Explaining weight-loss surgery; rethinking aspirin's role in preventing strokes, heart attacks; finding reliable health information online: Upstate Medical University's HealthLink on Air for Sunday, Dec. 5, 2021
Bariatric surgery chief Lauren Rabach, MD, provides a look at weight-loss surgery options. Cardiology chief Debanik Chaudhuri, MD, addresses new guidelines about aspirin usage to prevent heart attacks and strokes. Medical librarian Olivia Tsistinas gives advice for finding credible health information online.
Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a surgeon shares what to consider if you're thinking about weight-loss surgery:
Lauren Rabach, MD: "It's not uncommon that the day after surgery, we're already taking them off their medications, high blood pressure medications, we're lowering their dosages of their insulin or their oral diabetes medications."
Host Amber Smith: A cardiologist explains the new guidelines about aspirin usage to prevent heart attacks:
Debanik Chaudhuri, MD: "The recommendation of taking an aspirin came from older clinical trials, which were done in the '80s and the early 2000s."
Host Amber Smith: And a medical librarian gives advice for finding credible health information online:
Olivia Tsistinas: "One of the best things to do is to scroll all the way down to the bottom of the page and figure out who created the page."
Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.
Host Amber Smith: This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, we'll explore new guidelines about who should and should not take aspirin to prevent heart attacks and strokes.
Host Amber Smith: Then, a medical librarian tells how to find credible health information online. But first ,a surgeon tells about surgical weight-loss options.
Host Amber Smith: From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is HealthLink on Air. If you are someone who has struggled to lose a significant amount of weight, you may have wondered whether surgery was an option. I'm talking with Dr. Lauren Rabach, who leads the metabolic and bariatric surgery program at Upstate, and we'll be covering who qualifies and what he or she can expect from weight-loss surgery. Dr. Rabach, thank you so much for taking time to talk about this with "HealthLink on AIr."
Lauren Rabach, MD: Thank you for having me.
Host Amber Smith: Now, who is the ideal candidate for weight-loss surgery?
Lauren Rabach, MD: So the ideal candidate for weight-loss and bariatric surgery is one that's motivated, one that wants to really make a difference and an impact in their current lifestyle, whether that is getting off of certain medications, not wanting to take any further insulin or be on a CPAP machine for sleep apnea. So those are patients that we would recommend looking further into bariatric surgery.
Lauren Rabach, MD: Patients who qualify have to have a certain BMI cutoff or body mass index, and that is a BMI greater than 40 if you don't have any other related medical conditions or a BMI of 35 with those medical conditions associated with obesity. And that can be anything from high blood pressure to type 2 diabetes to osteoarthritis and joint pain, high cholesterol, sleep apnea.
Lauren Rabach, MD: There's about 15 associated diagnoses that qualify, and actually the Society of Metabolic and Bariatric Surgery have correlated almost 40 disease processes that are directly associated with obesity.
Host Amber Smith: Are there any issues that might disqualify someone from weight-loss surgery?
Lauren Rabach, MD: It's very individualized. We take a look at the whole patient, what other medical conditions they have, what prior surgeries and current medication list that they'll need to take moving forward with their medical problems, so I'd say there aren't any true, hard contraindications, but we do have a multidisciplinary team to look at the patient as a whole,so from all organ systems, from mental health standpoint, are they safe and optimized to undergo that surgery?
Lauren Rabach, MD: And that's really the goal before offering them a date (to undergo surgery).
Host Amber Smith: Is weight-loss surgery an option for someone who wants to treat their diabetes?
Lauren Rabach, MD: Yes, it is. Weight-loss surgery is probably the best tool we have for treatment of diabetes. We've looked at this in big, large studies. The Swedish obesity study is probably the biggest one to date, and it compares baratric surgery to just diet and exercise alone in terms of the percent of resolution at one year, five years, 10 years down the road. And you're looking at a much higher rate of resolution, over three times as high, in patients with bariatric surgery and especially with the gastric bypass.
Host Amber Smith: So someone who has diabetes, do they have to be obese also in order to have this same procedure?
Lauren Rabach, MD: They do. They need to have a BMI of greater than 35, a body mass index, at present time based on what the requirements are for their particular reinsurance.
Host Amber Smith: So once somebody is thinking about surgery and has come to see someone like yourself, what else happens?
Host Amber Smith: What else do patients need to do before they have the operation?
Lauren Rabach, MD: You know, I think first starting with talking to their primary care doctors or providers that they feel very close with to kind of have a conversation, with their goals, with losing weight and getting healthier. I think a good support system from family from friends, is important.
Lauren Rabach, MD: And then from there, what they can expect is a full examination, not only their heart and lungs, but also mental health. So we have them evaluated by our psychologists, our dietitians, their primary care providers, as well as myself and the other surgeons in the group to see. Are they healthy and ready for a big bariatric surgery, such as a Roux-en-Y gastric bypass or sleeve.
