You.

Coming up next on this special health and medical edition of Arizona Horizon, encouraging news about advancements in treating the blood cancer, multiple myeloma.

Also tonight, new research looks at the positive impact that the nutrient choline has on Alzheimer's disease and the differences between E.R.

and urgent care facilities and what those differences mean for patients seeking treatment.

Those stories and more.

Next, on this special edition of Arizona Horizon.

Arizona Horizon is made possible by contributions from the Friends of Arizona PBS.

Members of your public television station.

Good evening, and welcome to this special health and medical edition of Arizona Horizon.

I'm Ted Simons.

Researchers at Mayo Clinic Arizona have developed new treatments for the blood cancer multiple myeloma.

The advancements are extending life spans and offering hope to patients and their families.

We learn more about these advancements from Doctor Rafael Fonseca.

He's a chief innovation officer at Mayo Clinic, Arizona.

Thank you for having me.

It's a pleasure.

Let's talk about multiple myeloma.

What is multiple myeloma?

So myeloma is a cancer that arises from the bone marrow.

Some people will call it a blood cancer and affects mostly individuals in their 60s and 70s.

It is a cancer that results from the abnormal growth of the cells that normally would protect us by producing antibodies.

Everyone's familiar with antibodies now with Covid, yes, but the cells can go rogue.

And if they grow in an excessive way, that's what leads to the cancer form, which is myeloma.

And patients, as a consequence, can have a number of symptoms like destruction of bones, anemia and also problems with their kidneys.

How common?

You have about 35,000 new diagnosis per year in the United States, so it's not an uncommon.

Cancers.

The second most common blood cancer after lymphoma.

Risk factors involved.

You know, most of it is just general susceptibility.

Age is of course, a factor is very slightly more common in men.

It's twice as common in individuals that are African American.

But by and large there's nothing you do or you should stop doing that would make it less likely to occur.

Nothing environmental that you found so far.

No.

Nothing major.

There's a few factors, but they're not major players in the risk.

The treatment.

We can talk about your treatment, but heretofore, what was the treatment for multiple myeloma?

Well, when I started training, it was old fashioned chemotherapy.

That's 25 years ago.

Plus, when we were using pills that were, you know, considering the chemotherapy category.

And ever since we've come a long way where we now bring small molecules, targeted treatments, and, most importantly, I think immunotherapy approaches.

Immunotherapy is a big deal here.

That is correct.

How so?

Well, you know, people, had a hard time at the beginning to know how to harness the person's immune system to fight back against cancer.

Cancer.

At the end of it all, it's a failure of our immune system to have recognize those cells as cancers.

So now, through genetic engineering and also through biotechnology, we can actually prime the person's own immune cells to go and fight back very specifically against this cancers.

Was there.

And I know so many advances here from Mayo Clinic Arizona.

But was there an moment in terms of this development?

Yeah.

You know, I think the ha moment is a combination of things and that comes out from the past 20 years where we have seen over 20 FDA, approvals for various treatments of myeloma.

And we soon realized that one of them alone would not do the trick.

So we had to create a team.

And now through a team approach, meaning that we combine some of this, drugs or treatments that we have available, we can put a large number of patients into very durable remission.

And when you talk about durable remissions, are these situations where they are still compromised in some way, shape or form?

Because I know I know someone who has this and who has it, it's like he's cured for goodness sakes, for the past 20 years.

Yes.

I mean, the best situation would be for someone not to be my patient, of course, that we meet socially, but the treatments are surprisingly well tolerated, and many of my patients, as I see them out in the street, I tell them, you know, people would not know that you're dealing with multiple myeloma.

Now we're very mindful.

We're careful with the side effects.

We explain all of this in detail to patients, but our goal is to get them back to the normal lives and as much as possible, to a normal life expectancy.

Did research on other cancers guide this research on this particular cancer?

I think it's true, but it's true also in the reverse direction that is myeloma research has guided developments in other cancers, and we all talk to each other.

We're somewhat siloed approach that.

Yes I focus on myeloma.

But when we go to our meetings I want to learn what they're doing in brain and lung cancer and all other cancer.

What about lymphomas, leukemia, these sorts of things.

Is is there a bit of a silo with multiple myeloma or Candida?

The silo walls are thinner there because actually their next door neighbor cell lymphoma, as a next door neighbor to myeloma.

And, well, they're fundamentally different, if you ask me, from the science and the biology, some of the treatments that our user we use as well to, and we exchange the use of some of those drugs and newer treatments like Car-T.

