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Autism (transcript)
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(ANNOUNCER)                     

Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association; an association of independent, locally-operated and community-based Blue Cross and Blue Shield companies, supporting solutions that make safe, quality, affordable healthcare available to all Americans.

 

(ANNOUNCER)

Second Opinion is produced in association with the University of Rochester Medical Center, Rochester, New York. 

 

(MUSIC)

 

(DR. PETER SALGO) 

Welcome to Second Opinion, where you get to see firsthand how some of the country’s leading healthcare professionals tackle health issues that are important to you.  Now each week our studio guests are put on the spot with medical cases based on real life experiences.  By the end of the program, you’re going to learn the outcome of this week’s case and I hope you’ll be better able to take charge of your own healthcare too.  I’m your host, Dr. Peter Salgo, and today our panel includes Dr. Susan Hyman of the University of Rochester Medical Center, Dr. Catherine Lord of the Institute for Brain Development, New York Presbyterian Hospital.  Special guest, Tom McGurk, Dr. Gary Stobbe of the University of Washington Medical Center, and our Second Opinion primary care physician, Dr. Lisa Harris of Rochester, New York.  Welcome back, Lisa. 

 

(DR. LISA HARRIS)

Thank you.

 

(DR. PETER SALGO)

Let’s get to work, shall we.  Let me tell you about our patient today.  His name is Harry.  Harry is six years old and he’s in his pediatrician’s office with his parents.  Harry is having a difficult time adjusting to kindergarten.  His teacher describes him as very smart. These are quotes from the chart.  And one of her top readers but she says he’s difficult to manage.  He fixates on the wrong things.  He’s moody.  He has trouble getting along with his classmates.  It turns out Harry has never been in daycare.  He’s never been in nursery school, so his teacher and his parents thought at first he just needed some more time to adjust to this new environment. But four months have gone by and he doesn’t seem to be making any progress.  In fact his teacher says he is, and this is another word directly from the chart, regressing both in the classroom and at home.  And the teacher then says Harry may have attention deficit disorder.  You’ve got to take him and get him some drugs.  I think she used the word medication.  Lisa, what do you think?  He’s in your office.

 

(DR. LISA HARRIS)

So any child that is not being managed appropriately in the classroom whether because of classroom management from the teacher or because of other issues has been labeled with attention deficit disorder.  So we get a lot of referrals with parents bringing kids in asking for them, asking for medication because someone has suggested that they have attention deficit disorder.

 

(DR. PETER SALGO)

Lisa, Harry’s pediatrician, she says it’s too soon to consider any medication and she refers Harry and his parents for a diagnostic workup.  And this included a neurologist, a speech therapist, and a psychologist.  Now after all of this, all these experts see Harry.  They schedule a follow up appointment with their pediatrician, Lisa, and they learn that based on the evaluation of all of these folks Harry has been diagnosed with autism, specifically Asperger’s Syndrome. So first of all why don’t we get some definitions out of the way?  What’s autism?

 

(DR. GARY STOBBE)

Well autism is a condition that is involving the development of the brain.  And what we see is we see a developmental pattern in which the social and language development goes astray and is not developing on a correct trajectory.  And in addition to the language and social deficits that we see, we see also an unusual pattern of developing repetitive behaviors and restricted interests.  And it’s these three components, the language and communication, the social and the repetitive behaviors and restricted interests that we have to see for the diagnosis.

                       

(DR. PETER SALGO)

And Asperger’s, which was apparently given to them as form of autism, how does that differ from autism?

 

(DR. CATHERINE LORD)

Asperger’s is a term used to describe children and adults who have autism who don’t have language deficits.  So many kids and adults with autism have language problems and some of them get better.  A lot of them get better but Asperger’s was really coin to describe people that have never had language problems and have at least average intelligence. 

 

(DR. SUSAN HYMAN)

But the language problems are subtle.

 

(DR. CATHERINE LORD)

They are subtle.  That is true.  In fact people with Asperger’s Syndrome still do have pragmatic language problems.  That means problems carrying on conversations or they may choose unusual words.  They may say things in a more formal fashion. 

 

(DR. PETER SALGO)

This sounds like a very complex subtle diagnosis to make.  Is it hard to make this diagnosis?