Lauren Rabach, MD: So they meet with a support group at least one time. And the support group is really run by our coordinators, but also a big role in the support group is prior patients who have had successes or patients that are going through the pipeline. And so this is a good group for more information and more resources that come from other people, such as our coordinator, our nurses, and other people who have experienced the surgery.
Lauren Rabach, MD: We also would like to see some demonstration of weight loss, but again, that's very individualized and oftentimes we don't give the patients preoperatively a number that they have to hit. It's more the small changes that they're making to their lifestyle, to their activity, to their diet. So then afterwards, they're the most successful with their weight loss. Education is a very, very big component to what we do, to what we offer to these patients. More so than the surgery. The surgery is just a very small piece to the puzzle for them to be successful.
Host Amber Smith: This is Upstate's "HealthLink on Air." I'm your host, Amber Smith, speaking with Dr. Lauren Rabach. She leads the metabolic and bariatric surgery program at Upstate, which has a robust web presence at upstate.edu/bariatric.
Host Amber Smith: We've covered who qualifies for weight-loss surgery. And now we're going to look more closely at the types of surgery available and what patients can expect. So, Dr. Rabach, can you describe the different types of surgeries?
Lauren Rabach, MD: Absolutely. So the two most popular surgeries that we do currently are the sleeve gastrectomy, and that is where we remove about 80% to 85% of the patient's stomach. And this works in a couple of ways, so you are going to have that restrictive effect in which you can't eat as many calories or consume as much as you would have prior to the surgery. But we think, more importantly, what really drives weight loss after this is what we call the metabolic effect.
Lauren Rabach, MD: So you have changes in your hormones that interact between your stomach and that interacts between your brain that are altered after this surgery. We think this is really important for driving weight loss and really promoting, like I said, the metabolic effect in those appetite hormones being very suppressed.
Lauren Rabach, MD: The second common surgery that we do is called the Roux-en-Y gastric bypass. Now both of these surgeries that I'm talking about are performed in the minimally invasive approach. So small incisions. Patients tend to go home about a day after that surgery. With the gastric bypass, it's similar in that you're creating a smaller pouch from their normal size.
Lauren Rabach, MD: But you're also bringing up a piece of their small intestine in that way food is traveling in a different orientation than where it was before, so it will bypass. And that's where we get the word gastric bypass. The first portion of your small intestine called your duodenum. And this is very important also for the metabolic effect, which is similar to the sleeve gastrectomy, but what's even more important about it is the ability to bypass that first portion of the small bowel really makes a huge difference in terms of the ability to increase the amount of insulin that we're secreting, but also decreasing our insulin resistance, which helps with diabetes, long term.
Lauren Rabach, MD: And there a direct effect on glycemic control. And like I mentioned before, the appetite hormones, so we know about grelin and incretin, and we also know about GLP 1, and these hormones are directly altered after these surgeries. And you can see these alterations up to even five, 10 years after when we do look at these patients and the levels of their hormones afterwards.
Lauren Rabach, MD: So that's the biggest difference when you compare these two surgeries that we perform and you look at that with diet and exercise. And so those two surgeries are the most common ones that we do today. The gastric band was one that we had performed, I'd say in the 90s and early two thousands, it was a very popular surgery.
Lauren Rabach, MD: Today. We tend to see patients who have them and more often than not, we are removing these bands and offering revisional surgery for those patients. These bands were really popular because it provided that restrictive effect. So the band goes around your stomach and is inflated so that when it's inflated with more water, that inflation tightens around your stomach.
Lauren Rabach, MD: And so you have that restriction and you can't eat as much. But what we found was it's only providing restriction and not that metabolic such as the gastric sleeve and the bypass provides. And so that's why we've kind of gone away from the gastric band and are really offering the sleeve and the bypass at higher rates for the best long term outcomes.
Host Amber Smith: So looking at the gastric sleeve and the gastric bypass, I'm curious which one is the safer option, which one lasts longer. And how do you go about helping a patient decide which one is the right one for that?
Lauren Rabach, MD: Amber, that's a really good question. And a common one that I get asked when I meet with patients.
Lauren Rabach, MD: So it really comes down to looking at the patient as a whole. And I bring that up time and time again, because everyone's an individual and comes with different medical conditions and a different background. So we kind of see what their prior history was with surgeries, with medical history. We also look at, you know, what medications they're going to need to be on.
Lauren Rabach, MD: Long-term. And so that will play a role into which surgery is best for who. Now, after we go through the process of making sure you're ready for surgery, the necessary lab work and testing, we then meet as a team. And that team is the patient, myself, our dieticians, because it's really as a team decision.
Lauren Rabach, MD: And at the end of that, we decided on what operation is best for that individual. Now comparing risks associated with the sleeve and the bypass. They're actually very similar. They have very low risks of complications and side effects, especially in the year 2021. We've really done a lot of advancements as far as lowering our complication rates and getting patients out safely at that one day post-op mark. I mean, getting them back to doing their normal activities, by about seven to 10 days. So low complication rates, similar complication rates between the surgeries that we offer. And patients tend to say similar length of time. About a day after surgery. The amount of time it takes to perform the surgery is very similar and their postoperative diet is also very similar in their recovery.
