>>Lori Casey: According to the Skin Cancer Foundation, one in five Americans will develop skin cancer in the course of their lifetime, and it's the most common form of cancer.

What is your risk, and what are the signs?

Well, stay tuned for this edition of Being Well.

Our guest is dermatologist Doug Leone from the Dermatology and Mohs Surgery Institute, and he'll be answering all sorts of questions related to skin cancer prevention and treatment.

That's all coming up next, so stay right here.

[Music Plays] Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active managing stress, and regular check-ups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Additional funding by Jazzercise of Charleston.

Thanks for joining us for this edition of Being Well.

I'm your host, Lori Casey, and today we're talking about skin cancer.

And I'm so pleased that Dr. Douglas, Doug... Douglas or Doug?

>>Dr.

Leone: Either one is fine, yeah.

>>Lori Casey: Leone from Sarah Bush Lincoln Health System is here to talk to us about skin cancer.

Let's get the discussion started by talking to us about how prevalent is it, and are we seeing an increase in skin cancer rates.

>>Dr.

Leone: Yeah, that's a great question.

Skin cancer is quite prevalent, and it's been on the rise pretty significantly for the past 10 to 15 years.

As a matter of fact, there's a statistic out there now saying if you are a non-Hispanic, white person, there's a 40 or 50% chance you'll have skin cancer by the time you're 50 years of age.

So, that's half the people that are of caucasian descent that will have skin cancer by the time they're 50 years old.

>>Lori Casey: And what are some of the things that those people did, and myself included, in our childhood or in our lifestyle that could cause skin cancer?

>>Dr.

Leone: Another good question.

Well, I think that has a lot to do with laying out in the sun, sunbathing activity.

A lot of people worked outside.

And, you know, 10, 20, 30 years ago, and longer than that, there was no big push to wear sun protection, no big push to use sunscreen.

So, those are the big factors: laying out in the sun, you know, working outside, and just not being smart about avoiding sun.

>>Lori Casey: And you said earlier, people are just living longer.

>>Dr.

Leone: Exactly.

That's another big reason for the increase, is the average lifespan has gone up.

And then also, the other big reason is a lot of people with kidney transplants, heart transplants, liver transplants, they're on a lot of medications that suppress their immune system.

And when you suppress your immune system like that, you get a really explosive amount of skin cancer, so that's another big reason.

>>Lori Casey: Okay.

That's interesting; I never thought about that.

So, what actually causes a skin cancer to develop in somebody?

What's going on in your body?

>>Dr.

Leone: Well, what happens is over time, every time our cells replicate and divide, they make mistakes.

And eventually, those mistakes happen in the on/off switch that tells a cell when to divide and when not to divide, and that really happens for any cancer.

And then, any time you have other things causing more mistakes, such as alcohol, smoking, other carcinogens, and in skin cancer, basically, it's the sun, causing more mutations in those on/off switches, it's just a matter of time before you develop skin cancer.

So, really all that skin cancer is, it's your normal skin cells that have lost their ability to know when to stop dividing, and then they grow at the expense of all your other cells.

>>Lori Casey: So, how does the sun impact that, you have to explain the UVA, UVB rays, and ultraviolet lights; which of those lights is creating these changes in those cells to begin with?

>>Dr.

Leone: Yeah, it's the UVA and UVB lights, especially the UVB.

And so, what happens is that's just a form of radiation.

So, people don't understand that the sun is actually beaming down radiation, and it causes change at the cellular level and mutations in our DNA, which tells the cells when to stop dividing and when to start dividing.

>>Lori Casey: Okay.

So, you think, oh, it's just skin cancer; I can't die from skin cancer.

Is that true?

>>Dr.

Leone: It's absolutely not true.

And that's one thing we have to explain to a lot of our patients.

They think, well, it's just on my skin, you know, do I have to get this treated?

And, you know, some skin cancers are kind of slow growing.

But for the most part, they all have to be treated in a pretty timely manner, because a lot of the skin cancers are quite dangerous, especially we know melanoma, but even squamous cell carcinoma can be quite dangerous.

So, you need to get those treated in a pretty timely fashion.

>>Lori Casey: So, what, if skin cancer, so skin cancer can lead to other cancers, correct?

>>Dr.

Leone: It won't lead to other cancers per say, but it absolutely can spread to different parts of the body.

>>Lori Casey: That's a better question.

Where does it typically spread to, if left untreated?

>>Dr.

Leone: Usually, it spreads to a lymph node first.

