Podcast appearances and mentions of case reports

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Dr. Gilbert Tang, Editor-in-Chief of Journal of the American College of Cardiology (JACC): Case Reports, professor in the Department of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, surgical director of the Structural Heart Program at Mount Sinai Health System, and the director of Structural Heart Education at the Mount Sinai Fuster Heart Hospital in New York, NY, USA. They were joined by Drs. Mateo Marin-Cuartas, associate editor of JACC: Case Reports, CTSNet JANS Editor, and cardiac surgeon at Leipzig Heart Center, Germany, and Tsuyoshi Kaneko, Chair of American College of Cardiology (ACC) Cardiac Surgery Member Section and Chief of Cardiac Surgery at Washington University in St. Louis, MO, USA, to discuss JACC: Case Reports. Chapters 00:00 Intro 01:45 Instructional Video Competition 05:30 JANS 1, Lung Cancer Metastasis 09:08 JANS 2, Uncorrected Pectus 11:29 JANS 3, Ambulatory VV Life Support 13:38 JANS 4, EuroSCORE II 14:28 Video 1, TAVR Removal Double Patch 16:09 Video 2, ROK Procedure AF 17:46 Video 3, RATS Lobectomy 19:11 JACC Case Reports 35:28 Upcoming Events 36:03 Career Center They discussed the mission of the journal and the types of submissions it receives. They also covered the types of cases accepted and the various categories within the journal has, such as the "How We Did It" section. Additionally, they talked about the upcoming partnership between JACC: Case Reports and the ACC, as well as past collaborations that JACC has undertaken. Dr. Marin-Cuartas shared insights about his role as an associate editor and highlighted the most interesting case he has encountered in JACC: Case Reports. Furthermore, Dr. Kaneko discussed being the Chair of the ACC Cardiac Surgery Member Section. Joel also highlights recent JANS articles on the evolutionary characterization of lung cancer metastasis, the impact of severe uncorrected pectus excavatum on outcomes after aortic surgery in Marfan syndrome, determining an optimal central cannulation strategy for ambulatory veno-venous extracorporeal life support, and refitting EuroSCORE II for 120-day mortality after coronary artery bypass grafting using nationwide registry data. In addition, Joel explores complex imaging TAVR removal double patch double valve, RATS extended left upper lobectomy with intrapericardial vascular control and bronchoplasty, and ROK procedure for the treatment of atrial fibrillation. Before closing, Joel highlights upcoming events in CT surgery.   JANS Items Mentioned Evolutionary Characterization of Lung Cancer Metastasis Impact of Severe Uncorrected Pectus Excavatum on Outcomes After Aortic Surgery in Marfan Syndrome Determining an Optimal Central Cannulation Strategy for Ambulatory Veno-Venous Extracorporeal Life Support Refitting EuroSCORE II for 120-Day Mortality After Coronary Artery Bypass Grafting Using Nationwide Registry Data CTSNet Content Mentioned Complex Imaging TAVR Removal Double Patch Double Valve RATS Extended Left Upper Lobectomy With Intrapericardial Vascular Control and Bronchoplasty ROK Procedure for the Treatment of Atrial Fibrillation Other Items Mentioned JACC: Case Reports 2026 Instructional Video Competition Winners Career Center CTSNet Events   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Nick Norwitz has an MD, a PhD, and a cholesterol level that should have killed him — at least according to the standard model of cardiovascular disease. For seven years, his total cholesterol held above 700. His LDL sat in the high 500s. Every clinical algorithm flagged him as a cardiac emergency. He took none of the prescribed medications.His just-published case report shows zero coronary plaque. Not reduced. Not minimal. Zero.This episode isn't a victory lap. It's a serious conversation about what that result means — for how medicine measures risk, how it handles outliers, and why the incentive structures that shape clinical decisions may be more dangerous than any single cholesterol number. Dr. Philip Ovadia and Nick Norwitz also go deep on a fraudulent case report published in Circulation, why statins suppress GLP-1 levels and almost no cardiologist knows it, and what happens when the patient who refuses to follow the algorithm turns out to be right.#metabolichealth #cholesterol #ketodiet #heartdisease #LDLcholesterol #evidencebasedmedicine #lowcarb #preventivecardiologyBIG IDEAA patient with seven years of astronomically high cholesterol and zero coronary plaque is not an outlier to dismiss — he is a question medicine is obligated to answer.Nick Norwitz Contact InfoNewsletter: staycuriousmetabolism.com (Top 2 Best-Selling in Science, Globally)YouTube: https://www.youtube.com/@nicknorwitzMDPhD (>1M Subscribers)Twitter: https://x.com/nicknorwitzInstagram: https://www.instagram.com/nicknorwitz/LinkedIn: https://www.linkedin.com/in/nicknorwitz/Threads: https://www.threads.net/@nicknorwitzFacebook: https://www.facebook.com/nicknorwitzNick's Case Report:Seven Years of 700 Cholesterol Without CoronaryAtherosclerosis: A Lean Mass Hyper-Responder Case ReportSend Dr. Ovadia a Text Message. (If you want a response, you must include your contact information.) Dr. Ovadia cannot respond here. To contact his team, please send an email to team@ifixhearts.com Order at Amazon: Stay Off My Kitchen Table  Like what you hear? Head over to IFixHearts.com/book to grab a copy of my book, Stay Off My Operating Table. Ready to go deeper? Talk to someone from my team at IFixHearts.com/talk.Ready to take control of your health?  Grab Dr. Ovadia's brand new book Stay Off My Kitchen Table now! This isn't just another diet book; it reveals why it's not just what you eat, but what your body actually absorbs that determines your health.If you're struggling with low energy, stubborn weight, or feeling like “healthy eating” isn't working… this book shows you exactly how to fix it.Learn how to reset your gutEliminate hidden foods sabotaging your progressUnlock real energy, metabolism, and longevityDon't wait until it's too late. Take action today. Get your copy of Stay Off My Kitchen Table now.Learn More:Take Dr. Ovadia's metabolic health quiz: iFixHearts Dr. Ovadia's website: Ovadia Heart HealthTheme Song : Rage AgainstWritten & Performed by Logan Gritton & Colin Gailey (c) 2016 Mercury Retro RecordingsAny use of this intellectual property for text and data mining or computational analysis including as training material for artificial intelligence systems is strictly prohibited without express written consent from Dr. Philip Ovadia.

It's the return of Merlin. Not the birdsong identification app this time, but the Rolls-Royce Merlin - engine of the historic Supermarine Spitfire warplane. The Case Reports trio are faced with another set of patient puzzles to work through in this latest episode. In the first case (1:25), a 68-yo man, retired from farming, presents with a 6-year history of behavioural changes. Most notably, he had developed a sense of great pleasure in listening to engine sounds, like those of the historic aircraft flying over his house. He had become increasingly emotionally detached and ritualistic, and gained a sweet tooth. MR scans of the brain revealed an uncommon syndrome. https://pn.bmj.com/content/26/2/169 The second case (21:15) relates to a 47-yo woman who developed abnormal movements in all of her limbs. She had undergone a complex cardiac surgery 12 years before, and another prolonged cardiac surgery within recent weeks. The case discusses the longterm follow-up of her treatment for these involuntary movements. https://pn.bmj.com/content/26/2/157    The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the October 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Clinical Lecturer in Neurology at the Institute of Cognitive Neuroscience, University College London, and an Honorary Neurology SpR at the National Hospital for Neurology and Neurosurgery. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://bit.ly/4aXF46i). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening.

La mano alien es uno de esos fenómenos neurológicos que obligan a replantearse qué significa realmente “controlar” una acción: pacientes cuya mano no está paralizada, pero tampoco les obedece, realizando movimientos con apariencia intencional que surgen fuera de su voluntad e incluso interfieren con la otra mano. En este episodio utilizamos este cuadro tan llamativo como clínicamente revelador para ir mucho más allá del síntoma y explorar cómo el cerebro construye la acción, integrando intención, ejecución y percepción dentro de una red compleja que, cuando se desorganiza, rompe la coherencia entre lo que queremos hacer y lo que finalmente ocurre. Desgranamos los distintos fenotipos —frontal, calloso y parietal— como expresiones de fallos en nodos específicos de esa red, analizamos su base neurofisiológica y aterrizamos todo esto en la clínica. Cómo reconocer la mano alien, cómo valorarla desde la fenomenología y la interacción con el entorno, y qué estrategias terapéuticas pueden tener sentido en función del mecanismo predominante. Un episodio que no solo explica un síndrome raro, sino que abre una ventana para entender que el movimiento no es simplemente contraer músculos, sino construir continuamente la experiencia de ser quien actúa. Referencias del episodio: 1.     Biran, I., Giovannetti, T., Buxbaum, L., & Chatterjee, A. (2006). The alien hand syndrome: What makes the alien hand alien?. Cognitive neuropsychology, 23(4), 563–582. https://doi.org/10.1080/02643290500180282 (https://pubmed.ncbi.nlm.nih.gov/21049344/). 2.     Bru, I., Verhamme, L., de Neve, P., & Maebe, H. (2021). Rehabilitation of a Patient with Alien Hand Syndrome: a Case Report of a 61-Year Old Man. Journal of rehabilitation medicine. Clinical communications, 4, 1000050. https://doi.org/10.2340/20030711-1000050 (https://pmc.ncbi.nlm.nih.gov/articles/PMC8054745/). 3.     Di Pietro, M., Russo, M., Dono, F., Carrarini, C., Thomas, A., Di Stefano, V., Telese, R., Bonanni, L., Sensi, S. L., Onofrj, M., & Franciotti, R. (2021). A Critical Review of Alien Limb-Related Phenomena and Implications for Functional Magnetic Resonance Imaging Studies. Frontiers in neurology, 12, 661130. https://doi.org/10.3389/fneur.2021.661130 (https://pmc.ncbi.nlm.nih.gov/articles/PMC8458742/). 4.     Feinberg, T. E., Schindler, R. J., Flanagan, N. G., & Haber, L. D. (1992). Two alien hand syndromes. Neurology, 42(1), 19–24. https://doi.org/10.1212/wnl.42.1.19 (https://pubmed.ncbi.nlm.nih.gov/1734302/). 5.     Graff-Radford, J., Rubin, M. N., Jones, D. T., Aksamit, A. J., Ahlskog, J. E., Knopman, D. S., Petersen, R. C., Boeve, B. F., & Josephs, K. A. (2013). The alien limb phenomenon. Journal of neurology, 260(7), 1880–1888. https://doi.org/10.1007/s00415-013-6898-y (https://pubmed.ncbi.nlm.nih.gov/23572346/). 6.     Haq, I. U., Malaty, I. A., Okun, M. S., Jacobson, C. E., Fernandez, H. H., & Rodriguez, R. R. (2010). Clonazepam and botulinum toxin for the treatment of alien limb phenomenon. The neurologist, 16(2), 106–108. https://doi.org/10.1097/NRL.0b013e3181a0d670 (https://pubmed.ncbi.nlm.nih.gov/20220444/). 7.     Hassan, A., & Josephs, K. A. (2016). Alien Hand Syndrome. Current neurology and neuroscience reports, 16(8), 73. https://doi.org/10.1007/s11910-016-0676-z (https://pubmed.ncbi.nlm.nih.gov/27315251/). 8.     Lewis-Smith, D. J., Wolpe, N., Ghosh, B. C. P., & Rowe, J. B. (2020). Alien limb in the corticobasal syndrome: phenomenological characteristics and relationship to apraxia. Journal of neurology, 267(4), 1147–1157. https://doi.org/10.1007/s00415-019-09672-8 (https://pmc.ncbi.nlm.nih.gov/articles/PMC7109196/). 9.     Ma, Y., Liu, Y., Yan, X., & Ouyang, Y. (2023). Alien hand syndrome, a rare presentation of corpus callosum and cingulate infarction. Journal of the neurological sciences, 452, 120739. https://doi.org/10.1016/j.jns.2023.120739 (https://pubmed.ncbi.nlm.nih.gov/37536055/). 10.  Mark V. W. (2025). Alien Hand: Current Research Trends. Current neurology and neuroscience reports, 25(1), 63. https://doi.org/10.1007/s11910-025-01449-z (https://pmc.ncbi.nlm.nih.gov/articles/PMC12449344/). 11.  Park, Y. W., Kim, C. H., Kim, M. O., Jeong, H. J., & Jung, H. Y. (2012). Alien hand syndrome in stroke - case report & neurophysiologic study -. Annals of rehabilitation medicine, 36(4), 556–560. https://doi.org/10.5535/arm.2012.36.4.556 (https://pmc.ncbi.nlm.nih.gov/articles/PMC3438424/). 12.  Romano, D., Sedda, A., Dell'aquila, R., Dalla Costa, D., Beretta, G., Maravita, A., & Bottini, G. (2014). Controlling the alien hand through the mirror box. A single case study of alien hand syndrome. Neurocase, 20(3), 307–316. https://doi.org/10.1080/13554794.2013.770882 (https://pubmed.ncbi.nlm.nih.gov/23557374/). 13.  Sarva, H., Deik, A., & Severt, W. L. (2014). Pathophysiology and treatment of alien hand syndrome. Tremor and other hyperkinetic movements (New York, N.Y.), 4, 241. https://doi.org/10.7916/D8VX0F48 (https://pmc.ncbi.nlm.nih.gov/articles/PMC4261226/). 14.  Sellal, F., Cretin, B., Musacchio, M., Berthel, M. C., Carelli, G., & Michel, J. M. (2019). Long-lasting diagonistic dyspraxia suppressed by rTMS applied to the right motor cortex. Journal of neurology, 266(3), 631–635. https://doi.org/10.1007/s00415-018-09178-9 (https://pubmed.ncbi.nlm.nih.gov/30631917/). 15.  Wolpe, N., Moore, J. W., Rae, C. L., Rittman, T., Altena, E., Haggard, P., & Rowe, J. B. (2014). The medial frontal-prefrontal network for altered awareness and control of action in corticobasal syndrome. Brain : a journal of neurology, 137(Pt 1), 208–220. https://doi.org/10.1093/brain/awt302 (https://pmc.ncbi.nlm.nih.gov/articles/PMC3891444/). 16.  Wolpe, N., Hezemans, F. H., & Rowe, J. B. (2020). Alien limb syndrome: A Bayesian account of unwanted actions. Cortex; a journal devoted to the study of the nervous system and behavior, 127, 29–41. https://doi.org/10.1016/j.cortex.2020.02.002 (https://pubmed.ncbi.nlm.nih.gov/32155475/).

Send us Fan MailIf your case report already feels harder than expected, it's probably not the writing......it's the case you chose.In this episode, we walk through what's actually making the process more difficult - and how to think about your case report more strategically so you can move forward with clarity.In this episode, we cover: - What actually makes a case report feel difficult - Where most people go wrong early in the process - How to approach your case more strategically - What to focus on before you start writingResources:Case Report Idea Generator: https://TheOncoPT.com/generatorPick Your Perfect Patient Masterclass: https://TheOncoPT.com/perfectWriting Sprint: https://TheOncoPT.com/sprintIf you want a structured way to get started on your ABPTS oncology case report, I'm hosting a LIVE writing sprint later this month where we'll work through this together.You can find the details here: https://TheOncoPT.com/sprint Follow TheOncoPT on Instagram.Follow TheOncoPT on LinkedIn.

