POPULARITY
2 episodes with clinical endocrinologists
2 episodes with clinical endocrinologists
2 episodes with clinical endocrinologists
2 episodes with clinical endocrinologists
2 episodes with clinical endocrinologists
SERGE A. JABBOUR, MD, FACP, FACE is a Professor of Medicine and the Director of the Division of Endocrinology, Diabetes, and Metabolic Diseases at Jefferson. He is also the Director of the Jefferson Diabetes Center. Dr Jabbour completed his training in Endocrinology, Diabetes, and Metabolic Diseases at Thomas Jefferson University in Philadelphia.Dr Jabbour has been recognized with many honors and he is holder of many teaching awards. Dr Jabbour was named Top Doc in Philadelphia area every year since 2011 by Philadelphia Magazine and one of the best endocrinologists in the nation by Castle Connolly every year since 2012. Dr Jabbour is a member of numerous professional organizations, including The Endocrine Society, American Diabetes Association and American Association of Clinical Endocrinologists.Dr Jabbour has published many articles and chapters on diabetes, metabolic syndrome, various endocrine topics; he serves on the Editorial Board of many journals and he just finished in September 2021 his 5-year tenure as the Chair of the Endocrine Board Review Committee for The Endocrine Society.Dr Jabbour's main research interest is in the field of diabetes. He is involved in many clinical research trials related to new diabetes drugs. He also gives many lectures all over the world on different endocrine topics, mainly diabetes, either in the setting of grand rounds, symposia or other CME presentations. I am truly honored to have such an inspiring and world-class endocrinologist with me today. Welcome Dr. Jabbour, let's see how many people we can convince to do endocrinology.Jefferson Endocrinology:https://www.jeffersonhealth.org/clinical-specialties/endocrinology-diabetes-metabolic-diseases?gclid=CjwKCAjwiOCgBhAgEiwAjv5whBW4FTPRCa_lVxnQI577rjIie4qMEkxca7tNsBwTxndwYCamtYfiMBoCknsQAvD_BwEJefferson Diabetes Center:https://www.jeffersonhealth.org/clinical-specialties/diabetes-center___0:00 - Intro1:49 - Statistics About Endocrinology3:10 - What Is Endocrinology?5:22 - Journey Into Medicine and Endocrinology13:07 - Keeping the Team Happy15:42 - An Average Day/Week of an Endocrinologist19:40 - Advice for People Looking Into Leveling up Ranks22:50 - If I Give You $100 Million, What Would You Do?25:25 - Best Thing About Being an Endocrinologist27:35 - Making a Rare Diagnosis32:16 - Passion for Studying Diabetes34:21 - Things We Should Know About Type 2 & 1 Diabetes53:06 - What Do You Think About Ozempic and Glp-1?59:44 - Dietary Tips1:06:21 - Hemoglobin a1c Levels1:20:10 - SGLT2 Inhibitors1:16:48 - Future of Endocrinology1:19:34 - Changes Over the Years1:20:17 - Myths About Diabetes1:24:29 - High Number of Diabetic Patients in the U.S.1:30:39 - Advice to People Looking Into Endocrinology1:32:36 - Maximizing Competitiveness Going Into Endocrinology1:39:00 - What Makes the Best-Med Students/Residents/Fellows?1:42:28 - Advice to People Entering a Career in Medicine1:45:17 - What Advice Would You Give Your 18-Year-Old Self?1:48:20 - Adapting to the U.S.1:49:43 - Closing Message1:51:57 - Outro__ResourcesWho Moved My Cheese? by Dr Spencer Johnson: https://amzn.eu/d/dZHrYY8 ___View the Show Notes Page for This Episode for transcript and more information: zhighley.com/podcast___Connect With ZachMain YouTube: @ZachHighley Newsletter: https://zhighley.com/newsletter/Instagram: https://www.instagram.com/zachhighley/?hl=enWebsite: https://zhighley.comTwitter: https://twitter.com/zachhighleyLinkedln: https://www.linkedin.com/in/zach-highley-gergel-44763766/Business Inquiries: zachhighley@nebula.tv___Listen for FreeSpotify: https://open.spotify.com/show/23TvJdEBAJuW5WY1QHEc6A?si=cf65ae0abbaf46a4Apple Podcast: https://podcasts.apple.com/us/podcast/the-zach-highley-show/id1666374777___Welcome to the Zach Highley Show, where we discuss personal growth and medicine to figure out how to improve our lives. My name is Zach a Resident Physician in Boston. Throughout these episodes I'll interview top performers from around the world in business, life, and medicine in hopes of extracting the resources and techniques they use to get to the top.The best way to help the show is share episodes on any platform. If you think a friend or family member will like a certain episode, send it to them!See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast
In this first ever CE episode, we discuss the A-Zs of continuous glucose monitors (CGMs). In specific, our learning objective for the CE are: Describe commonly available types of continuous glucose monitors (CGMs) in the US market and the features and capabilities of these devices. Summarize the evidence and guideline recommendations for use of CGMs in the management of diabetes. Identify the role of the pharmacist in the selection of CGMs and provision of education to patients and providers. Interpret the ambulatory glucose profile (CGM data output) and recommend changes in antihyperglycemic regimen for a patient. ACPE-Accredited Pharmacist CE (1.0 hrs) To obtain CE credit for a $5 fee, visit the following link: https://rfums.wufoo.com/forms/z1qzh5vf0ggr832/. Once payment is successful, you will be redirected to our CE partner (CE Impact) to complete an evaluation and to earn 1.0 hour of CE credit. CE is available for 12 months after episode publication. Key Concepts There are two main types of stand-alone personal CGMs available in the US market – real-time (rtCGM) and intermittently scanning (isCGM). [1] These CGMs vary in their features such as sensor wear time, sensor warm up time, sensor application site, reader availability, approved age for use, fingerstick calibration, non-adjunctive FDA labeling, interconnectability with other technology such as insulin pumps, and drug interactions – these variabilities can be used in decision-making when selecting an appropriate CGM for a patient. [2-7] Based on the evidence for use, both types of CGMs (real-time and intermittently scanning) are recommended in patients with Type 1 and Type 2 diabetes who are on multiple-daily insulin or continuous insulin infusion (pump), patients with Type 2 diabetes on basal insulin therapy, and as adjunct use in patients with diabetes who are pregnant. The strength of recommendations in general is stronger for real-time CGMs than for intermittently scanning CGMs. [1,11] These recommendations are supported by the evidence that CGMs can help improve glucose control, reduce risk of hypoglycemia, diabetes-related hospitalizations, and patient/caregiver satisfaction. Pharmacists play an integral role in education, on-going support, data interpretation, and resulting disease management in patients who qualify for CGM use and providers who care for patients with diabetes. [14] The ambulatory glucose profile is a standardized data output that informs understanding of glucose trends. [15] The recommended goal for most patients is to maintain a glucose range between 70-180 mg/dL with at least 70% of time spent in this range with variability coefficient of no more than 36%. [1,11,15] Supplemental Content Comparison of rtCGM and isCGM devices "Mary's" Example AGP Report (adapted from Battelino et al.) References ElSayed NA, Aleppo G, Aroda VR, et al. American Diabetes Association. Chapter 7. Diabetes technology: Standards of medical care in diabetes - 2023. Diabetes Care. 2023;46(suppl 1):S111-S127. Dexcom G6 User Guide. Dexcom, Inc. 2020. Accessed February 20, 2023. https://s3-us-west-2.amazonaws.com/dexcompdf/G6-CGM-Users-Guide.pdf. Dexcom G7 User Guide. Dexcom, Inc. 2022. Accessed February 20, 2023. https://dexcompdf.s3.us-west-2.amazonaws.com/en-us/G7-CGM-Users-Guide.pdf#page=12 Guardian Connect System User Guide. Medtronic MiniMed. 2020. Accessed February 20, 2023. https://www.medtronicdiabetes.com/sites/default/files/library/download-library/user-guides/Guardian-Connect-System-User-Guide.pdf. Eversense E3 User Guide. Sensionics, Inc. 2022. Accessed February 20, 2023. https://www.eversensediabetes.com/wp-content/uploads/LBL-4002-01-001-Rev-F_Eversense-E3-User-Guide_mgdL_R1_web.pdf FreeStyle Libre 3 User's Manual. Abbott Diabetes Care Inc. 2022. Accessed February 20, 2023. https://freestyleserver.com/Payloads/IFU/2022/q2/ART44140-002_rev-A.pdf FreeStyle Libre 2 User's Manual. Abbott Diabetes Care Inc. 2020. Accessed February 20, 2023. https://freestyleserver.com/Payloads/IFU/2020/q2/ART40703-001_rev-D-Web.pdf. Products. American Diabetes Association. Accessed February 20, 2023. https://consumerguide.diabetes.org/ Wood A, O'Neal D, Furler J, Ekinci EI. Continuous glucose monitoring: a review of the evidence, opportunities for future use and ongoing challenges. Intern Med J. 2018 May;48(5):499-508. Edelman SV, Argento NB, Petty SJ, Hirsch IB. Clinical implications of real-time and intermittently scanned continuous glucose monitoring. Diabetes Care. 2018;41:2265-2274. Fonseca VA, Grunberger G, Anhalt H, et al. Continuous glucose monitoring: A consensus conference of the American Association of Clinical Endocrinologists and American College of Endocrinology. Endocr Pract. 2016;22(8):1008-21. Reiterer F, Polterauer P, Schoemaker M, Schmelzeisen-Redecker G, Freckmann G, Heinemann L, Del Re L. Significance and Reliability of MARD for the Accuracy of CGM Systems. J Diabetes Sci Technol. 2017 Jan;11(1):59-67. doi: 10.1177/1932296816662047. Epub 2016 Sep 25. PMID: 27566735; PMCID: PMC5375072. Food and Drug Administration. Premarket Notification 510(k). 2022. Accessed February 25, 2023. https://www.fda.gov/medical-devices/premarket-submissions-selecting-and-preparing-correct-submission/premarket-notification-510k. Isaacs, Diana. The pharmacist's role in continuous glucose monitoring. Pharmacy Today. 2020;26:37-54. Battelino T, Danne T, Bergenstal RM, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations from the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593-1603.
I am interviewing Dr. Rachel Kilpatrick for Diabetes Awareness Month!Dr. Kilpatrick is a full time practicing endocrinologist who spends most of her time managing patients with diabetes, and other hormone disorders including insulin resistance, polycystic ovarian syndrome, thyroid disorders, adrenal disease, pituitary disease, and other complicated endocrine disease. She has a special interest in Lifestyle medicine and is pursuing a certification in lifestyle medicine. She believes that most diseases can be modified positively with lifestyle intervention. Dr. Kilpatrick is board certified in both internal medicine as well as endocrinology, diabetes, and metabolism. She did her medical school training at the University of Texas Southwestern Medical School, and did her internal medicine residency and endocrinology fellowship at Washington University in St Louis. Dr. Kilpatrick is a member of the American Diabetes Association, the Endocrine Society, the American College of Physicians, and the American Association of Clinical Endocrinologists. She is also a Fellow of the American Association of Clinical Endocrinologists.You can find Dr. Kilpatrick on Instagram and Facebook :Facebook: @rachelkilpatrickmd Instagram: @rachelkilpatrickmd Twitter: @rachelkilpatrickmdTikTok: @rachelkilpatrickmdDuring the Podcast, we discuss:What are the different types of Diabetes?What Causes Diabetes ?What are the symptoms of diabetes?If I have Diabetes, what should I be the most worried about?What are three things you would ask every diabetic to start doing today?What three things would you like all diabetics to stop doing right now?How does stress affect diabetes?Mindfulness has been shown to improve diseases related to stress, such as anxiety, depression, and chronic pain.As a gift to my listeners, I am giving away access to my course Mindfulness Meditation Mastery. All it takes is to signup to receive your free access.Sign UpWelcome to the Art of Healing Podcast.Let's explore your mind, body and spirit through Integrative Medicine, Meditation and Reiki.Don't miss the latest episodes. Sign up to get the weekly newsletters and get the Art of Healing Podcast in your inbox:Healing Arts Weekly Newsletter Thank you for listening to the Art of Healing Podcast.Ready to start your journey into Meditation, Mindfulness or Reiki?Learn about the Programs at Healing Arts here.Want to make sure you catch every episode of the Art of Healing? Click here for my weekly newsletter.Never miss an episode of Art of Healing Podcast...the podcast devoted to helping you heal your mind, body and spirit.Sign up for my weekly newsletter, and never miss an episode along with other great content:Art of Healing PodcastStay in touch socially here:Healing Arts Link in BioLearn more about me and my offerings here:Healing Arts Health and Wellness
Deepak is founder of The Chopra Foundation and Chopra Global, as well as Professor of Family Medicine and Public Health at UCSD and senior scientist with Gallup Organization. He is author of over 90 books translated into 43 languages, including New York Times bestsellers. Chopra has been at the forefront of the meditation and personal transformation revolution. TIME magazine has described him as “one of the top 100 heroes and icons of the century.” Larry King has described his work as “some of the most important of the decade.” The Wall Street Journal has declared his books “must reads for your career”.His books have been awarded the prestigious Nautilus Award and Quill Award. Two of his books have been recognized on “The Books of The Century Bestsellers List”. He is a columnist for the San Francisco Chronicle and contributes to Oprah.com, Intent.com, and Huffington Post. He has been recognized as one of “The 100 Most Influential People in Health and Fitness “, the #17 “most influential thinker in the world” and #1 in Medicine. As background, Dr. Chopra is Board Certified in Internal Medicine, Endocrinology, and Metabolism. He is a Fellow of the American College of Physicians and a member of the American Association of Clinical Endocrinologists.