And usually, it will spread to a local lymph node; for instance, if you have a skin cancer in the arm, it usually spreads to a lymph node either near the elbow or in the armpit, or up in the clavicle area.

And so, depending on where the skin cancer is, it will spread to regional lymph nodes, but the lymph nodes are usually the first location.

They can spread through the blood, but that's not quite as common.

>>Lori Casey: Okay.

Are there certain ethnic types or people that are more at risk for skin cancer than others?

>>Dr.

Leone: Absolutely.

So, the more pale your skin, the more at risk you are for skin cancer.

And so, the people who have red hair, very light skin, that tend to get a lot of sun burns opposed to sun tans are at much greater risk for skin cancer than someone who may have darker skin, and maybe like, say, dark hair, brown eyes, and a little bit of that olive colored skin.

And then, African Americans are much less at risk for squamous cell and basal cell carcinoma vs. other, you know, caucasians.

>>Lori Casey: But anybody can get skin cancer.

>>Dr.

Leone: Absolutely.

Everybody can get skin cancer.

>>Lori Casey: Okay.

So, I know that there's three types of skin cancer, and I'm going to have you explain the different types from kind of mild up to the more severe.

>>Dr.

Leone: Sure.

And the most common type of skin cancer is what's called a basal cell carcinoma, is by far the most common.

There's about anywhere from 2 to 3 million new cases per year diagnosed.

And thankfully, for us, it's also the least dangerous.

So, we kind of luck out there.

So, those don't tend to spread to lymph nodes nearly as often, but they're very locally destructive and will destroy all your local tissue, so they still need to be treated.

The second most common is what's called the squamous cell carcinoma.

There's probably around 700,000 to a million new cases of those diagnosed a year.

They're fairly more dangerous than a basal cell carcinoma, and definitely can spread to lymph nodes if left untreated.

In certain areas, those can be more dangerous, such as the lips and the ears.

So, the rate of spread to lymph nodes in those locations is much higher, and they're much, much more dangerous.

The least common would be melanoma, which again, thankfully for us is the most dangerous, so thankfully, it's the least common.

And those will probably kill about 20 to 30% of the people that are diagnosed with invasive melanoma.

As a matter of fact, I saw a stat that one person in the U.S. dies every year of melanoma right now.

So.

>>Lori Casey: So, is there a more common place where skin cancer develops than others?

>>Dr.

Leone: Oh yeah.

And that's another misconception.

Skin cancer can develop anywhere.

I mean, it can develop on the bottoms of the feet, the buttocks, the armpit, places that never see the sun.

>>Lori Casey: Really?

>>Dr.

Leone: That's right.

>>Lori Casey: How is that possible?

>>Dr.

Leone: Well, like I said, every time cells divide, they're making mistakes.

And so, you don't need to have anything else promoting skin cancer to develop; you don't need the sun, but it definitely accelerates things.

So, that's how it's possible.

Any time a cell divides, a mistake can be made.

So, that's how.

>>Lori Casey: So, where is the most common place that it does occur, though?

>>Dr.

Leone: There's a little bit of difference between males and females.

Usually, in males it's going to be the head because of baldness, the ears, the nasal tip, basically the face in general, and then the chest and back for males, because we walk around with our shirts off, or you know, we're at the beach with our shirts off more often.

They take their shirts off to work outside.

And then for females, it's again the face, the ears, and it happens to be the upper chest and the legs.

So, the big difference between males and females is kind of the v-neck area of the chest for females, and then the lower legs for females because they wear a lot of shorts and dresses in the summer.

>>Lori Casey: Okay.

So, I read about the ABCDE rule for the signs of skin cancer.

Can you run us through that and tell us what that means?

>>Dr.

Leone: Sure.

That's a really great generalization about what to watch for for the melanoma type of skin cancer.

The A stands for asymmetry.

And basically, what that is is a mole that you have, that you can't really fold upon itself and half, that it matches, that one half matches pretty perfectly.

So, that's basically the asymmetry.

B stands for border.

A perfect mole has a nice smooth, round border.

Any mole that has a jagged border, or a notched border, or irregular looking border that's basically not round is something that could be a warning sign.

C stands for color.

And if we see more than two to three different shades of color, especially darker colors, that's a big warning sign.

And then, D is diameter.

And that's probably, of all the ABCs, the least important, but that's anything greater than a pencil eraser in size could be a warning sign that that is dangerous.

