Explaining vasectomies; lung cancer screening; hoarding's impact on families: Upstate Medical University's HealthLink on Air for Sunday, Dec. 31, 2023

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a urologist gives details about the vasectomy.

Timothy Byler, MD: ... Recovery is usually one to two weeks. Some men report a little longer, and some men tell me they played basketball the next day. ...

Host Amber Smith: A chest surgeon tells who qualifies for lung cancer screening.

Michael Archer, DO: ... There's good research to show that when folks are screened for lung cancer, we identify tumors earlier, and we are able to get patients treated to cure more frequently. ...

Host Amber Smith: And psychiatry researchers explain how hoarding disorder affects family members.

Luba Leontieva, MD, PhD: ... Most people know that they're hoarders. They may be very defensive in admitting that they are hoarding, they have hoarding problem, due to lots of shame associated with it. ...

Host Amber Smith: All that, and a visit from The Healing Muse. But first, the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, we'll learn about lung cancer screening. Then we'll explore hoarding disorder and its effects on family members. But first, what's important to know about vasectomy?

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

A vasectomy is a permanent form of birth control that appeals to some men. To understand what's important to know about this sterilization procedure, I'm talking with Dr. Timothy Byler. He's an associate professor of your urology at Upstate, and one of the things he specializes in is vasectomy.

Welcome back to "HealthLink on Air," Dr. Byler.

Timothy Byler, MD: Thank you for this opportunity, Amber.

Host Amber Smith: Do most of the men you see realize that a vasectomy is permanent?

Timothy Byler, MD: This is a big part of our first visit with men, is to ensure that they understand that it should be considered permanent. There's a lot of misconceptions about vasectomy and its reversibility. Lots of large studies have shown that it is reversible and has a very high rate of being successful.

However, I want to put some caution that this is in very experienced hands, and from major centers that do a lot of reversal. The majority of urologists do not perform reversal. In fact, in our department, one out out of 20 urologists does this procedure, so it's not something you can do everywhere. So we do emphasize that it should be considered to be a permanent procedure.

Host Amber Smith: If a man has a female spouse or a significant other, how often does that person have a say in whether the man has a vasectomy?

Timothy Byler, MD: We don't require a female partner or significant other to be present during the discussion, but certainly we emphasize that this is an important discussion that should be done with them.

Host Amber Smith: So this is not often offered to young men who haven't started families or haven't been in relationships?

Timothy Byler, MD: We highly encourage men, usually around age 25 or under, to wait because of the permanence. There was a large study recently performed that the average age was 36, and 4% were childless at that time. So that speaks to the volume of younger men.

Host Amber Smith: So mostly it's used for family planning.

Timothy Byler, MD: Yes, definitely.

Host Amber Smith: Well, let's talk about how a vasectomy is done. What's involved in the first appointment?

Timothy Byler, MD: The first appointment is really to gauge the patient's expectations and highlight the risks involved. Simple questions, like, why do you want a vasectomy, have you discussed this with your partner, as we've reviewed. I also take the opportunity to examine the patient and ensure that there's not going to be any difficulty in performing the procedure.

We screen for any kind of need for more than local anesthesia, and we'll get to that in just a minute, uncomfortability with the exam, anatomic changes that might influence the procedure. Some men do need additional workup prior to having a vasectomy. For example, they could be on certain medications that will increase the risk, and we screen for these kinds of issues.

We review that it is a permanent procedure and discuss the long-term risks associated with the procedure.

Host Amber Smith: You mentioned anesthesia. What are the options for that?

Timothy Byler, MD: Ninety-five percent of men do this under a local anesthesia, which means they're in the office, they're awake, and we just numb up the scrotum. There is a small subset of men that need additional anesthesia for various reasons. So we do have men that go to the operating room and have an actual anesthesiologist sedate them for it, but that's certainly the minority.

Host Amber Smith: So most of these are done as an outpatient or just in the doctor's office.

They come in like they would for an appointment, and they're able to go home soon after?

Timothy Byler, MD: Yes, the procedure takes about 20 minutes. We do recommend that you'd have a driver, but honestly, a lot of men are able to drive themselves home, because they're fully awake, and they're not sedated at all.

Host Amber Smith: Well, what does the surgery involve? What do you actually do?

Timothy Byler, MD: The patient is brought into the procedure room, and a nurse will prepare them. We use a cleaning solution on the scrotum and put sterile drapes around. We then numb up a small portion of the scrotum and make a small incision right in that area, and we grab the vas deferens (sperm duct).

This is often the hardest part for men. They can get sensations almost as if they had a hit to the scrotum. So they'll get sometimes nauseous, sometimes hot, even some stomach discomfort briefly, and that goes away as we free things up.

We then take a segment of the tube itself out, so it's in two pieces, and we put metal clips on each end and then put it back in.

That's the procedure.

Host Amber Smith: Does it leave a scar?

Timothy Byler, MD: Usually you can't find them at all. The incision is 1 centimeter (barely wider than a pencil), so it's very small, and the scrotum is very forgiving in the sense that it's folded, and the scar blends into it, so usually men cannot tell where they (the incisions) were.