 

(DR. GARY STOBBE)

Sometimes it is.  I mean sometimes a case that this that presents at age six, you know really the problem isn’t seen until you put the child into the social environment.  There are a variety of forms which is very confusing for people.  And we see some kids that presented very young age, age one-and-a-half and two where you can see these repetitive behaviors and it becomes very apparent early.  And you see other cases like this one that are more subtle.

 

(DR. PETER SALGO)

He’s six, six-and-a-half, six years old. 

 

(FEMALE VOICE)

Yes.

 

(DR. PETER SALGO)

Don’t his parents have a hint something?

 

(TOM MCGURK)

I find it hard to believe at six that they wouldn’t have seen something. 

 

(DR. SUSAN HYMAN)
Actually for the kids with the highest functioning it is not unusual.  The main age of diagnosis for Asperger’s Syndrome is probably early school age. 

 

(DR. GARY STOBBE)

Right.  And if you have a kid that is, let’s say an only child and hasn’t gone to preschool, he really hasn’t had a lot of opportunity to see the difference between the other kids development. 

 

(TOM MCGURK)

That’s how my wife knew, because we were at a Pep’s Group in Seattle.

 

(DR. PETER SALGO)

What’s a Pep’s Group?

 

(TOM MCGURK)

Pep’s is a.

 

(DR. PETER SALGO)

We should make it clear.  You’re a dad.

 

(TOM MCGURK)
I’m a dad.

 

(DR. PETER SALGO)

You have a child who has a problem.

 

(TOM MCGURK)

Who has autism, that’s his diagnosis.  Yeah.  But a Pep’s Group is a group of moms who all basically have their babies around the same time so they get together to support each other and stuff.  And the kids develop and they develop friendships over time.  So my wife was watching our son develop and all the milestones that all our friends’ kids were hitting he wasn’t and she was seeing that.  And she was saying to me there’s something going on here and I would say there’s nothing wrong with my son.

 

(DR. PETER SALGO)

Well Tom how old was your child?

 

(TOM MCGURK)

Two-and-a-half.

 

(DR. PETER SALGO)

Two-and-a-half, so pretty young actually. 

 

(TOM MCGURK)

We had a really good pediatrician who basically said get him into speech therapy. Once he was in speech therapy I was still massively in denial.  And my wife was not.  So the speech therapist called us in one day after hours and she said I need to talk to you guys.  And sat us both down at a table and I will never forget this for as long as I live.  She looked at me and she said, Mr. McGurk, do you think your son is going to go to college?  And I said, of course my kid is going to go to college.  She leaned in and said then spend all the money now.  Like that.  But it was the punch in the stomach that I needed to get me out of the world of there’s nothing wrong with my kid to I have to start working with him now.

 

(DR. PETER SALGO)

Tell me more about this.  I mean a punch in the stomach.  First of all was that the only diagnostic procedure that your son had?

 

(TOM MCGURK)

Oh god, good lord, no.  He went to the CHDD, which is over at the University in Washington. 

 

(DR. PETER SALGO)

What is CHDD?

 

(DR. GARY STOBBE)

It’s a center at the University of Washington that does diagnostic evaluations. 

 

(TOM MCGURK)

And that was an all day event.  It was actually two days. 

 

(DR. PETER SALGO)

What kind of tests do they do?

 

(TOM MCGURK)

Everything.  You had psychologists there, a regular physician, neurological workup, and then at the end of the day they say come back tomorrow and we’ll talk to you.  You sit at a table that’s probably twelve feet long with seven doctors looking at you at the other end and they look at you and say well it is our opinion that your son has autism. 

 

(DR. GARY STOBBE)

I think it’s important; an important part of that story is that this diagnosis is based on a clinical evaluation.  It’s not based on a blood test.  I mean I wish we had an x-ray or a blood test.

                       

(DR. PETER SALGO)

Tell me more about this evaluation.

 

(DR. GARY STOBBE)

Well the evaluation is observing behavior and then also getting a very accurate and detailed history of developmental patterns.  So it’s really that combination of this historical aspect of development along with what we observe in the clinic.  And the observation is looking at behaviors such as eye contact.  Does the child turn to and reference the parent and reference the person that’s talking.  Does the child share in events like if you have a toy and do they share in the enjoyment of the toy.  Do they form a triangle between the object and the person and themselves and what’s called joint attention?  And so there are these particular aspects that are looked at and this is a process that is, I think to a parent, it’s a little bit unsatisfying because you want that more objective piece of data. 