So remission is possible.

Is it likely or is that just too individual a case?

It is.

Very likely.

So nowadays, if you take a patient who has a newly diagnosed myeloma, I should say that 95% plus of patients should achieve very good remission.

What we call a complete remission, meaning a disappearance of those tumor markers that allow us to know that there's myeloma in the background, should occur in about 70 to 75% of.

How are we talking cure here?

Well, you know, it's it's hard right now to talk about that.

I am personally convinced we already curing a fraction of our patients for most of the ones we tell them are curious, when we look back and we see that they were diagnosed 15 or 20 years ago, and still there's no evidence of recurrences.

Yeah, yeah.

We're going to talk about vaccines, mRNA vaccines tomorrow, but I want to find out if there is such a thing as a vaccine possible for this.

You know, there's some work going on, but it's not at the forefront for our progress right now.

I think most of the most exciting areas is modifying the person's own T-cell something go karts, yes, and bispecific antibodies.

So we use those now routinely in the clinic.

And with, you know, wonderful results.

So and I want to talk about what you're doing and why these results are so wonderful.

What are you doing differently than other hospitals research organization what they're up to.

Well, we've taken a multi-pronged approach that involves, you know, multiple aspects, of course.

You know, working with the multidisciplinary teams.

We have research laboratories that are devoted to the study of myeloma, its origins.

Importantly, how can we go about treating this?

We think we can provide state of the art clinical care.

And that's aided and in no small part because of the technology we have for diagnosis, for monitoring.

And also a big chunk of this is our participation in clinical trials.

So it's a composite of all of that that I think makes this quite special for patients.

And so advancements from here, where do you go.

What do you focus on.

Well, we started here working quite a bit on genetics.

And that was that was the genesis of our program and understanding genetics as prognostic markers also as therapeutic tools.

And now we have evolved to make that be a pathway for drug development, some of which seems to be quite effective.

Okay.

Is that drug development in the market or is it still under.

Some of that is in the market.

Some of that is commercially available.

Some of that is still under development that we hope will bring additional options for patients.

I got to tell you, this seems like it's a we've talked about immunotherapy on this program since really it was a brand new word and we were all very excited about it.

It has seems to have come a long way, but this seems like it is a an especially good cancer story.

Am I getting that wrong?

You know.

I think this may sound self-serving, but I think myeloma has been an example for many other cancers because the number of approvals, the developments and understanding the disease and most importantly, the ability to change the survival for patients made it a very attractive field.

I mentioned I started 25 years ago.

No one wanted to do myeloma.

You were last in line if you were doing myeloma.

Nowadays, everyone wants to work in myeloma because of this dynamic environment.

Wow.

Well, congratulations on all the great work there and the great stories.

Doctor Rafael Fonseca again, Mayo clinic, Arizona.

Again, it's we love doing positive health stories, and this is one of them.

Good to have you here.

Thank you.

It's my pleasure to be here.

You just.

Hi.

I'm Catherine and I, a host of Horizonte, the groundbreaking program that has served as a platform for Arizona's Latino community for more than two decades.

Latinos care about issues across the.

Board, just like everyone.

Else.

There's a lot of diversity in thought and opinion.

We just need to make sure parents understand the value.

And having a multilingual student, we like to hear our voices heard.

Stream episodes online at easy PBS, short YouTube, or on the PBS app.

Arizona PBS would like to recognize all of our dedicated legacy society members.

These are individuals who have generously included Arizona PBS in their estate planning.

We are so grateful these loyal viewers chose to make The Future of Arizona PBS a part of their lasting legacy.

Thank you.

To learn how you can join the Legacy Society, please call Robyn Duda at (602)496-3614.

Thank AOC.

Researchers are looking at choline as a factor in helping reduce the risk of Alzheimer's disease.

We looked at these promising results with Ramon Velasquez, a neuroscientist at ASU Neurodegenerative Disease Research Center.

What is choline?

That's a great question.

First of all, thank you for having me.

Choline is a organic compound that's produced endogenously by our body, right.

So our body mammalian species, that means animals, other other forms of animal including humans.

We can produce it.

However, it's been noted based on multiple years of research, that the amount you make within your body is not enough.

So you need to actually consume it in your diet.

You need dietary.

Choline.

Okay.

Dietary choline.

What do we need to eat more of?

So what do you need to eat more of?

It depends on what type of diet you're typically attuned to.

Right.

So we know that there's individuals that are plant based eaters.

Some do eat animal products, some don't.