And then, E stands for evolving or changing, and that's probably the most important of the ABCDEs.

Any time you see a mole that's getting bigger, changing in size, shape, color, or the borders are changing, that should just be instantly looked at by a physician.

>>Lori Casey: Okay.

And then, ABCDE, did you do E?

>>Dr.

Leone: Yeah, E was evolving or changing.

>>Lori Casey: Oh, evolving.

Okay.

So, as I'm looking at my, you know, I've spent years out in the sun, so I've got a lot of these really flat brown spots.

Will they, are those possibly could lead to skin cancer if they're totally flat, and they're just a discoloration?

>>Dr.

Leone: Yeah.

That's a great, great question, because that's a huge... >>Lori Casey: Get a little diagnosis here... [Laughter] >>Dr.

Leone: Yeah.

People tend to think like this elevation is the big warning sign, and you notice we didn't say anything about elevation.

>>Lori Casey: E did not stand for elevation.

>>Dr.

Leone: That's right.

And I think a lot of people think that it does.

And in fact, it doesn't.

Elevation is not really a warning sign at all, unless it's a brand new, rapidly evolving elevation for change.

But most moles that are flat or elevated are not going to turn into melanoma.

And there are some studies out there saying most melanomas happen from brand new moles that you've never even had in the past, so a new mole popping up.

Of course, I don't know how reliable that is, because I don't know how often someone's checking every one of their moles, but... [Laughter] >>Lori Casey: Counting all of them.

Some of us have more than others.

>>Dr.

Leone: Yeah, but that's a good question.

Your moles right now, just kind of looking at your forearms, they all look like they're pretty symmetrical and same color, they're all smaller than a pencil eraser in size.

But someone like you with a lot of moles should get a skin check, you know, once a year, and just kind of educate you and get to know your skin, and kind of tell you what your risk for melanoma is, because it changes a lot from person to person.

>>Lori Casey: That's what I was going to ask is when, should a mole check be part of our regular check up every year?

Or what do you recommend?

>>Dr.

Leone: Yeah, that's a good question.

And that all depends on what the family history is, and your skin type, and your sun exposure type.

So, if you came to me and said, oh geez, my mom and brother both had melanoma, and my grandpa had melanoma, you ought to be coming in every four to six months for a head-to-toe type of skin check.

If you come to me and you have darker skin, you don't have a lot of moles, and you say, geez, no one in my family's had skin cancer, I never had a lot of sun exposure, well then, I'd say kind of come in every two to three years or as needed, you know.

Now, the older you get, like any cancers, incidence of skin cancer goes way up, so then you should probably come in every year just to be safe if you've never had a history of skin cancer.

>>Lori Casey: Okay.

So, we all know from media and what we see on TV that sunscreen is important, very, very important.

Can you explain what we should be looking for?

The SPF, and there's ones that block UVA, UVB rays; what should we be looking for when getting a sunscreen?

>>Dr.

Leone: So, that's another question we get a lot in the office.

And it's confusing out there, because you see all these different ingredients, and what kind of SPF do you need, and water proof or not.

But overall, the best type of sunscreen you should use is an SPF 30 or greater; that blocks 98% of the UVB type rays, okay?

And then, what I like to look for is something called a broad spectrum sunscreen; that means it covers UVA and UVB.

Because the SPF is really only telling you how it blocks the UVB rays.

The UVA rays are what cause us to look older and can cause melanomas, and there's no rating system out there for that right now.

But if you use a broad spectrum sunscreen, that will cover UVA along with UVB.

And my personal favorite, and most dermatologists' favorites are the ones that contain zinc or titanium.

And those are actually metal blockers, and they actually reflect 100% of all UVAs and UVBs, they're blocking everything.

You know the stuff the life guards used to use back in the 70s, that real white... [Laughter] Obviously, not the most cosmetically appealing.

But thankfully, over the past few years, they've micro-sized the zinc and titanium, so it's very difficult to see when you put it on in the new types of sunscreen.

So, that's basically what you're looking for, is an SPF 30 or greater, something that says broad spectrum, and then something that has zinc or titanium in there, and then something, water proof is no longer used as a labeling for sunscreen, but you want to find one that says water resistant.

>>Lori Casey: Okay, why did they change the water proof?

>>Dr.

Leone: Water proofing kind of gave the notion or put the perception out there that you could just jump in the water, it's not going to wash anything off.

And there's no sunscreen that is not affected by water.

