and good evening.

>> Thank you so much for watching HealthLine on PBS for Duane.

I'm your host Mark Evans and it's a first tonight we are actually doing our first HealthLine show on our brand new set here in the PBS Fort Wayne Studios.

>> So stick around and you'll see some new things and another first we have a physician on our panel who has never been on HealthLine before.

>> It's his first time and very nice gentleman.

We got to talk before the show started Dr. Tyler Atkins' who is a neurosurgeon.

>> Thank you so much for being here.

Thanks for having me on.

OK, so first time on the show first time on this brand new set.

A lot of firsts tonight we want to open up our phone lines because this is going to be a very interesting topic to talk about and of course the phone line number is on your screen 866- (969) 27 two zero or just (969) 27 two zero here locally and ask questions about general neurosurgery and minimally invasive procedures and you'll know more what we're talking about in just a couple of seconds.

But Dr. Atkins, I was wondering if you can just kind of preface the program by telling us what your specialty is as a neurosurgeon.

>> You just don't handle the brain, do you?

Yeah, that's right.

So neurosurgery is just a title that often confuses people a little bit right away because people commonly say brain surgeon or spine surgeon and that's what a neurosurgeon is is really both of those things.

Right.

And some specialize in one or the other more so but everyone trained in neurosurgery can do both and then it can often get infused with neurology because it's the same thing both physicians treating the brain spinal cord and nerves of all the disorders that affect them.

But the the train for a neurosurgeon is a bit different.

>> It's focus on things that we can typically treat with with surgeries that's ranges from brain tumors and vascular problems like aneurysms, head injuries, brain bleeding to all all variety of spinal disorders from arthritic degenerative disorders to trauma and tumorous cancerous disorders as well.

>> In fact, one of your associates did my back surgery about 10 years ago and yeah, and I had to learn a lot about what a neurosurgeon does and you know, how they take care of folks.

>> But you mentioned brain tumors and I've got to tell you something that's something during my research for this show and it just dawned on me I think I've known three people personally in the last five years who actually had a brain tumor.

>> Are they on the uptick and if so, why?

Yeah, that's a great observation and in fact they are and there there's there's a lot of reasons and some of it's artificial.

You know, the easiest artificial reason is that we get more brain imaging now for for various reasons headaches or accidents.

You hit your head imaging just more readily available and so we find things that we might not have found because they're not causing problems.

So we call those incidental brain tumors and a lot of times those can be benign but so we find those more frequently and additionally some types of brain tumor are occurring more frequently specifically metastatic brain tumors.

That's a cancer that's spread from somewhere in the body.

>> There's more of that occurring because people are living longer with cancer which is good news.

>> Yeah.

That an illness that previously would have been fatal for somebody before they lived long enough to develop a metastatic spread is instead developing a brain tumor and so oncologists and neurosurgeons are seeing people with metastatic tumors more frequently in the later stages of an illness that we're doing a better job treating overall.

>> What about cell phone usage?

Is that bringing the increase of brain tumors?

>> There is active research in that but there's no definitive proof yet and so you know, people who are cautious, even some surgeons that I know are concerned about enough that they you know, they'll use a wireless headset or instead of holding the phone always to the side of their head.

But the physics of it doesn't really suggest a good mechanism for either the type of radiation that's used in phones would cause cancerous changes in your cells, your DNA the way that a radiation treatment can.

But it's a scary enough topic and it's plausible enough that people are looking into it actively.

But no, no positive connection there yet.

>> Well, how do you know you have a brain tumor?

I mean are there any symptoms you feel something in your head or is that something that as far as your mobility I mean how do you know these things?

>> You know, actually feeling anything in your head is probably one of the least common.

The brain itself does not have any sensation.

It's one of the reasons why we can people have heard of people having awake brain surgery.

One of the reasons I'm going to talk about that and one of the reasons why is because the brain doesn't feel there's no need for it to for our bodies to feel but the the head the scalp and the skull and then the brain covering a thin material that's called the dura does have a lot of sensation in that that brain covering is actually some of the source of just migraine headaches among many other things.

>> And Doctor, you know what?

I think you're getting ready to answer a question that Thomas would like to ask.

So if you don't mind, we'll line one.

>> And Thomas, go ahead with your question please for Dr. Atkins.

All right.

All right, Doctor, how are you doing tonight?

Hi, Thomas.

I'm great.

How are you?

Great, thanks.

You guys both kind of pose a few answers.

I was going to ask if there were some indico versions of brain tumor or slight symptoms the person would be able to detect a tumor happening.

But we were kind of going into that interesting enough you touched a topic I wanted to kind of ask the question has there been any type of research or definitive proof of this big technology that's popping up all over the city?

I mean they put a big tower right in front of a couple houses down the way from where I live and they just got these towers up all over the place and I'm just I'm wondering if that stuff's going to pan out maybe be harmful and things you mentioned before that there's research going on for that right now.