The highest concentration of calling you will find in eggs, also in poultry as well as in fish products like salmon, leafy greens and also beans.

Interesting.

I saw broccoli listed.

Broccoli as well.

Yeah.

Okay.

Is that enough?

If I start eating broccoli every other day and salmon on the other day, is that going to be enough?

It depends.

Right.

So what you need to do and what really we're trying to advocate here is there needs to be awareness, right.

Most Americans are not reaching the recommendations that are required, by the Institute of Medicine to get adequate choline right.

And there's actually numbers on this.

Right.

So adult women require 425mg of calling a day.

Men require 550mg of calling a day.

Most Americans are not getting enough.

Interesting.

All right.

Is supplements.

Are they okay?

Supplements are available.

So these are particularly important for plant based eaters and for those in general that don't want to consume a lot of animal products, because the animal products do have a higher amount of choline and they are available.

Okay.

Can you have too much choline?

So in order to reach the amount that's considered toxic amounts of calling, you need to consume 6.5 times the recommended daily amount, which is about 3.5g.

That's a lot of choline.

The side effects of having too much calling it, include low blood pressure, and you also produce a fishy odor smell because of the metabolite.

But those are the side effects, but it's very difficult to reach that amount.

The supplements you can you take a pill.

Should you take a powder?

What do you look for in these supplements.

So the supplements that are available in regards to choline, are going to be in pill forms.

And there's various different types.

Right.

So there's choline chloride.

That is the most common form that's available.

It gets gets metabolized by by by your liver and then is circulating through your bloodstream and does have the ability to get up into your brain.

There's also another form known as alpha GPC.

It's a type of choline that is easier to get up into your actual brain.

So we recommend alpha GPC as one of the most, effective.

Forms you mentioned gets up into your brain.

How does it get up into your head?

So the way it does that is by using, ultimately our vasculature.

You're right.

Our, the, circulating throughout your blood.

Right.

So if choline is, is processed by your stomach and then it makes its way into digestive tracks, it can be absorbed into your brain.

In order to do that, there's actually transporters in what's called the blood brain barrier, which protects from things that you don't want to get into your brain on getting in.

And then choline is allowed to transport into the brain.

Wow.

How interesting.

And once it gets into your brain, does it affect neurotransmitters as it does affect?

That is a great question.

And that's what we've been finding.

Right.

So when these recommendations were first established in 1998, we believe or the scientific field believe that it was predominantly related to fat metabolism in your liver.

What we have found now is that it's important and creating chemicals in your brain that are important for learning and memory, higher order cognition.

It also allows for building cell membranes, which are going to protect what goes in and out of your cells and overall gain and enhance cognitive function.

And I know from your research that if you take the choline and you get enough choline and you exercise, which seems like a panacea these days for everything.

Yes.

You're on a pretty good track.

Yes.

That's actually I'm glad you brought this up.

I'm actually heading to a workout class after this.

Right.

And what we have done in that regard, and there's a lot of research around this, is that combining lifestyle factors that are important that are going to allow for reduction in a lot of metabolic dysfunction, some metabolic dysfunction, for example, includes disorders like diabetes, high blood pressure, things like things of that sort.

Those are risk factors for disorders like Alzheimer's.

These we can reduce those by one exercising in two.

There is evidence that, choline can actually buffer or reduce those aspects.

The probability of having, a, prevalence for Alzheimer's is goes down drastically.

Okay.

Are they on separate tracks or do they kind of work together?

I don't know.

I mean, do we know that?

So do we know whether there's combined effects?

If we combine both the literature?

There is a little thin.

We are actually, working on some of this with colleagues at ASU currently.

But we know that the processes that they affect are similar.

Right.

So if you exercise you're going to have you're going to affect cardiovascular function.

That's going to promote health.

And if you take choline it actually has the ability to regulate, for example glucose levels, which is important because you don't want to progress to diabetes risk factor for all.

Interesting.

Interesting okay.

How do you know you're not getting enough choline.

That is a number one question that we always get.

There's no test that you can go and routinely get.

No blood test.

Right.

There is a blood test but you have to request it.

Right.

You can go to your doctor, say can I can measure the amount of controls that happen the way that we get around that is by doing dietary questionnaires.

We can actually give you a dietary questionnaire, and we can estimate the amount of choline that you're actually consuming.

Right.

The most Americans one, do not know what choline is, right?

Usually when I give seminars, I ask, who knows what choline is?

About 10% of individuals raise their hand.

They know what it is.

90% of Americans are deficient in colon.