So, if you're swimming, it doesn't matter what the bottle says; it's going to reduce the effectiveness of the sunscreen.

So, any time you get out of the water, after you've been in the water 30 minutes or greater, you should reapply the sunscreen.

>>Lori Casey: Okay.

So, when should you have sunscreen on?

>>Dr.

Leone: So really, any time you're going to be outside, outdoors for more than 30 minutes, you should use an SPF 30 or greater in the summer months.

That's when the sun is the strongest.

And then, you should reapply every three to four hours if you're not in the water, and if you are in the water, every half hour to hour.

The question we get, too, a lot is do we need to wear sunscreen in the winter.

And yes, you do.

Of course, the sun is much weaker.

So, I think for the winter time, we're not outside a lot here in the Midwest, something with an SPF of 15 or greater for the face would probably do just about what you need it to.

>>Lori Casey: Well, a lot of women's cosmetics, foundations, and things like that already have SPF 15 in them.

>>Dr.

Leone: That's correct.

>>Lori Casey: But that's also not, if you're going to go out and mow the lawn and be outside, that's probably not enough.

>>Dr.

Leone: Yeah, that's, exactly; that's kind of the SPF you want if you're walking from your car to the grocery store, you know, in the parking lot type of deal, just kind of blocking the minor sun exposure.

But not at all, that's not at all sufficient for being at the beach or being outside mowing the lawn, working in the garden, stuff like that.

>>Lori Casey: And what about applying it on children?

Start right away?

>>Dr.

Leone: Yeah.

I recommend, there are a few really good brands out there that are specific for babies.

And again, I like, personally, the zinc and titanium because they're non-chemical sunscreens; they're just physical blockers, and there's no worry about absorption of those chemicals into the skin.

>>Lori Casey: So, as far as children, is their skin more susceptible to skin cancer because they're younger?

Or does it not matter?

>>Dr.

Leone: They're not more susceptible to skin cancer per say, because again, they're so young, and the incidence of cancer in general in young people is much lower.

But they're much more susceptible to sunburn.

And their skin is thinner, they haven't had exposure for their skin to be darker.

And so, just because, basically, the skin is so much thinner, they're at risk for much more sunburn.

>>Lori Casey: Okay, so when you brought up sunburn, if you've had a couple of really bad burns as a kid, does that, other than, you know, maybe making you look older as an adult, what does repeated sunburn do?

Does that increase your risk?

>>Dr.

Leone: Big time.

Yeah.

And I think most things, if you read them nowadays, say the biggest risk for melanoma right now is actually fewer exposures to sun, but those exposures were very intense.

So, if someone had, maybe, let's say three to six intense sunburns, they're at very high risk for melanoma, compared to someone who has not had those blistering or very intense sunburns.

>>Lori Casey: So yeah, I was going to say, what do you classify as an intense sunburn?

>>Dr.

Leone: I would say any sunburn that kind of incapacitates you or, you know, is so painful that it's hard to really do your daily activities for a few days, is an intense sunburn.

Of course, any blistering sunburn qualifies as an intense sunburn.

>>Lori Casey: Alright.

So, keep that sunscreen on.

And let's talk a little bit about tanning beds.

I can imagine what your answer to questions about tanning beds would be, but is the exposure, the light or whatever, different in a tanning bed vs. just laying out in the regular sun or being in the regular sun?

>>Dr.

Leone: Yes, it's much more intense, and that's why you can tan so fast in a tanning both.

You know, in 10 minutes in a tanning booth, you can get the amount of exposure of natural sunlight that would take like, about two to three hours.

So, it's much more intense and focused.

And the worry about tanning booths is that that specific ultraviolet, which is often UVA, is more of at risk for melanoma.

So, that's a big concern with the tanning booths.

>>Lori Casey: Okay.

But a little bit of sunlight is good for us, correct?

>>Dr.

Leone: Yeah.

I mean, a little bit of sunlight is good to synthesize Vitamin D, although some dermatologists argue that you can get all the Vitamin D you need with vitamin supplementation.

But I think in general, the sun makes people feel good and, you know, you have to, I tell patients all the time you have to live your life.

I mean, I get some patients that come in and have a melanoma or get their first skin cancer, and like, oh my goodness, I'm not going outside anymore.

It's like, you know, we're here, we live once, and you can't live like that.

I mean, you just have to be smart about it and use some sun protection.

But it's no reason not to go out and have fun in the sun.

>>Lori Casey: Do you think in popular culture, it used to be, oh, I feel so good with a tan, I like the way I look with a tan; do you think that's becoming less popular?