Caffeinators, get in we're going to Budapest! You know we love to talk about veterinary medicine around the world. At our last staff meeting, we went through the AVECCTN membership list and reached out to everyone that works in a country we hadn't featured yet. Miklós Róth from Hungary was the first to write back and what a fun conversation this is. We talked about what vet med looks like in Hungary, his mentor who is the lone specialist veterinarian in the country, lack of formal education, all of it. Miki shared with us how he built his knowledge and skills base by traveling to other countries to learn, and also how he discovered becoming a VTS and what that process looked like and the difficulties he encountered-spoiler alert, he wrote 75 CASE REPORTS. You've got to hear his story! Our Links: Check out our sponsor https://betterhelp.com/vettechcafe for 10% off your first month of therapy Follow us on Facebook: https://www.facebook.com/vettechcafe Follow us on Instagram: https://www.instagram.com/vettechcafepodcast Follow us on LinkedIn: https://www.linkedin.com/company/vet-tech-cafe Like and Subscribe on YouTube: https://www.youtube.com/channel/UCMDTKdfOaqSW0Mv3Uoi33qg Our website: https://www.vettechcafe.com/ Vet Tech Cafe Merch: https://www.vettechcafe.com/merch If you would like to help us cover our podcast expenses, we'd appreciate any support you give through Patreon. We do this podcast and our YouTube channel content to support the veterinary technicians out there and do not expect anything in return! We thank you for all you do.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This short episode covers the basics of neuroleptic malignant syndrome.Hosts: Eric Yu (MS3)Dr. Angad Singh (PGY2)Dr. Shaoyuan Wang (PGY5)Audio Editing: Dr. Angad Singh (PGY2)References:1. Park, J., Tan, J., Krzeminski, S., Hazeghazam, M., Bandlamuri, M., & Carlson, R. W. (2017). Malignant catatonia warrants early psychiatric‐critical care collaborative management: two cases and literature review. Case Reports in Critical Care, 2017(1), 1951965.2. Simon, L. V., Hashmi, M. F., & Callahan, A. L. (2023). Neuroleptic malignant syndrome. In StatPearls [Internet]. StatPearls Publishing.2. Tan, C. M., & Kumachev, A. (2023). Neuroleptic malignant syndrome. CMAJ, 195(43), E1481-E1481.4. Trollor, J. N., & Sachdev, P. S. (1999). Electroconvulsive treatment of neuroleptic malignant syndrome: a review and report of cases. Australian & New Zealand Journal of Psychiatry, 33(5), 650-659.For more PsychEd, follow us on Instagram (⁠⁠@psyched.podcast⁠⁠), Facebook (⁠⁠PsychEd Podcast⁠⁠), X (⁠⁠@psychedpodcast⁠⁠), and Bluesky (⁠⁠@psychedpodcast.bsky.social‬⁠⁠). You can email us at ⁠⁠psychedpodcast@gmail.com⁠⁠ and visit our website at⁠⁠ psychedpodcast.org⁠⁠.

Send us Fan MailIf you have a few case report options but don't feel confident choosing, this is the stage where most people get stuck.In this episode, we walk through what's actually making the process more difficult - and how to think about your case report more strategically so you can move forward with clarity.In this episode, we cover: - Why having multiple case report ideas can create hesitation - The most common decision struggles PTs experience - How to evaluate your options more clearly - What actually makes one case stronger than another - How to move forward with confidenceResources:Case Report Idea Generator: https://TheOncoPT.com/generatorPick Your Perfect Patient Masterclass: https://TheOncoPT.com/perfectWriting Sprint: https://TheOncoPT.com/sprintIf you want a structured way to get started on your ABPTS oncology case report, I'm hosting a LIVE writing sprint later this month where we'll work through this together.You can find the details here: https://TheOncoPT.com/sprint Follow TheOncoPT on Instagram.Follow TheOncoPT on LinkedIn.

Listen in as Ruth Werner and Dr. Niki Munk discuss three Post-Traumatic Stress Disorder-related case reports from the International Journal of Therapeutic Massage and Bodywork (IJTMB) September 2025 Special Issue on Massage Therapy and Mental Health: Hanus, A., & Fogarty, S. (2025). The effects of massage therapy on post-traumatic stress disorder: a case report. International Journal of Therapeutic Massage & Bodywork, 18(3), 42. https://pmc.ncbi.nlm.nih.gov/articles/PMC12370315/ Clark, M., & Steinberg, B. (2025). The Effects of Massage Therapy on Medically Induced Trauma and Touch Aversion: A Case Report. International Journal of Therapeutic Massage & Bodywork, 18(3), 86. https://pmc.ncbi.nlm.nih.gov/articles/PMC12370311/ Fraser, A. (2025). Therapeutic Massage and Homecare to Reduce Dissociation in Post-traumatic Stress Disorder: A Case Report. International Journal of Therapeutic Massage & Bodywork, 18(3), 5. https://pmc.ncbi.nlm.nih.gov/articles/PMC12370312/