>> Yeah, And the concern about five GB I've read into that as well and you know that's not in regard to the physics itself of what type of radiation people are getting exposed to.

>> It's not fundamentally different.

It's not a different kind of radiation.

It's not like those are x rays or gamma rays or something terrifying like that.

But you can hear about in movies or people getting radiation treatment to blast a tumor.

>> There's still microwaves which is the radio frequency that's used for telecom communication and satellites, et cetera.

It just uses different different set up of how that is more densely packed information.

>> But it's not a different energy that theoretically doesn't have any increased risk of getting through your body, getting into your cells and hurting your DNA.

>> And so there's no, you know, fundamental risk associated with it.

But that doesn't mean maybe there isn't something we don't understand and so it's worth keeping an open mind and continuing to look into it not just definitively dismiss it but not something that I'm afraid of or I'm afraid for my children and my wife to be around 5G or anything like that at this point.

>> A very good question.

Thank you for your call.

Another one coming in.

We'll get to that in just a second.

But you were talking about how you can tell if you have a brain tumor.

>> Yeah.

And is that done through MRI?

Yeah, once once you have a suspicion.

So like I said, sometimes you find an incidental one that you're getting a head scan for another reason.

But I was I was answering the question of can you.

Does it hurt?

And the only time it really hurts is if a tumor is large enough or in the right location that's pushing on the surface somewhere on the brain covering or pushing against the bone either on the top what we call the convexity of the head or underneath the brain what we call the skull base where it's actually pushing on things on the outside, not just the brain itself.

I've been amazed to see people have surprisingly large tumors that have no pain at all.

>> Had no idea they had yeah.

No idea and that's presumably something that's been growing for years in certain cases.

And so the other way that we we find them is usually functional effects and so a tumor grows either from the outside of the brain and pushes on it or grows from within the brain itself and sort of chews up the brain as it gets bigger and bigger than either of those effects or methods of growth cause dysfunction of the brain as it goes and depending on how fast it grows decides how quickly those effects show up.

>> And so the effects are kind of like a stroke but slow and so they're harder to pick up.

So you know the same things that you think of with a stroke like weakness can't walk, can't talk suddenly blind in one eye or something like that but insidiously coming on over the course of months, sometimes shorter weeks but sometimes even years of wow I've been stumbling for years now that I think of it that has been you know, just getting clumsy on me and I just thought it was old age and then you know, you get in a car wreck and they scan your head and they say oh look at this big benign tumor that's been pushing on your brain's probably been there for years.

>> Wow.

I didn't realize that they would go on for years.

Yeah, the benign one certainly can the malignant brain cancers generally don't you don't get that much time until they get big enough to cause noticeable problems.

>> But we're going to take a call from Kathy here in just a minute.

I'll actually transcriber question she prefers not to be on the air but that'll be a just a moment.

Kathy , thank for that call.

>> But Doctor, I want to talk about something else to you.

You handle aneurysms and can you explain aneurysm is yeah.

>> Yeah, that's a great question.

I think aneurysms often get thought of as it's an event like people to say oh, I'm going to have an aneurysm if I get so worked up.

I've heard that just like people say if they're going to have a heart attack but an aneurysm that isn't an event.

>> It's a thing it's an abnormal part of a blood vessel where the normal healthy all the blood vessel is ballooning out and stretching with increased risk of that part of the abnormal blood vessel tearing and bleeding.

And so the event that people are referring to is really when an aneurysm ruptures that's a very, very dramatic and potentially life threatening event or some say up to a one in four people and they rupture don't survive to get to the hospital because they're sudden dramatic bleeding in the brain.

>> Is that an age related thing?

Certainly can be, yeah.

>> So it's there's a connection there that the increasing incidence with age because it is one of the common causes is wear and tear of blood vessels.

>> So just like aneurysms elsewhere in the body you can get the most other common location.

But by the abdominal aortic aneurysm people have heard of that as a stretching of the largest blood vessel in the body and the abdomen which increases with the same wear and tear processes they couldn't get at all of our blood vessels.

>> But there's other conditions to some rare genetic conditions that increased risk for aneurysms.

>> But the it's the the rupture that is the dramatic event that people think of .

But the aneurysms themselves are things that are there and growing potentially for four years, maybe even decades.

And so when we find aneurysms not because they've ruptured but because we were lucky and got again picture for another reason like maybe a person had headaches and we just got a picture and saw an aneurysm then it's a question of how long has it been there?

Is it growing?

Do we need to do something about it?

Not always an emergency but when they rupture, you know, that's what gives the the term that we use is the thunderclap headache which is the worst headache of your life .

Yeah.

That often makes people lose consciousness or even go comatose immediately.