Or is it still prevalent in certain age groups of, particularly, young women is what...?

>>Dr.

Leone: Yeah.

I mean, let's be honest, everybody looks better with a tan, right?

It bumps us up like two points on the scale, 1-10, with a tan.

So, it's hard to argue that we don't look better with a tan.

And I think that's pretty prevalent opinion among everyone, and especially the young females.

I mean, you see them going to prom or, you know, getting ready to go on Spring Break, and those people are tanning like crazy.

And the worry about that, again, is that's those short, intense bursts of sun exposure we're talking about where ultraviolet exposure that are turning out to be the greatest risks for melanoma.

So.

>>Lori Casey: Alright.

Well, we've got about five minutes left, and I need to ask you about how are skin cancers treated...

In a number of ways.

>>Dr.

Leone: There's a number of ways.

Some skin cancers that are very superficial and aren't very deep can be simply treated with a creme, which is pretty amazing.

They've been out for a while, or a very gentle, light scrape with an instrument, which takes, you know, about five minutes to do.

>>Lori Casey: And that's something that you do in your office.

>>Dr.

Leone: Yes.

Yep.

And some more advanced skin cancers that are deeper in the skin, the treatment of choice there is to have them cut out surgically, and then sutures are usually placed.

And then, radiation is another option.

That's usually reserved for people who are older and incapacitated, not able to undergo the surgery.

The surgery is pretty much the gold standard for all skin cancers.

One of the newer techniques out there is called Mohs, that's spelled M-O-H-S. A lot of people ask me what that stands for, and that's actually the last name of the gentleman who invented the surgery; his name was Frederic Mohs.

And that's a newer type of skin cancer treatment, which actually has the highest cure rate and leaves the smallest scar.

And they do that by mapping out exactly where the skin cancer is and chasing on the skin only where the skin cancer is, and leaving the normal skin alone, so.

>>Lori Casey: And what's the benefit of that vs. the more traditional surgery?

>>Dr.

Leone: Well, basically, the cure rate is much higher; you're talking 98 to 99% cure rates with most of the cancers that you're treating.

And it also leaves the smallest scar.

The big advantage is that when we cut out skin cancer using the Mohs technique, is we check 100% of the border.

Most people are surprised to hear that traditional surgery, where you just cut out a piece of skin cancer, they only check 5 to 10% of the border.

So, they do take bigger pieces of skin, and so the cure rates are still fairly good.

But the big advantage of the Mohs surgery is checking 100% of the border and giving a super high cure rate, and also leaving the smallest scar, which most people are... >>Lori Casey: ...Not just arbitrarily taking out a large, well, relatively, it's small compared to the whole body, but... >>Dr.

Leone: Exactly.

The amount of skin you take out for the Mohs surgery is much smaller than it would have been if you had done a general surgical excision.

>>Lori Casey: So, do people sometimes, maybe with more severe case, had the surgery, and then also get some radiation on top of it?

>>Dr.

Leone: That's another really good question.

That's especially prevalent for some of the skin cancers that may wrap around the nerve, or are more advanced.

You asked me earlier what type of skin cancers are, and we kind of summarized it with basal cell cancers, squamous cell cancer, and melanoma.

Well, basal cell and squamous cell cancers, there are subtypes of those that are much more aggressive than the other types.

And os, often for those we'll do surgical excision, and if they look pretty advanced or wrap around a nerve, specifically, we'll recommend that radiation also be used.

>>Lori Casey: Okay.

So, in these last few minutes, give us a rundown quick of some of the things that we can do to prevent skin cancer.

>>Dr.

Leone: Well, the single best thing is using proper sun protection.

You'll see that the sun is strongest in the summer months, especially from 10 a.m. to 4 p.m.

So, I'm not saying that you can't go outside then, but make sure you use a broad brimmed hat, and then also use an SPF 30 or greater that you reapply.

And then, if you're going to be out, and your arms and hands are going to be exposed, make sure you're wearing some longer sleeves, and even some gloves if you're going to be out gardening or doing something like that.

So, those are the big things.

And also, avoiding those short, intense bursts of sun exposure.

So, a lot of us, you know, in the winter we may go down south to Florida, or the Caribbean, or Mexico, and those are the times you really have to be careful, because your skin is most vulnerable; it's been wintertime here, you haven't been outside, you don't have any type of base tan, and you're going to be going and getting one of those intense bursts of sun exposure, so.