Deb (00:03.606)Within the next seven months, up to 1.5 million Americans could lose access to a medication that they’ve relied on for decades. Not because it’s dangerous, but because a pharmaceutical giant may have lobbied the FDA to eliminate their competition. And if you’re one of them, your doctor may already have told you about this issue and stopped prescribing it.This isn’t a conspiracy theory. This is documented in federal court filings. This is happening right now. And the company that stands to profit, well, they’re the same ones manufacturing the only product that might survive.Today on Let’s Talk Wellness Now, we’re exposing the desiccated thyroid extract crisis, the corporate manipulation behind it, and what you need to do right now to protect your health. Stay with me because I’m about to share what could save your access to the medication keeping you alive.Welcome back to Let’s Talk Wellness Now, the show where we uncover the root causes of chronic illness, expose regulatory capture in healthcare, and empower you with the tools to advocate for yourself. I’m Dr. Deb, naturopathic doctor, your medical detective, and today we’re diving into one of the most consequential and corrupt healthcare decisions affecting patients right now. If you or someone you love takes Armour thyroid, NP thyroid, or any desiccated thyroid extract,for hypothyroidism or if you’ve struggled to find a thyroid medication that actually works for your body, this episode is absolutely critical. And if you have celiac disease, gluten sensitivity or corn allergies, what I’m about to reveal will make your blood boil. Now grab your cup of coffee, don’t forget your notebook and settle in because what’s happening to this medication right now is a masterclass in how pharmaceutical companies use regular Deb (02:06.544)agencies to eliminate competition, control markets, and price gouge patients. And I have all the receipts. Deb (02:20.982)Let me start with what might surprise you. Desiccated thyroid extract, or DTE as we call it, is actually one of the most oldest thyroid medications in the world. And I mean old. From the 1890s through 1970, this was the standard treatment for hypothyroidism.Now let’s really dive into that. From the 1890s to the 1970s, this was standard hypothyroidism treatment.In 1965 alone, and this is documented in peer-reviewed literature published in the Journal of Clinical Endocrinology and Metabolism, approximately four out of every five prescriptions for thyroid hormone in the United States were of natural desiccated thyroid preparations.The Journal of Clinical Endocrinology and Metabolism is a very high-end journal. Now think about that. This wasn’t some fringe therapy. This was mainstream medicine. Armour Thyroid, the most recognizable brand name, has been manufactured since the early 1900s, well over a century ago.and this is cited again in NIH bookshelf. When the FDA was officially established in 1938, Arbor thyroid was already on the market. And this is important and I want you to understand why. Under the federal Food, Drug and Cosmetic Act, any drug that was already being marketed before 1938 was automatically grandfathered into the system. That means it didn’t have to Deb (04:08.112)go through the formal FDA approval process. And this again is cited under the Federal Food, Drug and Cosmetic Act, grandfathered drugs and exemptions. And this is crucial to understanding what happens next. By the 1970s, synthetic levothyroxine, brand name Synthroid and generics became the preferred treatment. Hmm, wonder why?It was easier to standardize, came into consistent doses, and worked well for most patients, and could be mass manufactured. By the 1980s, levothyroxine had largely replaced desiccated thyroid in clinical practice, according to the American Thyroid Association 2014 guidelines for the treatment of hypothyroidism. But here’s what matters. Some patients…a very significant minority of them, never felt right on levothyroxine alone. Despite their lab work looking normal, they still had fatigue, brain fog, weight gain, cold intolerance, and depression.These patients often found relief when they switched back to their desiccated thyroid, which contains both T4 and T3 hormones, the way human thyroid naturally produces them. And this is not anecdotal. This is documented in randomized double-blind crossover studies published in Endocrine Practice.For decades, that was fine. Their doctors prescribed it, insurance sometimes covered it, patients were getting better, and the system worked really well. Until August 6th of 2025, just a short time ago, everything changed. On that date, the FDA sent letters to manufacturers, importers, and distributors of desiccated thyroid extract products stating that these medications would need an approval. Deb (06:04.654)a biologics licensed application, a BLA, to remain legally on the market. And this is cited in the FDA’s official statement, FDA’s actions to address unapproved thyroid medications. understand it says unapproved thyroid medications. However, desiccated thyroid, specifically Armour, has been approved since 1938. And this was dated August 6th through 7th, 2025.This wasn’t a guideline. This wasn’t a suggestion. It was an endorsement of action. And the timeline they gave them? Well, just 12 months to transition patients to another medication before enforcement action could begin.This was also cited by an FDA notice to the industry, animal derived thyroid products notice to industry, August 6th, 2025. Now do the math, that means August 2026, seven months from now, 1.5 million Americans currently taking this medication. And this number comes from the FDA official statement, citing that it’s an estimation of 1.5 million patients receiving prescriptions for these medications.could potentially lose their thyroid access. Now, here’s where it gets interesting. The FDA didn’t wake up in August of 2025 and decide to regulate desiccated thyroid after a century. This decision has a much longer backstory. And understanding that backstory is critical to understanding what’s really happening in this industry.The shift started in 2022. Back in September of 2022, over three years ago, an FDA branch chief sent a letter to the National Associations of Boards of Pharmacy noting that the agency had decided to designate DTE as a biological product, which would affect its eligibility for compounding. Deb (08:13.972)This also is cited in an FDA letter to the National Association of Boards of Pharmacy September 2022.Then two months later, in November of 2022, the FDA’s Office of Compounding Quality and Compliance sent a softer letter acknowledging that many Americans take medication to treat hypothyroidism and some choose to take DTE products. The letter stated that the FDA would focus enforcement on cases that pose the greatest public health risks, such as serious adverse offense or serious product quality or adulteration.also is cited by an FDA letter from Francis G. Bromel, the director, Office of Compounding Quality and Compliance, November of 2022. Now, let me just think about this for a second. If this drug has been on the market since the 1800s, been FDA approved since 1938, would we not have seen a health crisis long before 2022?I honestly don’t know of any other drug that’s been around this long that’s used by this many people. Now granted, I haven’t done the research on it either, which I can do for you guys, but I’m just thinking if a drug is on the market today and it causes harm, it doesn’t make it three years, five years before you see lawsuits everywhere. Why are there no lawsuits on this drug? Why are there no major reactions that people are seen having?Hmm, just thought. But here’s the pattern. The FDA was already laying the groundwork back in 2022, testing the waters, signaling where this was headed. The August 2025 action. Then this came down. Deb (10:09.806)August 6, 2025, the FDA announced its position publicly and sent formal letters to all DTE manufacturers, importers, and distributors. This was cited by the FDA Enforcement Action August 6, 2025, letters to manufacturers, importers, distributions of DTE products. The agency stated several concerns. First, DTE products have experienced quality and dosing issues.The FDA cited, and I’m quoting directly from their statement, over 500 adverse events reported associated with DTE products from 1968 to 2025. From 1968 to 2025, we had 500 adverse reactions? What is that math equate to?A couple a year? Come on guys, this is insane! With a substantial increase, you, between 2019 and 2020 that the agency suggested was related to voluntary recalls of sub-potent or super-potent products.This was cited in the FDA statement, over 500 adverse events reported associated with ADT products from 1968 through 2025.Second, the agency expressed concern about batch inconsistency. According to the FDA’s official statements, tablets made from the same manufacturing batches may not always provide the same thyroid hormone levels. Okay, this was cited in the FDA statement, tablets made from the same manufacturing batches may not always provide the same thyroid hormone levels. Thirdly, and I want to actually let’s back up. I want you to remember I said that Deb (12:11.216)because further down in this podcast, we’re going to talk about this. This is an important point to remember. Thirdly, the agency raised concerns about potential impurities from animal source material, including potential for viral contamination due to the animal source and supraphysiological levels of T3.the FDA statement on impurities, viral contamination and super physiological T3 levels. Now I will tell you, I’ve been prescribing armarithograde for 20 years. I’ve rarely seen a super physiological dose given of T3 in lab results, unless the patient takes their medication like four or five hours before you do the blood test, then you’ll see a false rise because you’re actually seeing the medication. You’re not seeing people walking aroundsuperphysiological T3 levels. Nobody would like that feeling. So anyway, I digress. Now let me pause here because this is where I need to give you some context that the FDA hasn’t quite emphasized yet. Of course, we have another connection and it is the China connection.So the FDA’s concerns about contaminated drugs and quality issues don’t exist in a vacuum. In 2024, the U.S. over 828,000 metric tons of pharmaceuticals, seven times the level from 2000. And here’s the kicker. China and India supply the majority of active pharmaceutical ingredients. APIs for U.S. generics accounting for 70 to 80 % of the total genericdrug supply. According to Reuters industry report in 2024, they state that China supplies 82 % of the APIs for critical drugs. Deb (14:08.204)Got to question that, right? Why are we giving all of our drug formulas to China and allowing them to import them into our country? In fact, roughly 20 % of the critical drugs have APIs exclusively sourced from China. And China controls 80 to 90 % of the global production for antibiotics and other key compounds. This was also cited by Reuters industry data thatcontrols 80 to 90 percent of the global production for antibiotics and other key compounds. Now just think about this. They control 80 to 90 percent of our medication. They control 20 percent of our critical drugs and we just put what kind of tariff on them? Hmm.In 2025 alone, the FDA issued multiple warning letters to foreign manufacturers for contamination issues and failure to follow good manufacturing practices. This is also cited by the FDA warning letters 2024 through 2025 and multiple citations to foreign manufacturing facilities. This is a systematic problem affecting the entire US drug supply, not just desiccated thyroid.So when the FDA suddenly became concerned about DTE quality and contamination, part of that concern was legitimate. But this is crucial. The same inconsistencies and contamination issues exist across the entire generic drug supply. And the FDA has not taken the same enforcement action against them. Let that sink in.They have not taken the same enforcement action against the other drug companies. So what’s behind all of this? Where is this all coming from? Hmm. Let’s address something directly, because you deserve to know it. And I’m going to cite my sources precisely so that when the medical boards have something to say about this, and they might, I have a documentation for every single word that I am about to speak. Deb (16:24.878)According to the court documents filed in October 2025, in the case ofa urine, a urine. I’m going to say that wrong. Pharmaceuticals versus Dr. George Tidmarsh from ABBV, the multinational pharmaceutical company that manufactures armor thyroid, reportedly petitioned the FDA in 2024, asking the agency to reclassify DTE as a biologic and to prohibit other manufacturers from selling unlicensed DTE products unless they havehad an investigational new drug application, we call this an IND, and a clinical development program aimed at eventual approval. This is cited in the court filing a Urena pharmaceuticals lawsuit versus Dr. George Tidmarsh, October 2025, reported by Fierce Pharma. Now let me explain why this matters and why this is one of the most brazen examples of regulatory capture I’ve ever seen in my career.AbbeVee is one of the world’s largest pharmaceutical companies. In 2024, they reported over $54 billion in revenue. Drop the mic on that one.They have the resources, the regulatory expertise, the legal teams, and the financial capacity to navigate a biologics license application process that costs between $500 million and $1 billion. Let that sink in. Deb (18:07.882)A drug that’s been on the market since the 1800s that was grandfathered in 1938 that’s making plenty of money right now. They’re going to spend 500 million to $1 billion to get a biologics license application. Why would they do that? Well, we’re about to find out. Most otherDTE manufacturers, smaller companies like Acela Pharmaceuticals, which makes NP-thyroid, and RLC Labs, which made WP-thyroid, do not have those same resources. And this is cited in Pharma Voice in 2025. Why a treatment older than the FDA is getting new regulatory scrutiny. So when you petition the FDA to reclassify a drug in a way that requires this type of expensivetime-consuming biological approval, you’re not just asking for safety. You’re asking to eliminate your competitors from the marketplace. Now, I want to be very precise here. These allegations are documented in federal court filings, and it hasn’t been approved in court. It’s also been reported by multiple industry sources, including Fierce Pharma. But I’m telling you,what has been reported in legal proceedings, not stating it as an absolute fact because you deserve to know the difference and because I have to protect my license. Now, what do we know for certain?AbbeVee is working on a biologics license application for Armour thyroid through clinical trials called Avantia. This is cited by the AbbeVee corporate statement 2025 Avantia clinical trial for Armour thyroid. A cell of pharmaceuticals has been pursuing BLA approval for NP thyroid for seven years since 2017 and it completed its phase two trials successfully in 2025. They’re now moving Deb (20:15.448)into Phase 3 trials. This is also cited by the Acela Pharmaceuticals CEO statement 2025 seven-year pursuit for BLA approval completed Phase 2 trials moving to Phase 3.RLC Labs, which manufactured WP thyroid, has made no public announcement about pursuing BLA approval and really probably don’t have a plan to do this since they’ve been off the market for some time now. About five years, I think maybe a little longer. Here’s the market manipulation.If only ABBV is successful and obtains a BLA approval for Armour thyroid, that company would effectively have a monopoly on the DDT market. And in pharmaceutical markets, monopolies historically lead to price increases.We’ve seen this pattern over and over again when turning pharmaceuticals acquired Daraprim and raised their price from $13.50 to $750 per tablet overnight. When Myelin raised EpiPen increased prices by 400 % when insulin manufacturers colluded to raise prices in lockstep. This is the playbook.use regulatory barriers to eliminate your competition and then exploit pricing power. For a drug that’s been on the market since the 1800s, guess corporate greed is everywhere. They’re not making enough money on this product already and they’re taking advantage of the rules that they can manipulate their competition by. And here’s what really makes me furious. The American Thyroid Association, the professional organization Deb (22:06.672)representing endocrinologists sent letters to the FDA commissioner on October 8th of 2025 and September 18th of 2025.advocating for continued patient access to DTEs. This is cited in the American Thyroid Association statement and letter to the FDA commissioner dated October 8th, 2025 and September 18th, 2025. The American Association of Clinical Endocrinologists issued a statement on September 9th of 2025 supporting equitable access and personalized medicine for DTE. This was also cited in the American AssociationAssociation of Clinical Endocrinologists, AACE, statement dated September 9th, 2025. Even the medical establishment, which has historically favored levothyroxine, is saying, wait, this is going too far. Patients need access to this medication. But the FDA is moving forward anyway. Why? Well, where does it always lead us? Follow the money trail.Okay, so I need to explain what a biologics license application actually is because this is where the rubber meets the road for what’s going to happen to pricing and availability. What is a BLA?A BLA is a biologics license application. It’s a formal request submitted to the FDA to market a biologic product in the United States. A biologic is defined under the Public Health Service Act section 351 as a product derived from or made using living material, in this case, animal thyroid glands. And this is cited in the FDA definition for biologic products. So they’re putting armor thyroid right Deb (23:57.377)right up with stem cells and exosomes. Think about that. Stem cells and exosomes cost thousands of dollars per application because of how they have to be harvested, stored, freezed, all of that. But we’re talking about a thyroid gland. Good Lord, people.Unlike regular drug applications for synthetic medications which follow a simpler pathway, the BLA process is designed for complex biological products like monoclonal antibodies, vaccines, and gene therapy products. It’s a much more expensive, much more time-consuming process. The BLA processis what manufacturers have to do. And we’re going to talk about that. So according to Reprocell and Forge Biologics analysis of the FDA’s BLA process, here’s what companies need to submit. First, they need to complete a clinical trial data, phase one, two, and three trials, proving safety and efficacy for desiccated thyroid. Haven’t we done that since it’s been on the market since the 1800s? Just saying.This means they have to conduct large randomized controlled trials comparing it to levothyroxine, measuring safety outcomes, efficacy outcomes, and quality of life metrics. Second,Chemistry, Manufacturing and Controls, CMC’s data. Detailed information about how the product is manufactured, quality control measures, stability testing and specifications that must be met for every batch. Third, preclinical and animal safety data. Fourth, labeling and product information. Now, I think we have labeling and product information. Deb (25:53.717)since the 1800s? But just saying. Fifth, they need Pharma Covigilance Plan, a detailed plan for monitoring safety after the product is on the market. Haven’t they had to do that since the 1800s? And they have to have a timeline. And this is the critical part. The FDA’s standard review time for a BLA is 10 months.That’s after the application is deemed complete and accepted for filing. So this is cited by the FDA standard review timeline, BLA submission, and FDA review.Now, before you even get to filing, you need to conduct the clinical trials and compile all the data that’s typically several years of work. How are you going to prove safety and effectiveness in a large clinical trial long term? What do they consider? What do they deem long term? Three months, six months, a year, two years. These companies had 10 months.Well, maybe 12. They did it a year in advance. But unless you knew this was coming, how are you going to put together a trial, enroll the people, have all the trial components set up and ready to go in less than 12 months unless you knew it was coming beforehand? Even ifhad started all their clinical trials in 2024, completing them, compiling the data, and getting a complete application ready for submission, this would likely take you through mid-2026, then add another 10 months for FDA review. We’re looking at 2027 at the earliest for most of these companies to receive a BLA application. Deb (27:54.319)But the FDA gave the manufacturers until August of 2026. That’s approximately 19 months from when the August 2025 letters were sent. Most companies cannot reasonably complete the BLA approval in that timeframe. And when I’m talking about the 19 months, I’m talking about the information they would have had earlier. Now the cost.This gets me even more frustrated. Why are we spending this kind of money? The BLL process is extraordinarily expensive. The current FDA user fee for a BLA submission is approximately $483,560 just for the filing fee. And this is cited at the FDA user fees prescription drug user fee rates for 2025.The full cost of conducting clinical trials, CMC studies, and all the supporting documentation typically ranges from $500 million to over $1 billion, depending on the scope of the trials and the complexity. And this is cited in JAMA’s network, Open2023. A cell of pharmaceuticals has been pursuing the BLA approval since 2017. That’s eight years. And it’s just now.moving into phase three trials with a planned enrollment of approximately 300 patients. This is cited by the Acela Pharmacies CEO statement of 2025. Now that’s unusual. That’s typical for this process. This is not unusual. This is typical for this process to take seven, 10 years to get approval for this. So if Abby’s the one that requested this,Abby V. And Acela started this in 2017. Was Abby V threatened by Acela that Acela might get this approval and it would be quietly done without anybody seeing it? And maybe Abby V would be left out of the market after a century? Who knows? It’s possible. Deb (30:13.112)But for smaller manufacturers without billions in revenue, this cost is completely prohibitive. And this is why this matters. When you push an old established medication through an extraordinary, expensive approval process with a compromised timeline, one of three things happen. First, only the largest companies can afford it, creating a monopoly. And when that happens, the company that holds the only approved product can set pricing withminimal competitive pressures. Two, smaller manufacturers can’t afford it and their products disappear and the market shrinks and access decreases. Three, we see a combination of both and who pays the price? Literally, patients do. Now here’s whereThere’s something I want you to really think about because this is where the regulatory argument falls apart when you look at it carefully. The FDA’s concern about DTE is that, and I’m quoting their official statement, tablets from the same manufacturing batches may not always provide the same thyroid hormone levels. This is from their FDA statement.And that’s a legitimate quality concern, right? It is. Thyroid medications have a narrow therapeutic window like any other hormone, meaning the difference between an effective dose and the dose that causes problems can be quite small. But here’s what the FDA doesn’t emphasize. Generic drugs have the exact same dosing inconsistency issue, and it’s considered acceptable and has been since we allowed generics on the market.So how does a generic drug dose work anyway? Well, for generic drugs to be approved as bioequivalent to a brand name medication, the FDA requires that the generic drugs bioavailability fall within 80 to 125 % of the brand name product. Isn’t that a dose inconsistency? Deb (32:22.894)from the brand name medication? 800 or sorry, 80 to 125%. According to the pharmacy times analysis of the FDA’s bioequivalent standards, the 80 to 125 % bioequivalence rule means that a generic drug can have 20 to 45 % variability compared to the original brand product.Now, most generics are much closer than that. The FDA study data shows that the mean difference for an AUC value between generic and reference products is about three and a half percent in the two year post-Waxman hatch period, and 80 % of the generics fall within a five percent range. But the FDA’s regulations allow for that much higher variability. And this is cited in an FDA study data mean difference for AUC.Now, let me put this in plain language. A patient could take a generic levothyroxine tablet where one batch provides, say, 75 micrograms of an active thyroid hormone. And the next batch from a different manufacturer, a different generic manufacturer, could provide up to 93.75 micrograms, 125 % of that 75. That’s an 18 microgram difference.in the same prescribed dose. Now, this is considered acceptable and patients tolerate it and this system works.Yet the FDA’s argument against DTE is that batch-to-batch inconsistency is unacceptable and requires this expensive biologic approval? That’s a double standard. So why is batch inconsistency acceptable for generic levothyroxine, but supposedly unacceptable for desiccated thyroid? I’ll give you the regulatory answer. Deb (34:29.366)because DDT is a biological product derived from an animal tissue and the FDA considers biological products to require more rigorous control. That’s the regulatory answer, but I’ll give you the real answer.because there’s no billion dollar pharmaceutical company with a patent pending on generic levothyroxine who petitioned the FDA to regulate their competitors more strictly. The inconsistency argument is legitimate, but it’s selectively applied. And that matters when you’re trying to understand whether this is really about patient safety or whether it’s about market control.Now I want to talk about something that hasn’t gotten nearly enough attention in this discussion and it’s something that makes me absolutely furious. What is Armour Thyroid? According to the official prescribing information published by AbbeV and available through rxabbev.com and the FDA’s daily med database, Armour Thyroid contains the following inactive ingredients. Calcium steroid,dextrose derived from corn, mycocrystalline cellulose,sodium starch glycolate and a opadri white coating. Now let’s talk about dextrose. Dextrose is a sugar derived from corn and while manufacturers claim that the corn derived dextrose in armor thyroid is gluten free, here’s the problem. Cross contamination during corn processing can introduce gluten proteins especially if the corn is processed in facilities that also handle Deb (36:18.808)wheat, barley, or rye. Corn sensitivity is extremely common in patients with celiac disease and non-celiac gluten sensitivity, and studies show that up to 50 % of the celiac patients react to corn proteins due to molecular mimicry, and the corn proteins look similar enough to gluten that the immune system attacks them. And this is cited by RestartMD.com.And here’s what’s documented in peer-reviewed medical literature in a 2023 case report published in Case Reports in Endocrinology. These researchers documented five patients with gluten intolerance or celiac who were taking natural desiccated thyroid. Three of those patients also reported lactose intolerance. Now these patients had to switch from DTE to liquid levothyroxine formulations to avoid the inactiveSo here’s my question. If AbbeV becomes the only manufacturer with an approved DTE product and their formulations contain corn-derived dextrose that triggers reactions in celiac patients, what are those patients supposed to do? They can’t take armor because of the corn. They can’t take compounded DTE because the FDA is banning compounding of these biologics. They can’t take NPKsor WP thyroid because those companies may not survive the BLA process. So they’re left with a synthetic version of levothyroxine which may not work for them.Now the NP thyroid and WP thyroid difference. Now here’s what’s interesting according to drugs.com comparison of inactive ingredients and P thyroid and P thyroid has calcium steroid dextrose also derived from corn, mineral oil, multi-crystalline cellulose. Deb (38:19.31)cross carmelicin sodium and a opadri to white. So NP thyroid also has corn-derived dextrose. WP thyroid on the other hand was specifically formulated to be hypoallergenic according to ROC labs, but it’s no longer available and its ingredients were inulin from chicory root and medium chain triglycerides. No corn, no gluten, no common allergies. So todayWe do not have a glandular thyroid, a DTE, that is not potentially contaminated with gluten. Yet, patients with autoimmune thyroid disease are supposed to avoid gluten.Now, some of these people can handle a DTE and many cannot, so that argument could be a mute point. But at the end of the day, the one product that we had that was designated for patients with multiple chemical sensitivities, celiac disease and coron allergies, has been off the market for a long time already.We have a monopoly problem. So if ABBV becomes the only approved manufacturer, patients with these celiac diseases and corn allergies will either be forced to take a medicine that makes them sick and triggers their immune reaction or switch to a synthetic that doesn’t adequately treat their hypothyroidism or choose to go without treatment. This is not hypothetical. This is real patients with real medical needs who are about to lose accessto the only formulation that works for their body. And the FDA’s response is silence. Deb (40:07.69)Now I want to highlight something that hasn’t gotten nearly enough attention in this discussion. Compounding pharmacies. What is a compounding pharmacy? Compounded medications are custom made by licensed pharmacists to meet a patient’s specific needs. Maybe you need a different strength that was commercially available, but you have an allergy to a filler or a dye in the commercial product. Maybe you need a liquid formulation or instead of a tablet or you need a capsule. That’s when compoundingin. And the FDA’s, this is the FDA’s definition of compounding. And for decades, compounding pharmacies have been making desiccated thyroid extract for patients who needed customization. Some patients couldn’t take the commercial products because of the dyes and the fillers, and some needed strengths that were not available. And these compounding pharmacies filled the gap.But reclassification changes everything. When the FDA reclassified DTE as a biologic in 2022 and reinforced that decision in August of 2025, explicitly stated, and I’m quoting directly from the FDA’s official statement, these unapproved animal-derived thyroid medications are not eligible for compounding because these products are regulated as biologic products under the Public Health Service Act.How can that be? These products have been approved since 1938 and the Biologics Act didn’t go into effect or doesn’t go into effect until August of 2026.So how in 2022 were they able to say that the compounding pharmacies could not make these products? Anyway, what this means is after August 2026, compounding pharmacies will no longer be permitted to compound a desiccated thyroid extract, even for patients with specific medical needs. Now, compounding pharmacies can still compound T4 and T3 separately, synthetic versions of levothyroxine and liothyronine, according to Deb (42:12.728)healing dose compounding pharmacy. These pharmacists can create custom ratios of these two synthetic hormones to approximate what a patient was receiving from a DTE. But that’s not the same thing. Some patients respond better to the whole DTE preparation than to a compounded synthetic combination. And for patients with specific allergies to standard fillers like your celiac patients that I just talked about, losing the ability to get a compounded DTE alternative isreal hardship. This is going to be a ripple effect. For a subset of patients, maybe 5 to 10 percent of those on DTE compounding was their lifeline and it was their way to get a medication formulation that worked for their unique body. When compounding goes away, these patients lose that option as well and for some it will be a significant problem. Now let’s talk about what this likely means for your wallet.The current pricing right now, according to SingleCare and GoodRx, Armour Thyroid costs approximately $150 to $157 for a 90-day supply of 60-milligram tablets, about $1.67 per tablet. With discount cards, some patients can get it down to $101 to $152 for a 90-day supply.Generic levon thyroxine costs about $70 for a 90 day supply, less than half that price. And p-thyroid costs approximately $133 for a 90 day supply of 60 milligrams with a discount card about $83 to $101.What happens after we get BLA approval? Well, here’s the pharmaceuticals pricing model. When a company spends 500 million to $1 billion to bring a product to market, including conducting massive clinical trials, the cost tens of millions of dollars they recoup in that investment through pricing power. And this is cited in the pharmaceutical pricing models. If ABBIEV is the only company with an approved BLA of DTE, Deb (44:18.248)They have pricing power. They don’t have competitors. They can set their price, whatever they want. And historically, when drugs transition from grandfather status, which is basically unregulated to formal formally approved status, prices often increase significantly, not always, but often. And typically they have to get re-approval for insurance. SoTouring Pharmaceuticals acquired DARPM and raised the price again from $1,350 to $750 overnight, a 5,000 % increase. This is the playbook.Let’s talk about insurance coverage. This is the other consideration. Insurance companies sometimes have different coverage policies for approved versions versus unapproved drugs. And right now, many insurance plans cover armor thyroid or NP thyroid, even though they’re technically unapproved because they’ve been on the market for decades and patients are on them. Once a drug becomes formally approved, insurance companies may have new contractual relationships, prior authorization requirements, or preferred drugs.list that could affect your coverage. If 1.5 million people have to get a prior auth for their insurance to cover this new medication, this is going to drive the doctor’s offices crazy. We do not have the staff to man this. We do not have the manpower. We do not have the time. This is going to interrupt people’s ability to get their medications. This is going to create chaos within the system. And some patients might see better coverage, but manymost likely are going to see worse coverage and some might find themselves in a situation where they need to try to get the drug approved first or get an approval for something else like levothyroxine and they’re going to have to document that it didn’t work and the documentation that they had from 20 years ago is probably not going to be enough because it’s not documented anywhere. It’s lost in the system after 10 years. So for patients the practical takeaway is expect Deb (46:25.774)a price increase. I would say possible, but I don’t think that’s true. think you’re going to see a price increase if they get approved. Expect possible insurance complexities, budget accordingly, talk to your insurance company now about what your coverage is going to look like in 2027 if they even know. And if you want my honest assessment of what is likely to happen,I’ll give you a scenario, 30 % likelihood. The FDA enforces the August 26 deadline and DTE products not approved by then are pulled from the market. Patients will have 30 to 90 days to transition to other medications. Some patients suffer significant symptom relapse. Compounding for DTE becomes illegal and this disruptiveness of the system creates a real hardship. Scenario two.which is 50 % likely. This is actually what the FDA commissioner, Marty McCreary suggested on August 13th of 2025 when he posted on social media. The FDA is committed to pursuing the first ever approval of desiccated thyroid access pending results of the ongoing clinical trials. In the meantime, we’ll ensure access for all Americans. Hopefully that continues. What this likely means is the FDA uses enforcement discretion to allow continuedsales while approvals are being pursued and the deadline gets extended. Maybe patients get access for another two to three years while companies work on a BLA approval. This would be the least disruptive scenario, but it’s also legally uncertain because the enforcement letters have been formally rescinded. And scenario three, which is 20 % likelihood, one or two companies get BLA approval. Those products stay on the market at higher product prices and companies, products, other companiescompanies, products are pulled, the market shrinks, availability is limited, prices are higher, but patients can still get something. This is likely if a seller successfully completes phase three trials for NP-thyroid. And my assessment is based on the regulatory language and the enforcement letters that have not been rescinded yet, that the pattern of FDA enforcement, I believe scenario two enforcement discretion with an extended time frame is most likely what we’re going to see. Deb (48:49.488)doesn’t mean patients should sit back and do nothing. It means you should be prepared for change while advocating for access. If you want to keep Arm or Thigh Right on the market, 1.5 million people need to start talking about this publicly and flooding our Congress people, Bobby Kennedy, the FDA, with what you want to see happen. We have the ability to shape this and to change this with our voice. But if we sit back on our laurels and we do absolutelynothing. What is going to happen is what the FDA wants to have happen and ABV wants to have happen because they’re going to simply think people don’t give a shit. And if the American people are going to be lazy and not want to step forward and actually start using their voice for some good and instead of just going to social media and bitching and hoping something is going to happen, well, then we’re going to get what we deserve. But if you start taking someaction and you start advocating for the things that you want. Contacting your representatives, contacting your U.S. tell them the FDA has done this. Many of them may not know this, may not be on their radar. Tell them what you want. Start going after this. Start writing to the FDA Commissioner’s Office. They have a website. They have a Commissioner’s Office at fda.hhs.gov. Be responsible.respectful, but be firm. Explain your scenario. How long you’ve been on DTE. Why levothyroxine doesn’t work. What symptoms you experience when not adequately treated. How this decision will affect your quality of life and your pocketbook. Let’s do something proactive. So let’s consider this. Moving forward, work with your provider who understands the regulatory landscape around DTE. You can discuss the evidence for and against combination therapy.You can monitor for thyroid function with free T3 and free T4 testing, not just TSH. If you’re willing to try individualized approaches, you can do that. If you need help finding a functional medicine provider who understands this issue, come to serenityhealthcarecenter.com or explorethevanari.com. It’s a self-directed functional medicine support group. And right now what is happening is going to shape how history Deb (51:19.024)is made with not just armor thyroid, but many drugs to come. And it is important for you to take action. So I want to thank you for joining me today on Let’s Talk Wellness Now. This episode is about far more than thyroid medication. It’s about your right to personalized medical treatment. It’s about your regulatory capture and corporate influence. And it’s about what happens when billion dollar companies shape healthcare policy in ways that reduce patient choice and increase their profits.this episode resonates with you or you know somebody who’s going to be affected by desiccated thyroid, please share it. Post it on social media, send it to your doctor, email it to your representatives, tag AbbeVee, tag FDA. Make noise because the only way we stop this is if we make it too politically costly for them to continue. Your voice truly matters. Your health truly matters and you deserve access to treatments that work best for your unique body.If you’re ready to explore comprehensive personalized health care that puts you in control, visit us at SerenityHealthCareCenter.com. Learn more about functional medicine approaches to thyroid and beyond and explore my new platform, Venari.com, which is a self-directed functional medicine tool. Thank you for joining me today. Until next time, I’m Dr. Deb reminding you, your health is your responsibility, your choice, and your right. Be well, stay informed, fight back.and I’ll see you in the next episode. And if you’re looking for a full citation list of this episode, you can head over to letstalkwellnessnow.com and I will post all the citations for you so you have them in your arsenal as well. Thank you again.The post Episode 259 – The Desiccated Thyroid Crisis: FDA's Unseen Impact & Corporate Manipulation first appeared on Let's Talk Wellness Now.