Host Amber Smith: What is the recovery like? You said some men are able to just drive themselves back home, but what do they do after that? Are they supposed to take it easy?

Timothy Byler, MD: Yes. Recovery is usually one to two weeks. Some men report a little longer, and some men tell me they played basketball the next day, but generally speaking, it's somewhere between five and 15 days or so.

It's usually worse in the beginning. It's more swelling and discomfort, so we suggest, for the first few days, ice and rest. And as they feel better and better, they can ease themselves into full activity. Pain is usually very minor and on a Tylenol and ibuprofen level.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with associate professor of urology Dr. Timothy Byler about vasectomy.

Are there any physical effects on sexual drive or performance after a vasectomy?

Timothy Byler, MD: No, the vasectomy just removes the sperm from the semen. It does not affect testosterone level, sex drive or erections. There were some questions, and some men do ask me about the risk of prostate cancer or testicular cancer.

These have also been shown to not be affected by vasectomy.

Host Amber Smith: Does vasectomy have any impact or protection against sexually transmitted diseases (STDs)?

Timothy Byler, MD: Unfortunately, no. We still recommend barrier protection for STD prevention.

Host Amber Smith: What about those permanent clips you mentioned, that are left on the ends of the vas deferens?

Can a man feel those afterward? How small are they?

Timothy Byler, MD: They're also very small, but, yes, I do occasionally have men call me up maybe a year or two later and say they felt something, and they wanted me to check it out. It's usually the clip. It's small, but if you're really feeling above the testicle, you could feel a little bump where it is.

Host Amber Smith: How long after the procedure until the vasectomy takes effect?

Timothy Byler, MD: After a vasectomy, a man walks out of the procedure with a completely normal ejaculate. In other words, he could impregnate that day if he wanted. There is a lot of sperm beyond the point of the surgery that's performed. There's a high concentration in the prostate and the seminal vesicles, which are beyond that point.

So most studies show that 20 to 30 ejaculations are needed to clear that area of semen, and until that's done, they are still potent. We see men back around 12 weeks, because we assume that the first two, three weeks, let's say, they're not really sexually active, and then they'll need to do 20 to 30 ejaculations.

So we give them some time to kind of do that.

Host Amber Smith: You check after 12 weeks?

Timothy Byler, MD: Yes, and we encourage using protection in that in-between period.

Host Amber Smith: So please explain what may cause a failure of the procedure. I mean, this is supposed to be 100%, but sometimes there is a failure, right?

Timothy Byler, MD: Failure is actually very rare. It's under 1% of men with the modern methods that we use to block the tube. A lot of that stuff is historical, but yes, it still can happen.

Host Amber Smith: Is there anything that men can do to improve the chance of success for this procedure?

Timothy Byler, MD: The most important thing is to avoid ejaculation during the healing process. This allows the ends of the vas deferens to basically scar, so they don't leak sperm.

Once we have a vasectomy semen analysis at 12 weeks that is negative, the rate of something happening down the road is one in 2,000. This is pretty rare medically.

Host Amber Smith: I want to go back to, we talked about reversal and how challenging that procedure can be. If the ends of these vas deferens are separated, and they're missing a chunk in the middle, do they try to reconnect them in some way if you're trying to do a reversal? How is that done?

Timothy Byler, MD: Yes, a reversal is done by making a larger incision in the scrotum and finding the two ends and basically putting them back together, which is why it's fraught with failure. It's a very small tube. It doesn't take much to block it again, and there's parts of it missing.

Host Amber Smith: And so getting those reconnected and working is the goal, I guess, right?

Timothy Byler, MD: In a reversal, yes. we also know that over time, the reversal success rates will go down, so a guy one year out versus 10 years out, the 10-year guy will have a much lower rate of patency (clear passage) of the vas deferens because of exactly what we're talking about, further scarring and issues.

Host Amber Smith: So those little clips, I know they're very small, but do they set off metal detectors, or do you have to declare them if you have an MRI (magnetic resonance imaging)?

Timothy Byler, MD: Excellent question. No, they do not set off any kind of alarms. If you have a CT scan, they may show up as artifact on it, but that shouldn't influence any major imaging.

And no, they do not set off metal detectors.

Host Amber Smith: Can you go over the risks that you like to make sure that men are aware of before they have a vasectomy?

Timothy Byler, MD: Of course. I think the most important thing is to realize that it is surgery. I think a lot of men think of it as "I'm just having a vasectomy," but it is a surgical procedure, so it does carry with it surgical risk.

Immediate concerns would be bleeding and infection and swelling. Now, fortunately, these rates are very low. But even in very experienced hands, so over a hundred vasectomies done per year, the rate of bleeding was 1.6% in a recent study. So it does happen.

Long-term risk would be post-vasectomy pain syndrome, which does affect 1% to 2% of vasectomy patients. There's a lot of reasons for this, but it's very unclear what we can do to prevent it, so we can't really pick out who's going to be affected by it. So these are things I discuss with the men.

Host Amber Smith: Do most men say later on that they're satisfied that they had this procedure? I mean, years later, maybe you don't see them, but, do you have a sense that men are satisfied with this?