That means they're not getting the recommended daily intake amount that they need.

If 90% of Americans are deficient, and we've seen just this increase in Alzheimer's, which obviously has something to do with lifespans and increasing lifespans, I mean that that alone suggests something's going on.

Yeah.

I think what this suggests is that choline is a component that we need to be attuned to in order to try to deter from disorders like Alzheimer's disease, I think.

But but I think, once again, going back to the combination of factors, right?

It's not just choline.

It's a combination such as do you get enough exercise?

Are you cognitively engaged?

Right.

We were just, having a conversation about how do crossword puzzles actually activate areas of your brain that can actually promote what's called cognitive resilience.

That causes a buffer.

So when a disease like Alzheimer's is hits your neurons, which are the cells in your brain that produce our behaviors can kind of remove those.

So they don't actually overtake your behaviors.

This is really interesting because again, I mean, I think in defense talking chlorine, you're talking about a swimming pool here and most people just haven't heard about it.

And it's so important.

Again, we're it's great information.

Thank you.

So good to have you here.

And good to see you again.

It was.

A pleasure.

Thank you.

All right.

Thank you.

You're.

When does illness or injury mean a trip to an urgent care facility as opposed to an emergency room?

And what does knowing the difference mean in terms of saving time, money, and resources for both patients and medical staff?

To get some answers to those questions, we talked to Sami A, she's a nurse practitioner at Banner Urgent Care.

Good to have you here.

Thanks for having me.

Yeah.

Thanks for coming on in here.

All right.

The practical difference between an emergency room and for those who haven't even been to an urgent care facility.

What are they?

So the urgent care she's minor, illnesses, minor injuries, you know, people that are having, lower urinary symptoms, maybe sexually transmitted, concerns, but we'll see.

People with the common cold, flu, people with Covid can come in and see us.

If you're having a bad cough, we can diagnose pneumonia, treat pneumonia, things like that.

Simple lacerations.

If you fall and you have your hand outstretched and you hurt your wrist, we can X-ray that.

And usually you can stabilize it until you've seen by a specialist.

Okay, so a broken bone, stitches, these sorts of things can be handled by urgent care.

We can handle them depending on the severity.

Right.

So if you fall if you twist your ankle yeah I'll explain it even better.

So all of our X-ray technicians, the majority of them are capable of X-ray in the knee down and the shoulder.

The collarbone out.

Oh, interesting.

And then we do chest X-rays for infectious reasons.

Yeah.

So no spine?

No, neck?

No head.

Yeah.

And no hip.

I would life threatening situations get to the er.

To the ER.

Absolutely severe chest pain, numbness, weakness, loss of consciousness, hitting your head and having a concussion.

Yeah.

Injuries like that really should be seen in the ER.

All right.

Yeah.

Abdominal pain.

So.

So what are the ramifications though?

If you go to the wrong place.

There are no ramifications.

We want you to be seen somewhere right.

So the only thing that people run into is they come to urgent care.

We assess them and we deem them necessary to go to the ER.

And people will get a little upset because they thought they made the right choice.

But really essentially we want the best outcome.

So we will just recommend er call 911.

Do non non-emergent transport if they don't have a ride.

Interesting.

Okay.

Insurance.

What are the insurance implications here.

We take most insurance in the, in the urgent care except for out of state Medicaid.

Interesting.

Okay state we take most insurances and when they come in they can call the urgent care.

We'll also like we'll we'll, you know, give them information on their insurance.

But as far as the ramifications are concerned, I would think going to the wrong place might put some undue pressure on staff, maybe unnecessary pressure on staff.

True.

No work.

We're very well equipped for emergency situations.

It's that we lack equipment.

Yeah, to diagnose certain things.

All right.

Okay, I want to I'm going to give you a bunch of scenarios.

I know you guys are going to try and quiz me, but I've turned the tables.

I like it.

I like the scenario aspect of it.

Okay.

Chest pain, tightness, confusion, shortness of breath.

Where do we go?

Er, er.

No question, no question.

Unless you have if you're younger and you've been working out and you're like oh my chest kind of heard.

Yeah, yeah.

You might come to the urgent care.

We might rule out that, you know, you have more of, musculoskeletal pain.

But if you're have chest pain that's crushing, arm weakness, I would say call 911.

That's that's signs of a heart attack.

That's that's serious.

Drive yourself.

Yes.

Yeah.

Okay.

Scenario.

Child bitten by a dog.

A child's in pain.

Where do you take the kid?

We can bring them to the urgent care.

If they're bitten by a dog.