Send us Fan MailIf your case report already feels harder than expected, it's probably not the writing......it's the case you chose.In this episode, we walk through what's actually making the process more difficult - and how to think about your case report more strategically so you can move forward with clarity.In this episode, we cover: - What actually makes a case report feel difficult - Where most people go wrong early in the process - How to approach your case more strategically - What to focus on before you start writingResources:Case Report Idea Generator: https://TheOncoPT.com/generatorPick Your Perfect Patient Masterclass: https://TheOncoPT.com/perfectWriting Sprint: https://TheOncoPT.com/sprintIf you want a structured way to get started on your ABPTS oncology case report, I'm hosting a LIVE writing sprint later this month where we'll work through this together.You can find the details here: https://TheOncoPT.com/sprint Follow TheOncoPT on Instagram.Follow TheOncoPT on LinkedIn.

Zara M. Patel, MD, Professor of Otolaryngology–Head and Neck Surgery at Stanford Medicine and Director of the Stanford Initiative to Cure Smell and Taste Loss, discusses her pursuit of a cure for olfactory dysfunction, the science behind smell recovery, and the research milestones that have redefined what is possible for patients with smell and taste loss. Dr. Patel reflects on her cross-country training journey, the curiosity-driven path that led her into an underexplored corner of the specialty, and how olfactory training and platelet-rich plasma (PRP) injections went from novel ideas to evidence-based treatments. The conversation also covers the biology of olfactory nerve regeneration, the importance of mentorship in building an academic career, and the expanding frontier of neuro-rhinology. This episode is featured as part of celebrating WIO Day every March 8. Helpful Resources: Links for physicians and patients watching this: Stanford Initiative to Cure Smell and Taste Loss: https://med.stanford.edu/content/sm/smell.html/ Patient education page for Olfactory Training: https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2782042 PRP studies:Pilot study: https://pubmed.ncbi.nlm.nih.gov/32337347/ Randomized Controlled Trial: https://pubmed.ncbi.nlm.nih.gov/36507615/ Long term follow-up cohort study: https://pubmed.ncbi.nlm.nih.gov/39740091/ Systematic Evidence Based Review of PRP use in all fields of ENT: https://pubmed.ncbi.nlm.nih.gov/38914822/ Case Report for use in Post-Traumatic Anosmia: https://pubmed.ncbi.nlm.nih.gov/39913151/

A 62‐year-old man is undergoing a CT‐guided core biopsy of a lung nodule when he develops an iatrogenic pneumothorax. After admission to the Royal Adelaide hospital he has ongoing dyspnoea, oxygen desaturation, and chest pain not helped by a preexisting Chronic Obstructive Pulmonary Disease. The treatment for the patient's symptoms doesn't immediately go to plan but his care team apply a combination of recent technologies to bring the condition under control. Pomegranate [Case Reports] have been developed to help Trainees rehearse diagnostic problem solving and case presentation.GuestsAssociate Professor Arash Badiei FRACP (Royal Adelaide Hospital; Adelaide University)HostsAssociate Professor Stephen Bacchi FRACP (Northern Adelaide Local Health Network; Adelaide University)Dr Brandon Stretton (Central Adelaide Local Health Network;)ProductionProduced by Dr Stephen Bacchi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Desert Whispers' by Tellsonic and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and med students Srishti Sharma, Prakriti Sharma and Cindy Shi. Key Reference (Spoiler Alert)* * * * *Persistent air leak successfully treated with endobronchial valves and digital drainage system [Altree, Respirol Case Rep. 2018] Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox or any podcasting app. 

In this Shortcast, Sophie Manoy summarises a newly reported case of holocarboxylase synthetase deficiency presenting with neonatal cholestatic liver disease. This is only the second such case described and highlights a possible genotype–phenotype correlation that broadens the recognised clinical spectrum of this rare but treatable disorder. Holocarboxylase Synthetase Deficiency: A Second Case Report With Neonatal Cholestatic Liver Disease Sophie Manoy, et al https://doi.org/10.1002/jmd2.70051

Du siehst sie in jedem Gym: schwarze EMS-Anzüge, 20 Minuten Training, große Versprechen. Aber was macht dieser Strom im Körper wirklich?In dieser Folge des Elektrotechnik Podcast klären wir, wie EMS in der Medizin Muskeln bei Herzinsuffizienz, Sarkopenie und Reha rettet und warum derselbe Strom im Studio auch Rhabdomyolyse und Nierenschäden auslösen kann, wenn Trainer keine Ahnung haben. Giancarlo the Teacher redet über Pulsbreite, Milliampere, DIN-Normen, Risiken und Nutzen verständlich für Azubis, Meister und Ingenieure.Wenn Du wissen willst, ob EMS ein sinnvolles Tool oder nur teurer Strom für Faule ist, dann ist diese Folge Pflichtprogramm.Quellen:Q1: Le YH et al. Outcomes Addressed by Whole Body Electromyostimulation and Related Techniques in Middle Aged and Older Adults. Evidence Map, 2024. https://opus.hs-furtwangen.de/frontdoor/deliver/index/docId/10731/file/outcomes.pdfQ2: Whole Body Electromyostimulation and Musculoskeletal Diseases. German Journal of Sports Medicine, 2024. https://www.germanjournalsportsmedicine.com/fileadmin/content/archiv2024/Issue_2/DtschZSportmed_10.5960dzsm.2024.590_Review_Kemmler_Whole-Body_Electromyostimulation_and_Musculoskeletal_Diseases_2024-2.1.pdfQ3: Schaltnetzteil Funktionsweisehttps://www.neumueller.com/de/knowledge/stromversorgung/schaltnetzteilfunktionsweiseQ4: E-Stim: Neuromuskuläre Elektrostimulation zur Therapie der Sarkopenie bei Patienten auf der Intensiv- oder Überwachungsstationhttps://drks.de/search/de/trial/DRKS00025106Q5: Viderman D et al. The Impact of Transcutaneous Electrical Nerve Stimulation on Acute Postoperative Pain. Systematic Review und Meta Analyse, Journal of Clinical Medicine, 2024.https://www.mdpi.com/2077-0383/13/2/427Q6: Wang JJ et al. Frequencies of Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain. Network Meta Analysis, 2026. plus Frontiers in Pain Research 2024 zu Elektrotherapien bei CLBP.https://www.sciencedirect.com/science/article/abs/pii/S1877065725001216Q7: Wirksamkeit der Ganzkörper Elektromyostimulation auf Muskelkraft, Anthropometrie und Leistung. Deutsche Zeitschrift für Sportmedizin, Übersichtsartikel.https://www.zeitschrift-sportmedizin.de/wirksamkeit-ganzkoerper-elektromyostimulation-muskelkraft-anthropometrie-leistung-wb-ems-trainingQ8: DIN EN 60601 2 10 / VDE 0750 2 10. Medizinische elektrische Geräte, Besondere Festlegungen für die Sicherheit von Geräten zur Stimulation von Nerven und Muskeln. plus Zusammenfassung der Anforderungen durch Prüflabore.https://www.dinmedia.de/de/norm/din-en-60601-2-10/393710944Q9: Flexistim – Gebrauchsanweisung TensCare – 5.3 Impulsbreitehttps://www.cardiovibe.de/media/pdf/5f/f4/52/TensCare-Flexistim-Bedienungsanleitung.pdfQ10: Federolf PA. Elektromyostimulation und Maximalkraft der unteren Extremität. Universität Innsbruck, 2024.https://diglib.uibk.ac.at/download/pdf/11334160.pdfQ11: Federolf PA. Elektromyostimulation und Maximalkraft der unteren Extremität. Universität Innsbruck, 2024.https://diglib.uibk.ac.at/download/pdf/11334160.pdfQ12: Krafttraining: Definition und Grundlagenhttps://www.medi-karriere.de/magazin/krafttrainingQ13: „Was sagen Ärzte zu EMS Training“ Überblick zu Nutzen und Risiken inklusive Rhabdomyolyse Hinweis, vegardians, 2025.https://vegardians.de/blogs/fragen-antworten/was-sagen-arzte-zu-ems-training-uberzeugend-ehrlich-profi-checkQ14: Optirise 2025 Wissenschaftliche Forschung über EMS Training und Nebenwirkungen.https://www.optirise.nl/de/ems-training/wissenschaft-nebenwirkungenQ15: Fallberichte und Reviews zu EMS induzierter Rhabdomyolyse, inklusive Nordberg 2023 und aktuellem Case Report 2025, plus Übersichtsartikel zu Rhabdomyolyse und mögliche Nierenbeteiligung.https://pubmed.ncbi.nlm.nih.gov/37873991/Q16: Neue internationale EMS-Guidelineshttps://fitnesstribune.com/neue-internationale-ems-guidelines/Q17: Arnold Schwarzenegger. „There are no shortcuts everything is reps, reps, reps.“ Zitat aus „Total Recall: My Unbelievably True Life Story“ und diversen Sekundärquellen.https://www.azquotes.com/quote/498067https://www.paypal.com/donate/?hosted_button_id=9UW85PQWLBWZSSupport this podcast at — https://redcircle.com/elektrotechnik-podcast/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What unsuspecting dangers lie within a garden compost bin? The Case Reports team are back to uncover a new pair of neurological mysteries. The first case this episode (1:24) comes from Edinburgh, centred on an 88-yo woman who presents with headache and eye-pain on her right side. She receives an early diagnosis of migraine, but returns a few weeks later with intermittent vomiting and subsequent progressive visual loss. https://pn.bmj.com/content/26/1/83  The second case (19:51) from Wessex features a common presentation of tingling feet, with a 62-yo man who develops gait instability. More curious are a significant drop in his weight, as well as a scaly patch on his chest. https://pn.bmj.com/content/26/1/63   The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the October 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Clinical Lecturer in Neurology at the Institute of Cognitive Neuroscience, University College London, and an Honorary Neurology SpR at the National Hospital for Neurology and Neurosurgery. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://bit.ly/4aXF46i). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening.