Timothy Byler, MD: Yes. I usually see men back somewhere between three and four months, and at that point, most men would not know they had it. They have no symptoms anymore. They have no scars. They have no sexual side effects. And when I see men that had a vasectomy in the past, it's an afterthought.

They're not really discussing it. It's like, "Oh yeah, I had one of those."

Host Amber Smith: When they go in for other things that are totally unrelated to urology, is this something that's important to let other medical providers know that they've had?

Timothy Byler, MD: I think it's important to always mention all of your previous medical and surgical procedures, but this has very little influence on non-urologic surgery.

Host Amber Smith: So when the men come in for their first appointment, they might want to have an idea of a time when they can be away from work or school for a couple of weeks to recover, is that right?

Timothy Byler, MD: Yes, this is something else we discuss in the first appointment. Mainly the guys that are doing more manual jobs. And you really need to think about the first couple of days, especially, like maybe one week. Often guys that have desk jobs can go right back to work, especially if they're working from home. There's nothing that would be barring them. I've had guys work from home, day of procedure.

Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Byler.

Timothy Byler, MD: Thank you.

Host Amber Smith: My guest has been Dr. Timothy Byler, an associate professor of urology at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

New guidelines for lung cancer screening -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Lung cancer remains the leading cause of cancer deaths in the U.S., and screening people who are at high risk for the disease is improving lung cancer survival rates. Recommendations for who should consider screening have recently been updated, so for help understanding whom this applies to, I'm talking with Dr. Michael Archer. Dr. Archer is an assistant professor of surgery at Upstate, specializing in chest surgery.

Welcome to "HealthLink on Air," Dr. Archer.

Michael Archer, DO: Thanks so much, Amber. I really appreciate you having me on.

Host Amber Smith: Now, the idea behind screening is that you can find and treat cancers early, is that right?

Michael Archer, DO: That's exactly right. We know, generally speaking, that cancers that are identified early have a much higher rate of cure. And so, as we've seen demonstrated for breast cancer and colon cancer, when we find those cancers early, we can do a much better job with providing folks a cure.

And, similarly, there's good research to show that when folks are screened for lung cancer, we identify tumors earlier, and we are able to get patients treated to cure more frequently.

Host Amber Smith: I'm curious about how fast lung cancers grow and at what point or what stage people might experience symptoms.

Michael Archer, DO: The short answer is they all grow at different rates, but, generally speaking, the doubling time for lung cancer is somewhere around 500 days, so it's over a year for it to double in size. But the reality is, is we want to find these things when they're a centimeter (less than half an inch), not when they're 5 centimeters or 7 centimeters.

And for those of you who don't deal with lung cancer all the time, those 5-centimeter, 7-centimeter tumors, those are big deals. And your question about symptoms: Again, the idea with screening is, we want to catch these things before they ever become symptomatic, because unfortunately, once somebody's having symptoms related to a lung cancer, that often means that the tumor's done something bad, right?

It's either grown into a chest wall, which can cause pain, or sometimes people end up coughing up blood, and that typically means the tumor's invaded some sort of structure that is going to make it more problematic to treat and very unlikely to be able to achieve a cure when we're getting into those much later stages of lung cancer diagnosis.

Host Amber Smith: OK, so who qualifies for lung cancer screening?

Michael Archer, DO: The U.S. Preventive Services Task Force has updated the recommendations for lung cancer screening. So it includes individuals who have smoked greater than 20 pack-years. And what a pack-year is, is we look at what you smoke per day. So somebody who smokes a pack per day, and has been doing it for 20 years, meets that criteria. They are considered a 20 pack-year smoker. And so, as you can imagine, not everybody smokes a pack a day. Some people smoke two packs, some people smoke a half a pack per day, and so we do that sort of calculation.

So it's a 20 pack-year history. Anyone who is between the ages of 50 and 80, and that recently dropped to include younger individuals, and then those who have quit within 15 years. So there is still some risk of lung cancer, even in those who have quit up to about the 15-year standpoint. And then once we get to 15 years, we think that we go back to our general risk of the general population.

So, 50 to 80 years old, 20 pack-years or greater and then, if you've quit smoking within 15 years.

Host Amber Smith: So among those people you described, or the categories, who is it the highest risk? Is it the person who has smoked the longest and the most, necessarily, or not?

Michael Archer, DO: So pack-year history, you can be 50 years old and still have a 100 pack-year smoking history.

We know that the more that somebody smoked and over a longer period of time, that absolutely increases the risk of lung cancer. And so within that group of individuals, we might say that those are the folks that we're trying to get to. But the reality is that even if you've smoked 21 pack-years, and you're just 51 years old, you're still at risk, right?

That's what the trials have demonstrated, and really the idea is, we want to get people in to get them cured of their lung cancer and not be in a situation like you had mentioned, where you're coughing up blood, or you're having chest pain, or we find out, long after we had a chance to cure something, that we can't.

So get people in early and really getting the word out has been the biggest hurdle that we've had, is just making sure that people know that lung cancer screening exists. I mean, we all know that breast cancer screening is there. Everyone knows to get their mammogram and to get their colonoscopies for colon cancer screening, but not everybody knows about lung cancer screening.