Deepak Chopra is the author of Life After Death: The Burden of Proof. He is also founder of The Chopra Foundation, a non-profit entity for research on well-being and humanitarianism, and Chopra Global, a modern-day health company at the intersection of science and spirituality, is a world-renowned pioneer in integrative medicine and personal transformation. Dr. Chopra is Board Certified in Internal Medicine, Endocrinology and Metabolism, a Fellow of the American College of Physicians, and a member of the American Association of Clinical Endocrinologists. He serves as a Clinical Professor of Medicine at the University of California, San Diego, and hosts the podcast Daily Breath.The World Post and The Huffington Post global internet survey ranked “Chopra #17 influential thinker in the world and #1 in Medicine.” He is the author of over 90 books translated into over forty-three languages, including numerous New York Times bestsellers. For the last thirty years, Chopra has been at the forefront of the meditation revolution and his book, Total Meditation (Harmony Book, September 22, 2020) will help to achieve new dimensions of stress-free living and joyful living. TIME magazine has described Dr. Chopra as “one of the top 100 heroes and icons of the century.” More information about the guest can be found at https://www.deepakchopra.com/
According to the American Association of Clinical Endocrinologists, an estimated 27 million Americans have thyroid disease, and more than half of those individuals are undiagnosed and unaware that they have a thyroid condition.However, it's important to understand that if more comprehensive thyroid testing was used by doctors and functional reference ranges were used to interpret that testing instead of the overly lax lab reference ranges, a much larger number of people would be classified as having some type of thyroid dysfunction.Most doctors rely almost exclusively on the thyroid stimulating hormone or TSH test to detect thyroid dysfunction, yet TSH is not even technically a marker of thyroid function, it's actually a marker of pituitary function. Even worse, the medical community can't even agree on what the normal reference range is for the TSH test.My other issue with conventional medicine is its refusal to actually look at underlying causes of thyroid dysfunction including but not limited to gut inflammation, chronic stress, adrenal issues, nutrient deficiencies, toxins in our food, air, and water, and chronic infections such as periodontal disease and h. Pylori.The thyroid's primary function is to control the body's metabolism – the rate at which cells perform duties essential to living. It manages how we turn our food into energy by facilitating the processes of energy production in the mitochondria. I want you to think of your thyroid as your body's “engine,” which sets the pace at which the body operates. Too little thyroid hormone can cause the body's systems to slow down, and too much thyroid hormone can cause the body's systems to speed up.In today's episode, I've brought back my friend and pharmacist Jim Paoletti to talk about this amazing gland that does so much for us. In fact, there's not a single cell in the body that doesn't depend on thyroid hormone in some way.Jim Paoletti, B.S. Pharmacy, FAARFM, FIACP is an independent clinical consultant on hormones, nutrition, and wellness. Jim has 40 years of experience with bio-identical hormone therapies in clinical practice, both in retail pharmacy and as a consultant and educator. Jim served previously as Director of Provider Education for ZRT Laboratory, Beaverton, Oregon, and as consultant and Education Director for Professional Compounding Centers of America of Houston, TX.He is a graduate and former faculty member of the Fellowship of Anti-Aging and Functional Medicine. Jim has lectured extensively and internationally on all aspects of compounding and BHRT to medical practitioners and consumers, and has several articles published on BHRT and compounding pharmacy issues. Jim has published the book A Practitioner's Guide to Physiologic Bioidentical Hormone Balance.Listen to the full episode to hear:Why your doctor may be relying on testing that provides an incomplete picture of thyroid functionHow laboratory reference ranges don't reflect optimal functional ranges that end up leaving patients frustrated and without resolutionWhy assessing adrenal function is key to evaluating and treating thyroid issuesWhy synthetic vs natural thyroid hormone replacement is misleadingLearn more about Jim Paoletti, BS Pharmacy, FAARFM, FIACP:A Practitioner's Guide to Physiologic Bioidentical Hormone BalanceLearn more about Sami:Eatfor.lifeBook Your Complimentary ConsultationEat For Life cookbooks for each unique biotypeResources:Overcoming Thyroid Disorders 3rd EditionWhy Do I Still Have Thyroid Symptoms? when My Lab Tests Are Normal: a Revolutionary Breakthrough in Understanding Hashimoto's Disease and Hypothyroidism, Dr. Datis Kharrazian
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-241 Overview: Seven percent of the US population has an active levothyroxine prescription, which is significantly greater than the number of people diagnosed with overt hypothyroidism. Many of these prescriptions appear to be for the treatment of subclinical hypothyroidism and other conditions in euthyroid individuals. Join us to uncover the latest findings on the use of levothyroxine and what the evidence tells us about appropriate use and misuse of this drug. Episode resource links: Brito, J., Ross, J., El Kawkgi, O., Maraka, S., Deng, Y., Shah, N., Lipska, K. & (9000). Levothyroxine Use in the United States, 2008-2018. JAMA Internal Medicine, Publish Ahead of Print, doi: 10.1001/jamainternmed.2021.2686. Johansen, M., Marcinek, J., Yun, J. & (2020). Thyroid Hormone Use in the United States, 1997–2016. Journal of the American Board of Family Medicine, 33 (2), 284-288. doi: 10.3122/jabfm.2020.02.190159. Jeffrey R. Garber, Rhoda H. Cobin,Hossein Gharib,James V. Hennessey, Irwin Klein, Jeffrey I. Mechanick, Rachel Pessah-Pollack, Peter A. Singer,Kenneth A. Woeber. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association; November–December 2012. https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext; https://www.endocrinepractice.org/action/showPdf?pii=S1530-891X%2820%2943030-7 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
Deepak is founder of The Chopra Foundation and Chopra Global, as well as Professor of Family Medicine and Public Health at UCSD and senior scientist with Gallup Organization. He is author of over 90 books translated into 43 languages, including New York Times bestsellers. Chopra has been at the forefront of the meditation and personal transformation revolution. TIME magazine has described him as “one of the top 100 heroes and icons of the century.” Larry King has described his work as “some of the most important of the decade.” The Wall Street Journal has declared his books “must reads for your career”.His books have been awarded the prestigious Nautilus Award and Quill Award. Two of his books have been recognized on “The Books of The Century Bestsellers List”. He is a columnist for the San Francisco Chronicle and contributes to Oprah.com, Intent.com, and Huffington Post. He has been recognized as one of “The 100 Most Influential People in Health and Fitness “, the #17 “most influential thinker in the world” and #1 in Medicine. As background, Dr. Chopra is Board Certified in Internal Medicine, Endocrinology, and Metabolism. He is a Fellow of the American College of Physicians and a member of the American Association of Clinical Endocrinologists.
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-241 Overview: Seven percent of the US population has an active levothyroxine prescription, which is significantly greater than the number of people diagnosed with overt hypothyroidism. Many of these prescriptions appear to be for the treatment of subclinical hypothyroidism and other conditions in euthyroid individuals. Join us to uncover the latest findings on the use of levothyroxine and what the evidence tells us about appropriate use and misuse of this drug. Episode resource links: Brito, J., Ross, J., El Kawkgi, O., Maraka, S., Deng, Y., Shah, N., Lipska, K. & (9000). Levothyroxine Use in the United States, 2008-2018. JAMA Internal Medicine, Publish Ahead of Print, doi: 10.1001/jamainternmed.2021.2686. Johansen, M., Marcinek, J., Yun, J. & (2020). Thyroid Hormone Use in the United States, 1997–2016. Journal of the American Board of Family Medicine, 33 (2), 284-288. doi: 10.3122/jabfm.2020.02.190159. Jeffrey R. Garber, Rhoda H. Cobin,Hossein Gharib,James V. Hennessey, Irwin Klein, Jeffrey I. Mechanick, Rachel Pessah-Pollack, Peter A. Singer,Kenneth A. Woeber. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association; November–December 2012. https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext; https://www.endocrinepractice.org/action/showPdf?pii=S1530-891X%2820%2943030-7 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-241 Overview: Seven percent of the US population has an active levothyroxine prescription, which is significantly greater than the number of people diagnosed with overt hypothyroidism. Many of these prescriptions appear to be for the treatment of subclinical hypothyroidism and other conditions in euthyroid individuals. Join us to uncover the latest findings on the use of levothyroxine and what the evidence tells us about appropriate use and misuse of this drug. Episode resource links: Brito, J., Ross, J., El Kawkgi, O., Maraka, S., Deng, Y., Shah, N., Lipska, K. & (9000). Levothyroxine Use in the United States, 2008-2018. JAMA Internal Medicine, Publish Ahead of Print, doi: 10.1001/jamainternmed.2021.2686. Johansen, M., Marcinek, J., Yun, J. & (2020). Thyroid Hormone Use in the United States, 1997–2016. Journal of the American Board of Family Medicine, 33 (2), 284-288. doi: 10.3122/jabfm.2020.02.190159. Jeffrey R. Garber, Rhoda H. Cobin,Hossein Gharib,James V. Hennessey, Irwin Klein, Jeffrey I. Mechanick, Rachel Pessah-Pollack, Peter A. Singer,Kenneth A. Woeber. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association; November–December 2012. https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext; https://www.endocrinepractice.org/action/showPdf?pii=S1530-891X%2820%2943030-7 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-241 Overview: Seven percent of the US population has an active levothyroxine prescription, which is significantly greater than the number of people diagnosed with overt hypothyroidism. Many of these prescriptions appear to be for the treatment of subclinical hypothyroidism and other conditions in euthyroid individuals. Join us to uncover the latest findings on the use of levothyroxine and what the evidence tells us about appropriate use and misuse of this drug. Episode resource links: Brito, J., Ross, J., El Kawkgi, O., Maraka, S., Deng, Y., Shah, N., Lipska, K. & (9000). Levothyroxine Use in the United States, 2008-2018. JAMA Internal Medicine, Publish Ahead of Print, doi: 10.1001/jamainternmed.2021.2686. Johansen, M., Marcinek, J., Yun, J. & (2020). Thyroid Hormone Use in the United States, 1997–2016. Journal of the American Board of Family Medicine, 33 (2), 284-288. doi: 10.3122/jabfm.2020.02.190159. Jeffrey R. Garber, Rhoda H. Cobin,Hossein Gharib,James V. Hennessey, Irwin Klein, Jeffrey I. Mechanick, Rachel Pessah-Pollack, Peter A. Singer,Kenneth A. Woeber. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association; November–December 2012. https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext; https://www.endocrinepractice.org/action/showPdf?pii=S1530-891X%2820%2943030-7 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
Our guest endocrinologist, Dr. Akshay Jain, will be answering your questions about T1D technology, devices, and the latest scientific research. Dr. Jain is the first Canadian physician to be triple board-certified by the American Boards in Endocrinology, Internal Medicine and Obesity Medicine. He is also the past president of the Canadian Chapter of the American Association of Clinical Endocrinologists. In 2020, he became the only non-American physician to feature on Medscape's list of 25 Top Rising Stars of Medicine. Dr. Jain is a renowned educator and has spoken at over 700 medical conferences/events across the world to date! His clinical interests include diabetes, obesity, thyroid disorders and osteoporosis. He is also fluent in 6 languages including English, Hindi, Gujarati, Marathi, Marwari and Urdu. Join us for this Huddle to hear from Dr. Jain on topics around T1D teach such as T1D device coverage, CGM usage, and looping techniques. Over 18 and interested in sharing your experiences living with type 1? Register to attend a live huddle at www.t1dhuddle.com