A 75 year-old man with severe aortic stenosis is deemed unsuitable for surgery on the basis of a porcelain aorta detected with cross-sectional imaging. The patient had, a decade earlier, been diagnosed with hypertrophic cardiomyopathy after presenting with cardiac arrhythmia. A dual chamber ICD was implanted at the time for secondary prevention and other comorbidities were managed. The patient is now being considered for staged alcohol septal ablation (for the HCM) and transcatheter aortic valve replacement (for the aortic stenosis), however, additional complications force an experimental two-in-one procedure.GuestProfessor Ross Roberts-Thomson FRACP (Central Adelaide Local Health Network; University of Adelaide)HostsAssociate Professor Stephen Bacchi FRACP (Northern Adelaide Local Health Network; University of Adelaide)Dr Alistair Leslie (Central Adelaide Local Health Network;)Key Reference (Spoiler Alert)* * * * *Two-in-one: Combined transcatheter therapy for hypertrophic cardiomyopathy and aortic stenosis [IHJ Cardiovascular Case Reports (CVCR). 2020]  ProductionProduced by Stephen Bacchi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Desert Whispers' by Tellsonic and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPDto record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

BUFFALO, NY – February 11, 2026 – A new #casereport was published in Volume 17 of Oncotarget on February 6, 2026, titled “Exploring the potential link between mRNA COVID-19 vaccinations and cancer: A case report with a review of haematopoietic malignancies with insights into pathogenic mechanisms.” In this report, led by first author Patrizia Gentilini along with corresponding author Panagis Polykretis from the “Allineare Sanità e Salute” Foundation and Independent Medical Scientific Commission (CMSi), Milano, an international team of researchers presented a detailed case involving a healthy, athletic woman who developed acute lymphoblastic leukemia and lymphoblastic lymphoma shortly after receiving her second dose of the Pfizer-BioNTech COVID-19 mRNA vaccine. The authors reviewed existing literature and discussed possible immune-related mechanisms that could connect mRNA vaccines to blood cancers, calling attention to the need for further investigation. The case report focuses on a 38-year-old woman who began experiencing immune-related symptoms the day after her second COVID-19 mRNA vaccine dose. Within months, she was diagnosed with an aggressive blood cancer affecting early-stage lymphocytes. While she initially achieved complete remission through chemotherapy, she later experienced a central nervous system relapse and underwent a stem cell transplant. The sequence of events raises questions about whether the vaccine-induced immune response may have contributed to disease onset or progression. To provide broader context, the authors reviewed several other reports describing similar cancer cases after COVID-19 vaccination. These included lymphomas, leukemias, and other haematopoietic disorders. In many cases, symptoms appeared shortly after vaccination. While these instances remain rare, the authors argue that the patterns merit closer study. They also discuss potential mechanisms, including immune suppression, increased inflammation, and vaccine-related interference with key cancer-protective proteins such as p53. One concern highlighted in the report involves lipid nanoparticles used to deliver the vaccine, which may circulate beyond the injection site and reach organs such as the bone marrow. The authors note that changes in immune signaling, antibody responses, and genetic material could, under certain conditions, create conditions favorable to cancer development in susceptible individuals. However, they emphasize that a definitive cause-and-effect relationship has not been established. “The carcinogenic risk associated with these technologies, which has long been known within the gene therapy field, represents an area of research that cannot be ignored, given the fundamental principle of medicine “primum non nocere” (first, do no harm).” Although the case does not prove that vaccination caused the cancer, it adds to a small body of evidence suggesting that immune disturbances from mRNA vaccines should be studied further. The authors emphasize the importance of continuing long-term safety monitoring as mRNA vaccine technologies are expanded to other uses. Understanding potential rare risks is essential for ensuring informed public health decisions while maintaining trust in vaccine programs. DOI - https://doi.org/10.18632/oncotarget.28827 Correspondence to - Panagis Polykretis - panagis.polykretis@gmail.com Abstract video - https://www.youtube.com/watch?v=OO-wewH7mEY To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Spotify - https://open.spotify.com/show/0gRwT6BqYWJzxzmjPJwtVh MEDIA@IMPACTJOURNALS.COM

Explore a complex case of Thoracic Outlet Syndrome, double crush, & triple crush injuries. Learn about diagnosis, treatment, & patient support. Q: Overview of Neck, Nerve, or Both? A: My wife experienced numbness in her upper extremities. As an athletic trainer (AT), I initially suspected Thoracic Outlet Syndrome (TOS). She eventually sought medical attention and was diagnosed with TOS. Conservative treatment, including medication and a home exercise program, was recommended. However, therapy seemed to worsen her symptoms. An MRI of the vascular system came back normal, except for a benign thyroid mass. A cervical MRI revealed stenosis in C5, C6, and C7, which, when combined with her other symptoms, provided clarity. I consulted a spine surgeon, who advised exhausting conservative options before considering surgery for insurance coverage. My wife, who has a fear of anesthesia, opted for pain management and received injections. An EMG to rule out carpal tunnel syndrome indicated 70% carpal tunnel involvement. An upper extremity specialist diagnosed a double crush injury, meaning nerve compression at two sites. She underwent left-side carpal and cubital tunnel release, followed by a two-level cervical fusion. Post-surgery, she regained sensation in her pinkies. The right side was subsequently treated. She experienced relief for about a year before numbness recurred. Another round of CT, MRI, and EMG scans returned normal. Pain management suggested a shoulder issue, leading to an MRI of the shoulder. While the report mentioned a slight rotator cuff tear, a physician who reviewed the scans deemed her shoulder pristine. This doctor’s examination of her neck, however, exacerbated her symptoms, leading to a diagnosis of lower brachial plexus TOS. Despite my initial concern about the previous treatments, the doctor affirmed that the cervical fusion was necessary. A C8 nerve block did not provide relief but offered further diagnostic information. We were then referred to a specialist in Dallas, where a diagnostic nerve block in the scalenes provided immediate relief. Months later, Botox injections were administered for extended relief. The doctor’s words, “How does it feel to not be crazy?” significantly validated her experience. She then underwent a first rib removal on the left side, which resulted in an 11-day hospital stay with complications including two chest tubes, a needle aspiration, and 100cc of fluid in the pleural cavity. Upon returning home, she began physical therapy but developed shortness of breath with deep breaths due to a costochondral fracture, likely from the chest tube or aspiration. She is currently awaiting a consultation for ultrasound injections to address this. The journey continues. Q: What inspired you to share this story? A: The primary motivation was to share the complex journey and its takeaways. This case involved a “triple crush” — compression at the first rib, cubital tunnel, and carpal tunnel. A key takeaway is the importance of acknowledging when you “don’t know, but know the next step.” In healthcare, we often focus on obvious issues, but a broader perspective is often needed before returning to specific concerns. It’s also crucial to acknowledge the psychological toll on patients without answers, highlighting the profound impact of chronic pain. Q: You mentioned how emotionally draining the journey was. What advice do you have for clinicians to support patients? A: Remind patients that recovery is an “ultramarathon, not a sprint.” Reinforce this message, as other healthcare professionals will likely echo it. Sometimes, when my wife is in pain, she doesn’t want to discuss it, and that’s acceptable as long as I am there to support her. The doctor’s validation, “How’s it feel to not be crazy?” significantly improved her emotional well-being. Supporting patients in seeking further opinions is also vital. Q: Overlapping issue on a personal level, how did you navigate the multiple diagnoses? A: My ability to navigate this well stems from my access to top medical professionals through my profession. My connections as an athletic trainer allowed me to consult doctors and seek referrals. While they may not know specific TOS treatments, they can guide us to the appropriate specialists. Q: Any difficulties separating the Athletic Trainer (AT) role from the husband role? A: There were no difficulties in separating the AT from the husband role. My wife knew me as both from the beginning of our relationship, so there was no separation or conflict. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Carolyn McMakin, MA, DC - https://frequencyspecific.com     Kim Pittis, LCSP, (PHYS), MT - https://fsmsports365.com 00:00 Introduction: The Power of FSM 01:58 Case Study: Chronic Pain and FSM Treatment 09:43 Q&A: FSM for Allergic Skin Rashes 11:24 Q&A: Kidney Stones and FSM 12:58 Q&A: Chronic Pain and Emotional Factors 22:02 Q&A: FSM for Thyroid Eye Disease 28:11 Q&A: FSM and COVID-19 30:10 Q&A: Customizing FSM Protocols 32:36 Understanding Back Pain and Facet Joints 33:23 Client Case: Lumbar Stenosis and Treatment Approaches 36:23 Treating Scarring and Kidney Issues 41:38 Massage Therapy and Frequency Specific Microcurrent 43:24 Advanced Training and Case Reports 55:45 Interstitial Cystitis and Male Patients 58:31 Holiday Wishes and FSM Resources **Understanding Patient Dynamics** When interacting with patients entrenched in long-term pain, it's essential to consider how their family dynamics or personal history might influence their health conditions. Patients may inadvertently cling to their pain, viewing it as a form of control or normalcy within a chaotic family structure. Addressing these dynamics sensitively is crucial to effective treatment. **FSM's Unique Approach to Pain and Scar Tissue** FSM offers an innovative way to address pain that stems from scar tissue and inflamed nerves. Traditional medical systems often lack tools to relieve patients from such chronic pain effectively. FSM tackles this issue by focusing on the fundamental cause: the scar tissue within nerves. By addressing these physical barriers, FSM provides relief where standard treatments may falter. **Case Study: Overcoming Chronic Nerve Pain** Consider the scenario of a patient who has undergone multiple surgeries and suffers from persistent sciatica due to scarred nerves. FSM can improve sensation and reduce pain levels by utilizing specific frequencies targeting the affected nerves and their surrounding structures. Through meticulous manipulation and microcurrent application, practitioners can transform a patient's experience from constant unyielding pain to manageable levels, allowing for a renewed quality of life. **Addressing Comorbid Conditions** Pain rarely appears in isolation. Conditions such as kidney toxicity, allergic skin reactions, or systemic causes like inflammation from menopause may exacerbate a patient's situation. FSM can address these underlying issues by employing targeted frequencies that alleviate symptoms and restore balance to affected organs. **The Necessity for Patience in Treatment** A critical element of successful FSM treatment is patience—for both the practitioner and the patient. Chronic conditions often require multiple sessions to achieve notable improvements. Encouraging patients to trust the process and embrace incremental progress is vital to successful outcomes. **Special Considerations: Allergies and Autoimmunity** When dealing with conditions like allergic skin rashes, it's crucial to address both the symptomology and the immune system's overreaction. By running sequences that mitigate allergic responses and enhance vagus nerve function, FSM can provide relief from chronic allergic manifestations. **The Role of the Practitioner: Creating Customized Solutions** Medical practitioners are encouraged to incorporate FSM by tailoring it to the unique needs of each patient. The versatility of FSM's frequency applications allows clinicians to craft individualized treatment protocols—ranging from sciatica pain management to addressing internal organ complications like kidney stones or interstitial cystitis.

Another set of intriguing cases from the latest issue of the journal, pored over by the Case Reports team.  In the first case, a 24-yo man presents acutely with reduced consciousness, following 3 days of right-sided headache. His mother reports sudden behavioural changes with jerky movements and enlarged pupils. He is agitated, not obeying commands and not moving his left-side limbs. He had a history of autism and vascular Ehlers-Danlos syndrome and was on medication for stroke prevention. An MRI scan led to a differential diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES), but the final conclusion came post-discharge after a further review of his scans.  https://pn.bmj.com/content/25/6/549 The second report (19:37) describes two curious instances of functional neurological disorder (FND), both of which improved after the patients were in comatose states. The first patient is a 59-yo man who had developed muscle weakness shortly after at car crash at age 49, and had subsequently been reliant on a wheelchair for more than 8 years. Recently the patient had been infected simultaneously with severe cases of flu and COVID-19, during which he had been sedated and placed in an induced coma for several weeks. Awakening from the coma, the patient showed surprising signs of new mobility. In the second patient, a 40-yo woman presented with flaccid paralysis of her left arm, with loss of sensation up to the shoulder. She had a history of bipolar disorder and agoraphobia. She was diagnosed with FND and participated in physiotherapy and hypnotherapy with no improvement. Thirteen months later she was readmitted following an overdose on a mix of analgesics and sedatives, and was ventilated in the ITU for several hours. Upon waking the patient noticed that her previously paralyzed arm had completely recovered. https://pn.bmj.com/content/25/6/562  Further reading: Advances in functional Neurological disorder (BMJ Neurology Open)   The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the October 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening.