Lauren Rabach, MD: So patients tend to do well with both of them, both the sleeve and the bypass have excellent long-term weight loss results, excellent results in resolving patient's comorbid conditions like high blood pressure, diabetes, high cholesterol. And these are high rates. I'm talking like 80, 90% for a lot of these conditions.
Lauren Rabach, MD: So it's quite significant and quite amazing that we're able to do this with such low risk to the patient.
Host Amber Smith: 80 to 90% of success that it stays for long term, do you mean?
Lauren Rabach, MD: That we're able to resolve certain conditions. So we've looked at patients, who've had both a sleeve and bypass and looked at how their success was at even five years after surgery and patients who've had a sleeve or a bypass, the chance of getting off those medications, not needing their C-PAP machine anymore for their sleep apnea is very high. And that's what I'm talking about 80, 90, sometimes 95% resolution rates, especially when you're looking at diabetes, high blood pressure, high cholesterol we've really had excellent results with getting patients off of those medications for good.
Host Amber Smith: So it sounds like you have a lot of patients whose lives have really been improved quite a bit by this surgery. Not to mention they've also lost weight, but they've also improved their health status?
Host Amber Smith: I agree. Absolutely. It's not uncommon that the day after surgery, we're already taking them off their medications, high blood pressure medications, we're lowering their dosages of their insulin or their oral diabetes medications, even 24 hours after their surgery. And it continues even weeks, months down the road as trying to reduce their dosages or taking them off their medications in general
Host Amber Smith: Can you tell me once the patient has a surgery date on the calendar, how do you tell them to prepare for that? What do they need to do to get ready?
Lauren Rabach, MD: By the time they have their surgery date, they're already very well-prepared. So they've met me or one of the surgical providers, they've met with our dieticians on a pretty consistent basis, at least once a month, where we talk about the educational component, which is very key. So the diet to expect, activity level that we'll want them to participate in as soon as they're done, the vitamins that they're going to have to start taking shortly after the surgery. All of these things we've talked about and the patients have their expectations very clear by the time that surgery date rolls around.
Lauren Rabach, MD: And then after that, it's really just about implementing those small changes so that they're very successful with their weight loss. Long-term making sure that they're really hitting their goals, that they're getting the necessary lab work and meeting with the necessary providers to make sure that they're on track.
Host Amber Smith: So it sounds like even before the operation, the patient kind of starts living the life they're going to be living after the operation. They have to be prepared for that and used to it so that it's not like they come into the hospital and have the operation and it's a whole different world when they leave. They are already accustomed to what they're going to have to eat and how they're going to have to behave.
Lauren Rabach, MD: Exactly. It's a, you know, it's a very powerful tool that we have, but at the end of the day, it's a long journey, and they're going to have ups and down and there's going to be days where they take two steps forward and one step back. And so having all of that education before the surgery, it makes it an easier transition for them when they have to go through such big changes during the surgery.
Host Amber Smith: Well, I want to thank you so much for taking time out of your schedule to help explain all of this to us. My guest has been Dr. Lauren Rabach. She's a surgeon who leads the metabolic and bariatric surgery program at Upstate. I'm Amber Smith for Upstate HealthLink on Air.
Host Amber Smith: you take a daily aspirin next on Upstate's HealthLink on Air.
Host Amber Smith: From Upstate Medical university and Syracuse, New York, this is HealthLink on Air. For many years, many patients have taken an aspirin a day to prevent heart disease or stroke, but recently a group of doctors on the US Preventive Services Task Force, proposed recommendations that might change this practice here to tell us more about this is Dr. Debanik Chaudhuri. He's an assistant professor of medicine and he's the division chief of cardiology at Upstate. Dr. Chaudhuri. Thank you for making time in your schedule to talk about this.
Debanik Chaudhuri, MD: Thank you for inviting me for this.
Host Amber Smith: Now many doctors have advised their patients once they reach a certain age to take an aspirin a day. And before we get into the new recommendations I'd like to ask, why did that become sort of a rule that people would take aspirin once they reached a certain age? What does the aspirin do?.
Debanik Chaudhuri, MD: Oh, that's a great question. I think we will have to trace our way back a little bit to the history of aspirin and how it came about. As you know, aspirin in a unrefined form has been used for thousands of years, and then eventually toward the end of the 19th century, human beings were able to synthesize aspirin outside of a willow bark for the first time. And at that time it was used as an antipyretic. The anti-platelet action was first noticed in the 1950s by actually a family physician on the west coast, I believe.
Debanik Chaudhuri, MD: And in the 1960s, the anti-platelet activity for aspirin was first brought into focus. Now, after the initial clinical trials, in the 1980s for myocardial infarction, there was a huge interest in aspirin because it clearly showed an improvement in survival in patients who were on aspirin, as opposed to who were not.