 

(DR. SUSAN HYMAN)

One of the other things that comes into this initial evaluation that goes into this full day is thinking about it dimensionally.  That it’s not autism that you’re looking at.  You’re looking at intellectual ability, language ability, motor ability, whether or not there’s also ADHD and all these things affect how this front of autism might present. 

 

(DR. LISA HARRIS)

Absolutely.

 

(DR. SUSAN HYMAN)

And I’m sure it’s overwhelming.

 

(DR. PETER SALGO)

So as devastating as that news was to you.

 

(TOM MCGURK)

And it was.  It was the worst day of my life probably. 

 

(DR. GARY STOBBE)

This is a big blow for a parent.  I mean you’re basically taking their view of the future and erasing it. 

 

(TOM MCGURK)

I didn’t realize.

 

(DR. GARY STOBBE)

And really not replacing it with anything.  You’re not; you know the providers at this moment in time aren’t telling you what’s going to happen with my child.

 

(TOM MCGURK)

I went to see a speaker and it was a guy who was forty-five who had autism and he had been to college.  And even now starting to feel something because after he spoke I realized Connor was seven at that time.  That was the first time since he was two-and-a-half I had allowed myself to picture his future beyond the next day because for the first two years I was in how do I fix him mode. 

 

(DR. PETER SALGO)

To put a button on this, autism is the word you heard.  Asperger’s has come up in this group.  Would you have used autism or Asperger’s here for a child who’s verbal?  A child who’s reading? 

 

(DR. GARY STOBBE)
I think the parent needs to understand that Asperger’s is a form of autism, so I got in the habit of using both terms. 

 

(DR. CATHERINE LORD)

And I think the general proposal is to just have Autism Spectrum Disorders.  I think there’s a place for Asperger’s in the sense of self advocacy.  I think in terms of describing.  But the trouble is that it’s not a fixed category.  I mean kids move in and out, so it seems to make more sense to just say there’s a whole spectrum.

 

(DR. PETER SALGO)

Everything I’m seeing, everything I see in the popular press says it’s on the rise. There’s a lot more autism now than there was.  Is that because we’re getting better at doing what you do, for example, in diagnosing it or do you guys really think there’s something more to autism out there?

 

(DR. GARY STOBBE)

Well it’s definitely being influenced by awareness. So our awareness, the age of diagnosis has gotten to a younger age so we do a better job of identifying it.  We’ve educated pediatricians better so they recognize it. 

 

(DR. PETER SALGO)

After leaving the pediatricians office, you know where I’m going with this.  Harry’s parents throw themselves into researching autism and their first question is why.  What causes autism?

 

(DR. SUSAN HYMAN)

If you think about autism, it’s a multi-genetic trait, multi-genetic disorder where you’re inheriting some genes from one side of the family and some genes from the other.  You have a critical mix of predisposition that in the face of environmental factors that turn these genes on and off you get a pattern of behavioral traits.  And that’s why it’s so heterogeneous.  Why it’s so different.

 

(DR. PETER SALGO)

But we’re seeing a lot more autism.  We’re vaccinating all our kids. 

 

(DR. GARY STOBBE)

Right.

 

(DR. PETER SALGO)

You know that this vaccine strongman was going to come up.  Can we put this one to rest?

 

(DR. SUSAN HYMAN)
I’m wearing my Academy of Pediatrics hat.  The evidence does not support vaccines but I’m a true believer that there are environmental factors.

 

(DR. GARY STOBBE)
I think when you look at the onset of autism when it typically, when you typically start to notice it around eighteen to twenty-four months.  And especially a group of kids with autism that have what we call the regressive form of autism where they actually lose language.  You can understand why parents would be fearful about vaccines because we are giving so many more vaccines at that, at that age.  And also we have not come up with a good answer to replace the fear.  We haven’t been able to say here is the cause. 

 

(DR.  PETER SALGO)

But I got to tell you.  I heard one I’m going to put on my American Academy of Pediatrics hat.  That’s a political out.  I don’t want to hear it if I’m a parent.  I don’t want to hear what the consensus group thinks.  And then I heard I don’t know what causes but I do know it isn’t that.

           

(DR. GARY STOBBE)

See here’s my problem with this discussion, is that this takes us away from the real work.  You know and this is what I get afraid of is, you know again, because I can’t give that answer you have the parent then that’s spending two hours on the internet when they need to be spending those two hours on the floor interacting with their child. 