And platforms like this are incredibly helpful to inform not only patients, but other health care providers, that this is something that there's very good data to support -- lung cancer screening -- and that we are capable of really reducing the risk of dying from lung cancer.

Host Amber Smith: Now for pack-years: When you talk about a pack-year, does it matter what type of tobacco was smoked?

Michael Archer, DO: That's an interesting question. I think, generally speaking, the pack-year came from the fact that cigarettes are packaged in packs, and we all generally know how many cigarettes are in a pack.

Whether or not a cigar smoker or somebody who uses marijuana regularly, whether those folks are, in fact, at the same risk as somebody who smokes cigarettes, I don't know that we exactly know that. We know that smoking anything really can have some effect on the lungs.

And we know that the things that are packaged within commercially available cigarettes are carcinogenic, and we have very good data over a very long period of time to demonstrate that, whereas for things like marijuana and cigars, we probably don't have as strong a data.

So, as it pertains to the screening, it really does primarily select out cigarette smokers.

Host Amber Smith: The guidelines don't really talk about vaping because vaping's new, but for future 50-year-olds, is vaping as much of a risk factor as cigarettes?

Michael Archer, DO: That's a very interesting question as well.

I mean, things are so new about vaping, I don't think we know. Anecdotally, we've seen a lot of young individuals who have vaped, who've had lung injury that is not completely unrelated to lung cancer, but patients that have developed lung injuries to the point where they need oxygen, or they're in the ICU (intensive care unit) on the ventilator, and we think that this is a vaping-related phenomenon. And so clearly, inhaling anything other than ambient air is likely not good for your lungs. And I do worry about folks that are vaping in 2023 and what that might look like in 2073, right? I just hope that it's not as much of a risk maybe as cigarette smoking.

Because I think, initially, some lung cancer providers thought that it was a good way to get people not to smoke cigarettes anymore, so, "OK, you want to vape? Go for it." I know for my patients, I don't suggest that that's a good alternative, only because I've seen how vaping can kind of go sideways.

And so, I guess time will tell with that.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with chest surgeon Michael Archer, an assistant professor of surgery at Upstate.

What about the person who years ago, in college, say, smoked briefly? They didn't do 20 pack-years, they just smoked socially, maybe during college. They don't really qualify for the screening, it doesn't sound like, but is their risk still higher?

Michael Archer, DO: No. That's why we selected this group out, is because we know that there is certainly increased risk, and the highest-risk group of individuals for lung cancer are smokers, right?

But there are about 10% to 20% of lung cancers that are diagnosed will occur in never-smokers or nonsmokers, so that can be confusing to some people. And it actually leads to stigma amongst patients that develop lung cancer because everybody has this idea, "Well, I smoked for so many years, I did this to myself."

The reality is, is just like any other cancer, there are some cancers that are sporadic, and they'll come up just by chance. And as we age, you may develop those. And so, you smoke briefly in college, that person doesn't need to be screened for lung cancer. Really, we talk about anyone who smoked less than 100 cigarettes in their lifetime is really considered a never-smoker, right? That they're basically equivalent. And as it pertains to lung cancer risk, that 20 pack-year threshold is there for a reason, because we know that that's the inflection point where we really do need to be more concerned about the development of lung cancer.

Host Amber Smith: Well, you brought up nonsmokers. What about the nonsmoker who lived for many years with a heavy smoker?

Michael Archer, DO: Gosh, a great question. Again, the reason we were able to develop guidelines, from an institutional level and from a national guideline perspective, is that we had to create studies that were going to answer questions.

So the, biggest question that was posed to all of us was, we know that smoking is a risk factor for lung cancer. How can we identify these things earlier? So we had to kind of select out those folks that we thought were at the absolute highest risk.

So if you lived with a smoker -- you know, I grew up around a smoker, right? I don't sit around worrying about my risk, even though I know that I am probably, compared to the population that was never exposed to secondhand smoke, I'm at slightly increased risk of developing a lung cancer.

But as it stands right now, we don't have any data to suggest that we should be screening individuals who have a secondhand smoke exposure. Similarly, we have things that we know are carcinogenic for developing lung cancer. Things like radon and asbestos exposure. They're not included in the guidelines. And so, even though we know that that is a risk factor for developing lung cancer, it's not something that we can offer screening for right now.

Host Amber Smith: Well, I'd like to have you explain what's involved in the screening. First, it's paid for by health insurance, right? It's covered?

Michael Archer, DO: Exactly right. Both Medicare and Medicaid in the state of New York will cover lung cancer screening. Most private insurers will also cover it.

The screening process itself is really straightforward. There has to be a conversation about the risks and benefits of doing lung cancer screening, right? There's always a risk that we might identify other things or maybe a nodule that's not cancerous that might lead to a procedure, but that risk is pretty low.

The test itself, you show up to get a CT scan, the whole visit should take about 15 minutes, and the scan itself takes about two minutes, maybe even less to go through the CT scanner. You lay down on a bed, it slides you through a big doughnut, and you're out within a couple minutes.

Host Amber Smith: Are there concerns about radiation exposure from the CTs?