Debanik Chaudhuri, MD: So that is where the interest in using aspirin as a tool for primary prevention of cardiovascular disease started. And it was thought that since aspirin does such a great job of keeping people alive after they have had a heart attack, it just stands to reason that if you have coronary heart disease and haven't had a previous heart attack, and as you age over a period of time, you were more and more likely to have those sort of blockages that are not maybe symptomatic. It was thought that having an aspirin will prevent a heart attack and hence, keep people alive for longer. I think that was the rational and that time. And there are some primary prevention trials, which did bear it out to a certain extent.
Host Amber Smith: So aspirin is something you said it's been around thousands of years.
Host Amber Smith: It started out to treat pain, right? As a pain reliever? And then fever, the antipyretic is fever. How long ago was it that we learned that it would thin the blood?
Debanik Chaudhuri, MD: Oh, actually, this was noticed in the 1950s. So actually, I believe the name of the gentlemen was Dr. Larkin. He was out of west coast and, he noticed that if people took a lot of aspirin for pain relief, they ended up having some bleeding episodes. So he's surmised that giving aspirin for specifically that purpose might reduce their cardiovascular events, prevent myocardial infarction. He reportedly treated about 6,000 office patients with essentially chewing gum, aspirin, contending to chewing gum. But in 1950s, his initial observations were kind of ignored and the approach died with him. And then it was revived in the 1960s where some new laboratory methods were discovered and people saw that when blood treated with aspirin was loaded, more light went through, which means that platelets were not clumped. So that's how there was a resurgence in interest in aspirin's action on platelets.
Host Amber Smith: Interesting. Well, let's get into these new recommendations. What is the US Preventative Services Task Force. And why do doctors listen to this group's recommendations?
Debanik Chaudhuri, MD: So the US Preventative Task Force is a group of volunteers. I think there are 12 or 14 people on that panel. These are leaders in their field. They've volunteered their time to be on the US Preventative Task Force for four years. And their job is to, the way they define it is that they look for evidence gaps and knowledge gaps in the way we treat patients in various fields of medical sciences, and they look for those gaps and try to fill those gaps by recommending or directing of research, writing guidelines, essentially, also informing the Congress regarding which segments of healthcare need to be funded for further research, essentially ensuring that the healthcare money that is being spent, which is obviously astronomical, is utilized for the appropriate purposes, with the highest return on that investment.
Host Amber Smith: So, is it likely that the FDA, the Food and Drug Administration and other groups like American College of Cardiologists, is it likely that they're going to agree with new recommendations from this task force?
Debanik Chaudhuri, MD: Broadly, yes. Obviously all these specific organizations will have their own nuances, but yes, broadly they do tend to agree with the USPTF recommendations.
Host Amber Smith: And I know the actual recommendations are yet to be finalized, but just based on the proposed recommendations as a cardiologist, leading a department of your peers at Upstate, what do you think are the most important changes?
Debanik Chaudhuri, MD: I think the biggest change that the USPTF is going to accomplish is to make the recommendations for aspirin more contemporary. The recommendation of taking an aspirin game from all the clinical trials, which were done in the eighties and early two thousands. And at that time, the therapy for cardiovascular disease was not as robust as we have now. We have statins, we have ACE inhibitors, we have beta blockers, and they are more widely used. So now the newer clinical trials in the last 10 years or so that have come up, they have tried to answer the question of whether aspirin is still relevant within the context of more advanced therapy from the point of view of primary prevention, not from the point of view of secondary prevention, where aspirin is clearly indicated as of today. No doubt.
Host Amber Smith: Who are the patients that are likely not going to be advised to still take a daily aspirin?
Debanik Chaudhuri, MD: So let's start with the ones who are actually considered to be at a very high risk for cardiovascular disease. So let's say diabetes. The patients with diabetes were looked at in recent clinical trials. And if I can just name it, it's called the ASCEND Study. And in absence of established cardiovascular disease, they did not have any benefit with a preventive therapy with aspirin either. So these are the patients that would be excluded.
Debanik Chaudhuri, MD: So unless you had some sort of a demonstration either by an event or by imaging, that you have presence of plaques within the vascular tree somewhere, that pretty much excludes everybody else from aspirin as a primary preventative therapy for a cardiovascular event.
Host Amber Smith: Secondary prevention would be someone who's already had a heart attack or stroke, and they would still be probably recommended.
Debanik Chaudhuri, MD: Absolutely. And, just to also clarify, when we say primary prevention, such as those who have not had cardiovascular disease, there are certain modalities of imaging, which if demonstrate presence of plaques, which are a marker for atherosclerotic plaque, the kind of disease that causes heart attack or stroke, that is still considered cardiovascular disease.
Debanik Chaudhuri, MD: So let's say you do a carotid study and you show that there is a plaque in the carotid, that qualifies as cardiovascular disease. And then you do recommend aspirin in such patients. If you do a calcium score for the coronaries, and you see that there was a high calcium burden, which parallels presence of plaque in the coronary vascular tree, that qualifies as cardiovascular disease, even though these patients may not have had a heart attack or a stroke. So those modifiers are definitely available.