An L.A. based podcast brought to you by two forensic psychologists who dissect the intersections where true crime, forensic psychology, and entertainment meet. Episode Description: Crazy In Love: Erotomania Dr. Scott & Dr. Shiloh get into the subcategory of Delusional Disorder, Erotomania; to have the delusional or false belief of a secret or known admirer. This disorder is often the trigger for obsessive celebrity stalkers and has been the cause for numerous violent acts. The docs explore the origin, criteria, and research of this rare phenomenon and cover the cases of John Hinkley Jr., Margaret Mary Ray, and the shooter who killed rising star Christina Grimmie. Related episode: Stalking: The Crime of the 90's https://anchor.fm/lansc/episodes/25--Stalking-The-Crime-of-the-90s-e537ff Donate to the Christina Grimmie Foundation here: https://christinagrimmiefoundation.org/ Mentions: Lenora Consulting LLC https://www.lenoraclairellc.com/ 10ish Podcast https://www.10ishpod.com/ Resources Braun, Claude, and Sabrina Suffren. "A General Neuropsychological Model of Delusion." ResearchGate, Taylor & Francis (Routledge), Mar. 2010, www.researchgate.net/publication/41670340_A_general_neuropsychological_model_of_delusion. Accessed 26 Nov. 2021. Brüne, Martin. "Erotomanic Stalking in Evolutionary Perspective." Behavioral Sciences & the Law, vol. 21, no. 1, 16 Dec. 2002, pp. 83–88, pubmed.ncbi.nlm.nih.gov/12579619/#:~:text=Erotomania%2C%20the%20delusion%20of%20being,concerning%20prevalence%20rates%20and%20behavior.&text=The%20evolutionary%20perspective%20may%20provide,understanding%20of%20forensically%20relevant%20behaviors., 10.1002/bsl.518. Accessed 26 Nov. 2021. Christina Grimmie: The Murder of a Rising Star. Orlando Sentinel, 4 June 2018, disc 1-2. Podcast. "De Clerambault Syndrome (Erotomania) in the Criminal Justice System: Another Look at This Recurring Problem | Office of Justice Programs." Ojp.gov, 2021, www.ojp.gov/ncjrs/virtual-library/abstracts/de-clerambault-syndrome-erotomania-criminal-justice-system-another. Accessed 26 Nov. 2021. Ghosh, Tulika, and Minkesh Chowdhary. De Clerambault Syndrome: Current Perspective. Www.intechopen.com, IntechOpen, 12 May 2021, www.intechopen.com/chapters/72361. Accessed 27 Nov. 2021. Hayes, Crystal. "Forgotten Story of Singer's Legacy, Man Who Killed Her." Courier-Post, 18 Dec. 2016, www.courierpostonline.com/story/news/local/south-jersey/2016/12/18/forgotten-story-christina-grimmie-and-man-who-killed-her/95585040/. He Loves Me, He Loves Me Not. Directed by Laetitia Colombani, Samuel Goldwyn Films, 2003. Harmon RB;Rosner R;Owens H. "Obsessional Harassment and Erotomania in a Criminal Court Population." Journal of Forensic Sciences, vol. 40, no. 2, 2011, pubmed.ncbi.nlm.nih.gov/7602275/. Accessed 26 Nov. 2021. "How History Changed Anita Hill (Published 2019)." The New York Times, 2021, www.nytimes.com/2019/06/17/us/anita-hill-women-power.html. Accessed 27 Nov. 2021. Jamaluddin, Ruzita. "Same Gender Erotomania: When the Psychiatrist Became the Delusional Theme—a Case Report and Literature Review." Case Reports in Psychiatry, vol. 2021, 1 Sept. 2021, p. e7463272, www.hindawi.com/journals/crips/2021/7463272/, 10.1155/2021/7463272. Kelly, B. D., et al. "Delusion and Desire: Erotomania Revisited." Acta Psychiatrica Scandinavica, vol. 102, no. 1, July 2000, pp. 74–76, pubmed.ncbi.nlm.nih.gov/10892614/, 10.1034/j.1600-0447.2000.102001074.x. Accessed 26 Nov. 2021. Meloy, J. CASE REPORT Erotomania, Triangulation, and Homicide. "Risk Factors for Stalking Violence, Persistence, and Recurrence." The Journal of Forensic Psychiatry & Psychology, 2017, www.tandfonline.com/doi/abs/10.1080/14789949.2016.1247188?journalCode=rjfp20&. Accessed 26 Nov. 2021. Safeekh, AT, and Denzil Pinto. "Venlafaxine-Induced Psychotic Symptoms." Indian Journal of Psychiatry, vol. 51, no. 4, 2009, p. 308, www.ncbi.nlm.nih.gov/pmc/articles/PMC2802382/, 10.4103/0019-5545.58301. Accessed 26 Nov. 2021. Sederholm, Jillian. "Gunman Who Killed 'the Voice' Singer Had Extra Ammo, Knife: Police." NBC News, 11 June 2016, www.nbcnews.com/news/us-news/voice-singer-christina-grimmie-shot-after-florida-concert-n590161. Accessed 27 Nov. 2021. Shanee Edwards. "I Just Discovered the Crazy World of Erotomania Thanks to HBO's Confirmation." SheKnows, SheKnows, 17 Apr. 2016, www.sheknows.com/entertainment/articles/1119045/erotomania-and-confirmation-hbo/. Accessed 26 Nov. 2021.

A 72-year-old female presents to an Adelaide emergency department with bilateral eye pain and redness lasting several days. She has a history of hypertension, hypercholesterolemia and age-related macular degeneration for which she has received a range of medications. Anterior uveitis is identified as the proximal cause of the ocular pain but there are many possible aetiologies that require careful consideration. Pomegranate [Case Reports] have been developed to help Trainees rehearse diagnostic problem solving and case presentation.  Guests Associate Professor Jagjit Singh Gilhotra ,FRANZCO (Queen Elizabeth Hospital; University of Adelaide) Dr Yong Min (Shane) Lee FRACP (Royal Adelaide Hospital) HostAssociate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide)ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Key Reference (Spoiler Alert)* * * * *Bilateral occlusive retinal vasculitis secondary to intravitreal faricimab injection: a case report and review of literature [Lee, Eye Vis. 2024] Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

On “Banfield,” Ashleigh has new information in the D4VD and Celeste Rivas-Hernandez mystery. A grand jury reportedly is convening in the case. TMZ's Harvey Levin joins Ashleigh to talk about whether the young girl's body was partially frozen. Plus, how do you investigate a crime scene that sets sail? Ashleigh turns to FBI and maritime legal experts for insight into the mysterious death of Anna Kepner on a cruise ship. Also, Ashleigh shares must-see bodycam video from the arrest of escaped “Slender Man” stabber, Morgan Geyser.Ashleigh Banfield is *the* definitive authority on the nation`s biggest true crime stories. A veteran award-winning journalist, Ashleigh brings a sharp focus to the crime stories gripping America, distilling facts and analyzing context in a way which captures viewers` interests and imaginations. No one knows the prosecution and the defendants` cases better than BANFIELD, all the while keeping the victim at the heart of every story we tell just another reason NewsNation is truly News for All Americans.Weeknights at 10p/9C. #BanfieldNewsNation is your source for fact-based, unbiased news for all Americans. More from NewsNation: https://www.newsnationnow.com/Get our app: https://trib.al/TBXgYppFind us on cable: https://trib.al/YDOpGyGHow to watch on TV or streaming: https://trib.al/Vu0Ikij

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826251357570

Enjoy a lively and informative discussion as MTF Case Report Contest Chair, Robin Miccio, speaks with 2025 Silver Award winner Hailey Robertson about her report, "Massage Therapy for Multiple Sclerosis."

Two new cases from the latest issue of the journal present the podcast team with some rare explanations, and a chance to test yourself on food trivia.   In the first case (1:18), from Malaysia, a 49-yo left-handed woman develops 10 days of recurrent left-sided focal facial seizures. These seizures progressed to epilepsia partialis continua, which is controlled with some difficulty by employing a broad range of six different anti-seizure medications. Further symptoms arose during monitoring, including emotional lability as well as dystonia, left arm dysfunction, dysphasia and dysarthria. EEG imaging showed focal slowing in the right hemisphere. https://pn.bmj.com/content/25/5/475 The second case (22:20) features a Northamptonshire chef in her 60s, who presents to the emergency department with a week-long history of nausea, vomiting, and abdominal pain. This progressed to dysphagia and dypsnoea, as well as a downshift in the pitch of her voice. Her conditioned worsened, with respiratory arrest requiring CPR to re-establish circulation. Neurological examination was initially done while sedated, showed fixed and dilated pupils.  https://pn.bmj.com/content/25/5/493 Overloaded with Greek terms today? Here are some definitions from BMJ Best Practice and NHS UK: Dystonia is a movement disorder characterised by sustained involuntary muscle contractions and abnormal postures of the trunk, neck, face, or extremities. Dysphasia, also known as aphasia, is an acquired impairment of language that affects comprehension and production of words, sentences, and/or discourse. Dysarthria is difficulty with speaking, caused by damage or weakness of the muscles needed for speech. Dysphagia is difficulty with the act of swallowing solids or liquids. Dyspnoea, also known as shortness of breath or breathlessness, is a subjective sensation of breathing discomfort. The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the October 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening.

This series will be discussing four evidence reports commissioned by Natural England which were deposited on Applied Ecology Resources and explored the importance of nature inclusion across various communities. In this episode, Clare will be discussing the barriers to inclusion for ethnic minorities, and how we might be able to overcome them. The Queen Elizabeth Olympic Park: Whose Values, Whose Benefits? by Dr. Bridget Snaith - https://openaccess.city.ac.uk/id/eprint/19291/ 9 Rules for the Black Birdwatcher by J. Drew Lanham - https://orionmagazine.org/article/9-rules-for-the-black-birdwatcher/ Applied Ecology Resources Report: Ethnic Minorities - https://www.britishecologicalsociety.org/applied-ecology-resources/document/20220436860/

This series will be discussing four evidence reports commissioned by Natural England which were deposited on Applied Ecology Resources and explored the importance of nature inclusion across various communities. In this episode, Clare will be discussing the barriers to inclusion for older people, and how we might be able to overcome them. Wild at Heart, Sheffield & Rotherham Wildlife Trust - https://www.wildsheffield.com/discover/your-community/wild-at-heart/?srsltid=AfmBOooBDMSVIiz51JkVIAN2lotY4qAD5uogVfGTUXRPAOWbK6BOnBs8 Welcome to DalesBus - https://www.dalesbus.org/ Applied Ecology Resources Report: Older People - https://www.britishecologicalsociety.org/applied-ecology-resources/document/20220436863/

This series will be discussing four evidence reports commissioned by Natural England which were deposited on Applied Ecology Resources and explored the importance of nature inclusion across various communities. In this episode, Clare will be discussing the barriers to inclusion for those in low-income areas, and how we might be able to overcome them. Applied Ecology Resources Report: Low Income Areas - https://www.britishecologicalsociety.org/applied-ecology-resources/document/20220436862/

This series will be discussing four evidence reports commissioned by Natural England which were deposited on Applied Ecology Resources and explored the importance of nature inclusion across various communities. In this episode, Clare will be discussing the barriers to inclusion for those with disabilities, and how we might be able to overcome them. PEDALL Inclusive Cycling | New Forest National Park - https://www.pedall.org.uk/ Sensing Nature - https://sensing-nature.com/ Applied Ecology Resources Report: People with Disabilities - https://www.britishecologicalsociety.org/applied-ecology-resources/document/20220436861/

Show notes at pharmacyjoe.com/episode1061. In this episode, I’ll discuss a case report of seizures precipitated by esmolol in sterile water formulation. The post 1061: Beware of the Diluent! A Case Report of Seizure From Esmolol In Sterile Water appeared first on Pharmacy Joe.

CardioNerds join Dr. Neel Patel, Dr. Victoria Odeleye, and Dr. Jay Ramsay from the University of Tennessee, Nashville, for a deep dive into cardiovascular medicine in the vibrant city of Nashville. They discuss the following case: A 57-year-old male with a history of prior cardiac surgery, hypertension, and polysubstance use presented with syncope and chest pain. Initial workup revealed a large saccular ascending aortic aneurysm. While under conservative management, he experienced acute hemodynamic collapse, leading to the discovery of an unprecedented aorto-right ventricular fistula. This episode examines the clinical presentation, diagnostic journey, and management challenges of this rare and complex aortic pathology, highlighting the role of multimodal imaging and the interplay of multifactorial risk factors. Expert commentary is provided by Dr. Andrew Zurick III. Episode audio was edited by CardioNerds Intern student Dr. Pacey Wetstein.   US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Saccular Aneurysm Risk: Saccular aortic aneurysms, though less common than fusiform, carry a higher inherent rupture risk due to concentrated wall shear stress, often exacerbated by prior cardiac surgery, chronic hypertension, and polysubstance use.     Unprecedented Rupture: The direct rupture of an aortic aneurysm into a cardiac chamber, specifically the right ventricle, is an exceedingly rare event, with no prior reported cases in the literature, highlighting the unpredictable nature of complex aortic pathology.     Hemodynamic Catastrophe: A large aorto-right ventricular fistula creates a massive left-to-right shunt, leading to acute right ventricular pressure and volume overload, culminating in rapid cardiogenic shock and refractory right ventricular failure.     Multimodal Imaging Imperative: Multimodal imaging (CT angiography for anatomy, TTE/TEE for real-time hemodynamics and fistula detection, CMR for tissue characterization) is indispensable for rapid diagnosis and comprehensive characterization of life-threatening cardiovascular emergencies.     High-Risk Intervention: Emergent surgical repair of a ruptured aortic aneurysm with an aorto-right ventricular fistula is a high-risk procedure associated with significant mortality, underscoring the need for prompt multidisciplinary care and realistic outcome expectations.     Notes - Notes (drafted by Dr Neel Patel):  What are the unique characteristics and rupture risk of saccular aortic aneurysms?  Saccular aortic aneurysms are less common than fusiform aneurysms.     They are generally considered more prone to rupture due to higher wall shear stress concentrated at the neck of the aneurysm, acting as a focal point of weakness.     Contributing Factors to Aneurysm Formation and Rupture in this Case:  Prior Cardiac Surgery: Aortic cannulation during the VSD/ASD repair decades ago likely created a localized structural weakness or predisposition.     Chronic, Poorly Controlled Hypertension: Imposed relentless systemic stress on the arterial walls, accelerating dilation and weakening.     Polysubstance Use: Particularly stimulants like cocaine and methamphetamines, which directly contribute to vascular damage by inducing severe, uncontrolled hypertension and direct arterial wall injury. This significantly increases the risk of aneurysm formation and rupture, especially with pre-existing conditions.     The direct rupture of an aortic aneurysm into a cardiac chamber, specifically the right ventricle, is an exceedingly rare event, with no prior reported cases in the literature,

The wonders of the animal kingdom make an absorbing reappearance this episode, so grab your scuba mask before listening - or your chef's hat. The first case this month is the kind that even an experienced neurologist would be nervous to encounter (1:35). A holidaymaker in his sixties presents to the emergency department with vomiting, dizziness, and an inability to walk, amongst several other symptoms. A suspicion of stroke was quickly replaced by a different hypothesis following discussions with the patient's family members. https://pn.bmj.com/content/25/4/377   The second case follows a presentation over the span of multiple decades (18:44). A woman first presents in her thirties with extreme lethargy and occasional migraines. She was diagnosed with panhypopituitarism and treated with steroid replacement. Following breast cancer in her late forties, treated by surgery and radiotherapy, the migraines worsened, prompting further investigation. https://pn.bmj.com/content/25/4/359   The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the June 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Brian Kennedy, Letícia Amorim. Editing by Brian O'Toole. Thank you for listening.

