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Anchor lead: A new type of surgery on the thyroid gland is now available in the US, Elizabeth Tracey reports

Surgery on the thyroid gland to evaluate masses that might be cancerous is very common, and unfortunately, leaves a scar right across the front of the neck. Now a new approach totally avoids leaving a scar.  Jon Russell, a head and neck surgeon at Johns Hopkins who utilizes this approach, says patients especially appreciate this.

Russell: Here in the United States at Johns Hopkins we have done more of these than anyone else in the United States, to our knowledge. We’ve found repeatedly it’s been safe, our operating times are approaching the operating times that we would do for a normal surgery, these patients walk out, we send them home oftentimes the same day. They come back and they see us in a week and they feel great. they’re just always ecstatic and they say I had it done, and I don’t have a scar. :24

Russell says the operation is also suited for parathyroid masses.

Russell: We’ve actually done some parathyroidectomies as well and it works perfectly for a well-localized parathyroid it’s the perfect surgery.  :08

Russell predicts that soon most such surgeries on the thyroid will utilize this new approach. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: There is a way to make thyroid surgery scarless, Elizabeth Tracey reports

Masses in the thyroid gland that require surgery are very common, with over a hundred thousand taking place each year in the United States. Jon Russell, a head and neck surgeon at Johns Hopkins, says many patients are women younger than fifty.

Russell: Unfortunately we might tell a young woman with no scar that she needs to have her thyroid lobe taken out and we are going to put an incision right across the middle of her neck, and it usually heals up well but you’re always going to have a scar.  :12

Russell says the good news is there’s now an operation that doesn’t leave a scar.

Russell: We just go inside of the mouth in front of the mandible and just come right down on top of the thyroid gland. It works so well, it gives us a very comfortable anatomic visualization of what’s going on. Most importantly it’s safe. If you have a safe procedure that’s also esthetically ideal, that’s what you want. :18

Russell says Hopkins is one of the few places in the US that is capable of using this approach. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Everyone’s individual features must be considered in blood pressure management, Elizabeth Tracey reports

While experts around the world debate the best way to manage blood pressure, how can those of us who are concerned about our own manage? Gregory Prokopowicz, a blood pressure expert at Johns Hopkins, says while evidence is gathered and sifted, attempting to follow any set of guidelines by the book is probably not the best approach.

Prokopowicz: I do think that there’s some room for clinical judgment there. Part of the difficulty is that these guidelines tend to get linked up to reimbursement issues and quality issues and clinicians are held to standards that may not always be realistic. Even though the guideline authors always take great pains to say these are guidelines they can’t be applied in every situation, these numbers tend to get a life of their own and then they take on perhaps an exaggerated importance. :30

Prokopowicz says each person’s risks and benefits with regard to managing blood pressure must be considered and a tailored plan developed. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Which type of obesity surgery is most common? Elizabeth Tracey reports

Obesity management is changing, a recent review in the New England Journal of Medicine reports. Kimberly Steele, a bariatric surgeon at Johns Hopkins, says such changes begin with the type of operation most people opt for.

Steele: A few years ago, 80% of our patients were having gastric bypass and the sleeve about 20%. Now the sleeve is taking over.  For what reasons? A lot to do with media, a lot to do with the concept that the sleeve is less invasive than the gastric bypass. The long term results of the sleeve are still now out. It’s yet to be seen what will come in the future with the sleeve. But right now, it seems to be the procedure of choice.   :30

Steele says the entire approach to obesity management is much more comprehensive in nature and also includes longer and more intensive follow up, to help ensure that weight loss persists over time. A team of providers including nutritionists and behavioral therapists are involved. At Johns Hopkins, I’m Elizabeth Tracey.

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A woman with breast cancer has lost her hair due to chemotherapy. She is looking at her new wig - the picture is isolated on a white background.

This week’s topics include risks of gestational diabetes, managing low back pain, ED physician opioid prescribing, and cooling the scalp for chemotherapy.

Program notes:
0:34 Risk of gestational diabetes to infant
1:33 Needing a C-section increased
2:32 Managing low back pain
3:31 Chronic pain nonpharmacologic first
4:32 Imaging not helpful
5:01 Prescribing patterns among ED docs
6:05 Some prescribed infrequently
7:01 What accounts for three fold difference?
8:02 Scalp cooling and chemotherapy
9:02 Two different studies showed 50-60% less hair loss
10:35 End
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Cancelled Stamp From The United States Featuring An Appeal For Early Testing For Sickle Cell.

This week’s topics include sickle cell trait and HbA1c, carcinogen levels and e-cigarettes, mutations and myelodysplastic syndrome, and kids ingesting pet medicines.

Program notes:

0:33 Kids eating medicines intended for pets
1:34 Retrospective poison center data
2;28 Must have appropriate medication dispensing
2:40 Sickle cell trait and hemoglobin A1c
3:41 In diabetes the higher your HbA1c
4:39 Sickle cell trait affects the level
5:39 In general their level is higher
6:33 e-cigarettes and toxins
7:33 Those with dual usage also had carcinogens
8:16 Myelodysplastic syndrome and mutations
9:16 Specific mutations and clinical features predictive
10:12 Can help more effective therapy
10:36 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/02/10/sickle-cell-trait-and-diabetes/

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Anchor lead: What needs to be considered before bariatric surgery in a teenager? Elizabeth Tracey reports

Two recent studies on bariatric surgery in teenagers have shown that over several years of follow-up, weight loss for most did persist as well as improvements in things like blood pressure and blood lipids.  Kimberley Steele, bariatric surgeon and Director of Adolescent Bariatric Surgery at Johns Hopkins, says this is great news for those considering surgery, but she urges everyone to take a conservative approach.

Steele: I think it’s very important not to jump straight to bariatric surgery. For parents and pediatricians its important to take a step back and try the traditional methods first: lifestyle intervention, medications if we need, behavioral interventions and exercise. If after an attempt all of those are failing and that adolescent is having difficulty with activities of daily living, with worsening of the medical comorbidities, then bariatric surgery should be considered. :32

Steele is working with other Hopkins specialists to open a comprehensive wellness and weight loss center for overweight and obese children and adolescents. At Johns Hopkins, I’m Elizabeth Tracey.

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