Host Amber Smith: It sounds like a lot of people are still going to be taking aspirin as a preventive.
Debanik Chaudhuri, MD: It's quite possible, especially if they have less commonly used modalities, such as a coronary calcium score or carotid study, duplex study that demonstrates presence of plaques, which are a harbinger of future events. They would probably still benefit from aspirin.
Host Amber Smith: Now do the recommendations address the different dosages, because some people take a baby aspirin, so to speak, and some people take larger doses. Does that matter?
Debanik Chaudhuri, MD: In terms of secondary prevention in patients who already have established cardiovascular disease, this question has been answered, to the effect that 81 milligrams of aspirin is just as effective. Also recent trials that looked at this particular question, try to answer this question. And the answer was that both were equally effective, and at least in the more recent trial, it showed that the bleeding risks were not any more with 325 milligrams than with the 81. So I guess they're equivalent. So if 81 milligrams is enough and at least there is some data to suggest that it causes less bleeding from older studies, it may be just safe to go straight to 81, if you have to continue to take it.
Host Amber Smith: You're listening to Upstate's HealthLink on Air. I'm your host, Amber Smith talking with the chief of cardiology at Upstate Dr. Debanik Chaudhuri about the use of aspirin as a preventative for heart attack or stroke. So let me ask you about the patients who are no longer likely to be advised to take daily aspirin. These are people that were taking it as a primary preventive. In other words, they didn't have a history of heart attack or stroke but there was some reason that, maybe they would be at risk for it. So they were taking the aspirin to prevent something that might happen, correct?
Debanik Chaudhuri, MD: Yes, that's correct. And, most of these patients were recommended on the basis of an estimation of their 10-year risk. So previously it was recommended that if your 10-year risk exceeds 10%, then it may be a good idea to consider aspirin. Whereas in light of current data, even in diabetes patients, specifically diabetes patients with no established cardiovascular disease. And even in those group of patients, it really did not show any benefit. There was clearly a reduction in ischemic events and by that I mean, having ischemic stroke or heart attacks, but the benefits were essentially countered by the increase in bleeding. So overall it did not show any benefit. So that has to be taken into account that we forget that aspirin does come with a small but substantial risk of bleeding also.
Host Amber Smith: So I'm sure you would say that patients who have been taking aspirin should definitely check with their doctor first, but in general, if someone is now advised not to take it, is it safe to just stop cold turkey or do you need to taper off of aspirin?
Debanik Chaudhuri, MD: Anytime you discontinue an anti-platelet medication there is a short period of slight uptick in the body's ability to form thrombus. But when patients are on a small dose of aspirin, once you stop it, it just kind of gradually fades away. So you can potentially stop right away.
Host Amber Smith: Is there something that a person should replace the aspirin with? Is there another medication or something that they should consider?
Debanik Chaudhuri, MD: As off now there is no such recommendation. I think they should focus on primary prevention in terms of their risk factors. Let's say diabetes or hypertension, and the focus should be on controlling those risk factors.
Host Amber Smith: Well, I'd like to ask you about some other ways to prevent heart disease aside from aspirin and aside from medication. Because I imagine recommendations maybe vary depending on each individual patient, but in general, what sorts of preventive steps do you find yourself advising patients to take?
Debanik Chaudhuri, MD: Well, as you know, in both SHEA (Society for Healthcare Epidemiology of America) guidelines and also in the U S Preventive Task Force recommendations, lifestyle modification plays a central role: diet, exercise, and also how one conducts oneself in general interactions. I mean, we know that if you are a type A personality, angry and constantly in conflict, it does increase the risk of a heart attack or stroke significantly, like at least over 20% that we know of. On the other hand, if you're a type D personality where you have low self-esteem and conflict averse, but you're constantly having some difficulty of adjustment within, that is even more significant in terms of causing future cardiovascular events.
Debanik Chaudhuri, MD: So, all those things -- mental health, behavioral health -- all of those things come together. If you have anxiety, your risk of a heart attack goes by more like 30%. I think in addition to the lifestyle modification and diet, I think a significant stress has to be put on mental health as well.
Host Amber Smith: Have you reviewed the results of a recent study? It was in a journal of the European Society of Cardiology, and it seemed to indicate that going to sleep between 10 and 11:00 PM would help lower a person's risk of developing heart disease. So I wonder what impacts sleep might have?
Debanik Chaudhuri, MD: That essentially tells you that you should stop binge watching Netflix. There is a clear signal from clinical trials that heart attacks tend to happen early in the morning. Sudden cardiac death also tends to happen early in the morning. There are studies on platelet reactivity, even when patients are on certain anti-platelet agents, which show that platelets are stickier between 5:00 AM and 10:00 AM than at other times, especially on, certain medications. So there is a circadian diurnal variation of people's predisposition, predeliction, vulnerability to heart attacks, if you will. And one of the things on that same study, what the author suggested was that if you're sleeping late, you're also waking up late and the early morning sun is supposed to be one that resets the circadian clock, and you're missing that. So that clock is perennially disturbed, and that may have some impact on the way physiology reacts to that. But it certainly stands to reason that like many of us, we are checking phones while going to sleep. All those things are disruptive for sleep and certainly adds to the mental stress. I can only imagine if somebody is a social media buff and are looking for the "likes" at 10:00 PM and if the "likes" don't come through, they would be stressed.