Episode 448 Deepak Chopra is a First Class Father and a world renowned pioneer in integrative medicine and personal transformation. TIME magazine included Deepak Chopra in their list of the top 100 heroes and icons of the Twentieth Century. In conjunction with his medical achievements, he is recognized as a prolific author of over 90 books translated into over forty-three languages, including numerous New York Times bestsellers. For the last thirty years, Chopra has been at the forefront of the meditation revolution. He is the founder of The Chopra Foundation, a non-profit entity for research on well-being and humanitarianism. Dr. Chopra is Board Certified in Internal Medicine, Endocrinology and Metabolism, a Fellow of the American College of Physicians, and a member of the American Association of Clinical Endocrinologists. In this Episode, Deepak shares his Fatherhood journey which includes two children. He discusses the pandemic from the physical and spiritual point of view. He describes the benefits of meditation, how to introduce kids to meditation and what age to start. He talks about his AI twin Digital Deepak and how it can help parents through seven different aspects of their lives. He offers some great advice for new or about to be Dads and more! DEEPAK CHOPRA - https://www.deepakchopra.com Belcampo Meat - https://belcampo.com/?utm_source=FATHERHOOD&utm_medium=INFL&utm_campaign=FATHERHOOD MY PILLOW - https://www.mypillow.com Promo Code: Fatherhood Save Up To 66% Off 1-800-875-0219 More Ways To Listen - https://linktr.ee/alec_lace First Class Fatherhood Merch - https://shop.spreadshirt.com/first-class-fatherhood-/we+are+not+babysitters-A5d09ea872051763ad613ec8e?productType=812&sellable=3017x1aBoNI8jJe83pw5-812-7&appearance=1 Follow me on instagram - https://instagram.com/alec_lace?igshid=ebfecg0yvbap For information about becoming a Sponsor of First Class Fatherhood please hit me with an email: FirstClassFatherhood@gmail.com --- Support this podcast: https://anchor.fm/alec-lace/support
In this episode, Dr. Rakesh Jain and Dr. Andrew Cutler review the pathophysiology and comorbidities in patients with schizophrenia and explore how serious mental illnesses (SMIs) may affect the whole patient. They also discuss the potential dysfunction that may be present across multiple symptoms in patients with schizophrenia based on evidence from antipsychotic-naïve patients. TAKE HOME POINTS – When considering physical comorbidities—including infectious, respiratory, metabolic, and cardiovascular diseases—in patients with SMI, including schizophrenia and bipolar disorder, multiple studies have reported an increased prevalence compared with the general population. There may be dysfunction across cardiometabolic, immune, and endocrine systems in patients with schizophrenia—whether we see elevation of certain blood cytokines or an imbalance between adiponectin and pro-inflammatory cytokines, this may contribute to a persistent cycle of obesity and inflammation. There are opportunities to improve whole patient care through comprehensive management of comorbidities and behavioral risk factors that may be present in patients living with SMIs like schizophrenia. For example, efforts to enhance tobacco smoking cessation, given over half of people with schizophrenia smoke and smoking is a known risk factor for cardiovascular disease, may involve behavioral interventions and cognitive behavioral therapy that have shown promise for smokers with SMIs. References ADA, APA, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Diabetes Care. 2004;27:596-601. APA. Practice Guideline for the Treatment of Patients with Schizophrenia (September 2020). https://doi.org/10.1176/appi.books.9780890424841. Accessed September 17, 2020. Cohn TA et al. Can J Psychiatry. 2006;51(6):382-386. Bahorik AL et al. J Psychosom Res. 2017;100:35-45. Balu DT. Adv Pharmacol. 2016;76:351-382. Brisch R et al. Front Psychiatry. 2014;5:47. De Hert M et al. Eur Psychiatry. 2009;24(6):412-424. De Hert M et al. World Psychiatry. 2011;10(1):52-77. Di Chiara T et al. J Nutr Metab. 2012;2012:175245. Diez JJ et al. Eur J Endocrinol. 2003;148(3):293-300. Fernandes BS et al. Mol Psychiatry. 2016;21(4):554-564. Freyberg Z et al. Front Neurosci. 2017;11:432. Gonzalez-Blanco L et al. Schizophr Res. 2016;174(1-3):156-160. Grimm O et al. Neurosci Biobehav Rev. 2017;75:91-103. Hayes JF et al. Br J Psychiatry. 2017;211(3):175-181. Helleberg M et al. Lancet HIV. 2015;2(8):e344-350. Huckans MS et al. Psychiatr Serv. 2006;57(3):403-406. Khokha JY et al. Schizophr Res. 2018;194:78-85. Leonard BE et al. J Psychopharmacol. 2012;26(5 Suppl):33-41. Lucatch AM et al. Front Psychiatry. 2018;9:672. Mangurian C et al. J Gen Intern Med. 2016;31(9):1083-1091. Menzaghi C. Diabetes. 2007 May;56(5):1198-1209. Myles N et al. J Clin Psychiatry. 2012;73(4):468-475. Nakamizo S et al. Trends in Immunotherapy. 2017;1(2):67-74. NIMH. Mental illness. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#part_154788. Accessed May 8, 2019. NIMH. Schizophrenia. https://www.nimh.nih.gov/health/statistics/schizophrenia.shtml. Accessed August 26, 2020. Pillinger T et al. Mol Psychiatry. 2018;24(6):776-794. Ringen PA et al. Front Psychiatry. 2014;5:137. Sokal J et al. J Nerv Ment Dis. 2004;192(6):421-427. Stahl SM. Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. Cambridge University Press; 2013. Toda M et al. Curr Psychiatry Rep. 2007;9(4):329-336 Yang AC et al. Int J Mol Sci. 2017;18(8). © 2020 Alkermes, Inc. All rights reserved. UNB-003069
For over a century, the treatments and technologies used to treat diabetes have evolved. New tools are now available to aid in diabetes management and to help patients further manage and better control their glucose levels. 1,2 Through their recently announced collaboration, Dexcom and Lilly are at the forefront of enhancing diabetes care. 3 In this episode Dr. Chad Worz and guest speakers Deirdre Ibsen and Dr. Thomas Blevins discuss these important technological and therapeutic achievements over time, as well as 2 products available from Dexcom and Lilly and how they may benefit patients with diabetes. References: Dexcom G6 Pro User Guide. https://dexcompdf.s3-us-west-2.amazonaws.com/Dexcom-G6-Pro-User-Guide.pdf. Accessed October 12, 2020. Lyumjev [Prescribing Information]. Indianapolis, IN: Lilly USA, LLC. Eli Lilly and Company. Lilly and Dexcom team up on new program to help improve diabetes management. https://provider.dexcom.com/products/dexcom-g6-pro/training-resources. Accessed October 12, 2020. Centers for Disease Control. National Diabetes Statistics Report 2020 Estimates of Diabetes and Its Burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed October 1, 2020. American Diabetes Association. Diabetes and Quality of Life. http://journal.diabetes.org/diabetesspectrum/00v13n1/pg48.htm. Accessed October 1, 2020. American Diabetes Association. Caring for the Caregiver. https://spectrum.diabetesjournals.org/content/17/1/37.full-text.pdf. Accessed October 15, 2020. Ali MK, Bullard KM, Gregg EW. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med. 2013;369(3):287-288. Foster NC, Beck RW, Miller KM, et al. State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018. Diabetes Technol Ther. 2019;21(2):66-72. American Diabetes Association. 7. Diabetes Technology: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(suppl 1):S77-S88. Hirsch IB. History of Glucose Monitoring. https://professional.diabetes.org/sites/professional.diabetes.org/files/media/db201811.pdf. Accessed October 1, 2020. White JR. A brief history of the development of diabetes medications. Diabetes Spectr. 2014;27(2):82-86. Science History Institute. Frederick Banting, Charles Best, James Collip, and John Macleod. https://www.sciencehistory.org/historical-profile/frederick-banting-charles-best-james-collip-and-john-macleod. Accessed October 1, 2020. American Diabetes Association. Timeline. https://www.diabetes.org/resources/timeline. Accessed October 9, 2020. Humalog [Prescribing Information]. Indianapolis, IN: Lilly USA, LLC. Selam J-L. Evolution of diabetes insulin delivery devices. J Diabetes Sci Technol. 2010;4(3):505-513. American Association of Diabetes Educators. Insulin Injection Know-How. https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/general/Insulin_Injection_How_To_AADE.pdf. Accessed October 1, 2020. Hyllested-Winge J, Jensen KH, Rex J. A review of 25 years' experience with the NovoPen® family of insulin pens in the management of diabetes mellitus. Clin Drug Investig. 2010;30(10):643-674. Eli Lilly and Company. Lilly Launches KwikPen(TM) for Humalog(R) and Humalog Mixtures [press release]. https://investor.lilly.com/news-releases/news-release-details/lilly-launches-kwikpentm-humalogr-and-humalog-mixtures. Accessed October 12, 2020. American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(suppl 1):S66-S76. Garber AJ, Handelsman Y, Grunberger G, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2020 executive summary. Endocr Pract. 2020;26(1):107-139. Fonseca VA, Grunberger G, Anhalt H, et al. Continuous glucose monitoring: a consensus conference of the American Association of Clinical Endocrinologists and American College of Endocrinology. Endocr Pract. 2016;22(8):1008-1021. Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care. 2019;42(8):1593-1603. Dexcom G6 Pro Unblinded Patient Guide. https://dexcompdf.s3-us-west-2.amazonaws.com/Dexcom-G6-Pro-Unblinded-Patient-Guide.pdf. Accessed October 12, 2020. Dexcom Announces FDA Clearance of New Dexcom G6 Pro CGM. https://provider.dexcom.com/industry-news/fda-authorizes-dexcom-g6-pro. Accessed October 2, 2020. Beck RW, Riddlesworth T, Ruedy K, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. 2017;317(4):371-378. Beck RW, Riddlesworth TD, Ruedy K, et al. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Ann Intern Med. 2017;167(6):365-374. Polonsky WH, Hessler D, Ruedy KJ, Beck RW. The impact of continuous glucose monitoring on markers of quality of life in adults with type 1 diabetes: further findings from the DIAMOND randomized clinical trial. Diabetes Care. 2017;40(6):736-741. Pratley RE, Kanapka LG, Rickels MR, et al. Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial. 2020;323(23):2397-2406. Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C. Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND trial. J Diabetes Sci Technol. 2017;11(6):1138-1146. Lind M, Polonsky W, Hirsch IB, et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. 2017;317(4):379-387. Frequently Asked Questions. https://provider.dexcom.com/products/dexcom-g6-pro/faqs. Accessed October 15, 2020. Dexcom Products: Dexcom G6 Pro. https://provider.dexcom.com/products/professional-cgm. Accessed October 15, 2020. How to Customize Alarm and Alerts. https://www.dexcom.com/faqs/how-to-customize-alarm-and-alerts. Accessed October 15, 2020. Trend Arrows and Treatment Decisions. https://s3-us-west-2.amazonaws.com/dexcompdf/HCP_Website/LBL015804+G6+Trend+Arrows+and+Treatment+Decisions.pdf. Accessed October 15, 2020. Why CGM? https://provider.dexcom.com/why-cgm. Accessed October 12, 2020. Pharmacy Coverage. https://provider.dexcom.com/pharmacy-coverage. Accessed October 12, 2020. Is There Reimbursement for Using Dexcom G6 Pro? https://provider.dexcom.com/faqs/there-reimbursement-using-dexcom-g6-pro. Accessed October 12, 2020. Hypoglycemia Unawareness. https://provider.dexcom.com/education-research/clinical-evidence/clinical-studies/real-time-continuous-glucose-monitoring-cgm. Accessed October 15, 2020. Garg SK, Wernicke-Panten K, Wardecki M, et al. Safety, immunogenicity, and glycemic control of insulin aspart biosimilar SAR341402 versus originator insulin aspart in people with diabetes also using insulin glargine: 12-month results from the GEMELLI 1 trial. Diabetes Technol Ther. 2020;22(7):516-526. Dexcom G6 Pro Blinded Patient Guide. https://dexcompdf.s3-us-west-2.amazonaws.com/HCP_Website/Dexcom+G6+Pro+Resources/LBL017177+Rev+004+Artwork%2C+Dexcom+G6+Pro+Blinded+Patient+Guide+US_r5_WEB.pdf. Accessed November 24, 2020. Dexcom CLARITY Diabetes Management Software. https://www.dexcom.com/clarity. Accessed May 15, 2020. Blevins T, Zhang Q, Frias JP, Jinnouchi H, Chang AM. Randomized double-blind clinical trial comparing ultra rapid lispro with lispro in a basal-bolus regimen in patients with type 2 diabetes: PRONTO-T2D. Diabetes Care. Published online July 2, 2020. doi: 10.2337/dc19-2550. Klaff L, Cao D, Dellva MA, et al. Ultra rapid lispro improves postprandial glucose control compared with lispro in patients with type 1 diabetes: results from the 26-week PRONTO-T1D study. Diabetes Obes Metab. 2020;22(10):1799-1807. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices
For over a century, the treatments and technologies used to treat diabetes have evolved. New tools are now available to aid in diabetes management and to help patients further manage and better control their glucose levels. 1,2 Through their recently announced collaboration, Dexcom and Lilly are at the forefront of enhancing diabetes care. 3 In this episode Dr. Chad Worz and guest speakers Deirdre Ibsen and Dr. Thomas Blevins discuss these important technological and therapeutic achievements over time, as well as 2 products available from Dexcom and Lilly and how they may benefit patients with diabetes. References: Dexcom G6 Pro User Guide. https://dexcompdf.s3-us-west-2.amazonaws.com/Dexcom-G6-Pro-User-Guide.pdf. Accessed October 12, 2020. Lyumjev [Prescribing Information]. Indianapolis, IN: Lilly USA, LLC. Eli Lilly and Company. Lilly and Dexcom team up on new program to help improve diabetes management. https://provider.dexcom.com/products/dexcom-g6-pro/training-resources. Accessed October 12, 2020. Centers for Disease Control. National Diabetes Statistics Report 2020 Estimates of Diabetes and Its Burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed October 1, 2020. American Diabetes Association. Diabetes and Quality of Life. http://journal.diabetes.org/diabetesspectrum/00v13n1/pg48.htm. Accessed October 1, 2020. American Diabetes Association. Caring for the Caregiver. https://spectrum.diabetesjournals.org/content/17/1/37.full-text.pdf. Accessed October 15, 2020. Ali MK, Bullard KM, Gregg EW. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med. 2013;369(3):287-288. Foster NC, Beck RW, Miller KM, et al. State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018. Diabetes Technol Ther. 2019;21(2):66-72. American Diabetes Association. 7. Diabetes Technology: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(suppl 1):S77-S88. Hirsch IB. History of Glucose Monitoring. https://professional.diabetes.org/sites/professional.diabetes.org/files/media/db201811.pdf. Accessed October 1, 2020. White JR. A brief history of the development of diabetes medications. Diabetes Spectr. 2014;27(2):82-86. Science History Institute. Frederick Banting, Charles Best, James Collip, and John Macleod. https://www.sciencehistory.org/historical-profile/frederick-banting-charles-best-james-collip-and-john-macleod. Accessed October 1, 2020. American Diabetes Association. Timeline. https://www.diabetes.org/resources/timeline. Accessed October 9, 2020. Humalog [Prescribing Information]. Indianapolis, IN: Lilly USA, LLC. Selam J-L. Evolution of diabetes insulin delivery devices. J Diabetes Sci Technol. 2010;4(3):505-513. American Association of Diabetes Educators. Insulin Injection Know-How. https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/general/Insulin_Injection_How_To_AADE.pdf. Accessed October 1, 2020. Hyllested-Winge J, Jensen KH, Rex J. A review of 25 years’ experience with the NovoPen® family of insulin pens in the management of diabetes mellitus. Clin Drug Investig. 2010;30(10):643-674. Eli Lilly and Company. Lilly Launches KwikPen(TM) for Humalog(R) and Humalog Mixtures [press release]. https://investor.lilly.com/news-releases/news-release-details/lilly-launches-kwikpentm-humalogr-and-humalog-mixtures. Accessed October 12, 2020. American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(suppl 1):S66-S76. Garber AJ, Handelsman Y, Grunberger G, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2020 executive summary. Endocr Pract. 2020;26(1):107-139. Fonseca VA, Grunberger G, Anhalt H, et al. Continuous glucose monitoring: a consensus conference of the American Association of Clinical Endocrinologists and American College of Endocrinology. Endocr Pract. 2016;22(8):1008-1021. Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care. 2019;42(8):1593-1603. Dexcom G6 Pro Unblinded Patient Guide. https://dexcompdf.s3-us-west-2.amazonaws.com/Dexcom-G6-Pro-Unblinded-Patient-Guide.pdf. Accessed October 12, 2020. Dexcom Announces FDA Clearance of New Dexcom G6 Pro CGM. https://provider.dexcom.com/industry-news/fda-authorizes-dexcom-g6-pro. Accessed October 2, 2020. Beck RW, Riddlesworth T, Ruedy K, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. 2017;317(4):371-378. Beck RW, Riddlesworth TD, Ruedy K, et al. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Ann Intern Med. 2017;167(6):365-374. Polonsky WH, Hessler D, Ruedy KJ, Beck RW. The impact of continuous glucose monitoring on markers of quality of life in adults with type 1 diabetes: further findings from the DIAMOND randomized clinical trial. Diabetes Care. 2017;40(6):736-741. Pratley RE, Kanapka LG, Rickels MR, et al. Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial. 2020;323(23):2397-2406. Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C. Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND trial. J Diabetes Sci Technol. 2017;11(6):1138-1146. Lind M, Polonsky W, Hirsch IB, et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. 2017;317(4):379-387. Frequently Asked Questions. https://provider.dexcom.com/products/dexcom-g6-pro/faqs. Accessed October 15, 2020. Dexcom Products: Dexcom G6 Pro. https://provider.dexcom.com/products/professional-cgm. Accessed October 15, 2020. How to Customize Alarm and Alerts. https://www.dexcom.com/faqs/how-to-customize-alarm-and-alerts. Accessed October 15, 2020. Trend Arrows and Treatment Decisions. https://s3-us-west-2.amazonaws.com/dexcompdf/HCP_Website/LBL015804+G6+Trend+Arrows+and+Treatment+Decisions.pdf. Accessed October 15, 2020. Why CGM? https://provider.dexcom.com/why-cgm. Accessed October 12, 2020. Pharmacy Coverage. https://provider.dexcom.com/pharmacy-coverage. Accessed October 12, 2020. Is There Reimbursement for Using Dexcom G6 Pro? https://provider.dexcom.com/faqs/there-reimbursement-using-dexcom-g6-pro. Accessed October 12, 2020. Hypoglycemia Unawareness. https://provider.dexcom.com/education-research/clinical-evidence/clinical-studies/real-time-continuous-glucose-monitoring-cgm. Accessed October 15, 2020. Garg SK, Wernicke-Panten K, Wardecki M, et al. Safety, immunogenicity, and glycemic control of insulin aspart biosimilar SAR341402 versus originator insulin aspart in people with diabetes also using insulin glargine: 12-month results from the GEMELLI 1 trial. Diabetes Technol Ther. 2020;22(7):516-526. Dexcom G6 Pro Blinded Patient Guide. https://dexcompdf.s3-us-west-2.amazonaws.com/HCP_Website/Dexcom+G6+Pro+Resources/LBL017177+Rev+004+Artwork%2C+Dexcom+G6+Pro+Blinded+Patient+Guide+US_r5_WEB.pdf. Accessed November 24, 2020. Dexcom CLARITY Diabetes Management Software. https://www.dexcom.com/clarity. Accessed May 15, 2020. Blevins T, Zhang Q, Frias JP, Jinnouchi H, Chang AM. Randomized double-blind clinical trial comparing ultra rapid lispro with lispro in a basal-bolus regimen in patients with type 2 diabetes: PRONTO-T2D. Diabetes Care. Published online July 2, 2020. doi: 10.2337/dc19-2550. Klaff L, Cao D, Dellva MA, et al. Ultra rapid lispro improves postprandial glucose control compared with lispro in patients with type 1 diabetes: results from the 26-week PRONTO-T1D study. Diabetes Obes Metab. 2020;22(10):1799-1807. See omnystudio.com/listener for privacy information.
Las hormonas son sustancias químicas especiales fabricadas por partes del cuerpo llamadas glándulas. Son mensajeros que le dicen a otras partes del cuerpo cómo y cuándo trabajar. Las hormonas controlan casi todas las tareas del cuerpo. Estos incluyen la función sexual y cerebral, el crecimiento y la descomposición de los alimentos. Cuando las hormonas están desequilibradas, pueden aparecer síntomas. Las hormonas bioidénticas se definen como hormonas artificiales que son muy similares a las hormonas producidas por el cuerpo humano. Las hormonas comunes que se combinan son el estrógeno, la progesterona y la testosterona. Estos se utilizan luego como tratamiento para hombres y mujeres cuyas propias hormonas están bajas o fuera de equilibrio. Algunas formas recetadas de hormonas bioidénticas están prefabricadas por una compañía farmacéutica. Otros formularios son hechos a medida por un farmacéutico según la orden de un médico. A esto se le llama capitalización. La Administración de Drogas y Alimentos de los Estados Unidos (FDA) ha aprobado una serie de preparaciones de estradiol y progesterona bioidénticos, que son molecularmente idénticas a la estructura de las hormonas generadas por el cuerpo humano. Han pasado por pruebas de seguridad y pureza y para asegurarse de que cada dosis tenga la misma cantidad de hormonas. Las formas compuestas no han sido probadas ni aprobadas por la FDA. Escucha el podcast en tu plataforma favorita: Spotify, iVoox, Apple Podcast, Google Podcast, Anchor.Fm, Breaker.Audio, Pocketcast y Radio Public. Si deseas contactarte conmigo para tomar sesiones de coaching hormonal, puedes mandarme un mensaje a cualquiera de estas direcciones: hola@alquimiahormonal.com, https://edusantibanez.com/, o puedes simplemente mandarme un DM en mis redes sociales. Quieres adquirir la Guía Menopausia Integral Lo puedes hacer a través de este enlace. https://edusantibanez.com/ebook/ Enlances y/o referecias de los estudios y artículos relacionados con el tema de hoy: Stuenkel, CA. and Manson, JE: Compounded Bioidentical Hormone Therapy: Does the Regulatory Double Standard Harm Women? JAMA Internal Medicine. Published online October 9, 2017. Available at: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2656887 Accessed October 10, 2017. Cohen PA. Assessing supplement safety—the FDA’s controversial proposal. N Engl J Med. 2012;366:389-391. US Food and Drug Administration. Estrogen and estrogen with progestin therapies for postmenopausal women. Available at: www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm135318.htm. Accessed October 13, 2017. Goodman NF, Cobin RH, Ginzburg SB, Katz IA, Woode DE. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and treatment of menopause. Endocrine Practice. 2011;17(Suppl6):1-25. Cobin RH, Goodman NF. American Association of Clinical Endocrinologists and American College of Endocrinology Position Statement on Menopause—2017 update. Endocrine Practice. 2017;23(7):869-880. Manson, JE et al. Menopausal Hormone Therapy and Long-Term All-Cause and Cause-Specific Mortality. JAMA. September 12, 2017. https://jamanetwork.com/journals/jama/article-abstract/2653735 Accessed October 12, 2017. ¡Aprende a entender a tus hormonas para que ellas trabajen para ti y no en tu contra! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
References: American Academy of Clinical Endocrinologists' Guidelines: https://www.aace.com/pdfs/diabetes/algorithm-exec-summary.pdf https://www.aace.com/pdfs/diabetes/AACE_2019_Diabetes_Algorithm_FINAL_ES.pdf https://journals.aace.com/doi/pdf/10.4158/EP15672.GLSUPPL History of Diabetes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749019/ Hypoglycemia https://ihsgonline.com/wp-content/uploads/2017/05/Jan_2017-Diabetes_Care-Glucose_Concentrations.pdf Sleep Podcast: https://podcasts.apple.com/us/podcast/episode-93-sleep/id1199780143 For more of our stuff: Podcasts: goo.gl/X4H4z8 Website: www.barbellmedicine.com Instagram: @austin_barbellmedicine @jordan_barbellmedicine @leah_barbellmedicine @vaness_barbellmedicine @untamedstrength @michael_barbellmedicine @derek_barbellmedicine @hassan_barbellmedicine @michael_amato_barbellmedicine @charlie_barbellmedicine @alex_barbellmedicine @tomcampitelli Email: info@barbellmedicine.com Supplements/Templates/Seminars: www.barbellmedicine.com/shop/ Forum: forum.barbellmedicine.com/
Singer/songwriter Crystal Bowersox, who has diabetes, and Dr. Gregory Dodell, member of the American Association of Clinical Endocrinologists, discuss the new initiative "Know Before the Low" to help those living with diabetes be prepared for low blood sugar, which includes having a “rescue plan” in place for very low blood sugar emergencies and telling their support network about it in advance.