 

(TOM MCGURK)
And it is the truth.  It’s time is the most important thing with these kids.  Time.

 

(DR. PETER SALGO)

So you get to spend time drilling backwards or time going forward.

 

(TOM MCGURK)

You have to take the realization, I mean as a parent you come to the realization that your life has changed like any other diagnosis forever. 

 

(DR.  PETER SALGO)

Let me just pause for a minute.  Let’s try to sum up what we’ve talked about, just a little bit anyway.  Autism Spectrum Disorder is a range of complex neurodevelopment disorders.  It varies widely in severity and symptoms and may go unrecognized, especially in mildly effected children. Getting an accurate diagnosis requires a comprehensive evaluation from a multidisciplinary team.  And that’s what your son had.  Well we’re here today and we are discussing Harry.  Harry is six years old.  He’s recently been diagnosed with Autism Spectrum Disorder.  What is on the forefront?  What are we doing now for treating autism?  Where do we even start?

 

(DR. CATHERINE LORD)

Well I think that there are a number of interventions that start very early and that involve both directly working with the children and also working with parents.

 

(DR. PETER SALGO)

What is this applied behavioral analysis about?  We keep hearing about that.

 

(DR. CATHERINE LORD)

That’s the idea that you can teach a child if you do something, something good will happen.  And so that good thing ideally is part of the environment.  You figure out if I put this object in this toy something fun happens with the toy.  Or if I throw a ball to you you’ll throw it back to me.

 

(DR. PETER SALGO)

What about medication?  I mean everybody wants a magic pill right?  Does medication work?

 

(DR. GARY STOBBE)

We have medications that work effectively at treating certain symptoms that are associated with Autism Spectrum Disorders but we don’t have a medication currently that truly gets at the core deficits. 

 

(DR. PETER SALGO)

You know what I’m hearing.  I’m hearing I’m going to play with Connor.  I’m going to play with Harry.  And we’re going to teach him to focus better or maybe to interact better with me.  Or I’m going to give him medication to help take care of some of these other associated symptoms.  What about peer interaction?

 

(DR. GARY STOBBE)

It’s critical.

 

(DR. SUSAN HYMAN)
It’s critical.

 

(TOM MCGURK)

It’s huge. 


(DR. SUSAN HYMAN)
It’s huge.  And I think that, you know, in talking about this it’s not just play.  That these are children who’s brains don’t see that social reciprocity so you actually have to teach the underlying –

 

(TOM MCGURK)

Yes.

 

(DR. SUSAN HYMAN)

– components that go into language and go into pretend and go into play.  It’s not just saying oh go home and play with your child.  There’s a very scientific approach to building skills. Someone like Harry who’s in a school program, the educational team will want to put in a more socially based set of skill development so that he can go to college and work in the community.

 

(DR. PETER SALGO)

Can you.  Can you give me an example?  I mean I heard socially based but I don’t really know what that means.  What is a social?  Tell me about it.

 

(TOM MCGURK)
I’ll tell.  You’ve touched on a huge thing that is very important.  It takes a village.  These kids are not going to be fixed easily.  If people really want to address this situation and this problem, you are going to have to have community involvement.  When you get a child who gets diagnosed with autism the family tends to draw close together. They start to try and help the child out but what do you really need.  The kids in the neighborhood to come over and model typical play behavior with that kid and allow him to be on the fringe for a time.  Draw him in when he wants to play.  Let him go out when he’s not comfortable because of his sensory issues.  There’s a whole boatload of stuff that goes on there with that kid that you’ve just got to let him be but also try and bring him in.

 

(DR. PETER SALGO)

Diet?  Does diet play a role?

 

(DR. SUSAN HYMAN)
I don’t believe that diet plays a role in the way that many people commonly believe.  I believe that any intervention in autism or any other disorder needs to have an evidence base.  And we’re at a point in society where there’s this conflict between belief and evidence and that, you know, sitting around this room.  We’re believers in evidence. We’re believers in you can test a theory and see if it works.  And to date there are aspects about diet and autism that have been tested and don’t work but retain common belief. 

 

(DR. GARY STOBBE)

And as a neurologist I think about autism like I think about other neurological conditions where if you have a neurological condition and you tend to be more sensitive to your environment.  You know you don’t tolerate things as well as other individuals.  So if you have Alzheimer or multiple sclerosis and you get a cold or a urinary tract infection your neurological symptoms get worse when you have that, that stress on your body.  So you’re going to be more sensitive to a lactose intolerance if you have autism than a general kid.  And how is it going to manifest?  It might manifest with worsening autism behaviors.