Michael Archer, DO: Not really. We've augmented the type of radiation and the type of scan that we do, so it's a lower-dose CT scan. There are other CT scans that are done for other medical problems that do provide a higher dose of radiation.

But for lung cancer screening, it's a reduced dose, and it's just slightly more than you would be exposed to for, say, a mammogram. So when we think about how ubiquitous mammography is in helping individuals identify early-stage breast cancers, similarly, there's not much additional radiation to doing a CT scan, a low-dose CT scan, for lung cancer.

Host Amber Smith: What happens if a suspicious spot is found?

Michael Archer, DO: So a number of things can be done and, typically, when we look at CT scans all the time for folks that have been screened for lung cancer, there are certain nodules that may be identified, which we know straight out of the gate: This looks like a lung cancer. It was identified in screening, so by definition we know we're dealing with somebody who is at high risk.

And there are certain instances where we might just want to get a couple of additional tests, and we might think about just going in to remove that spot for diagnosis and potentially as a therapeutic maneuver, so, to treat the lung cancer,

There are other instances where it might prompt a biopsy, which would be done under CT scan guidance. So a little needle would go in between the ribs and biopsy that nodule. There are other times where we look at the nodule, and it might not look like a lung cancer, it might look like an old infection or something that looks very benign appearing.

And in those situations, we would likely just recommend another CT scan at some sort of interval, whether that's three months, six months, or maybe even a year, depending on how suspicious or not that nodule looks.

Host Amber Smith: But that doesn't happen at the same visit when you come for the screening. That would be scheduled for later?

Michael Archer, DO: Exactly right. So typically, what happens is you have your scan, it does take a few days to get that scan interpreted and for those results to either get back to you or back to the ordering provider, whether that's your primary care doctor or your lung doctor. And then it does take some interpretation, and then we would inform you on what we think the most appropriate next step is, whether it's biopsy or maybe even a referral to someone like myself, who's a lung cancer surgeon, where we see folks, and we see these nodules all the time, and we understand the nuances between what these nodules look like and whether or not we need to do more invasive testing or maybe just get another CT scan.

Host Amber Smith: So, let's say that you do discover an early lung cancer. How might that be treated?

Michael Archer, DO: Early-stage lung cancers, there's really two modes of treatment to achieve a cure. And so if somebody has good lung function and good heart function, we typically think about doing an operation.

I won't get too much into the details of that, but typically these days we do that minimally invasively, with the robot, so several small incisions, and we remove the spot. Sometimes it's just with a small piece of lung, sometimes it requires a little bit more of the lung substance, but that can only be offered to somebody who has good lung function to begin with.

And as you can imagine, there's the association with smoking and lung disease, so COPD (chronic obstructive pulmonary disease) and emphysema. And so if somebody's showing up already on oxygen, or they're already having trouble breathing, putting them through an operation usually does more harm than good. Fortunately for those individuals, we can offer radiation at abbreviated doses over a shorter term, called stereotactic beam radiotherapy. And that treatment can provide a cure that in some individuals will be comparable to what they would achieve with a lung cancer surgery.

And so, even if your lungs aren't in the greatest of shape, and you're already having trouble breathing, there are still ways that we can provide a cure for early-stage lung cancers in those individuals as well.

Host Amber Smith: If someone has one lung cancer that's discovered, are they at greater risk for another? I'm getting at whether they need to continue the screening after.

Michael Archer, DO: So we know they certainly are. And that risk is about 1% to 2% per year to develop what we call a second primary lung cancer. And so, as part of any lung cancer treatment for early-stage cancer, it typically involves getting CT scans on a regular basis.

So, after a lung cancer surgery for an early-stage lung cancer, we do a CT scan every six months for the first two years, then every year thereafter up to five years. Unfortunately, some people don't quit smoking even after they've had a lung cancer, and so those individuals get re-enrolled in screening at that five-year mark, and if we get to the five-year mark, and we don't identify another lung cancer, typically at that point, we think as long as somebody's quit smoking, we typically don't have to continue to follow them after that five-year mark, although some people would choose to do that. It's partially based on patient preference, and sometimes, just the type of lung cancer it was might drive us to maybe follow somebody along a little bit longer.

Host Amber Smith: For the more advanced lung cancers. in terms of treatment, do you ever remove the lung? Would that remove the cancer?

Michael Archer, DO: There are still rare instances where we will find cancers that are either large or in a particularly precarious position within the lung, that it might require removal of an entire lung. That's called a pneumonectomy.

A pneumonectomy by itself is kind of a big operation to go through and can really only be offered to really fit individuals. So again, the idea behind screening is that we're hoping to catch these things beforehand.

What we know now is that we have some more tools in the toolbox for lung cancer. So, whether it's chemotherapy or immunotherapy, there are certain strategies that can be used to maybe make a tumor that's big maybe a little bit smaller, to be able to get that out, but without having to remove the entire lung. But a few times a year, we'll still remove someone's entire lung, and as long as you choose the right person, living with one lung is certainly doable.

Host Amber Smith: Are you surprised, as a physician and a lung surgeon, or a chest surgeon, are you surprised that lung cancer kills more people than breast, colorectal and prostate cancers combined?