OK, that's that's an emergency and that sort of person needs to come to the hospital often get an aneurysm, treat it quickly.

>> OK, well that's good to know.

Kathy called the question a few minutes ago.

>> She says she's 80 years old, fell yesterday and hit her head and she was still able to function but her kids wanted to get checked out.

>> Could she have something to her brain?

Could she have I'm sorry?

>> Could she have done something to her brain hitting her head?

Yeah.

So I mean the that's a very, very common setup for a head injury and you know, the obviously she doesn't have any severe symptoms.

You know, if she's functioning just fine no significant headache, you know, not having a neurologic change and I'm less worried but there's other factors that would potentially make me concerned enough to think that it's worth going to a doctor and getting a head scan such as if she's on blood thinners, that's the biggest risk factor for people with falls that are otherwise mild that can potentially lead to dangerous internal brain bleeding.

So blood thinners like Coumadin or even aspirin sometimes but the more powerful ones, the anticoagulants are the ones that that lead to more dangerous bleeding.

But if you have no symptoms and you're not on a blood thinner and you fell and you feel OK, that's not necessarily an indication immediately to get a CAT scan even if you went to the emergency department, the emergency room physicians have a sort of a guideline for scenarios where they should get a CAT scan to look at you and sometimes they just watch you and say you look OK, just call back if there's problems so just monitor yourself.

Don't don't forget that this happened.

>> If you start to feel weak or or headaches that are coming that are not normal for you don't forget that you fell and hit your head.

>> OK, good advice.

I want to move on to something else too.

I was a little confused when I was preparing for this show but aneurysm in brain bleeding are those two different things.

>> Yeah, so brain bleeding is a very generic term that we have about 15 different medical terminologies for that based on where the bleeding is in the brain because like I mentioned earlier, there's a brain covering and any bleeding that's inside the skull will usually get referred to as brain bleeding but that can be outside that brain covering what you call an epidural hematoma underneath of that covering which is called a subdural hematoma.

>> Maybe people have heard these terms for and then you get actually into the brain itself or the type of leading that aneurysm causes again also outside there's multiple coverings of the brain but that type of bleeding is referred to as a subarachnoid hemorrhage again in reference to the different layers, the brain or the different layers of the covering and there's bleeding inside the brain called intrauterine comeaux hemorrhage ,intracerebral hemorrhage and then even deeper still in the fluid spaces in the middle of the brain something called intra ventricular hemorrhage.

>> Oh, and all of these things have different different threats to them.

Different level of emergency often based on the size and how it's affecting a person and they all want different treatments.

A lot of brain bleeding actually by the majority of it is related to trauma to falling in your head and having a small head bleed that's not life threatening, not going to change the function of your life .

But a lot of it can or other types of bleed can be life threatening and sometimes there's not surgery to be done for it because it's like having a catastrophic stroke and we can't undo the damage it's done and in other situations it's just pushing on the brain that we can totally save if or or mostly save a person's life and function by taking that bleeding or the hematoma out.

And so brain bleeding is very generic and so when I have family members call me and say oh you know, our our nephew, our cousin, our family, they have brain bleeding.

>> I'm like oh my God, I can't really tell you what's going on because that could mean so many things I could you know, that could mean they're going to be OK.

It was milder.

Oh my goodness.

They're comatose and this could be something life threatening.

>> I see.

So a physician and specifically a neurosurgeon when they hear brain bleeding what they want to do is they want to see a picture of a CT scan which is the how brain bleeding is diagnosed.

>> Ninety nine some of the time now.

>> Well, it makes sense to know.

All right.

Well let's move on here to a line three Matthew, thank you for hanging in there.

We appreciate your call here on PBS , PBS Fort Wayne's HealthLine program.

>> Your question please for Dr. Atkins.

>> Matthew, hello.

Hi there, Matthew.

Go ahead with your question.

Hello.

Yeah, I got a question on pertaining to like Foggy Foggy can't think clear the mind.

>> It's hard to concentrate and focus like fogginess and fuzziness.

Yeah.

And it comes and goes and what I don't think about it goes away.

>> OK, so this is something that you personally experienced Matthew is that correct?

>> Yes.

OK, have you seen any physicians about this to do any testing or is this just curious what it could possibly be?

Yeah I've checked it out they just prescribe medication for it.

OK, well without knowing what the other physicians have have done I'd be hard for me to to give you any better information than what someone who's had a chance to evaluate you personally but you know brain brain fogginess and brain fog in general is a term I think people have gotten a little more exposed to recently with covid because people refer to the brain fog or covid brain fog or post covid brain fog.

And so I think that's a term that intuitively makes sense to people and even in medical literature we often don't use a much fancier term than that because it's such a vague concept that the good thing is that most of the time that sort of concentration or fogginess is not issue of the the structure of the brain is very rare for that to be related to like a tumor or bleeding or you know, fluid buildup in the brain.