Host Amber Smith: Right. Well, it seems like there's probably room for more research on circadian rhythms, but also on aspirin. Even though it's been around, it seems like forever. It seems like maybe there's still a lot to learn about how it works, right?
Debanik Chaudhuri, MD: Certainly. We know that it blocks a certain enzyme that form certain humoral factors that both dilate as well as constrict blood vessels, called the cyclooxygenase pathways. But aspirin also has some other effects in some of the clinical trials, especially when followed for a long time. So we do not know everything about aspirin action by itself. And one thing we know for sure that there is clearly a benefit in terms of reducing heart attack or strokes. It's just that if we could divorce it's predisposition to cause bleeding from its ability to prevent stroke and heart attack, that would be potentially another gamechanger.
Host Amber Smith: Well, I appreciate you taking the time for this talk, Dr. Chaudhuri. My guest has been Dr. Debanik Chaudhuri. He's the chief of cardiology at Upstate. I'm Amber Smith for Upstate's HealthLink on Air
Host Amber Smith: Coming up next on Upstate's HealthLink on Air, the secrets to finding health information you can trust.
Host Amber Smith: From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is HealthLink on Air. Where can a person find reliable health information online? With me today to help answer this question is Olivia Tsistinas. She's an associate librarian at the health sciences library at Upstate. Welcome to HealthLink on here, Olivia.
Olivia Tsistinas: Hi there. Amber. I'm happy to be here.
Host Amber Smith: Now I know it can be intimidating for someone who has maybe a new diagnosis or a new condition to go online and try to find information about it, especially if this person is not used to doing research. So where do you advise people to begin?
Olivia Tsistinas: Well, the first thing that you're doing right, is going and taking a look to see what's out there.
Olivia Tsistinas: I want all of our listeners to know that going and looking online is only going to help them have a more robust conversation with their healthcare team. So just congratulate yourself on wanting to go and look in the first place. Once you get, and you're looking at that search engine box, there is a lot of results and it can be really overwhelming.
Olivia Tsistinas: One of my favorite places to have people start is MedlinePlus. It comes from the National Institute of Health and the National Library of Medicine. It's got a lot of wonderful verified sources and it's really easy to use.
Host Amber Smith: And it's free?
Olivia Tsistinas: It is free, it's accessible. And the really neat thing about them is that they link to other professional organizations. They're not creating their own independent content. So they're really finding some of the best of the best.
Host Amber Smith: So MedlinePlus, and that's a government website essentially?
Olivia Tsistinas: It is a dot gov. And so one of the wonderful cues that you can get from some of those web addresses is who's producing them. Anything with the.gov address, you know, that you're getting it through the National Library of Medicine, National Institute of Health, and it's going to be verified and credible. There aren't any commercial interests involved in the production of that.
Host Amber Smith: Now what else can you tell us about URLs? Because dot gov is one, but there's dot EDU. There's dot ORG. There's dot COM.
Olivia Tsistinas: If it's dot EDU, then it's coming from a school. So if you went to the health sciences library website or Upstate health sciences library website --library dot Upstate dot EDU. So you know, what's coming from a university. If it's a .org, that's coming from an organization. And that one can be really tricky. Maybe a decade ago or two decades ago. You'd know that that information was going to be from a smaller organization or from a national organization. And now it's a lot more easy for folks to get a hold of that URL. So that one proceed with caution. If it's a .com, all bets are off. It's not really clear if it's commercial interest. It could be a pharmaceutical company. It could be someone that's just interested in separating you from your money.
Host Amber Smith: So what you're saying is I really need to figure out which websites are trustworthy. And one way to kind of start doing that is looking at the web address or the URL. How else can I determine the purpose behind a particular website?
Olivia Tsistinas: That's an amazing thing to do. One of the best things to do is to scroll all the way down to the bottom of the page and figure out who created the page. Find the "about us." Find when it was published. Is it a recent website? Is it a website that hasn't been touched in over a decade? Once you get to that about us page figure out who they are and why they're providing that information to you. Again, are they interested in selling you a new drug that they've created? Are they a support group that's interested in supporting its members? Or is it really unclear? Sometimes you can get to the bottom of the page and there's just a lot of words and not a lot of answers about exactly who the folks are that created it.
Host Amber Smith: And the articles on there. In addition, do the articles need to be sourced with the name of the author or the reviewer?
Olivia Tsistinas: Having an author is really important. If you can find an author and then identify what that author's credentials are, then you're really cooking with gas. You've got to be able to figure out what their education is, what their experiences and why they are capable of producing this information for you. Recentsy is important. So we mentioned, has the article been touched in the last 10 years? Was it published in the last five years or is it something that is being touted in the news as a new discovery, but actually came out a while ago? The other thing that you can look at when you're looking at a website is what sponsorship is and if they're asking for money to see more information, if they're trying to get you to give up your information to have access. Do they want your email address? Do they want your name? Do they want your credit card information? And that's all a really great opportunity to take a pause and think about some of the other resources that you have available to you -- like your public library system.