Michael Archer, DO: Unfortunately, I'm not. I'm not surprised by that. And I think if you just drive downtown, or you're out on a weekend, you see the number of people that, despite years of hearing about the ill effects of smoking, I mean, people still do. And I totally get it. I mentioned earlier, I came from a family that had smokers in it, and I know how difficult it can be to quit. But it doesn't surprise me because we've had such incredible uptick in colon cancer screening, prostate cancer screening, breast cancer screening.

It's become something that you go to your family doctor, and you're, "Oh, have you gotten your colonoscopy yet?" It's on the forefront of everyone's mind. But when it comes to lung cancer screening, it hasn't had the same uptake. I mean, the screening rates are abysmally low, not only nationally, but even in the state of New York, somewhere in the 5% to 6% range for patients that are actually at risk.

And, some of that revolves around this nihilistic approach that says, "I've smoked for so many years, I'm bound to get lung cancer. Why should I look for it? I've done this to myself, right?"

And the reality is, we know that smoking's a risk, but you haven't done this to yourself, right? And it doesn't mean that it has to be a death sentence just because you've partaken in cigarette smoking, right? And so trying to break that stigma down, that it's OK to get screened for lung cancer, it's OK to have been a smoker and have a lung cancer, that we're here to hopefully find these things early and get folks treated, so they can live long and healthy lives after their diagnosis.

We want to avoid people getting into the situations that we mentioned earlier, where they're sitting at home, and next thing you know, they're coughing up a bit of blood or something like that, that even smokers will tell you it's a scary thing to happen. And if we can avoid doing that, it's probably better for folks, not only from a psychosocial standpoint, but certainly from a medical standpoint and an ability to achieve a cure.

It's certainly better to find these things smaller.

Host Amber Smith: You mentioned the low rate of people actually getting the screening. Do you think if half or two-thirds of the people who are eligible for screening actually got screened, do you think that could have an impact on survival rates so that lung cancer wouldn't be the biggest cancer killer?

Michael Archer, DO: No doubt. Over time we've seen anti-smoking campaigns and restrictions placed on cigarette smoking that have helped curb that overall trend of lung cancer-related deaths. But it's still, as you mentioned, it's still the cancer that tends to get folks.

I think if we were able to increase screening, that those numbers would drop fairly quickly. It's just we are way behind, and we need to do better from an institutional standpoint. And I work with New York state and the American Lung Association and the American Cancer Society. We're all very motivated to get the word out about lung cancer screening because that's our overall goal. If I could get rid of lung cancer tomorrow and not have to do another lung surgery related to lung cancer, I'd actually be pretty happy about that.

I think that'd be great.

Host Amber Smith: Well, Dr. Archer, I appreciate you making time to explain these new screening guidelines. Thank you.

Michael Archer, DO: No problem. Thanks for having me.

Host Amber Smith: My guest has been Dr. Michael Archer, an assistant professor of surgery at Upstate specializing in chest surgery. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air" -- the impact of hoarding disorder.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

The constant accumulation of clutter in a person's home can lead to depression and suicide ideation. Today I am talking about hoarding disorder and its effects on family members with two experts from Upstate's, department of psychiatry and behavioral sciences. Dr. Luba Leontieva is an associate professor and Dr. Anureet Sekhon is a medical graduate from India and a clinical observer.

Welcome to "HealthLink on Air," both of you.

Anureet Sekhon, MBBS: Thank you. Thank you for having us.

Luba Leontieva, MD, PhD: Thank you.

Host Amber Smith: Some people may not realize that hoarding is an actual mental disorder, so can you tell us how this disorder is defined, Dr. Sekhon?

Anureet Sekhon, MBBS: Sure. Hoarding disorder is a mental health condition in which a person feels a strong need to collect and store a large amount of items, regardless of their monetary value or usefulness. And any attempt to get rid of these items, it causes them significant distress. That distress is to an extent that it impairs their daily functioning.

Host Amber Smith: And how common is this?

Anureet Sekhon, MBBS: According to the studies, approximately 2% to 6% of the population of the states suffers from this disorder.

Host Amber Smith: And of those 2% to 6%, do you have an age range or a race or gender breakdown?

Anureet Sekhon, MBBS: Hoarding disorder is more common in older adults, like, above the age of 55 years, as compared to younger adults ranging from the ages of 34 to 44 years. But it can occur in younger ages as well.

As far as the gender is concerned, it appears to affect both men and women at the same rates. And it is believed to be a universal phenomenon, with consistent clinical features in all races, ethnicities, and cultural backgrounds, around the world.

Host Amber Smith: And Dr. Leontieva, did you have something to say about how common compulsive hoarding is?

Luba Leontieva, MD, PhD: Yes. Actually, I think that this is under-reported. Probably a lot of people saw a show, "Hoarders." It's reality tv. And there it says 19 million Americans are hoarders, which constitutes 6%. But my belief is that it's under-reported.

Host Amber Smith: Well, there's a lot of shame kind of tied up into that, and I know we're going to talk about that. Do people who are hoarders know that they're hoarders?