It can be and so you can't fully rule those things out unless you get brain imaging with the person having concerning symptoms.

But most most brain fogginess is more of a functional problem that can be related to other health conditions.

And so it's always important to get thoroughly checked out just by your primary care doctor to start with like is this a blood pressure thing, kidney problem, liver problem?

All of these can cause brain fogginess or concentration issues or medication related problem medications, side effects.

Those are far more common causes of of that sort of general complaint or a post viral thing like with covid then is something much more threatening like a like a brain tumor.

>> OK, well we have another call coming in.

In fact this very interesting topic you can always tell when people are glued to their set and want to get their calls in for answering or asking questions and getting some over the television advice I guess if you will.

But Rita is on line one and Rita, go ahead with your question for Dr. Atkins tonight and thank you for your call.

>> Oh, you're welcome.

I'm pretty sure I read something about r e m sleep behavior disorder essentially I guess I can get really violent when I'm asleep like kick my husband and he gets so upset with but I say that it's it's it's like it's like I'm asleep.

I don't know I'm doing it and it's said that these days this is something that's typically diagnosed in men but can occur in women.

I'm 66 and I would say this has been going on for several years and wondered if you had some information on how or if this should be treated.

So unfortunately I'm not going to have a bunch of great information for you.

This is a good example of something that is definitely brain related and sleep disorders.

I've certainly heard of it as well and certainly a neurologic thing.

>> But sleep disorders in general are not in the realm of neurological surgery.

>> It's sleep medicine, sleep medicine which which falls under actually a lot of physicians will treat sleep medicine disorders from from neurologists which is usually probably the center one.

But pulmonary doctors for disruptive sleep apnea even dentists will prescribe devices for sleep apnea.

>> Your nose and throat doctors will do procedures and things for sleep disorders.

But from the specific condition of a RTM sleep disorder it would definitely be in the realm of the neurologist that would most likely use sleep study in conjunction with EEG potentially to monitor brainwave activity during these events to see specifically what's happening to make sure it's not anything more concerning like a seizure that happens during sleep causing abnormal movements, et cetera.

But it's not something that tends to reach the level of of a neurosurgeon because fortunately there's usually nothing structurally wrong with a person's brain and that's that's the difference is the surgeons are you know, the carpenters of the brain if we get involved, if there's something that we can fix surgically which the realm of that is increasing all the time with things that used to not be surgical like Parkinson's disease is now very often treated by surgeons to place in brain stimulators to to slightly change the function of the brain.

So I kind of speak when I say it's a form problem only a structural problem only because we can help the function.

>> But to to this point sleep disorders are not not in the realm of things that I'm well versed to provide any good information.

>> OK, well thank you for the information you did provide and I think we have time for one more question.

>> Molly is online for she has a question about concussions.

>> Molly, go ahead please.

Thanks for taking my call.

I have become aware as a 60 year old woman that early in my youth from the age of maybe toddler to the age of first grade or second that I probably had three rather severe concussion and I'm curious because I'm pretty certain that might explain why I have a terrible ability to remember faces and names and events oftentimes and I'm wondering is would those brain injuries show up on an MRI?

>> My brain that's a good question.

Yeah, that is a good question.

So you know, concussion is the is a pretty vague concept of it but it's often thought of as the most mild version of a head injury that can be all you know, all the way to the severe end of the head injury is terrible intracranial bleeding person comatose.

But concussion is not a diagnosis that we make with imaging like we do with most other things.

>> And when we're diagnosing a brain injury it's diagnose based on how did you feel after you hit your head or in a fall did you were you dizzy?

>> Did you lose consciousness briefly and then it came back.

So a lot of these diagnoses are made without any imaging and even if imaging is obtained and there's nothing seen on the CAT scan, no bleeding but the person feels bad will say oh you had a concussion but the an MRI is definitely more sensitive at picking up small bleeding that happens and and that can be small bleeding from a from a concussion and a person who's not, you know, severely injured in that they're not comatose.

But we also use it sometimes to see I kind of microscopic bleeding in severe brain injuries where a person goes comatose but their CAT scan looks fine and MRI can show us usually why they're comatose.

>> But after after long after an injury from concussions, the chances of being able to see the evidence of that concussion from long before even in like football players who have that syndrome of chronic traumatic encephalopathy, chances are you're not going to see it on an MRI.

>> All right.

Thank you so much.

>> You know that half hour flew right by because it's time to do the old wrap up this give me the signal offset.

So what we're going to do is we're going to wrap it up and we thank you very much Dr. Tyler Atkins, a neurosurgeon for all your information and please come back again as we thank you.

>> OK, and we thank you for watching.

We'll be back next week with another show on Tuesday night.

Jennifer Blomquist will be your host all about diabetes.

Until then, thank you for watching.

>> Good night and good