 

(TOM MCGURK)

My son has had applied behavioral analysis, speech therapy.  We’ve had biomedical.  We’ve have done natural path.  We’ve also done audio integration therapy.  We have done playtime, the floor method.  We have a therapist in our house three days a week.  You know.  It’s constant.  It’s not like any other diagnosis in that we have this thing that’s going to help your kid. You’re constantly trying to figure out what to do to help him.

 

(DR. PETER SALGO)

Well let me move this along and tell you a little bit more about Harry.  Because yeah they were reluctant to accept the diagnosis but once they did they joined a parent support group and they found that group very helpful.  Their son is doing well academically.  He’s been able to remain in his school with some additional services.  But now they’re concerned that his Asperger’s will make him socially isolated and they’re worried about bullying.  Other kids ganging up.  Oh boy, I saw your eyebrows go up.

 

(TOM MCGURK)

Well we’re lucky.  We’re in a very good school.  We had a meeting where everybody agreed we’re going to say what’s on our minds and we said we’re afraid that your kids are going to bully our kid.  You’ve got to talk to them about the fact that our kid is different.  He’s quirky.  He’s weird.  He’s not going to talk to you.  He’s going to go off into the corner of the playground.  You know, have your kids understand that and have them know for him to get better one of the best thing is you’ve got to engage him. 


(DR. LISA HARRIS)

What’s amazing is that it clicked for you. That you understand that he’s going to be quirky in the corner and that’s okay. 

 

(TOM MCGURK)
Yeah.

 

(DR. LISA HARRIS)

And that’s he’s going to be a little bit different and that’s okay.  We have so many parents that come in and they’re screaming and yelling at their kid because they expect him to have “normal behavior”.  They want them to sit quietly.

 

(TOM MCGURK)
I still scream and yell at my kid. 

 

(DR. LISA HARRIS)

But I mean appropriately so. 

 

(TOM MCGURK)
Exactly.

 

(DR. LISA HARRIS)

But the expectations that he’s going to behave like all the other children.

 

(TOM MCGURK)
It took me two-and-a-half years, though to even get there. 

 

(DR. PETER SALGO)
After two.

 

(DR. GARY STOBBE)

We got a lot of progress that our society needs to make in accepting differences and but that age, you know, the middle school especially for these high functioning kids.  The high functioning kids tend, with autism, tend to have enough self awareness that they’re, they pick up on the bullying or the comments. And we all know that middle school is not the kindest time for humans.  And so it can be a real tough time and we see anxiety levels can become a real problem.  

 

(DR. SUSAN HYMAN)
The treatment is not just for the child, it’s for the school, his whole school community.

 

(DR. CATHERINE LORD)
The schools really can stop it.  I mean by setting an appropriate atmosphere and communicating.  They really can do it. 

 

(TOM MCGURK)
It’s a part of the treatment to have the community involved. 

 

(DR. PETER SALGO)

You’ve been at this now for a long time. 

 

(TOM MCGURK)
Yes.

 

(DR. PETER SALGO)

At this point you’ve had plenty of time to look at your son, see his progress.

 

(TOM MCGURK)

Which has been phenomenal. 

 

(DR.  PETER SALGO)

What are your expectations for him going forward?

 

(TOM MCGURK)

Now I want him out of the house.  (laughter) I want him to go to college. 

 

(DR. GARY STOBBE)

I mean every parents dream. 

 

(DR. PETER SALGO)

What do you think?  Realistically now. 

 

(TOM MCGURK)

Realistically.

 

(DR. PETER SALGO)

What is going to happen to him?

 

(TOM MCGURK)
I believe he will go to college.  I think he’s going to.

 

(DR. PETER SALGO)
That’s great. 

 

(TOM MCGURK)
I think he’s going to have a meaningful life.  I mean one of the big fears you see is will my child have a meaningful relationship when I’m gone.  Is he going to have friends?  Is he going to have happiness?  You know is he going to be able to find people that will accept the quirks that he has so that he can interact with them and still feel love and affection from other people.  You know and that is.  That’s like why you go crazy and you get so scared.  That fear factor his house is on fire, I got to put this out somehow.  You know, because time ticks away.  I can’t believe he’s in fifth grade.

