Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: With another new Covid vaccine added to the mix, what concerns remain? Elizabeth Tracey reports

Johnson and Johnson’s Covid-19 vaccine is now being deployed nationally along with the two previously authorized ones, yet having enough doses for everyone remains an issue and with new variants of the virus popping up, efficacy is also a concern. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: It seems like we’ve been doing this forever with Covid but it’s important to remember that it’s been a year. So there are a lot of questions that still remain about these vaccines. Perhaps the most important is how long the vaccine provides you with protection and the short answer is we don’t know because the first people haven’t been vaccinated for all that long. The other question is can we deviate safely from the protocols that have been studied in these vaccine trials and still provide people protection. Now that there’s been wider rollout of the vaccines we can actually study and see what that protection might be.   :29

Garibaldi says that studies regarding durability of protection as well as how well the vaccines match up to circulating viruses are active areas of research. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Should we be relaxing our guard now that Covid-19 numbers are dropping? Elizabeth Tracey reports

Covid-19 numbers are dropping, and that’s good news. Not so good is the rise of worrisome variants worldwide, which could stall or reverse this trend. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says infection rates are what keeps him up at night.

Garibaldi: I’m much more worried about just the level of infection we have in this country. We should be very happy that we’re at the best we’ve been since Halloween but you have to keep that in the context of oh my gosh we were up to almost 300,000 cases a day. We should be celebrating that improvement, but its still a lot of cases a day, and viruses mutate, so the more opportunities it has to mutate the more opportunities additional variants will pop up. These variants are popping up all the time, that doesn’t mean that they’re going to be more transmissible or more deadly, but just by chance there could be some that will acquire those characteristics.  :34

Garibaldi reminds everyone to keep up the good work with masks and distancing. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How concerned should we be about the number of new Covid variants emerging? Elizabeth Tracey reports

New Covid-19 variants are emerging all around the world, with some countries doing a much better job at genetically sequencing them than others. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says here in the US we likely need to be doing more sequencing.

Garibaldi: We need to do a better job of understanding what variants are out there. We know about the variants in the places that have been doing a lot of genetic testing, we’ve seen a variant pop up in California. There probably are more in the US. It’s important to use this as an opportunity to reinforce how much genetic testing we’re doing on these viruses to really understand as we start vaccinating people, as we see cases coming down, the next challenge is going to be identifying pockets where there could be a variant concern, and making sure that we put in play both targeted public health measures but maybe even targeted vaccinations.  :30

Garibaldi notes that current vaccines do seem to reduce both hospitalizations and severe disease, even if they don’t prevent infection, but says keeping a close eye on emerging strains will help us modify vaccines if necessary. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: At least one surgical approach may help resolve obstructive sleep apnea, Elizabeth Tracey reports

Maxillary-mandibular advancement is long hand for a surgical procedure used to treat obstructive sleep apnea. Robin Yang, an expert in the procedure at Johns Hopkins, describes what’s done.

Yang: Surgery itself takes about four to five hours. All of the incision are inside the mouth. So from an invasive standpoint we don’t leave any scars on your face, but it is invasive in the sense that we’re moving your upper and lower jaw. Because we’re changing the way you bite, we often have to limit your diet after surgery for about six weeks. Meaning people are on a non-chewing, soft diet for about six weeks after surgery. Any patients that can’t tolerate a CPAP machine is technically a candidate for maxillary-mandibular advancement.  :32

Yang notes that obstructive sleep apnea is more than a nuisance, it’s associated with long term cardiovascular risk as well as the risks of daytime sleepiness because of interrupted sleep. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What are surgical options for treating obstructive sleep apnea? Elizabeth Tracey reports

You’ve been diagnosed with obstructive sleep apnea, or OSA, and you’ve tried machines to ease your breathing at night but can’t tolerate them. Now what? Robin Yang, an OSA expert at Johns Hopkins, describes one surgical approach to treating the condition.

Yang: We do something called orthognathic surgery. Or maxillary-mandibular advancement. The oral cavity and the nasal cavity is a three dimensional box. There’s only so much room in that box. Teeth are in that box, your tongue, your soft palate. Once that box gets filled up air can’t flow through that box because it’s filled, and so certain treatment management can come in the form of trying to increase the size of that box, not only reducing the contents of what is in that box but making the box bigger.  :31

Yang says people who are considering surgery should have exhausted all other options first, and should select a center that has a comprehensive, multidisciplinary approach to the procedure. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Obstructive sleep apnea should first be treated as simply as possible, Elizabeth Tracey reports

Obstructive sleep apnea, or OSA, most often shows up as snoring. When someone is sleeping their airway becomes obstructed and snoring results, and the condition is associated with an increased risk for cardiovascular events as well as hazardous daytime sleepiness. Robin Yang, a specialist in the condition at Johns Hopkins, describes what can be done to help.