Luba Leontieva, MD, PhD: Yes. Most people know that they're hoarders. They may be very defensive in admitting that they are hoarding, they have hoarding problem, due to lots of shame associated with it.

Host Amber Smith: Are there symptoms to look out for?

Luba Leontieva, MD, PhD: Yes, as Anureet described, the inability to discard items and acquiring more and more items is the first symptom, cluttered living space to the point of hazard.

Host Amber Smith: But a lot of people, maybe collect certain things, or maybe they stock up on things when they're on sale at the store. Where do you cross the line into hoarding?

Luba Leontieva, MD, PhD: So the collections are not hoarding, because a lot of people collect various items. The hoarding is when the accumulated stuff is so much that it's to the point of people unable to move around in the house.

The various appliances are not functioning. The garbage accumulated. And this is very different from somebody who is collecting, say, baseball cards or something. They have a collection and that's nothing wrong with that.

Host Amber Smith: So it starts impacting their life, it sounds like?

Luba Leontieva, MD, PhD: Yes.

Host Amber Smith: Now, the two of you wrote a paper that focused on the family members of hoarders and the severe impact it can have. I'd like you to tell us about that. Dr. Sekhon, what were the living conditions, in the home that you focused on?

Anureet Sekhon, MBBS: The living conditions at home as described by the patient were unlivable. So he told us that hoarded possessions formed piles of material that reached the levels of countertops or even higher.

He expressed concerns that their home was no longer a safe place for both of them to live. He indicated that he faced difficulties navigating within the house, and the entrances were blocked. The shower was inaccessible. And the workspace was overwhelmed with boxes and miscellaneous items that occupied all the available living space.

Host Amber Smith: So this is a situation with a couple, the husband living with the wife who was the hoarder. Did the husband try to help his wife stop hoarding?

Anureet Sekhon, MBBS: Yes, several times. He mentioned that he made many efforts to persuade her to recognize the issue, but she appeared unable to fully comprehend it.

Like, she would often provide justifications and even occasionally she expressed the willingness to initiate a change, but she consistently struggled to follow through. Most likely it was due to her emotional distress that was it associated with parting with her things.

Host Amber Smith: Would you say it's typical that a low level of hoarding is ongoing for years before it builds up to the point where things are unlivable?

Yes. Oftentimes that is the case. So the initial symptoms often start showing during teenage or early adult years. And hence they're followed by a chronic course after that. So the slow progression of the disorder, it also makes it difficult to diagnose it in early stages. Is there something that makes it escalate? Is there an event or something that happens that suddenly make something that was quasi-manageable, become unmanageable?

Anureet Sekhon, MBBS: Mm-Hmm. Yeah. Stressful and traumatic life events, they can trigger hoarding behaviors. For example, death of a loved one, divorce, or having lost your possessions in a fire, something like that.

Host Amber Smith: Dr. Leontieva, can you tell us, how was the husband cared for?

Luba Leontieva, MD, PhD: The husband was cared (for) with psychiatric admission, medications and psychotherapy.

Host Amber Smith: So this impacted him enough that he needed treatment?

Luba Leontieva, MD, PhD: To great extent. Correct.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Luba Leontieva, who's an associate professor of psychiatry and behavioral sciences at Upstate, and Dr. Anureet Sekhon, who's a medical graduate from India, and a clinical observer at Upstate.

Your paper says that multiple family meetings were held with the wife present, where she promised to clean and declutter, but she never did. Is this typical, and if so, why?

Luba Leontieva, MD, PhD: Yes, this is actually very, very typical for hoarders to be unable to part with their possessions. The hoarding condition is what we call in psychiatry "ego-syntonic," meaning that the hoarders themselves are fine with the hoarding habit. Usually when it comes to motivation to declutter the space, it's the external forces that apply to them.

For example, the house is in such a bad condition that it's about to be foreclosed. Or the landlord is evicting the particular individual who has a hoarding disorder. Or the spouse is threatening to leave. Or the children are threatened to be taken by the CPS (Child Protective Services.) So it's almost always some other external forces that are being applied to the person who is hoarding to motivate the person to do something with this.

Host Amber Smith: Let's talk about the effects of hoarding on the health and well-being of family members. Dr. Sekhon, what do you see? ,

Anureet Sekhon, MBBS: Hoarding disorder can cause a lot of problems for family members as well as the hoarders themselves. First of all, the accumulated items, they can lead to inaccessibility of daily-use spaces like bathrooms and kitchens and workspaces. And then in regard to physical health, clutter can create tripping hazards, leading to severe injuries. It can even increase the risk of fires due to blocked exits and electrical issues.Hoarder homes may lack proper sanitation and hygiene. Hoarded food items may rot, posing health risks. They may attract pests, leading to unsanitary living conditions. And clutter can lead to moisture buildup and mold growth.

And, coming to the mental health problems associated with it -- hoarding can cause anxiety, shame, and emotional distress among family members, causing strained relationships within the family. Hoarders, they may avoid inviting friends and family over due to shame related to the disorder, and that can lead to social isolation, which can further lead to depression.

