Health Newsfeed – Johns Hopkins Medicine Podcasts

Anchor lead: Surviving hospitalization with Covid-19 may be just the beginning of recovery, Elizabeth Tracey reports

Among the many conditions that can develop once someone is discharged from the hospital after Covid-19 are mental health problems. Adam Kaplin, a psychiatrist at Johns Hopkins who’s working with many such patients, names depression as a particular issue.

Kaplin: Crazy high rates of depression, your final downstream common effect of any insult to the brain whether it’s a metabolic insult or an infectious insult. So that’s a big part of this is the inflammation but trying to convince people that it’s the infection that caused this because when they get home they expect, oh I’m home, I should be fine, and they’re not fine. They get sent home and they’ve got at least a month of rehab they have to do to even begin to get back to their old selves, emotionally, physically, all of this.   :32

Kaplin says acknowledging the challenges and seeking treatment for depression will help. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: When someone who’s been hospitalized with Covid-19, coming home can be a challenge, Elizabeth Tracey reports

Helping people to manage coming home after being hospitalized with Covid-19 takes a team, and Adam Kaplin, a psychiatrist at Johns Hopkins who’s working with these patients, says preconceptions both family and patient have need to be examined.

Kaplin: They feel like their family thinks they’re a pariah.  But when they actually ask their family thinks that they don’t want to hug them because they’ve been so ill, they don’t want to be reinfected or something, so they just have to talk about it, just to make it explicit. If you communicate with body language and everything else as opposed to direct communication you’re having a conversation but not controlling the content.  So a lot of times its just go talk, lay it on the line. Oh my husband is really worried about me and that’s why he didn’t hug me and wouldn’t sleep in the room.   :33

Kaplin says open communication about expectations and needs is key. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What are some of the consequences of ICU stays for Covid-19? Elizabeth Tracey reports

Post-traumatic stress disorder or PTSD is common after ICU stays, as well as a host of other problems. Adam Kaplin, a psychiatrist at Johns Hopkins who is working with many Covid-19 survivors, says one common theme he sees is stigma.

Kaplin: The stigma is such a profound aspect of this. They feel like they’ve got leprosy when they’re there because everybody’s gowned and everything like that, so there’s stigma in the hospital, then they go home and they’re told to isolate from their family because they don’t know how long it’s going to take for them to be negative. They go to their room and they cocoon in their room and now the room becomes the safe place for them, and then they’re terrified of leaving the room.  :27

Kaplin says a big part of his job is helping people to leave the comfort of their room and go to rehab appointments and re-establish more normal relationships with family and friends. He says everyone’s recovery will proceed at its own pace so patience is needed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Vaping leads to much worse disease when it comes to Covid-19, Elizabeth Tracey reports

Teenagers and young adults who vape are five to seven times more likely to become infected with Sars-CoV2 and develop Covid-19, a recent study found.  David Kass, a cardiologist at Johns Hopkins, isn’t surprised.

Kass: The more we’re learning about vaping the more we’re learning that its basically pro-inflammatory in that the lung is designed to breath air, ideally clean air. That’s it. It’s not designed to breath in smoke, cigarettes, pot, vapes with oils, and so if you’ve got a background where your lung tissue is already damaged whether you know it or not, then you get this, yes, that would make sense, and it is kind of the perfect storm. Why else should a 14 year old who catches this be at risk?    :30

Kass says education among those who vape is clearly needed to dispel two myths: that vaping is safe and that their age alone will protect them against severe Covid-19. He notes that in this study those who used both e-cigarettes and combustible cigarettes were at the highest risk. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Obese men are at especially high risk for severe Covid-19 disease, Elizabeth Tracey reports

Obesity is confirmed as a risk factor for severe Covid-19, a study in Annals of Internal Medicine reports. David Kass, a cardiologist at Johns Hopkins who wrote an accompanying editorial, says these studies provide further evidence of  obesity’s role in disease.