>>Lori Casey: So, if you have no history of skin cancer in your family, should you be checked anyway?

>>Dr.

Leone: Absolutely.

Absolutely.

And as far as genetics for skin cancer, per say, that is not a big risk factor, or as big as other things.

So, most of our patients that have skin cancer, in fact, have very little or no personal history or family history of skin cancer, so.

>>Lori Casey: You just have to keep watching, you know, and watch, you know, how your skin changes, and... >>Dr.

Leone: That's the big thing is just, you know, watch for those changing moles, and then, that's for melanoma.

And for any other spots, I tell people, most people come in and say, oh, I had a sore that wouldn't heal, it just kept bleeding, or a dot that started off as a pimple that just never went away.

So, those are the two most common things I hear for the basal cell and squamous cell cancer.

And another thing is just, you know, get a check one time.

Sometimes, we have free skin cancer screenings, but the best thing is come in and get your assessment of what your skin cancer risk is, because yours is not the same as your neighbors.

So, it's good to know.

I mean, you may not need a skin check every year, but you may need one every three to six months, depending on your history and how much sun exposure you've had, so.

>>Lori Casey: Okay.

Well, Dr. Leone, we're out of time.

We want to thank you for coming by Being Well today and sharing some great information with us.

>>Dr.

Leone: Oh, thanks for having me.

It was a pleasure.

[Music Plays] >>Kean: Chances are if you've had kids, you've had trouble getting them to bed.

They may want to be like grown ups and stay up late.

But now, doctors are finding that having a set bedtime can make a difference, especially when little ones get older.

It may not be the easiest thing to get your child to do, but scientists are finding that putting your little one to bed at a set time can help their attitude, both at home and at school.

>>Interviewee: Sleep is important for everybody, but especially for little ones, because it's so important for growth, in addition to learning, concentrating in school, and actually, for good behavior during the day.

>>Holly Firfer: A recent study in the Journal of Pediatrics found that children who went to bed at irregular times were more likely to have behavioral problems by the time they reached elementary school.

Researchers looked at data from more than 10,000 children and their sleeping behaviors at ages 3, 5, and 7.

They also looked at comments made by their mothers and teachers on that child's behaviors.

They found that, as they aged, children who went to bed at a certain hour had fewer problems in school than those who had no set bedtime.

And when parents switched their children to a more strict nighttime routine, the child's behavior improved.

For today's Health Minute, I'm Holly Firfer.

>>Kean: Pain, swelling, and stiffness in your joints all are symptoms of rheumatoid arthritis.

But because these symptoms come and go, the condition can be sometimes tricky to diagnose.

And it's important to get the right diagnosis because starting treatment early can make a difference.

>>Vivien Williams: Give me your best shot!

>>Holly Firfer: At first, Virginia Wimmer blamed her painful joints on too much volleyball.

>>Virginia Wimmer: In my knees and in my wrists.

>>Vivien Williams: For a couple years, she put up with the pain and swelling that would come and go.

Then, things got much worse.

>>Virginia Wimmer: I couldn't have a ball touch my arms.

>>Vivien Williams: She couldn't do much of anything, let alone play outside with her daughter.

Virginia Wimmer: That was really hard.

I, you know, she would beg me to play with her, and teach her, and help her, and I just had to sit and watch.

>>Vivien Williams: Virginia was diagnosed with rheumatoid arthritis.

>>Dr.

Manek: Rheumatoid arthritis is an inflammatory condition.

It's also associated with the immune system.

>>Vivien Williams: Dr. Nisha Manek says it happens when the immune system becomes deregulated.

You see, the joint capsule has a lining of tissue called the synovium.

The synovium makes fluid that keeps joints lubricated.

When you have rheumatoid arthritis, your immune system sends antibodies to the synovium and causes inflammation.

This causes pain and joint damage, especially in small joints in the fingers and wrists.

But it can affect any joint.

The good news is that treatment for rheumatoid arthritis has improved dramatically over the last years.

Medications such as methotrexate help bring the immune system back into balance, and steroids can help calm flare-ups.

So, what was once an often crippling disease can now be controlled for many people.

People like Virginia, whose disease is pretty severe.

>>Virginia Wimmer: You can get to the point where you are doing the things that you love, and that is the goal.

>>Vivien Williams: For Medical Edge, I'm Vivien Williams.

Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active managing stress, and regular check-ups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Additional funding by Jazzercise of Charleston.

[Music Plays]