Dr. Kelly N. Wood, MD is an internal medicine physician, board certified in Endocrinology, Diabetes and Metabolism. She earned her medical degree from The University of the West Indies in Barbados before relocating to the United States in 2006. Licensed in three states, Dr. Kelly is currently in clinical practice in Atlanta, Georgia. Beyond the stethoscope, Dr. Kelly is recognized as “The Bounce Back Coach,” helping high-performing women to bounce back from failed relationships, rebuild their self-esteem, and reclaim their identity. Her debut book, “Bounce Back to Better: Recovering from the Disappointment of a Failed Relationship,” walks readers through her personal journey of reconstructing her life after her engagement ended. Through a multi-dimensional platform that addresses the mind, body, and spirit, Dr. Kelly lives out her passion to help others achieve total wellness and lead a balanced life. She makes expert health and wellness advice accessible to all through speaking engagements, media appearances, her Facebook show, and personal blog. Dr. Kelly maintains connection with professional organizations such as the Endocrine Society and the American Association of Clinical Endocrinologists. She also holds a Master’s degree in Business Administration from West Connecticut State University. In this episode, Dr. Kelly joins the podcast to share her knowledge and experience as a well traveled medical professional. How she survived a tough program to become the professional she is today. How marriage and relationships impacted her career. Strategies used to invest in herself and growth as a business woman. Dr. Kelly got a chance to give us some insight on her journey as the The Bounce Back Coach. Today’s episode will even cover infertility and religious views on the issues that women are facing. You’re going to live this episode because Dr. Kelly six vulnerable and honest about her current state and the failures she’s experienced. More about Dr. Kelly Get the book Bounce Back to Better: Recovering from the Disappointment of a Failed Relationship
Deepak Chopra, M.D., F.A.C.P., is the co-founder of the Chopra Center for Wellbeing, the founder of the Chopra Foundation, and a world-renowned pioneer in integrative medicine and personal transformation. He is board certified in internal medicine, endocrinology, and metabolism. He is a Fellow of the American College of Physicians, a member of the American Association of Clinical Endocrinologists, and a clinical professor in the Family Medicine and Public Health Department at the University of California, San Diego. He is the author of some 90 books translated into over 43 languages, including numerous New York Times bestsellers. His most recent book is Metahuman: Unleashing Your Infinite Potential. His resume itself reflects the infinite potential itself that Deepak speaks of and will discuss with Mitchell in this week's interview. Interesting bonus gifts available when purchasing Metahuman at https://www.deepakchopra.com/metahuman Learn more at www.deepakchopra.com. Mitchell Rabin is the Founder, President and CEO of A Better World Foundation & Media, with a background in psychology stress management, acupuncture and social entrepreneurship. www.abetterworld.tv www.mitchellrabin.com --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/abwmitchellrabin/support
As a progressive disease diabetes presents an ongoing challenge for physicians to provide adequate control of patients’ diabetes, and new agents with novel mechanisms of action help reduce the burden in the management of diabetes. In a recent Peer Exchange discussion, Dr Peter Salgo, of Columbia University College of Physicians and Surgeons and NewYork-Presbyterian Hospital, led a discussion on novel agents and their role in treating patients with and with cardiovascular disease. On the panel was Dr. Om Ganda of Joslin Diabetes Center; Jim Kenney of JTKenney, a managed care consulting practice; and Dr Helena Rodbard, past president of the American College of Endocrinology and past president of the American Association of Clinical Endocrinologists. Listen to the full discussion: https://www.ajmc.com/peer-exchange/new-classes-for-treatment-of-type-2-diabetes/
Show Notes Jeff: Welcome back to EMplify the podcast corollary to EB Medicine's Emergency Medicine Practice. I'm Jeff Nusbaum and I'm back with Nachi Gupta for the 30th episode of EMplify and the first Post-Ponte Vedra Episode of 2019. I hope everybody enjoyed a fantastic conference. This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Nachi: As the obesity epidemic continues to worsen in America, bariatric procedures are becoming more and more common, and this population is one that you will need to be comfortable seeing. Jeff: Thankfully, this month's author, Dr. Ogunniyi, associate residency director at Harbor-UCLA, is here to help with this month's evidence-based article. Nachi: And don't forget Dr. Li of NYU and Dr. Luber of McGovern Medical School, who both played a roll by peer reviewing this article. So let's dive in, starting with some background. Starting off with some real basics, obesity is defined as a BMI of greater than 30. Jeff: Oh man, already starting with the personal assaults, I see how this is gonna go… Show More v Nachi: Nah! Just some definitions, nothing personal! Jeff: Whatever, back to the article… Obesity is associated with an increased risk of hypertension, hyperlipidemia, and diabetes. Rising levels of obesity and associated co-morbidities also lead to an increase in bariatric procedures, and thereby ED visits! Nachi: One study found a 30-day ED utilization rate of 11% for those undergoing bariatric surgery with an admission rate of 5%. Another study found a 1-year post Roux-en-y ED visit rate of 31% and yet another found that 25% of these patients will require admission within 2 years of surgery. Jeff: Well that's kind worrisome. Nachi: It sure is, but maybe even more worrisome is the rising prevalence of obesity. While it was < 15% in 1990, by 2016 it reached 40%. That's almost half of the population. Additionally, back in 2010, it was estimated that 6.6% of the US population had a BMI> 40 – approximately 15.5 million adults!! Jeff: Admittedly, the US numbers look awful, and honestly are awful, but this is a global problem. From the 80's to 2008, the worldwide prevalence of obesity nearly doubled! Nachi: Luckily, bariatric surgical procedures were invented and honed to the point that they have really shown measurable achievements in sustained weight loss. Along with treating obesity, these procedures have also resulted in an improvement in associated comorbidities like hypertension, diabetes, NAFLD, and dyslipidemia. Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. Nachi: Taken all together, the rising rates of obesity and the rising success and availability of bariatric procedures has led to an increased number of bariatric procedures, with 228,000 performed in the US in 2017. Jeff: And while it's not exactly core EM, we're going to briefly discuss indications for bariatric surgery, as this is something we don't often review even in academic training programs. Nachi: According to joint guidelines from the American Society for Metabolic and Bariatric Surgery, the American Association of Clinical Endocrinologists, and The Obesity Society, there are three groups that meet indications for bariatric surgery. The first is patients with a BMI greater than or equal to 40 without coexisting medical problems. The second is patients with a BMI greater than or equal to 35 with at least one obesity related comorbidity such as hypertension, hyperlipidemia, or obstructive sleep apnea. And finally, the third is patient with a BMI of 30-35 with DM or metabolic syndrome though current evidence is limited for this group. Jeff: Based on the obesity numbers, we just cited – it seems like a TON of people should be eligible for these procedures.
Show Notes Jeff: Welcome back to EMplify the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum and I’m back with Nachi Gupta for the 30th episode of EMplify and the first Post-Ponte Vedra Episode of 2019. I hope everybody enjoyed a fantastic conference. This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Nachi: As the obesity epidemic continues to worsen in America, bariatric procedures are becoming more and more common, and this population is one that you will need to be comfortable seeing. Jeff: Thankfully, this month’s author, Dr. Ogunniyi, associate residency director at Harbor-UCLA, is here to help with this month’s evidence-based article. Nachi: And don’t forget Dr. Li of NYU and Dr. Luber of McGovern Medical School, who both played a roll by peer reviewing this article. So let’s dive in, starting with some background. Starting off with some real basics, obesity is defined as a BMI of greater than 30. Jeff: Oh man, already starting with the personal assaults, I see how this is gonna go… Show More v Nachi: Nah! Just some definitions, nothing personal! Jeff: Whatever, back to the article… Obesity is associated with an increased risk of hypertension, hyperlipidemia, and diabetes. Rising levels of obesity and associated co-morbidities also lead to an increase in bariatric procedures, and thereby ED visits! Nachi: One study found a 30-day ED utilization rate of 11% for those undergoing bariatric surgery with an admission rate of 5%. Another study found a 1-year post Roux-en-y ED visit rate of 31% and yet another found that 25% of these patients will require admission within 2 years of surgery. Jeff: Well that’s kind worrisome. Nachi: It sure is, but maybe even more worrisome is the rising prevalence of obesity. While it was < 15% in 1990, by 2016 it reached 40%. That’s almost half of the population. Additionally, back in 2010, it was estimated that 6.6% of the US population had a BMI> 40 – approximately 15.5 million adults!! Jeff: Admittedly, the US numbers look awful, and honestly are awful, but this is a global problem. From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled! Nachi: Luckily, bariatric surgical procedures were invented and honed to the point that they have really shown measurable achievements in sustained weight loss. Along with treating obesity, these procedures have also resulted in an improvement in associated comorbidities like hypertension, diabetes, NAFLD, and dyslipidemia. Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. Nachi: Taken all together, the rising rates of obesity and the rising success and availability of bariatric procedures has led to an increased number of bariatric procedures, with 228,000 performed in the US in 2017. Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. Nachi: According to joint guidelines from the American Society for Metabolic and Bariatric Surgery, the American Association of Clinical Endocrinologists, and The Obesity Society, there are three groups that meet indications for bariatric surgery. The first is patients with a BMI greater than or equal to 40 without coexisting medical problems. The second is patients with a BMI greater than or equal to 35 with at least one obesity related comorbidity such as hypertension, hyperlipidemia, or obstructive sleep apnea. And finally, the third is patient with a BMI of 30-35 with DM or metabolic syndrome though current evidence is limited for this group. Jeff: Based on the obesity numbers, we just cited – it seems like a TON of people should be eligible for these procedures. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Nachi: As far as types of procedures go – while there are many, there are 3 major ones being done in the US and these are the lap sleeve gastrectomy, Roux-en-Y gastric bypass, and lap adjustable gastric banding. In 2017, these were performed 60%, 18%, and 3% of the time. Jeff: And sadly, no two procedures were created alike and you must familiarize yourself with not only the procedure but also its associated complications. Nachi: So we have a lot to cover! overall, these surgeries are relatively safe with one 2014 review publishing a 10-17% overall complication rate and a perioperative 30 day mortality of less than 1%. Jeff: Before we get into the ED specific treatment guidelines, I think it’s worth discussing the procedures in more detail first. Understanding the surgeries will make understanding the workup, treatment, and disposition in the ED much easier. Nachi: Bariatric procedures can be classified as either restrictive or malabsorptive, with restrictive procedures essentially limiting intake and malabsorptive procedures limiting nutrient absorption. Not surprisingly, combined restrictive and malabsorptive procedures like the Roux-en-y gastric bypass tend to be the most effective. Jeff: Do note, however that 2013 guidelines do not recommend one procedure over another and leave that decision up to local surgical expertise, patient specific risk factors, and treatment goals. Nachi: That’s certainly an important point for the candidate patient. Let’s start by discussing the lap gastric sleeve. In this restrictive procedure, 80% of the greater curvature of the stomach is excised producing early satiety and weight loss from decreased caloric intake. This has been shown to have both low mortality and a low overall rate of complications. Jeff: Next we have the lap adjustable gastric band. This is also a restrictive procedure in which a plastic band is placed laparoscopically around the fundus leaving behind a small pouch that can change in size as the reservoir is inflated and deflated percutaneously. Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. Nachi: 20-50% chance of removal, revision, or other cause for return to ER - those are some high numbers. Finally, there is the roux-en-y gastric bypass. As we mentioned previously this is both a restrictive and a malabsorptive procedure. In this procedure, the duodenum is separated from the proximal jejunum, and the jejunum is connected to a small gastric pouch. Food therefore transits from a small stomach to the small bowel. This leads to decreased caloric intake and decreased digestion and absorption. Jeff: Those are the main 3 procedures to know about. For the sake of completeness, just be aware that there is also the biliopancreatic diversion with or without a duodenal switch, as well as a vertical banded gastroplasty. The biliopancreatic diversion is used infrequently but is one of the most effective procedure in treating diabetes, though it does have an increased risk of complications. Expect to see this mostly in those with BMIs over 50. Nachi: Now that you have a sense of the procedures, let’s talk complications, both general and specific. Jeff: Of course, it should go without saying that this population is susceptive to all the typical post-operative complications such as venous thromboembolic disease, atelectasis, pneumonia, UTIs, and wound complications. Nachi: Because of their typical comorbidities, CAD and PE are still the leading causes of mortality, especially within the perioperative period. Jeff: Also, be on the lookout for self-harm emergencies as patients with known psychiatric disorders are at increased risk following bariatric surgery. Nachi: Surgical complications are wide ranging and can be grouped into early and late complications. More on this later… Jeff: Nutritional deficiencies are common enough to warrant pre and postoperative screening. Thiamine deficiency is one of the most common deficiencies. This can manifest within 1-3 months of surgery as beriberi or later as Wernicke encephalopathy. Symptoms of beriberi include peripheral neuropathy, ataxia, muscle weakness, high-output heart failure, LE edema, and respiratory distress. Nachi: All of that being said, each specific procedure has it’s own unique set of complications that we should discuss. Let’s start with the sleeve gastrectomy. Jeff: Early complications of sleeve gastrectomy include staple-line leaks, strictures, and hemorrhage. Leakage from the staple line typically presents within the first week, but can present up to 35 days, usually with fevers, tachycardia, abdominal pain, nausea, vomiting sepsis, or peritonitis. This is one of the most serious and dreaded early complications and represents an important cause of morbidity with an incidence of 3-7%. Nachi: Strictures commonly occur at the incisura angularis of the remnant stomach and are usually due to ischemia, leaks, or twisting of the gastric pouch. Patients with strictures usually have n/v, reflux, and intolerance to oral intake. Jeff: Hemorrhage occurs due to erosions at the staple line, resulting in peritonitis, hematemesis, or melena. Nachi: Late complications of sleeve gastrectomies include reflux, which occurs in up to 25% of patients, and strictures, which lead to epigastric discomfort, nausea, and dysphagia. Jeff: I’m getting reflux and massive heartburn just thinking about all of these complications, or the tacos i just ate…. Next we have the Roux-en-Y bypass. Nachi: Early complications of the Roux-en-Y Gastric Bypass include anastomotic or staple line leaks, hemorrhage, early postoperative obstruction, and dumping syndrome. Jeff: Leak incidence ranges from 1-6%, usually occurring at the gastro-jejunostomy site. Patients typically present within the first 10 days with abdominal pain, nausea, vomiting, and the feeling of impending doom. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever. Nachi: Similar to the sleeve, hemorrhage can occur both intraperitoneally or intraluminally. This may lead to hematemesis or melena depending on the location of bleeding. Jeff: Early obstructions usually occur at either the gastro-jejunal or jejuno-jejunal junction. Depending on the location, patients typically present either within 2 days or in the first few weeks in the case of the gastro-jejunal site. Nachi: If the obstruction occurs in the jejuno-jejunostomy site, this can cause subsequent dilatation of the excluded stomach and lead to perforation, which portends a very poor prognosis. Jeff: Next, we have dumping syndrome. This has been seen in up to 50% of Roux-en-Y patients. Nachi: Early dumping occurs within 10-30 minutes after ingestion. As food rapidly empties from the stomach, this leads to distention and increased contractility, leading to nausea, abdominal pain, bloating, and diarrhea. This usually resolves within 7-12 weeks. Jeff: Moving on to late complications of the roux-en y - first we have marginal ulcers. Peptic ulcer disease and diabetes are risk factors and tobacco use and NSAIDs appear to increase your risk. In the worse case, they present with hematemesis or melena. Nachi: Internal hernias, intussusception, and SBOs are also seen after Roux-en-y gastric bypass. Patients with internal hernias usually present late in the postoperative period following significant weight loss. Jeff: Most studies cite a rate of 1-3% for internal hernias, with mortality up to 50% if there is strangulation. Nachi: And unfortunately for us on the front lines, diagnosis can be challenging. Presenting symptoms may be vague and CT imaging may be negative when patients are pain free, thus laparoscopy may be needed to definitively exclude an internal hernia. Jeff: Strictures may occur both during the early and late period. Most are minor, but significant strictures may result in obstruction. Nachi: Trocar site hernias and ventral hernias are also late complications, usually found after significant weight loss. Jeff: Cholelithiasis is another very common complication of bypass surgery, occurring in up to one third of patients, usually occurring during a peak incidence period between 6-18 months. Nachi: For this reason, the current recommendation is that patients undergoing bypass be placed on ursodeoxycholic acid for 6 months preventatively. Jeff: Some even go as far as to recommend prophylactic cholecystectomy to prevent complications, but as of 2013, the recommendation was only ‘to consider’ it. Nachi: Nutritional deficiencies are also common complications. Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. Patients typically take vitamins postoperatively to prevent such complications. Jeff: And next we have late dumping syndrome, which is far more rare than the last two complications. In late dumping syndrome, 1-3 hours after a meal, patients suffer hypoglycemia from excessive insulin release following the food bolus entering the GI tract. Symptoms are those typical of hypoglycemia. Nachi: Lastly, let’s talk about complications of lap adjustable gastric band surgery. In the early post op period, you can have esophageal and gastric perforations, which typically occur during balloon placement. Patients present with abd pain, n/v, and peritonitis. These patients often require emergent operative intervention. Jeff: The band can also be overtightened resulting in distention of the proximal gastric pouch. Presenting symptoms include abd pain with food and liquid intolerance and vomiting. Symptoms resolves once the balloon is deflated. The band can also slip, allowing the stomach to move upward and within the band. This occurs in up to 22% of patients and can cause strangulation. Presentation is similar to bowel ischemia. Nachi: Later complications include port site infections due to repeated port access. The infection can spread into connector tubing and the peritoneal cavity causing systemic symptoms. Definitely start antibiotics and touch base with the bariatric surgeon. Jeff: The connector can also dislodge or rupture with time. This can present as an arrest in weight loss. It’s diagnosed by contrast injection into the port. Of note, this complication is less common due to changes in the technique used. Nachi: Much like early band slippage and prolapse, patients can also experience late band slippage and prolapse after weeks or months. In extreme cases, the patients can again have strangulation and symptoms of bowel ischemia. More mild cases will present with arrest in weight loss, reflux, and n/v. Jeff: The band can also erode and migrate into the stomach cavity. If this occurs, it usually happens within 2 years of the initial procedure with an incidence of 4-11%. Presenting symptoms here include epigastric pain, bleeding, and infections. You’ll want to obtain emergent imaging if you are concerned. Nachi: And lastly there are two rare complications worth mentioning from any gastric bypass surgery. These are nephrolithiasis, possibly due to increased urinary oxalate excretion or hypocitraturia, and rhabdomyloysis. Jeff: That was a ton of information but certainly valuable as most EM clinicians, even ones in practice for decades, are unlikely to have that depth of knowledge on bariatric surgery. Nachi: And truthfully these patients are complicated. Aside from the pathologies we just discussed, you also have to still bear in mind other abdominal conditions unrelated to their surgery like appendicitis, diverticulitis, pyelo, colitis, hepatitis, pancreatitis, mesenteric ischemia, and GI bleeds. Jeff: Moving on to my favorite - prehospital care - as always, ABCs first. Consider IV access and early IV fluids in those at risk for dehydration and intra-abdominal infections. In terms of destination, if it’s feasible and the patient is stable consider transport directly to the nearest bariatric center - early efforts up front will really expedite patient care. Nachi: Once in the ED, you will want to continue initial stabilization. Special considerations for the airway include a concern for a difficult airway due to body habitus. Make sure to position appropriately and preoxygenate the patients if time allows. Keep the patient upright for as long as possible as they may desaturate quickly when flat. Jeff: We both routinely raise the head of the bed for all of our intubations. This is ever more important for your obese patients to help maximize your chance of first pass success without significant desaturation. Nachi: And though I’m sure we all remember this from residency, it’s worth repeating: tidal volume settings on the ventilator should be based on ideal body weight, not actual body weight. At 6 to 8 mL/kg. Jeff: Tachycardic patients should make you concerned for hypovolemia 2/2 dehydration, sepsis, leaks, and blood loss. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. A HR > 120 with abdominal pain should make you concerned enough to discuss urgent ex-lap with the surgeon to evaluate for the post op complications we discussed earlier. Nachi: If possible, obtain a view of the IVC also while doing your ultrasound to assess for volume status. But bear in mind that ultrasound will undoubtedly be more difficult if the patient has a large body habitus, so don’t be disappointed if you’re not getting the best views. Jeff: Resuscitation should be aimed at early fluid replacement with IV crystalloids for hypovolemic patients and packed RBC transfusions for patients presumed to be unstable from hemorrhage. No real surprises there for our listeners. Nachi: Once stabilized, gather a thorough history. In addition to the usual questions, ask about po intolerance, early satiety, hematemesis, and hematochezia. Definitely also gather a thorough surgical history including name of procedure, date, known complications post op, and name of the surgeon. Jeff: You might also run into “medical tourism” or global bariatric care. Patients are traveling overseas to get their bariatric care more and more frequently. Accreditation and oversight is variable in different countries and there isn’t a worldwide standard of care. Just an important phenomenon to be aware of in this population. Nachi: On physical exam, be sure to look directly at the belly, making note of any infections especially near a port-site. Given the reorganized anatomy and extent of soft tissue in obese patients, don’t be reassured by a benign exam. Something awful may be happening deeper. Jeff: This naturally brings us into diagnostic testing. Not surprisingly, labs will be helpful in these patients. Make sure to check abdominal labs and a lipase. Abnormal LFTs or lipase may indicate obstruction of the biliopancreatic limb in bypass patients. Nachi: A lactic acid level will help in suspected cases of hypoperfusion from sepsis or bowel ischemia. Jeff: And as we mentioned earlier, these patients are often at risk for ACS given their comorbidities. Be sure to check a troponin if you suspect cardiac ischemia. Nachi: If concerned for sepsis, draw blood cultures, and if concerned for hemorrhage, be sure to send a type and screen. Urinalysis and urine culture should be considered especially for early post op patients, symptomatic patients, or those with GU complaints. Jeff: And don’t forget the urine pregnancy test for women of childbearing age, especially prior to imaging. Nachi: Check an EKG immediately after arrival for any patient that may be concerning for ACS. A normal ekg of course does not rule out a cardiac cause of their presentation. Jeff: As for imaging, plain radiographs certainly play a role here. For patients with respiratory complaints, check a CXR. In the early postoperative period, there is increased risk for pneumonia. Nachi: Unstable patients with abdominal pain will benefit from an emergent abdominal series, which may show free air under the diaphragm, pneumatosis, air-fluid levels, or even dilated loops of bowel. Jeff: Of course don’t forget that intra abd air may be seen after laparoscopic procedures depending on how recently the operation was performed. Nachi: Plain x-ray can also help diagnose malpositioned or slipped gastric bands. But a negative study doesn’t rule out any of these pathologies definitively, given the generally limited sensitivity and specificity of x-ray. Jeff: You might also consider an upper GI series. Emergent uses include diagnosis of slipped or prolapsed gastric bands as well as gastric or esophageal perforations. Urgent indications include diagnosis of strictures. These can also diagnose gastric band erosions and help identify staple-line or anastomotic leaks in stable patients. Nachi: However, upper GI series might not be easy to obtain in the ED, so it’s often not the first test performed. Jeff: This brings us to the workhorse for diagnostic evaluation. The CT. Depending on suspected pathology, oral and/or IV contrast will be helpful. Oral contrast can help identify gastric band erosions, staple-line leaks, and anastomotic leaks. Leaks can be identified in up 86% of cases with oral contrast. Nachi: CT will also help diagnose internal hernias. You might see the swirl sign on CT, which represents swirling of the mesenteric vessels. This is highly predictive of an internal hernia, with a sensitivity of 78-100% and specificity of 80-90% according to at least two studies. Jeff: While CT is extremely helpful in making this diagnosis, note that it may be falsely negative for internal hernias. A retrospective review showed a sensitivity of 76% and a specificity of 60%. It also showed that 22% of patients with an internal hernia on surgical exploration had a negative CT in the ED. Another study found a false negative rate of 32%. What does all this mean? It likely means that a negative study may still necessitate diagnostic laparoscopy to rule out an internal hernia. Nachi: While talking about CT, we should definitely mention CTA for concern of pulmonary embolism. In order to limit contrast exposure, you might consider doing a CTA chest and CT of the abdomen simultaneously. Jeff: Next up is ultrasound. Ultrasound is still the first-line imaging modality for assessing the gallbladder and for biliary tract disease. And as we mentioned previously, ultrasound should be considered for your RUSH exam and for assessing the IVC. Nachi: We also should discuss endoscopy, which is the test of choice for diagnosing gastric band erosions. Endoscopy is also useful for evaluating marginal ulcers, strictures, leaks, and GI bleeds. Endoscopy additionally can be therapeutic for patients. Jeff: When treating these patients, attempt to contact the bariatric surgeon for guidance as needed. This shouldn’t delay imaging however. Nachi: For septic patients, make sure your choice of antibiotics covers intra-abdominal gram-negative and anaerobic organisms. Port-site infections require gram-positive coverage to cover skin flora. Additionally, give IV fluids, blood products, and antiemetics as appropriate. Jeff: Alright, so this month, we also have 2 special populations to discuss. First up, the kids. Nachi: Recent estimates from 2015-2016 put the prevalence of obesity of those 2 years old to 19 years old at about 19%. As obese children are at higher risk for comorbidities later in life and bariatric surgery remains one of the best modalities for sustained weight loss, these surgical procedures are also being done in children. Jeff: Criteria for bariatric surgery in the adolescent population is similar to that of adults and includes a BMI of 35 and major comorbidities (like diabetes or moderate to severe sleep apnea) or patients with a BMI 40 with other comorbidities associated with long term risks like hypertension, dyslipidemia, insulin resistance and impaired quality of life. Nachi: Despite many adolescents meeting criteria, they should be referred with caution as the long term effects are unclear and the adolescent experience is still in its infancy with few pediatric specific programs. Jeff: Still, the complication rate is low - about 2.3% with generally good clinical outcomes including improved quality of life and reducing or staving off comorbidities. Nachi: Women of childbearing age are the next special population. They are at particular risk because of the unique caloric and nutrient needs of a pregnant mother. Jeff: Pregnant women who have had bariatric surgery have an increased risk of perinatal complications including prematurity, small for gestational age status, NICU admission and low Apgar scores. However, these risks come with benefits as other studies have shown reduced incidence of pre-eclampsia, large for gestational age neonates, and gestational diabetes. Nachi: 2013 guidelines from various organizations recommend avoiding becoming pregnant for at least 12-18 months postoperatively, with ACOG recommending a minimum of 2 years. Bariatric surgery patients who do become pregnant require serial monitoring for fetal growth and higher doses of supplemental folate. Jeff: We also have 2 pretty cool cutting edge techniques to mention this month before getting to disposition. Nachi: Though these are certainly not going to be done in the ED, you should be aware of two new techniques. Recently, the FDA approved 3 new endoscopic gastric balloon procedures in which a balloon is inflated in the stomach as a means of simulating a restrictive procedure. Complications include perforation, ulceration, GI bleeding, and migration with obstruction. As of now, they are only approved as a temporary modality for up to 6 months. Jeff: And we also have the AspireAssist siphon, which was approved in 2016. With the siphon, a g tube is placed in the stomach, and then ⅓ of the stomach contents is drained 20 minutes after meals, thus limiting overall digested intake. Nachi: Pretty cool stuff... Jeff: Yup - In terms of disposition, decisions should often be made in conjunction with the bariatric surgical team. Urgent and occasionally emergent surgery is required for those with hemodynamic instability, anastomotic or staple line leaks, SBO, acute band slippage with dilatation of the gastric pouch, tight gastric bands, and infected port sites with concurrent intra abdominal infections. Nachi: And while general surgeons should be well-versed in these complications should the patient require an emergent surgery, it is often best to stabilize and consider transfer to your local bariatric specialty facility. Jeff: In addition to the need for admission for surgical procedures, admission should also be considered in those with dehydration and electrolyte disturbances, those with persistent vomiting, those with GI bleeding requiring transfusions, those with acute cholecystitis or choledococholithiasis, and those with malnutrition. Nachi: Finally, patients with chronic strictures, marginal ulcers, asymptomatic trocar or ventral hernias, and stable gastric band erosions can usually be safely discharged after an appropriate conversation with the patient’s bariatric surgeon. Jeff: Definitely a great time to do some joint decision making with the patient and their surgeon. Nachi: Exactly. Let’s close out with some Key points and clinical pearls. Jeff: Bariatric surgeries are being performed more frequently due to both their success in sustained weight loss and improvements in associated comorbidities. Nachi: There is an increased risk of postoperative myocardial infarction and pulmonary embolism after bariatric surgery. There is also an increased risk of self-harm emergencies after bariatric surgery, mostly in patients with known psychiatric co-morbidities. Jeff: Nutritional deficiencies can occur following bariatric surgery, with thiamine deficiency being one of the most common. Look for signs of beriberi or even Wernicke encephalopathy. Nachi: Staple-line leaks are an important cause of postoperative morbidity. Patients often present with abdominal pain, vomiting, sepsis, and peritonitis. Jeff: Strictures can also present postoperatively and cause reflux, epigastric discomfort, and vomiting. Nachi: Intraperitoneal or intraluminal hemorrhage is a known complication of bariatric surgery and may present as peritonitis or with hematemesis and melena. Jeff: After significant weight loss, internal hernias with our without features of strangulation are a late complication. Nachi: Late dumping syndrome is a rare complication following Roux-en-Y bypass occurring months to years postoperatively. It presents with hypoglycemia due to excessive insulin release. Jeff: Esophageal or gastric perforation are early complications of adjustable gastric band surgery. These patients require emergent surgical intervention. Nachi: Overtightening of the gastric band results in food and liquid intolerance. This resolves once the balloon is deflated. Jeff: Late complications of gastric band surgery include port-site infections, connector tubing dislodgement or rupture, band slippage or prolapse, and band erosion with intragastric migration. Nachi: Given the myriad of possible bariatric surgeries, emergency clinicians should be cognizant of procedure-specific complications. Jeff: Consider obtaining a lactic acid level for cases of suspected bowel ischemia or sepsis. Nachi: Endoscopy is the best method for diagnosing and treating gastric band erosions. Jeff: Septic patients should be treated with antibiotics that cover gram-negative and anaerobic organisms. Suspected port site or wound infections require gram positive coverage. Nachi: Pregnant patients who previously had bariatric surgery are at risk for complications from their prior surgery as well as pregnancy-related pathology. Jeff: A plain radiograph may be useful in unstable patients to evaluate for free air under the diaphragm, pneumatosis, air-fluid levels, or dilated loops of bowel. Nachi: CT of the abdomen and pelvis is the mainstay for evaluation. Oral and/or IV contrast should be considered depending on the suspected pathology. Jeff: Have a low threshold for emergent surgical consultation for ill-appearing, unstable, or peritonitic patients. Nachi: So that wraps up Episode 30! Jeff: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Nachi: And the address for this month’s cme credit is ebmedicine.net/E0719, so head over there to get your CME credit. As always, the [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at EMplify@ebmedicine.net with any comments or suggestions. Talk to you next month! Most Important References Altieri MS, Wright B, Peredo A, et al. Common weight loss procedures and their complications. Am J Emerg Med. 2018;36(3):475-479. (Review article) Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014(8):CD003641. (Cochrane review; 22 trials) Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21 Suppl 1:S1-S27. (Society practice guidelines) Phillips BT, Shikora SA. The history of metabolic and bariatric surgery: development of standards for patient safety and efficacy. Metabolism. 2018;79:97-107. (Review article) Contival N, Menahem B, Gautier T, et al. Guiding the nonbariatric surgeon through complications of bariatric surgery. J Visc Surg. 2018;155(1):27-40. (Review article) Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient, 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727-741. (Society practice guidelines) Chousleb E, Chousleb A. Management of post-bariatric surgery emergencies. J Gastrointest Surg. 2017;21(11):1946-1953. (Review article) Goudsmedt F, Deylgat B, Coenegrachts K, et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass: a correlation between radiological and operative findings. Obes Surg. 2015;25(4):622-627. (Retrospective review; 7328 patients) Michalsky M, Reichard K, Inge T, et al. ASMBS pediatric committee best practice guidelines. Surg Obes Relat Dis. 2012;8(1):1-7. (Society practice guidelines)
What is an effective way to begin conversations about diet and nutrition discussions in a health care setting? This episode serves as a foundation for future podcasts, including important general concepts to keep in mind for all nutrition counseling. Articles/references: Claire P. Kelley, PsyDa, *, Geena Sbrocco, MS, RDb,c , Tracy Sbrocco, PhDa, Behavioral Modification for the Management of Obesity Dietary Guidelines for Americans. 08/08/2018; Available from: https://health.gov/dietaryguidelines/. Aspry, K.E., et al., Medical Nutrition Education, Training, and Competencies to Advance Guideline-Based Diet Counseling by Physicians A Science Advisory From the American Heart Association. Circulation, 2018. 137(23): p. E821-E841. Brook, R.D. and S. Rajagopalan, 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American Society of Hypertension, 2018. 12(3): p. 238-238. Tete, S., et al., Nutrition and Cancer Prevention. International Journal of Immunopathology and Pharmacology, 2012. 25(3): p. 573-581. Goldstein, L.B., et al., Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 2011. 42(2): p. 517-584. Sami, W., et al., Effect of diet on type 2 diabetes mellitus: A review. International Journal of Health Sciences-Ijhs, 2017. 11(2). Evert, A.B., et al., Nutrition Therapy Recommendations for the Management of Adults With Diabetes. Diabetes Care, 2014. 37: p. S120-S143. Garvey, W.T., et al., American Association of Clinical Endocrinologists and American College of Endocrinology Position Statement on the 2014 Advanced Framework for a New Diagnosis of Obesity as a Chronic Disease. Endocrine Practice, 2014. 20(9): p. 977-989. Jellinger, P.S., et al., American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease - Executive Summary. Endocrine Practice, 2017. 23(4): p. 479-497.
The American College of Physicians' 2018 HbA1c guidelines, which recommended achieving an HbA1c level between 7% and 8% in most patients with type 2 diabetes, were met with controversy, eliciting criticism from organizations like the American Diabetes Association and American Association of Clinical Endocrinologists. In this podcast, board-certified nurse practitioner Lucia Novak reflects on how these guidelines have impacted the landscape of diabetes care over the past year, and discusses the importance of individualized treatment. For more, visit www.consultant360.com.
In this video lecture, we discuss the imaging appearance of lipid-rich and lipid-poor adrenal adenomas, explain the CT washout calculation, and review the choice of CT vs. MRI for the evaluation of adrenal nodules. Also, we compare the 2017 ACR (American College of Radiologists) Incidental Findings Committee recommendations to the AACE/AAES (American Association of Clinical Endocrinologists and American Association of The post Imaging of Adrenal Adenomas & Incidentalomas appeared first on radiologist HeadQuarters.