Host Amber Smith: Now I worry that if I visit a website and I search for something like first trimester pregnancy, that I'm suddenly going to start getting ads for all sorts of maternity stuff. So how do I protect myself? If I visit websites, how do I protect my privacy?
Olivia Tsistinas: Targeted marketing is relentless, and I've definitely had that experience too, where I've gone to look at something for a baby shower. And then all of a sudden I'm getting ads thinking that I'm going to be a mom again. I'm not. One way that you can do it is you can open up the browser and most browsers have an opportunity to search incognito. And that way you're not having any cookies follow you. The internet is not going to track the information about what you're searching. And that can also be helpful if you're in a shared computer situation. So if there's some health information that you're seeking out, that you might not want other computer users in your home to be aware of, that's another great way to do it. Again. I'm going to point you back to the public library. If you went to your public library and you search there, that's a great way to not have those cookies follow you home.
Host Amber Smith: You're listening to Upstate's HealthLink on Air". I'm your host, Amber Smith talking with associate librarian, Olivia Tsistinas from Upstate's health sciences library. What can you tell us about health and medical apps? How do I make sure that an app that I download to my phone is something I can trust?
Olivia Tsistinas: Health apps have a whole nother set of criteria. So you've got your smartphone, and you've got a particular interest. That's usually what atarts the search. So whether you're looking at something to stop smoking, or you're tracking your steps, or you're tracking your mood, you go and you search the app store. The things I want people to think about when they get there is, is it easy to use it? Does it look like it's targeted for a consumer or does it look like it's something for a healthcare professional? I want you to check out the privacy and security options of that app. What are they collecting on you? And are they interested in taking your information and then, again, selling it to a third party? The way to do that is to see if that app has a web page. So if you can't find it right in that app store to go and put that app name into your browser and see if you can find more information on it. Price is always a concern. So if it's free, why is it free? Where is it coming from? Is it a larger organization? Is it a smaller organizations? Are there in app purchases? So you're going to only get so far and then it's not going to let you have full access to the services? The other thing is evaluation criteria. So not only the star rating. It's got five stars, that's great. But I want you to continue scrolling and see what the reviews are saying. Are there recent issues with an update. It's unclear while the five stars are there because all the ones on the very top are all at one stars.
Olivia Tsistinas: And again, to go back to timelines, is it a new app? What has changed recently? And where did to hear about it?
Host Amber Smith: That's all good advice. Well, let me ask you about Facebook and Twitter and TikTok and all these other social media places. People who I know, share articles on social media. And I believe most of these people mean well, but how do I know that the article they're sharing is accurate?
Host Amber Smith: So
Olivia Tsistinas: all of those social media places are rampant with misinformation and people share it for a variety of reasons. They want to be in the know, they want to take care of their loved ones. They want to feel like they're connected to people. One great thing to do is think if it looks too slick, then I don't know if I can trust it.
Olivia Tsistinas: If it's all very, very polished and it's not clear where that information is coming from, it's a big pause button. Also, if it seems too strange to be true, some of these things were created as memes to be entertainment, but then were forwarded as if they were true. There was one, a couple of years ago about a certain fish that was bred to have no bones in it, so they could just eaten readily. And when I saw it, I was like, that doesn't make any sense. It didn't make any sense. It wasn't true. Sometimes the websites can look professional, but the stories are false. And that's another opportunity to go down to that about us page and figure out what it is, if it's truthful.
Olivia Tsistinas: Sometimes those social media posts can have quotations that have been. So they aren't providing the full statement. They're only providing sensational chunks of the article. And it's the same way with data. So maybe they took a bigger study and they only cherry picked out specific terms and phrases to make it more sensational. Misleading graphs is another way that they do it. If you look on the side and you check out the scale, does it start at zero? Where does it go to? And are they the same? If they're comparing graphs? Another one that happens on social media, a lot is old images that are being circulated as new information.
Olivia Tsistinas: So those are all a bunch of reasons why, even though our friends who are trying to do the right thing, might be sharing old stuff. When you encounter that once you've become really savvy and you've started double-checking those things, I also want you to try to be empathetic with their people in your life.
Olivia Tsistinas: If you try to bring them the proper source of that information, something really gentle. Don't publicly shame them, and try to use really kind inclusive language. They were trying to do the right thing. So we were going to win more of them over with good information if we're softer and gentler about it.
Host Amber Smith: So approach some of the information that you see with some skepticism, healthy skepticism?
Olivia Tsistinas: I start everything with a lot of skepticism, and it's not a bad thing to do. Health information comes from a variety of places. And unfortunately, when it seems like it's the miracle that you've been waiting for, it's another reason to take a pause and make sure that it's something really wonderful before you get your hopes up.