Yang: The first line of treatment is always the least invasive. It not only starts with CPAP but it also starts with diet modification and other things that could potentially help you with your sleep habits. However if patients can’t undergo diet modification or lose some weight, CPAP machines do a great job of increasing the airflow through your nasal and oral pharynx as you’re sleeping. However we found in studies that up to 80% of people don’t enjoy having that, as well as the lack of compliance meaning it only works if you wear it.  :31

Yang says surgical options do exist to treat OSA. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: If you’ve been told you snore, following up with your physician is likely a good idea, Elizabeth Tracey reports

Obstructive sleep apnea, or OSA, most often is identified when someone is told they snore. Robin Yang, a surgeon who specializes in the condition at Johns Hopkins, says OSA isn’t just a nuisance for bed partners.

Yang: (Robin) The condition gets worse in the sense that it would affect other organ systems such as your heart, blood flow to your brain, as well as just generalized productivity during the day. It is incumbent upon you to get that evaluated as soon as possible to get the proper diagnosis as well as testing.  :17

Such a diagnosis should include a sleep study, Yang says.

Yang: We do recommend that a formal sleep study, which is an in-house laboratory study where they bring you in overnight, you actually sleep in the lab, and they hook you up to monitors that test your brain waves as well as your heart rate and your oxygen saturation, as the gold standard of diagnosis.  :17

Yang says several management and treatment options exist, so getting the diagnosis right is key. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A lot of people have put off routine cancer screening during the pandemic, and that may lead to more precise use of screening tools, Elizabeth Tracey reports

PSA testing, screening colonoscopy, and other cancer screenings have often fallen by the wayside during the COVID-19 pandemic. The next several months will reveal to what degree that impacts cancer diagnoses. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, comments.

Nelson: If you look at the screening tools we have all of them pretty much cry out for evolution toward ever more precision screening. More and more the issue is if you use the screening tool what is the next step, can you say that this cancer is one that needs to be treated aggressively and that this other cancer perhaps is one that doesn’t need to be treated aggressively and you can watch with confidence. That kind of approach has you use all the knowledge you’ve generated to say who do we need to go after, who can we leave alone in a vigilant way? And then respond when you need to.  :33

Nelson says more precise use of screening and subsequent management has been intensely studied for some time, and is bearing fruit for people diagnosed with cancer. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: If you’ve survived breast cancer, how long should you continue annual screening mammography? Elizabeth Tracey reports

If you’ve survived breast cancer and are now in your 70s or beyond, do you still need to have screening mammography? That question was examined in a recent study, and William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says it heralds good news.

Nelson: There’s lots of women surviving breast cancer. So the number of women who are breast cancer survivors reaching these ages are increasing and we need to have an approach to take care of them as best as possible.  :09

Nelson says specific recommendations are based on individual factors.

Nelson: If your life expectancy is greater than ten years, they argue that mammography is probably a good idea. That you might benefit from screening and early detection. In the middle between five and ten years then it’s something that you should think about, talk about, engage in collaborative decision making with your physician.  :17

Nelson says the lifetime risk for developing a second breast cancer can be up to 15%, so careful examination of the risks and benefits of screening is a good idea. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Women who get vaccinated for Covid-19 may develop swollen lymph nodes, Elizabeth Tracey reports

Covid-19 immunizations may cause the lymph nodes in the armpit, or axilla, to become swollen and tender for a time. Women who experience this side effect need not worry that they’ve suddenly developed breast cancer. That’s according to William Nelson, director of the Kimmel Cancer Center at Johns Hopkins.

Nelson: I think the upshot of all this is that lymph nodes can be swollen, by the way in men as well as women, but in this case women are the ones more concerned about their breast cancer risk. It’s probably best not to do the mammogram shortly after being vaccinated after four or five days you might have swollen lymph nodes a sore arm this kind of thing. It’s probably best to wait a month and you can always contact your physician over this. I think to be aware that swollen lymph nodes these kinds of things can occur as a consequence of vaccination. When they do they will get swollen and that swelling will go away.  :31

Nelson hopes such concerns will not cause women to put off being vaccinated against Covid-19. At Johns Hopkins, I’m Elizabeth Tracey.