Host Amber Smith: Well, some of this is explored in that TV show, "Hoarders." It's been on for 14 seasons, and the episodes are two hours long, focusing on someone who's struggling with hoarding tendencies and working with experts or friends and family to try to reclaim their lives. Dr. Leontieva, why do you think this show is so popular?

Luba Leontieva, MD, PhD: Well, it's reality TV, and people like to watch something that other people go through. It displays a great suffering from individuals and a horrible condition that they live with. But also in this series, the conditions often improve with intervention.

Host Amber Smith: So what advice do you have for hoarders and for their loved ones?

Luba Leontieva, MD, PhD: Well, the advice is that there is help out there. There is cognitive behavior therapy, which helps to start to take actions to declutter and prevent accumulation strategies. Many orders have organizational problems, inattention and past traumas, so therapy and medication management can help with that.

Host Amber Smith: Adult Protective Services and code enforcement didn't seem to offer any help in the case that you wrote about. Is there any agency that can help, that can step in? And I know it's different from state to state, but what would you advise people in New York?

Luba Leontieva, MD, PhD: Well, there should be an agency that helps with that. We just couldn't get to them. And, it is very unfortunate that the code enforcement and Adult Protective Services were not helpful and didn't have any teeth. Even if the house where the hoarder resides is a private house, still it can be a hazard for not only a person who is living there, but the neighbors because, God forbid there is fire or somebody fell and couldn't get help.

It's a tragedy. So I think that it should be help from the government authorities such as code enforcement and Adult Protective Services, but also a cleaning service available.

Host Amber Smith: Well, in this case, this gentleman, pleas and threats didn't work for him. Are there other strategies you might suggest that someone in this situation try?

Luba Leontieva, MD, PhD: The gentleman that we wrote (about) and his terrible family situation was really a sad example that when there is no other family members around that can reinforce the help that (is) needed, it is very hard to accommodate. It's very hard to help the person to get the message through that the situation needed to be helped. Some houses were foreclosed because the loan and mortgage is not paid. And some apartments, again, the person can be evicted. It wasn't the case in our gentleman and the description of this distress that it caused by the wife hoarding.

Host Amber Smith: Well, if hoarding is a mental diagnosis, what would happen if the hoarder was away from the home and a bulldozer came in and just took out all of the clutter? Would that fix the problem?

Luba Leontieva, MD, PhD: No. It will create a lot of anxiety, and I don't think that this is legal to bulldoze. But it'll create a lot of anxiety in the person who is a hoarder. The best scenario is to have a psychologist and a very skilled crew that can help a person to start making changes. And then the supervision is very important, as a follow-up.

Host Amber Smith: Is there anything like a 12-step program like Alcoholics Anonymous has for hoarders who are trying to get help?

Anureet Sekhon, MBBS: Yes. There is a 12-step program called Clutterers Anonymous for hoarders, just like there is for alcoholics. It forms a support group that guides members through a series of steps designed to help them gain insight and take responsibility and work toward recovery.

The only requirement for this membership is the desire to stop cluttering. So if someone with this disorder desires to stop cluttering, they can sign up for this program and get the required help.

Host Amber Smith: That's good to know. Well, thank you both for sharing information about this case. I appreciate it.

Anureet Sekhon, MBBS: Thank you for having us.

Luba Leontieva, MD, PhD: Thank you very much for having us.

Host Amber Smith: My guests have been Dr. Luba Leontieva, who's an associate professor of psychiatry and behavioral sciences at Upstate, and Dr. Anureet Sekhon, who's a medical graduate from India, and a clinical observer at Upstate.

I'm Amber Smith for Upstate's "HealthLink on Air."

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Leah Johnson is the author of "Bindweed," published by Cherry Grove Collections in 2021. The poem she sent us is called "Trauma," and it captures the steady horror of living in pandemic times when we cannot relax our vigilance.

"Trauma"

A squatter in the landscape

of the body, this beast. This echo

from childhood. The well-loved child

unsafe at home, unsafe at play.

And the habit of vigilance learned

so early is exhausting. I drag

the days and nights of pandemic

and deaths and riots, politics

and murders and insurrection,

the noise of the news. The incessant

noise. We wonder why we feel dread

gnawing at the edges of our beings.

Wonder what is this bitter flavor?

And I remember. It's the scent

of the beast in our mouths.

Jacqueline Jules is the author of "Manna in the Morning" from Kelsay Books 2021. Her poem "Every Death" asks us to consider what part we all play when spreading misinformation and demonizing anyone who disagrees with us.

"Every Death"

Should I be sad?

Watching a father of five, filming himself

from a hospital bed, pleading with others

not to make the same choice he did.

Does he deserve my grief

when he had the chance

to trust the truth as I see it?

My Facebook feed isn't filled

with posts tempting me to take

a drug meant for horses and cows

But I'm guilty, too,

clicking on headlines

to confirm my opinions,

seeking spaces

where my own thoughts

are echoed.

When chemo failed,

we tried everything

from onions to turmeric.

Every death,

preventable or not, leaves

loved ones gasping for air.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air," same-day hip and knee replacements.

If you missed any of today's show or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel.

This is your host, Amber Smith, thanking you for listening.