Kass: With obesity the body is not going to be able to deal with immune challenges, other stress challenges. It’s everywhere. And that makes it harder to flip the switch back to people understanding that, I’m not saying its cancer but it is a disease in a sense. It is something that is gradually going to make it harder for you to deal with other stuff. Just like having a really high cholesterol doesn’t hurt you in any obvious ways until you have a heart attack. High blood pressure, it is there, it’s a risk.                :32

Kass points out that younger obese men in these studies were most likely to be impacted, perhaps because their fat tends to be abdominal and more pro-inflammatory. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Even as Covid infections continue, other diseases as well as chronic conditions are also taking their toll, Elizabeth Tracey reports

Deaths from heart attacks are increasing, a recent study found, as people try to avoid hospitals because of their fears of Covid-19, and other infectious diseases are also increasing. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says integrating the multitude of factors surrounding individuals is critical to successful intervention.

Davidson: What is incredibly important is looking at the whole person. Looking at the whole person is going to help attribute risk, risk in terms of life. How do you get to work every morning? How many people live in your house? Do you have money for medication? The lack of a universal healthcare coverage system and the lack of access means that many individuals avoid going to healthcare settings until they’re really advanced in the disease.  :33

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Does personal protective equipment prevent infectious disease among healthcare workers? Elizabeth Tracey reports

Personal protective equipment or PPE may not adequately prevent infections among healthcare workers, a recent study concluded, with those working in the healthcare field 3.4 times more likely to become infected with COVID-19 than those not working in the field. Patricia Davidson, dean of the Johns Hopkins School of Nursing, comments.

Davidson: We really to need learn a lot more from what people have done in the global health settings, that have taken care of these very infectious rampant diseases. Because much of what we have done in developed nations more often than not PPE has been about protecting the patient. The majority of where PPE is worn people have had bone marrow transplants, people with immunosuppression. So we really need to think about what is an appropriate occupational health and safety model for the future.  :34

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: For women who’ve survived childhood cancers, how can their risk of breast cancer be reduced? Elizabeth Tracey reports

Girls who receive cancer treatment that may involve radiation to the chest area are at increased risk for subsequent breast cancer. Now a new study shows that MRI is the best method to screen them. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, comments.

Nelson: What they saw is that if you started screening at age 25 and you used annual mammography plus annual MRI you avert 56 to 71% of the deaths you’d see among people who weren’t screened. And when they did some cost effectiveness analysis trying to balance the cost of things like MRI every year against the outcomes, it looked like it might be better to start screening at age 30. I think what you see although this is modeled is this is going to be the best we can do to generate recommendations.  :29

Nelson applauds this study as part of the effort to identify best practices for those who’ve survived cancer, whether as adults or children. He points to the need for a comprehensive strategy for survivors, a group that is blessedly growing. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Allowing more people to get Medicaid reduces the risk for advanced cancer, Elizabeth Tracey reports

When the Affordable Care Act was implemented, many more people, especially those at lower incomes, were eligible for benefits under Medicaid. Now a new study shows that having that coverage reduced their risk for being diagnosed with an advanced cancer. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: What they found was a fifteen percent reduction or so of the odds of developing very advanced cancer, cancers that had spread throughout the body, we call metastatic cancer. There’s a fifteen percent lower chance of getting that in the second period after Medicaid expansion than in the period before. And they look in people with private insurance they didn’t have this change in the second period versus the first period so this does seem to be unique to this population. :26

Nelson notes that this reduction in advanced cancers is likely real since it wasn’t seen during the same period in those with private insurance, and argues for extension of these benefits to low income people, who may avoid seeking healthcare because of cost. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: More people should now be screened for lung cancer, Elizabeth Tracey reports

More people now meet the criteria for lung cancer screening, if new guidelines from the United States Preventive Services Task Force are implemented. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the update.

Nelson: They have proposed to change the guidelines by dropping the age to start screening from 55 years old to 50 years old. That may be more beneficial to African Americans at risk for lung cancer because if you look at the age distribution when they develop the disease it is at a little bit younger age. And then they backed off on the pack year recommendation from 30 pack years to 20 pack years. That may actually benefit women. Women seem to be more likely to get lung cancer by smoking less than men do.   :31

Nelson reminds everyone that the single best strategy for avoiding lung cancer is not to smoke, or to stop as quickly as possible, since after 15 years your risk drops to that of a never-smoker. At Johns Hopkins, I’m Elizabeth Tracey.