Derval McDonagh, Chief Executive of Inclusion Ireland, outlines the findings of a report into the process of the Farrelly Commission of Investigation into the ‘Grace' case.

CardioNerds guest host Dr. Colin Blumenthal joins Dr. Juma Bin Firos and Dr. Aishwarya Verma from the Trinity Health Livonia Hospital to discuss a fascinating case involving malignant ventricular arrhythmias. Expert commentary is provided by Dr. Mohammed Ali-Jazayeri. Audio editing for this episode was performed by CardioNerds Intern, Julia Marques Fernandes.  This case explores the puzzling presentation of exercise-induced ventricular tachycardia in a young, otherwise healthy male who suffered recurrent out-of-hospital cardiac arrests. With no traditional risk factors and an unremarkable ischemic workup, the challenge lay in uncovering the underlying cause of his malignant arrhythmias. Electrophysiology studies and advanced imaging played a pivotal role in systematically narrowing the differentials, revealing an unexpected arrhythmogenic substrate. This episode delves into the diagnostic dilemma, the role of EP testing, and the critical decision-making surrounding ICD placement in a patient with a concealed but life-threatening condition.  US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls- Malignant Ventricular Arrhythmias This case highlights the challenges and importance of diagnosing and managing ventricular arrhythmias in young, seemingly healthy individuals. Here are five key takeaways from the episode:  Electrophysiology (EP) studies play a crucial role in identifying arrhythmogenic substrates in patients with exercise-induced ventricular tachycardia (VT) without obvious structural heart disease. In this case, substrate mapping revealed late abnormal ventricular afterdepolarizations in the basal inferior left ventricle, providing valuable insights into the underlying mechanism.  Cardiac MRI can be a powerful tool for detecting subtle myocardial abnormalities. The subepicardial late gadolinium enhancement (LGE) in the lateral and inferior LV walls suggested an underlying myocardial process, even when other imaging modalities appeared normal.  The VT morphology can provide clues about the underlying mechanism. In this case, the right bundle branch block pattern with a northwest axis and shifting exit sites pointed towards a scar-mediated mechanism rather than a channelopathy or idiopathic VT.  Implantable cardioverter-defibrillator (ICD) placement is crucial for secondary prevention of sudden cardiac death (SCD) in patients with malignant ventricular arrhythmias, even in young individuals. The patient's initial deferral of ICD implantation highlights the importance of shared decision-making and patient education in these complex cases.  "Scar-mediated VT introduces the risk of new arrhythmogenic substrates over time, reinforcing the need for ICD therapy even when catheter ablation is considered." This pearl emphasizes the dynamic nature of the arrhythmogenic substrate and the importance of long-term risk mitigation strategies.  Notes - Malignant Ventricular Arrhythmias Notes were drafted by Juma Bin Firos.  1. What underlying pathologies cause ventricular arrhythmias in young patients without overt structural heart disease? Myocardial fibrosis: Detected via late gadolinium enhancement (LGE) on cardiac MRI Present in 38% of nonischemic cardiomyopathy cases Increases sudden cardiac death (SCD) risk 5-fold Often localized to subepicardial regions, particularly in the inferolateral left ventricle (LV) May precede overt systolic dysfunction by years Subclinical cardiomyopathy: 67% of young VT patients show subtle cardiac dysfunction Suggests VT may be the first manifestation of cardiomyopathy

Send us a textGot corrections on your ABPTS case report? Step #1 is DON'T PANIC.Corrections are common and totally fixable. Corrections don't mean you failed your case report - they are your chance to strengthen your case report and better show off your clinical reasoning.In this episode, I walk you through exactly how to read your feedback, make the right changes, and resubmit with confidence. Let's resubmit that case report.P.S. if you need help on your case report, you're going to looooooove Case Report Writing Workshop!Follow TheOncoPT on Instagram.Follow TheOncoPT on LinkedIn.

Send us a textDr. Divij Sharma presents a challenging case of altered mental status. Dr. Karlos Acurio-Ortiz tackles this mysterious presentation. Check out our website at www.theneurotransmitters.com to sign up for emails, classes, and quizzes! Would you like to be a guest or suggest a topic? Email us at contact@theneurotransmitters.com Follow our podcast channel on

This podcast was created using NotebookLM. This podcast emphasizes the increasing importance of geriatric dentistry due to the aging population and highlights how case reports are fundamental to educating future oral healthcare providers in this field. 

Send us a text⚠️ Quick note: Sorry for the audio quality in this episode — we've been having tremendous recording issues! Thanks for sticking with us.

CardioNerds (Dr. Rick Ferraro and Dr. Dan Ambinder) join Dr. Sahar Samimi and Dr. Lorraine Mascarenhas from Baylor College of Medicine, Houston, Texas, at the Houston Rodeo for some tasty Texas BBQ and a tour of the lively rodeo grounds to discuss an interesting case full of clinical pearls involving a patient with nonbacterial thrombotic endocarditis (NBTE). Expert commentary is provided by Dr. Basant Arya. Episode audio was edited by CardioNerds Intern Dr. Bhavya Shah. (Photo by Xu Jianmei/Xinhua via Getty Images)Xinhua News Agency via Getty Images We discuss a case of a 38-year-old woman with advanced endometrial cancer who presents with acute abdominal pain, found to have splenic and renal infarcts, severe aortic regurgitation, and persistently negative blood cultures, ultimately diagnosed with nonbacterial thrombotic endocarditis (NBTE). We review the definition and pathophysiology of NBTE in the context of malignancy and hypercoagulability, discuss initial evaluation and echocardiographic findings, and highlight important management considerations. Emphasis is placed on the complexities of anticoagulation choice, the role of valvular surveillance, and the need for coordinated, multidisciplinary care.   US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls- Nonbacterial Thrombotic Endocarditis Eliminate the Usual Suspects. NBTE is a diagnosis of exclusion! Always rule out infective endocarditis (IE) first with serial blood cultures and serologic tests.  More than Meets the Echo. Distinguishing NBTE from culture-negative endocarditis can be tricky. Look beyond the echo—focus on clinical context (underlying malignancy, autoimmune issues) and lab findings to clinch the diagnosis.  TEE for the Win... Mostly. While TEE is more sensitive than TTE, NBTE vegetations can be sneaky and may embolize quickly. Don't hesitate to use advanced imaging (i.e., cardiac MRI, CTA) or repeat imaging if you still suspect NBTE.  Choose your champion. In cancer-associated NBTE, guideline recommendations for anticoagulation choice are lacking. Consider DOACs and LMWH as agents of choice, but ultimately use shared decision-making to guide management.  No obvious trigger? Go hunting for hidden malignancies or autoimmune disorders. A thorough workup is essential to uncover the driving force behind NBTE.  Check out this state-of-the-art review for a comprehensive, one-stop summary of NBTE: European Heart Journal, 46(3), 236–245. Please note that the figures and tables referenced in the following notes are adapted from this review.  notes- Nonbacterial Thrombotic Endocarditis Notes were drafted by Dr. Sahar Samimi.  What is nonbacterial thrombotic endocarditis (NBTE)?   NBTE, previously known as marantic endocarditis, is a rare condition in which sterile vegetations form on heart valves.1  It occurs most commonly in association with malignancies and autoimmune conditions (i.e, antiphospholipid antibody syndrome or systemic lupus erythematosus).1 In addition, NBTE has been reported in association with COVID-19 infection, burns, sepsis, and indwelling catheters.2  Precise mechanisms remain unclear, but an interplay of endothelial injury, hypercoagulability, hypoxia, and immune complex deposition contributes to the formation of these sterile vegetations. 1  How do we diagnose NBTE?  Physicians should have a high level of suspicion for NBTE in at-risk patients (e.g., with active malignancy) who present with recent or recurrent embolic events (i.e., stroke, splenic, renal, or mesenteric infarct, and acute coronary syndrome).1 

Today, after a brief discussion on the recent deaths of Ozzy Osbourne and Malcolm Jamal-Warner, Asif and Ali discuss the career and complicated life of Hulk Hogan (7:15). They guys start off by discussing when they first heard of Hogan. They then go over his meteoric rise to become the most famous professional wrestler of all time. They then discuss his controversies including videos of Hogan using racist language and the Gawker trial, and the ongoing repercussions of these events. Hogan had a history of anabolic steroid use and died of cardiac arrest and so in the second half of the episode, Ali asks Asif about the heart complications of anabolic steroid use (34:30). He talks about how these steroids “build up” tissues and muscles and result in masculine-like effects (androgenization). He discusses how common anabolic steroid use is and how it has been linked to heart disease and heart failure in particular. Asif goes over the common symptoms that this type of heart failure would present with. He then goes over the testing that should be done as well as the treatment (mainly stopping steroid use). Music courtesy of Wataboi and 8er41 from PixabayContact us at doctorvcomedian@gmail.comFollow us on Social media:Twitter: @doctorvcomedianInstagram: doctorvcomedianShow Notes: Can You Mourn Hulk Hogan the Wrestler, But Not the Man? https://www.rollingstone.com/culture/culture-features/hulk-hogan-legacy-remembrance-1235393582/The Mortal Hulk Hogan: https://www.theringer.com/2025/07/24/wwe/hulk-hogan-obituary-wrestling-legacyWhat Hulk Hogan Left Behind: https://www.nytimes.com/2025/07/26/opinion/hulk-hogan-gawker.htmlHulk Hogan's son arrested on DUI charge in Florida city where he was involved in a car crash 16 years ago: https://www.nbcnews.com/news/us-news/hulk-hogans-son-arrested-dui-florida-city-was-involved-car-crash-16-ye-rcna125905Nobody Speak: Trials of the Free Press review – Hulk v Gawker in portrait of wealthy arrogance: https://www.theguardian.com/film/2017/jun/22/nobody-speak-trials-of-a-free-press-review-hulk-hogan-gawker-netflixAnabolic androgenic steroids and cardiomyopathy: an update https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1214374/full#B11Steroid-Induced Cardiomyopathy: Insights From a Systematic Literature Review and a Case Report https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.70171Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use https://www.ahajournals.org/doi/10.1161/circulationaha.116.026945 Hosted on Acast. See acast.com/privacy for more information.

BUFFALO, NY – July 24, 2025 – A new #casereport was #published in Volume 16 of Oncotarget on July 23, 2025, titled “Extracorporeal blood filtration leading to tumor growth arrest and reduced analgesic requirements in Stage IV poorly differentiated pancreatic adenocarcinoma: A case report.” In this report, Susanna Ulahannan from the University of Oklahoma Health Sciences Center and colleagues describe the use of extracorporeal blood filtration in a patient with metastatic pancreatic cancer. The patient experienced clinical improvement, reduced pain, and no signs of new tumor growth over 12 months of follow-up. Metastatic pancreatic cancer is difficult to treat and is often diagnosed at an advanced stage. In this case, a 51-year-old woman with stage IV poorly differentiated adenocarcinoma chose not to undergo standard chemotherapy. Instead, she received extracorporeal blood filtration with the Seraph® 100 device, which is designed to remove circulating tumor cells (CTCs) from the bloodstream. CTCs are thought to contribute to the spread of cancer to other organs. “Circulating tumor cells (CTC's) are tumor cells that are shed from the primary tumor and travel via blood or lymphatic system to form micro metastases in distant organs under a suitable environment.“ The patient received between nine and twelve treatments over the course of a year. These treatments were performed both abroad, where the device is approved for this use, and under a clinical protocol in the United States. Medical imaging showed that her disease remained stable, with no new metastases detected. She also reported improvements in appetite, energy levels, and pain control. Her opioid use was reduced by 90%. Blood samples confirmed a drop in CTC levels after treatment. This observation supports the idea that removing CTCs might help limit cancer progression in some patients. However, given that this is a single case report, larger clinical studies are needed to evaluate the effectiveness of this approach. The mechanism behind the patient's pain relief is not fully understood. Authors suggest that it may be related to the reduction of tumor cells or inflammatory molecules in the blood. Researchers noted that pro-inflammatory cytokines, known to influence pain, could also have been affected by the filtration process. This is the first documented case of stable disease and reduced symptoms following CTC filtration in advanced pancreatic cancer. While these findings should not be generalized, they highlight an approach outside standard protocols that should be further explored in clinical research. Future studies will be needed to determine whether this method can contribute to symptom management or disease control in other patients with metastatic pancreatic cancer. DOI - https://doi.org/10.18632/oncotarget.28756 Correspondence to - Susanna Ulahannan - susanna-ulahannan@ouhsc.edu Video short - https://www.youtube.com/watch?v=dro6iUGDrVQ Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28756 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, extracorporeal blood filtration, circulating tumor cells, metastatic pancreatic cancer, seraph 100, OncoBind To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Spotify - https://open.spotify.com/show/0gRwT6BqYWJzxzmjPJwtVh MEDIA@IMPACTJOURNALS.COM

CardioNerds (Dr. Claire Cambron and Dr. Rawan Amir) join Dr. Ayan Purkayastha, Dr. David Song, and Dr. Justin Wang from NewYork-Presbyterian Queens for an afternoon of hot pot in downtown Flushing. They discuss a case of congenital heart disease presenting in adulthood. Expert commentary is provided by Dr. Su Yuan, and audio editing for this episode was performed by CardioNerds Intern, Julia Marques Fernandes. A 53-year-old woman with a past medical history of hypertension visiting from Guyana presented with 2 days of chest pain. EKG showed dominant R wave in V1 with precordial T wave inversions. Troponin levels were normal, however she was started on therapeutic heparin with plan for left heart catheterization. Her chest X-ray revealed dextrocardia and echocardiogram was suspicious for the systemic ventricle being the morphologic right ventricle with reduced systolic function and the pulmonic ventricle being the morphologic left ventricle. Patient underwent coronary CT angiography which confirmed diagnosis of congenitally corrected transposition of the great arteries (CCTGA) as well as minimal non-obstructive coronary artery disease. Her chest pain spontaneously improved and catheterization was deferred. Patient opted to follow with a congenital specialist back in her home country upon discharge.   US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls- A Case of Congenital Heart Disease Presenting in Adulthood Congenitally Corrected Transposition of the Great Arteries (CCTGA) is a rare and unique structural heart disease which presents as an isolated combination of atrioventricular and ventriculoarterial discordance resulting in physiologically corrected blood flow.   CCTGA occurs due to L looping of the embryologic heart tube. As a result, the morphologic right ventricle outflows into the systemic circulation, and the morphologic left ventricle outflows into the pulmonary circulation.   CCTGA is frequently associated with ventricular septal defects, pulmonic stenosis, tricuspid valve abnormalities and dextrocardia.   CCTGA is often asymptomatic in childhood and can present later in adulthood with symptoms of morphologic right ventricular failure, tricuspid regurgitation, or cardiac arrhythmias.   Systemic atrioventricular valve (SAVV) intervention can be a valuable option for treating right ventricular failure and degeneration of the morphologic tricuspid valve.  notes- A Case of Congenital Heart Disease Presenting in Adulthood Notes were drafted by Ayan Purkayastha.  What is the pathogenesis of Congenitally Corrected Transposition of the Great Arteries?   Occurs due to disorders in the development of the primary cardiac tube   Bulboventricular part of the primary heart forms a left-sided loop instead of right-sided loop, leading to the normally located atria being connected to morphologically incompatible ventricles   This is accompanied by abnormal torsion of the aortopulmonary septum (transposition of the great vessels)   As a result, there is ‘physiologic correction' of blood flow. Non-oxygenated blood flows into the right atrium and through the mitral valve into the morphologic left ventricle, which pumps blood into the pulmonary artery. Oxygenated blood from the pulmonary veins flows into the left atrium and through the tricuspid valve to the morphologic right ventricle, which pumps blood to the aorta. Compared with standard anatomy, the flow of blood is appropriate, but it is going through the incorrect ventricle on both sides.  Frequent conditions associated with CCTGA include VSD, pulmonic stenosis and dextrocardia  

Part 2 of a 2-part series recapping the 2025 POSNA Annual Meeting in Las Vegas. In this episode, we sit down with the 2025 Program Committee — Drs. Julie Samora, Tony Riccio, John Vorhies, and Christine Ho — to hear what's new and what makes this year's meeting stand out. Drs. Lindsay Andras, Apurva Shah, Firoz Miyanji, and Christine Ho highlight some standout presentations from the Awards Papers session. Drs. Stu Weinstein and John Birch share their thoughts on memorable Case Reports and how this new format adds a unique dimension to the meeting. We also chat with Dr. Jon Schoenecker, winner of the Best Basic Science Paper, and Dr. Dan Sucato, winner of the Best Clinical Paper, to learn more about their award-winning research. Hosted by Tyler McDonald (University of South Alabama) and Will Morris (Scottish Rite for Children). Music by A. A. Aalto.

