratory testing results. But often, if it's only slightly out of the range, it may not have any indication that there's an underlying problem.

It's really important to realize though that there are some conditions that can really affect laboratory results. Extreme exercise, for instance, can cause you to have a protein in your urine. For instance, in times of dehydration if you've been out in the sun for long periods of time there may be some changes in your electrolyte results that you see. So you have to put it together with all of the other things that may be going on and other circumstances that may be affecting the patient.

Dr. Miller: One of the things that I've heard is that if you order a lot of tests and get a lot of results back, the chance that you'll have some abnormal results is normally higher anyways. Can you shed some light on that as a clinical pathologist?

Dr. Hussong: Yes. Sure. As you're thinking, the normal range is going to include 95% of the population but 5% of the population will not be included. As you exponentially increase that with a number of laboratory tests that you perform, you can imagine that your odds of being outside the reference range on any one of those tests greatly increases.

Dr. Miller: So basically, if I have 100 test results probably five of those are going to be normal but outside the reference range.

Dr. Hussong: Absolutely. That is a possibility that could happen with that. But, again, to realize that we're doing these tests for a reason and sometimes the abnormal results indicate that there's something abnormal going on with the patient. But if they're just slightly outside the reference range it may not indicate disease or an underlying issue at all.

Dr. Miller: So the key thing is to take a deep breath and make sure you get in touch with your physician so he can interpret the findings and help you understand them. And essentially, if they're not too far outside the reference range not to worry too much but definitely to talk to the physician about an interpretation of the lab results.

Dr. Hussong: I think that's absolutely right.

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