I mean, you're not going to give a child any more medication than Tylenol or ibuprofen.

That usually works for children a lot more than adults.

But we would assess them and we'd start them on prophylactic antibiotics, because that's the standard treatment.

And if stitches were needed, as long as it's not crazy, you would be able to do that.

Yes, but the deeper the bite, the more serious the issue.

Maybe you need.

Yeah.

Usually with a deeper the bite.

We don't really suture dog bites.

We unless they are, you know, the skin is severely torn.

Then we do a very light, a gentle suture, so that you can allow for drainage because we don't want to trap bacteria.

Okay, I got you.

All right.

Now there scenario here.

Are you ready for this one?

Ready.

All right.

Coughing up any amount of blood.

I would say that you are.

E.R.

Okay.

Not a good sign because.

That's a sign of a whole bunch of things that could be wrong.

Right?

All sorts of things.

Blood clot in the lungs, a bad, infection, you know, rusty colored sputum or TB.

So it really, it's it's pretty significant if you're coughing a significant amount of blood.

Right.

All right.

You have blood tinged sputum.

Spit.

Yeah.

That we don't worry about as much blood tinged.

But if you're coughing up, coughing up copious amounts of blood.

Right.

We want you to go.

To the ER, boy.

Okay.

Got another one here for you?

Yeah.

Relentless fever and flu symptoms.

You can come to the urgent care.

We'll diagnose you with the flu because we can run a rapid test we can treat within the first 48 hours.

We can give you Tamiflu if you're, you know, right.

Younger or older.

A lot of times, middle aged adults, younger adults don't really need an antiviral for the flu.

They need supportive care.

And most of the time people just want to know what am I sick with, right?

Is this the flu?

Is this Covid or is this just a common virus?

It would save a lot of time and a lot of money, I would imagine, to go to urgent care.

Yes, because I mean, if you go to the emergency room, be sitting there all day and they finally say you have the flu, go home.

And it's the price is astronomically different.

Yeah, yeah.

But what if the fever is like over 103 or something like.

That and it's not coming down with ibuprofen or Tylenol?

Yeah it does.

Or maybe it comes with a rash.

Fever with the rash.

Yeah.

Well, then you want to think about valley fever, right?

Yes.

Especially with the rash on the knees.

The ankles.

Is that a joint?

Is that with the erythema.

Dorsum is what it's called cough fatigue.

And then you get this crazy rash.

You you can come to the urgent care and we'll, we'll diet, we'll draw blood for valley fever and we'll do chest x rays and, you know, get you going on the right track.

But for me it's over 103.

You better be careful.

Right.

I mean, you.

Can get a little high.

That's pretty high.

I've seen a lot of adults with 103.5.

Yeah.

And I'll usually hydrate them and give them some, you know, Tylenol, ibuprofen.

And within an hour, their fever reduces because they've lost so much fluid and their body just cannot keep their temperature under control.

That's another one.

Arizona.

Specific symptoms.

Signs of dehydration.

Wow.

Exactly.

Nausea.

Yeah.

Headache?

Yes.

Abdominal pain.

That's early.

That's the early sign is.

I call it first.

Yeah.

You're thirsty.

You get you're going to get dehydrated.

Muscle cramps.

Those significant symptoms should go to the E.R.

because we cannot, do labs to assess for any kidney involvement.

Liver?

Because, you know what's severe?

Heat exhaustion?

Yes.

You can have a lot of end organ damage.

Last question here, Sammy.

And this is really great stuff here.

Is is there a concern now that too many people are going to the E.R.?

Is that is that a continuing, a growing concern?

I think we have so many people, people living in Arizona that I'm not sure if they're too many.

They're going I think some are going for the wrong reasons.

Yes.

So if they can use the urgent care, it'll alleviate the ERS burden, which is inundated in the winter time flu season.

People are desperate.

It's two in the morning.

They have a high fever.

They feel like absolute crap.

Excuse my language.

It's okay.

They feel so horrible that they just want someone to, you know, tell them what's wrong with them.

So, you know, sometimes waiting till 8:00 in the morning and going to urgent care would alleviate the burden of the emergency.

Oh, this is a great information, Sammy Samia Carter again, banner, urgent care nurse practitioner and expert on where you go when you need to go.

Thank you so much.

Thank you.

Appreciate you.

And that is it for now.

I'm Ted Simons.

Thank you so much for joining us on this special edition of Arizona Horizon.

You have a great evening.

Let me.

Be with you.

You.

And.

You.

Again and again.