CardioNerds Critical Care Cardiology Council members Dr. Gurleen Kaur and Dr. Katie Vanchiere meet with Dr. Yash Patel, Dr. Akanksha, and Dr. Mohammed El Nayir from Trinity Health Ann Arbor. They discuss a case of pulmonary air embolism, RV failure, and cardiac arrest secondary to an ocular venous air embolism. Expert insights provided by Dr. Tanmay Swadia. Audio editing by CardioNerds Academy intern, Grace Qiu. A 36-year-old man with a history of multiple ocular surgeries, including a complex retinal detachment repair, suffered a post-vitrectomy collapse at home. He was found hypoxic, tachycardic, and hypotensive, later diagnosed with a pulmonary embolism from ocular venous air embolism leading to severe right heart failure. Despite a mild embolic burden, the cardiovascular response was profound, requiring advanced hemodynamic support, including an Impella RP device (Abiomed, Inc.). Multidisciplinary management, including fluid optimization, vasopressors and mechanical support to facilitate recovery. This case underscores the need for early recognition and individualized intervention in cases of ocular venous air embolism. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls- Clear Vision, Clouded Heart: Ocular Venous Air Embolism with Pulmonary Air Embolism, RV Failure, and Cardiac Arrest Hypoxia, hypotension and tachycardia in a patient following ocular instrumentation are classic findings suggestive of pulmonary embolism from possible air embolism. The diagnosis of RV failure is based on clinical presentation, echocardiographic findings (such as McConnell's sign), and invasive hemodynamic assessment via right heart catheterization. Mechanical circulatory support can be considered as a temporary measure for patients with refractory RV failure. Central Figure: Approach to Pulmonary Embolism with Acute RV Failure Notes - Clear Vision, Clouded Heart: Ocular Venous Air Embolism with Pulmonary Air Embolism, RV Failure, and Cardiac Arrest 1. What is an Ocular Venous Air Embolism (VAE), and how can it be managed in critically ill patients? An Ocular Venous Air Embolism is defined as the entry of air into the systemic venous circulation through the ocular venous circulation, often during vitrectomy procedures. Early diagnosis is key to preventing cardiovascular collapse in cases of Ocular Venous Air Embolism (VAE).  The goal is to stop further air entry. This can be done by covering the surgical site with saline-soaked dressings and checking for air entry points. Adjusting the operating table can help, especially with a reverse Trendelenburg position for lower-body procedures. The moment VAE is suspected, discontinue nitrous oxide and switch to 100% oxygen. This helps with oxygenation, speeds up nitrogen elimination, and shrinks air bubbles. Hyperbaric Oxygen Therapy can reduce bubble size and improve oxygenation, especially in cases of cerebral air embolism, when administered within 6 hours of the incident. Though delayed hyperbaric oxygen therapy can still offer benefits, the evidence is mixed. VAE increases right heart strain, so inotropic agents like dobutamine can help boost cardiac output, while norepinephrine supports ventricular function and systemic vascular resistance, but this may also worsen pulmonary resistance.  Aspiration of air via multi-orifice or Swan-Ganz catheters has limited success, with success rates ranging from 6% to 16%. In contrast, the Bunegin-Albin catheter has shown more promise, with a 30-60% success rate. Catheterization for acute VAE-induced hemodynamic compromise is controversial, and there's insufficient evidence to support its ...

CardioNerds (Drs. Daniel Ambinder and Eunice Dugan) join Dr. Namrita Ashokprabhu, Dr. Yulith Roca Alvarez, and Dr. Mehmet Yildiz from The Christ Hospital. Expert commentary by Dr. Odayme Quesada. Audio editing by CardioNerds intern, Christiana Dangas. This episode highlights the pivotal role of cardiac MRI and functional testing in uncovering coronary vasospasm as an underlying cause of MINOCA. Cardiac MRI is crucial in evaluating myocardial infarction with nonobstructive coronary arteries (MINOCA) and diagnosing myocarditis, but findings must be interpreted within clinical context. A 58-year-old man with hypertension, hyperlipidemia, diabetes, a family history of cardiovascular disease, and smoking history presented with sudden chest pain, non-ST-elevation on EKG, and elevated troponin I (0.64 µg/L). Cardiac angiography revealed nonobstructive coronary disease, including a 40% stenosis in the LAD, consistent with MINOCA. Eight weeks later, another event (troponin I 1.18 µg/L) led to cardiac MRI findings suggesting myocarditis. Further history revealed episodic chest pain and coronary vasospasm, confirmed by coronary functional angiography showing severe vasoconstriction, resolved with nitroglycerin. Management included calcium channel blockers and long-acting nitrates, reducing symptoms. Coronary vasospasm is a frequent MINOCA cause and can mimic myocarditis on CMRI. Invasive coronary functional testing, including acetylcholine provocation testing, is indicated in suspicious cases.  US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Notes - Coronary Vasospasm What are the potential underlying causes of MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries)?  Plaque Rupture: Plaque disruption, which includes plaque rupture, erosion, and calcified nodules, occurs as lipids accumulate in coronary arteries, leading to inflammation, necrosis, fibrosis, and calcification. Plaque rupture exposes the plaque to the lumen, causing thrombosis and thromboembolism, while plaque erosion results from thrombus formation without rupture and is more common in women and smokers. Intravascular imaging, such as IVUS and OCT, can detect plaque rupture and erosion, with studies showing plaque disruption as a frequent cause of MINOCA, particularly in women, though the true prevalence may be underestimated due to limited imaging coverage.  Coronary Vasospasm: Coronary vasospasm is characterized by nitrate-responsive chest pain, transient ischemic EKG changes, and >90% vasoconstriction during provocative testing with acetylcholine or ergonovine, due to hyper-reactivity in vascular smooth muscle. It is a common cause of MINOCA, with approximately half of MINOCA patients testing positive in provocative tests, and Asians are at a significantly higher risk than Whites. Smoking is a known risk factor for vasospasm. In contrast, traditional risk factors like sex, hypertension, and diabetes do not increase the risk, and vasospasm is associated with a 2.5–13% long-term risk of major adverse cardiovascular events (MACE).  Spontaneous Coronary Artery Dissection: Spontaneous coronary artery dissection (SCAD) involves the formation of a false lumen in epicardial coronary arteries without atherosclerosis, caused by either an inside-out tear or outside-in intramural hemorrhage. SCAD is classified into four types based on angiographic features, with coronary angiography being the primary diagnostic tool. However, in uncertain cases, advanced imaging like IVUS or OCT may be used cautiously. While the true prevalence is unclear due to missed diagnoses, SCAD is more common in women and is considered a cause of MINOCA when i...

CardioNerds co-founders Dr. Daniel Ambinder and Dr. Amit Goyal are joined by Dr. Spencer Weintraub, Chief Resident of Internal Medicine at Northwell Health, Dr. Michael Albosta, third-year Internal Medicine resident at the University of Miami, and Anna Biggins, Registered Dietitian Nutritionist at the Georgia Heart Institute. Expert commentary is provided by Dr. Zahid Ahmad, Associate Professor in the Division of Endocrinology at the University of Texas Southwestern. Together, they discuss a fascinating case involving a patient with a new diagnosis of hypertriglyceridemia. Episode audio was edited by CardioNerds Intern Student Dr. Pacey Wetstein. A woman in her 30s with type 2 diabetes, HIV, and polycystic ovarian syndrome presented with one day of sharp epigastric pain, non-bloody vomiting, and a new lower extremity rash. She was diagnosed with hypertriglyceridemia-induced pancreatitis, necessitating insulin infusion and plasmapheresis.   The CardioNerds discuss the pathophysiology of hypertriglyceridemia-induced pancreatitis, potential organic and iatrogenic causes, and the cardiovascular implications of triglyceride disorders. We explore differential diagnoses for cardiac and non-cardiac causes of epigastric pain, review acute and long-term management of hypertriglyceridemia, and discuss strategies for the management of the chylomicronemia syndrome, focusing on lifestyle changes and pharmacotherapy.  This episode is part of a case reports series developed in collaboration with the National Lipid Association and their Lipid Scholarship Program, with mentorship from Dr. Daniel Soffer and Dr. Eugenia Gianos. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Hypertriglyceridemia Cardiac sarcoidosis can present with a variety of symptoms, including arrhythmias, heart block, heart failure, or sudden cardiac death. The acute management of hypertriglyceridemia-induced pancreatitis involves prompt recognition and initiation of therapy to lower triglyceride levels using either plasmapheresis or intravenous insulin infusion +/- heparin infusion. Insulin infusion is used more commonly, while plasmapheresis is preferred in pregnancy.   Medications such as fibrates and omega-3 fatty acids can be used to maintain long-term triglyceride reduction to prevent the recurrence of pancreatitis, especially in patients with persistent triglyceride elevation despite lifestyle modifications. Statins can be used in patients for ASCVD reduction in patients with a 10-year ASCVD risk > 5%, age > 40 years old, and diabetes or diabetes with end-organ damage or known atherosclerosis. Consider preferential use of icosapent ethyl as an omega-3 fatty acid for triglyceride lowering if the patients fit the populations that appeared to benefit in the REDUCE IT trial.   Apply targeted dietary interventions within the context of an overall healthy dietary pattern, such as a Mediterranean or DASH diet. Limit full-fat dairy, fatty meats, refined starches, added sugars, and alcohol. Encourage high-fiber vegetables, whole fruits, low-fat or fat-free dairy, plant proteins, lean poultry, and fish. Pay special attention to the cooking oils to ensure the patient is not using palm oil, coconut oil, or butter when cooking. Instead, use liquid non-tropical plant oils. Initiate a very low-fat diet (< 5% of total daily calories from fat) for 1-4 weeks when TG levels are > 750 mg/dL.  Recommend and encourage patients to exercise regularly, with a minimum goal of 150 minutes/week of moderate-intensity aerobic activity. If weight loss is required, aim for more than >225 - 250 minutes/week.   Develop patient-centered and multidisciplinary stra...

CardioNerds (Dr. Rick Ferraro and Dr. Dan Ambinder) join Dr. Sri Mandava, Dr. David Meister, and Dr. Marissa Donatelle from the Columbia University Division of Cardiology at Mount Sinai Medical Center in Miami. Expert commentary is provided by Dr. Pranav Venkataraman.   They discuss the following case involving a patient with cardiac sarcoidosis presenting as STEMI:  A 57-year-old man with a history of hyperlipidemia presented with sudden onset chest pain. On admission, he was vitally stable with a normal cardiorespiratory exam but appeared in acute distress and was diffusely diaphoretic. His ECG revealed sinus rhythm, a right bundle branch block (RBBB), and ST elevation in the inferior-posterior leads. He was promptly taken for emergent cardiac catheterization, which identified a complete thrombotic occlusion of the mid-left circumflex artery (LCX) and large obtuse marginal (OM) branch, with no underlying coronary atherosclerotic disease. Aspiration thrombectomy and percutaneous coronary intervention (PCI) were performed, with one drug-eluting stent placed. An echocardiogram showed a left ventricular ejection fraction (EF) of 31%, hypokinesis of the inferior, lateral, and apical regions, and an apical left ventricular thrombus. The patient was started on triple therapy. A hypercoagulable workup was negative. A cardiac MRI was obtained to further evaluate non-ischemic cardiomyopathy. In conjunction with a subsequent CT chest, the results raised suspicion for cardiac sarcoidosis with systemic involvement. In view of a reduced EF and significant late-gadolinium enhancement, electrophysiology was consulted to evaluate for ICD candidacy. A decision was made to delay ICD implantation until a definitive diagnosis of cardiac sarcoidosis could be established by tissue biopsy. The patient was started on HF-GDMT and discharged with a LifeVest. Close outpatient follow-up with cardiology and electrophysiology was arranged.  US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Cardiac Sarcoidosis Presenting as STEMI Cardiac sarcoidosis can present with a variety of symptoms, including arrhythmias, heart block, heart failure, or sudden cardiac death. Symptoms can be subtle or mimic other cardiac conditions.  Conduction abnormalities, particularly AV block or ventricular arrhythmias, are common and may be the initial indication of cardiac involvement with sarcoidosis.  The additive value of Echocardiography, FDG-PET, and cardiac MR is indispensable in the diagnostic workup of suspected cardiac sarcoidosis.  Specific role of MRI/PET: Both cardiac MRI and FDG-PET provide a complementary role in the diagnosis of cardiac sarcoidosis. Cardiac MRI is an effective diagnostic screening tool with fairly high sensitivity but is limited by its inability to decipher inflammatory (“active” disease) versus fibrotic myocardium. FDG-PT helps to make this discrimination, refine the diagnosis, and guide clinical management. Ultimately, these studies are most useful when interpreted in the context of other clinical information.  Primary prevention of sudden cardiac death in cardiac sarcoidosis focuses on risk stratification, with ICD placement for high-risk patients. For patients awaiting definitive diagnosis, a LifeVest may be used as a temporary measure to protect from sudden arrhythmic events until an ICD is placed.  Notes - Cardiac Sarcoidosis Presenting as STEMI 1. Is STEMI always a result of coronary artery disease?  By definition, a STEMI is an acute S-T segment elevation myocardial infarction. This occurs when there is occlusion of a major coronary artery, which results in transmural ischemia and damage,