Olivia Tsistinas: So if
Host Amber Smith: I gather information from government websites or well-known medical schools or large professional organizations, can I feel pretty secure that the information is credible?
Olivia Tsistinas: I would feel really secure in taking that to your healthcare provider. So that's a really wonderful thing to print off, to have in hand, to take with you and almost treat it like it's your savvy friend that's coming with you to your next medical appointment. That's going to be helpful in reminding you what you wanted to address with their healthcare provider. And it's also going to fit into that evidence-based practice model of where information is coming from. Evidence-based practice comes from our healthcare's experience, our providers experience, patient wishes, and also the best current evidence. So it's going to be part of your healthcare teams tool kit too.
Olivia Tsistinas: Do you have any advice for people who are seeking clinical trials?
Olivia Tsistinas: So there's a great website, clinical trials.gov. That's another one where I would want you to reach out to somebody to help you navigate it. Sometimes it can be a little bit hard to figure out. I would also reach out to your healthcare team and say, you know, this is the diagnosis that you've recently given me. Are you aware of any trials and can you help direct me?
Host Amber Smith: How do you as a librarian help a regular person? Because I know you work with medical students, but just regular people that don't have any training in medicine. How do you help that person make sense of medical journal articles that are written for scientists and doctors?
Olivia Tsistinas: So in a lot of the time I'm targeting information created for consumers. But one of the groups that we get a lot are folks that are facing chronic health conditions, or they're in support groups. They're almost like super consumers. So they've already gone through that basic level of information. And they're reaching out to us at Upstate health sciences library because they need a little bit more robust information. And so those are the folks that we take a look and we identify, okay, this is a study. It's got a structured abstract, and here's the conclusion of it. And that's a little capsule of information. That's right at the beginning of the article that they can then take to their health care team.
Host Amber Smith: And then their providers can help them make sense of whether this applies to their situation?
Olivia Tsistinas: Because what I never want you to do, even if you found an article that looks amazing, it's current, it's got great sources. It's got great references. You've been able to double check it up and down across the internet. I never want you to use that to make a change in your prescriptions, to stop taking something, to add something, to add an over-the-counter medicine, without talking to your healthcare team first.
Host Amber Smith: What topics have you found most difficult to find information about for people?
Olivia Tsistinas: Usually that's when things are latest, greatest, newest, now. So if it's not pharmaceutically related, it doesn't get as much funding. So sometimes it doesn't get as well studied. But also if it is something brand new. there is a big gap between our bench science and what's available at the bedside, sometimes up to 15 years. And so something that you might see coming out, it might be available only for rodents, but they're talking about it in the news as if it's available to people. So if it's just studies done on mice and rats, then it's not going to be something that I'm going to be able to find people information for, that they can apply to themselves.
Host Amber Smith: And some of that gets people's hopes up when they hear a news report about something that's not really clear on exactly how far along the pipeline it is.
Olivia Tsistinas: And that can be really hard for the medical library team, because we're the ones delivering the news that maybe it isn't ready for them yet, but it's something that's still coming.
Host Amber Smith: Well, let's remind listeners again, the number one place to start is the website--
Olivia Tsistinas: MedlinePlus dot gov. I refer people there all the time. It's got so many robust resources available to folks.
Host Amber Smith: Well, I want to thank you so much for making time to share all of this information. My guest has been Olivia Tsistinas. She's an associate librarian at the health sciences library at Upstate. I'm Amber Smith for Upstate's HealthLink on Air
Host Amber Smith: And now Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week selection.
Deirdre Neilen, PhD: Linda Lomenzo, a poet and literacy specialist in Massachusetts, shows us the long arc that healing requires in two short poems that describe an accident and its aftermath.
Deirdre Neilen, PhD: First comes. They arrive at the ER. Each of them separately, spaced apart by minutes. Like my thoughts, my brother cringes at the sight of me, my sister murmurs, Lynn Lynn. My lover smooths her hand on my forehead. They try not to gasp at the cervical collar, the stiff plastic cage that holds me. Mangled arm, swollen purple foot. They sit in chairs in one row across from my bed binge watching me like Netflix. And then after four months, I can take a walk. At the edge of my driveway I faced my greatest fear, acorns, hundreds of them like landmines beneath my crushed foot. Near the doorway to Mrs. Williams' house I peek at her indoor rock garden. St. Francis stands in ferns. Atop a pickup truck, a gardner showers grass seed across the berm, nods to me. On Bedford road, a familiar horse stands in the paddock, still wears a tartan plaid blanket, his eyes search mine. In a clear plastic bag, a sandwich lies on the sidewalk, seems lonely.
Host Amber Smith: This has been Upstate's HealthLink on Air, brought to you each week by Upstate Medical University in Syracuse, New York. Next week on HealthLink on Air. Meet the chemist. Who's developing a drug for diarrhea. If you missed any of today's show or for more information on a variety of health science and medical topics, visit our website at HealthLink on Air dot org.
Host Amber Smith: Upstate's HealthLink on Air is produced by Jim Howe with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening. .