 

(DR. GARY STOBBE)

But ultimately the job of the parent is the same. You know it is trying to help your child be happy. But for some families, you know, for some individuals with autism they don’t make the progress like your son has.

 

(TOM MCGURK)
Yeah.

 

(DR. GARY STOBBE)

And then it becomes an issue of the parent needing to redefine what is happiness for my child and how will my child be happy as an adult. 

 

(DR. LISA HARRIS)
And then as they get older, what are the long term care issues.  I mean once they hit adolescent and adulthood all of these supports go away. 

 

(DR. CATHERINE LORD)
Right.

 

(DR. LISA HARRIS)

And you really run into issues with the aging parent. 

 

(DR. PETER SALGO)

Which.  Which brings me Catherine to what’s on the horizon for treating autism, both as children and as adults?

 

(DR.  CATHERINE LORD)
Well I think that we know a lot about things we can do.  It’s just that the services are not organized.  I mean I think that we know things that we can do to help college students who have autism in terms of providing them with a little bit more structured social opportunities and back up.  We know about supported employment.  But it, at this point that just falls through the cracks. 

 

(DR. PETER SALGO)

We’re going to cure this?

 

(DR. SUSAN HYMAN)

No.

 

(DR. CATHERINE LORD)

It would be so wonderful but.

 

(DR. SUSAN HYMAN)
I think if you think about cure you get so caught up that you can’t treat it.  That if you can’t take one step at a time, and as Tom has described treat the next.  You know do the next thing on the horizon.  If you have your eye, you know, obviously we don’t want anyone to have autism except as it enriches society but we have interventions and we’re looking for interventions and we’re looking for ways to treat each of the component parts. 

 

(DR. PETER SALGO)

Let’s take a break just for a moment because there’s some things that I think we should really sum up.  There is no cure for Autism Spectrum Disorder but therapies and behavioral interventions can remedy specific symptoms and can bring about substantial improvement.  The idea treatment plan coordinates therapies and interventions that meet the specific needs of individual children.  Most healthcare professionals agree that the earlier you intervene the better.  Fair enough.  Let me tell you a little bit more about Harry.  He’s receiving both cognitive behavior and talk therapy to help him manage his emotions.  And he seems to be showing improvement in his kindergarten setting too.  What advice do you have for families facing this diagnosis, autism?

 

(TOM MCGURK)

Number one is when you hear it don’t be afraid of it because there have been so many developments even within the last ten years.  Number two get help immediately because if you start therapies with your child and there’s nothing wrong with him all you’re doing is making him smarter.  But if you wait you’re harming him by not admitting to yourself that there might be a problem.  Number three would be it takes a village.  If people who know people, a neighbor who has a child with autism, the best thing you can do is go over, introduce yourself and say I understand your child has autism.  I would love for our kids to play together but I don’t know how to do it.  It, you know, open up that door so that people can start helping out because that’s when the kids really start to develop as well.  Even if they’re lower functioning those kids love to be involved.  It’s just that it’s not the way that you’re normally used to seeing things.

 

(DR. PETER SALGO)

Can I.  I’m going to speak for all of us here.  You’re America’s dad.  You’re great. 

 

(TOM MCGURK)

And I’m, most of the guys I know who have kids with autism this is the way we are. 

 

(DR. PETER SALGO)
I think you’re being too generous.

 

(TOM MCGURK)
Well thank you.

 

(DR. PETER SALGO)
But I hope you’re right.  Thank you all so much for being here but unfortunately we are out of time.  If you’d like to continue this conversation and I hope you do, please go to our website.  There you are going to find the transcript of this show, more videos about autism, and links to resources.  The address is
www.secondopinion-tv.org.  Thanks for watching.  Thank all of you for being here.  And you, just spectacular, tt’s hard to talk about this sometimes and you’ve shared it with us.  I think that it’s just been great. 

 

(TOM MCGURK)

Well thanks for the opportunity. 

 

(DR. PETER SALGO)

You’re more than welcome.  I’m Dr. Peter Salgo and I’ll see you next time for another Second Opinion.

 

(MUSIC)

 

(ANNOUNCER)                     

Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association, an association of independent, locally-operated and community-based Blue Cross and Blue Shield companies, supporting solutions that make quality, affordable healthcare available to all Americans.

 

(ANNOUNCER)                     

Second Opinion is produced in association with the University of Rochester Medical Center, Rochester, New York.