Controversy and Clinical Insights into the Health Effects and Breast Cancer Today on Couch Talk I am talking with Dr. Edwin Lee. He is a past Couch Talk guest and one of the best physicians I know. And we're talking about one of my favorite topics, the use of bio-identical hormones in the treatment of menopausal symptoms in women. Dr. Lee believes that the best way to treat hormonal imbalance is by natural bio-identical hormone therapy. Natural hormones are the exact and identical hormones that are made in your body (versus synthetic hormones which are not chemically structured the same as in your body). He feels that the use of bioidentical hormones with estradiol, estriol, progesterone and or testosterone in women is essential, whereas the use of testosterone in men is crucial to prevent early mortality. Dr. Lee combines functional medicine to determine the root problem with the use of bioidentical hormones to help his patients achieve wellness – along with an emphasis on improving on diet, lifestyle, and nutrition. Listen to the interview: A Great Way to Kick off Breast Cancer Awareness Month! It's the start of Breast Cancer Awareness month, so this Couch Talk interview was very well timed! We talked a lot about our own patient and clinical outcomes over our decades of combined practices in using bio-identical hormones to treat hot flashes, depression, anxiety, mood swings, vaginal atrophy and other symptoms commonly seen in menopause. We also talked a lot about the confusion relating to breast cancer risk. In thisinterview, you will learn, Why Dr. Lee tells his menopausal patients that menopause itself is a dangerous disease with a higher rate of Alzheimer's or dementia, heart disease, and osteoporosis…and what he feels they can do to prevent all of this. The importance of both an individual patient's ability to detox and their current lifestyle (diet, exercise, sleep, etc.) in determining the right menopausal treatment plan for them. Why he doesn't recommend oral estrogen therapy (Premarin, Prempro) ever be used. Why bio-identical progesterone is truly the “wonder hormone” that helps with sleep, anxiety, irritability, PMS…and more…and how it is protective against breast cancer (and could save your marriage!) Why oral synthetic progesterone (Provera) is a bad choice, clearly linked to increasing the risk of strokes and heart disease. Why just taking a hormone is never enough (hint: you need to improve your lifestyle decisions)! What plant-based estrogen SERM (Selective Estrogen Receptor Modulator) Dr. Lee has recommended that helps with hot flashes (and is safe). And We Covered So Much More! Why is it that less than 1% of women who have taken HRT therapy in his clinical practice have developed breast cancer (compared to 11% of women developing breast cancer in the general population)? We discussed both of our clinical observations as to what the answer to this might be. Finally, we talked about our “polite disagreements” with the American Association of Clinical Endocrinologists (of which Dr. Lee is a member) recently stating in a position paper that they do not recommend the use of bio-identical hormone therapy in many cases… What? Well...we both feel that endocrinologists already use bio-identical hormone therapy all of the time for standard care with insulin, cortisol, thyroid, progesterone, testosterone, transdermal estradiol, etc.! So what is going on in this position paper? Is it the definition of what is “synthetic” versus “natural”? Is it a bit of bias from the Big Pharm companies? Such an interesting discussion with my favorite endocrinologist! Meet Dr. Edwin Lee A little bit about Dr. Edwin Lee, and I hope you'll listen to our interview in the audio posted above! He's board-certified in internal medicine, endocrinology, diabetes, and metabolism, and has completed special training in regenerative and functional medicine. He is an author and an international speaker and educator. Dr. Lee founded the Institute for Hormonal Balance in 2008. Currently, he is the Assistant Professor of Internal Medicine at the University of Central Florida College of Medicine. In addition to writing his books, including two awesome children's books, one called, Your Awesome Brain, and the other is Your Amazing Heart—I highly recommend these—he's written, for those of us that really want to get a better understanding on hormones, a couple of other books. One is called Feel Good, Look Younger: Reversing Tiredness Through Hormonal Balance, and the book, Your Best Investment: Secrets to a Healthy Body and Mind. Dr. Lee has also published many articles on internal medicine and endocrinology. He is an author in the fourth edition of Textbook of Critical Care. He's an active member of the Age Management Medicine Group and the American Association of Clinical Endocrinology. Find out more about Dr. Lee at http://instituteofhormonalbalance.com/
Controversy and Clinical Insights into the Health Effects and Breast Cancer Today on Couch Talk I am talking with Dr. Edwin Lee. He is a past Couch Talk guest and one of the best physicians I know. And we’re talking about one of my favorite topics, the use of bio-identical hormones in the treatment of menopausal symptoms in women. Dr. Lee believes that the best way to treat hormonal imbalance is by natural bio-identical hormone therapy. Natural hormones are the exact and identical hormones that are made in your body (versus synthetic hormones which are not chemically structured the same as in your body). He feels that the use of bioidentical hormones with estradiol, estriol, progesterone and or testosterone in women is essential, whereas the use of testosterone in men is crucial to prevent early mortality. Dr. Lee combines functional medicine to determine the root problem with the use of bioidentical hormones to help his patients achieve wellness – along with an emphasis on improving on diet, lifestyle, and nutrition. Listen to the interview: A Great Way to Kick off Breast Cancer Awareness Month! It’s the start of Breast Cancer Awareness month, so this Couch Talk interview was very well timed! We talked a lot about our own patient and clinical outcomes over our decades of combined practices in using bio-identical hormones to treat hot flashes, depression, anxiety, mood swings, vaginal atrophy and other symptoms commonly seen in menopause. We also talked a lot about the confusion relating to breast cancer risk. In thisinterview, you will learn, Why Dr. Lee tells his menopausal patients that menopause itself is a dangerous disease with a higher rate of Alzheimer’s or dementia, heart disease, and osteoporosis…and what he feels they can do to prevent all of this. The importance of both an individual patient’s ability to detox and their current lifestyle (diet, exercise, sleep, etc.) in determining the right menopausal treatment plan for them. Why he doesn’t recommend oral estrogen therapy (Premarin, Prempro) ever be used. Why bio-identical progesterone is truly the “wonder hormone” that helps with sleep, anxiety, irritability, PMS…and more…and how it is protective against breast cancer (and could save your marriage!) Why oral synthetic progesterone (Provera) is a bad choice, clearly linked to increasing the risk of strokes and heart disease. Why just taking a hormone is never enough (hint: you need to improve your lifestyle decisions)! What plant-based estrogen SERM (Selective Estrogen Receptor Modulator) Dr. Lee has recommended that helps with hot flashes (and is safe). And We Covered So Much More! Why is it that less than 1% of women who have taken HRT therapy in his clinical practice have developed breast cancer (compared to 11% of women developing breast cancer in the general population)? We discussed both of our clinical observations as to what the answer to this might be. Finally, we talked about our “polite disagreements” with the American Association of Clinical Endocrinologists (of which Dr. Lee is a member) recently stating in a position paper that they do not recommend the use of bio-identical hormone therapy in many cases… What? Well...we both feel that endocrinologists already use bio-identical hormone therapy all of the time for standard care with insulin, cortisol, thyroid, progesterone, testosterone, transdermal estradiol, etc.! So what is going on in this position paper? Is it the definition of what is “synthetic” versus “natural”? Is it a bit of bias from the Big Pharm companies? Such an interesting discussion with my favorite endocrinologist! Meet Dr. Edwin Lee A little bit about Dr. Edwin Lee, and I hope you’ll listen to our interview in the audio posted above! He’s board-certified in internal medicine, endocrinology, diabetes, and metabolism, and has completed special training in regenerative and functional medicine. He is an author and an international speaker and educator. Dr. Lee founded the Institute for Hormonal Balance in 2008. Currently, he is the Assistant Professor of Internal Medicine at the University of Central Florida College of Medicine. In addition to writing his books, including two awesome children’s books, one called, Your Awesome Brain, and the other is Your Amazing Heart—I highly recommend these—he’s written, for those of us that really want to get a better understanding on hormones, a couple of other books. One is called Feel Good, Look Younger: Reversing Tiredness Through Hormonal Balance, and the book, Your Best Investment: Secrets to a Healthy Body and Mind. Dr. Lee has also published many articles on internal medicine and endocrinology. He is an author in the fourth edition of Textbook of Critical Care. He’s an active member of the Age Management Medicine Group and the American Association of Clinical Endocrinology. Find out more about Dr. Lee at http://instituteofhormonalbalance.com/
This episode of the podcast features the practical and poetic wisdom from the one and only legendary Deepak Chopra! What an honor and thrill it was to sit down with Deepak to do a podcast that surfed many planes of consciousness, mysticism and science. Our conversation dealt primarily with the success of the scientific revolution over the course of the last 300 years and how that turned humanity away from it's mystic roots and quest for spiritual understanding. Deepak provides a roadmap on how to cultivate the spiritual heart while not turning ones back on science and logic. Sit back and settle into a download from one of the great icons of the modern spiritual movement. INTRO RANT - The American Spiritual Experience as seen through "Wild Wild Country" and "Come Sunday" Deepak Chopra, MD, FACP, Founder of The Chopra Foundation and the Chopra Center for Wellbeing, is a world-renowned pioneer in mind-body medicine and personal transformation, and is Board Certified in Internal Medicine, Endocrinology and Metabolism. He is a Fellow of the American College of Physicians and a member of the American Association of Clinical Endocrinologists. Chopra has authored more than 80 books, published in more than 43 languages, including 22 New York Times best sellers. Two of his books, Ageless Body, Timeless Mind (1993) and The Seven Spiritual Laws of Success (1995) have been recognized on The Books of The Century Bestsellers List. For the last three years, Greatist.com recognizes Dr. Chopra as one of “The 100 Most Influential People in Health and Fitness “. The World Post and The Huffington Post global internet survey ranked him #17 influential thinker in the world and #1 in Medicine Fitness. TIME magazine has described Dr. Chopra as “one of the top 100 heroes and icons of the century”.
Learn how to reverse thyroid symptoms and regain your health.According to the American Association of Clinical Endocrinologists, 27 million Americans have thyroid disease, and about 13 million of them are undiagnosed. A whopping 95% of people that have hypothyroidism may actually have an autoimmune disease called Hashimotos. Number-one New York Times bestselling author, Dr. Isabella Wentz, joins Dr. Friedman to share how to reverse thyroid symptoms and regain your health.
Thyroid cancer is one of the fastest growing cancers in the United States, especially among women. In Florida, thyroid cancer trails only melanoma skin cancer as the state’s fastest rising cancer. Today’s guest on episode 38 of STEM-Talk has made it his mission to not only treat thyroid cancer, but also raise awareness about the disease. Dr. Mark Lupo is founder and medical director of the Thyroid and Endocrine Center of Florida which is based in Sarasota. A graduate of Duke University, he went on to earn his medical degree at the University of Florida where he worked with the world-famous thyroid expert, Dr. Ernie Mazzaferri. Dr. Lupo also did his internship and residency in internal medicine at Florida and then won a fellowship in endocrinology, metabolism and nutrition at the University of California San Diego and the Scripps Clinic. Dr. Lupo’s research and practice are particularly focused on thyroid nodules, which are abnormal growths of thyroid cells that form a lump within the thyroid gland. Although the vast majority of thyroid nodules are benign, a small proportion do contain thyroid cancer. His practice is centered on diagnosing and treating thyroid cancer at the earliest stage and helping people avoid unnecessary surgeries. He also is very involved in teaching neck ultrasound, thyroid cancer and general thyroid disease to other physicians at the national level. He has published book chapters and several articles on thyroid disease and thyroid ultrasound. In addition to his work as the medical director of the Thyroid and Endocrine Center of Florida, he also is a clinical assistant professor on the faculty of the Florida State University College of Medicine. Dr. Lupo also was named the 2017 recipient of the Jack Baskin Endocrine Teaching Award, which is annually presented by the American Association of Clinical Endocrinologists. You can learn more about the Thyroid and Endocrine Center of Florida by visiting http://www.thyroidflorida.com. Show notes: 3:21: Ken and Dawn welcome Mark to the show and ask him what led him to study medicine at Duke. 4:52: Dawn asks Mark how he ended up choosing endocrinology with a particular interest in thyroid nodules and cancer as a specialty. 6:40: Dawn asks Mark how he found the time to go on incredible adventures, such as climbing Mount Kilimanjaro as he worked to establish a practice. 8:40: Mark provides an overview of the thyroid. 9:46: Dawn asks Mark to clarify about whether a thyroid nodule is the same thing as a goiter. 10:25: Ken comments on how thyroid nodules and cancer seem to be epidemic and how there has been an increase of instances in the United States. He asks Mark if there is a greater incidence of disease or if there is just better detection or a combination of both. 14:33: Dawn asks if we know why thyroid nodules and cancer seems more prevalent in women. 15:01: Dawn inquires about the survival rate for those diagnosed with thyroid cancer, and whether or not it has changed over the years. 17:45: Dawn comments on how she has been looking forward to this interview as a result of a thyroid scare she had in graduate school where there was an inconclusive biopsy. She asks Mark how common it is to have an inconclusive finding and unclear results about a sample. 20:52: Ken comments on his personal experience with thyroid nodules that led to surgery and a positive outcome, and how he met Mark early in this experience after hearing him on a podcast discussing fine needle aspiration. After hearing this podcast, Ken concluded that he most likely needed this procedure. Ken asks Mark to talk about this. 23:37: Dawn asks Mark how often the thyroid nodules are discovered incidentally. 27:34: Dawn asks if there are certain characteristics you can see by ultrasound that give you an idea as to whether you are looking at a benign or malignant nodule. 29:53: Dawn asks what the histological differences are between a benign ...
In this special mini-season, we are unlocking the vaults to bring you exclusive, in-depth conversations between Tony and four truly outstanding achievers and impressive innovators. These dynamic individuals are not just experts in their respective fields — they are pioneers. They are charting new territory and breaking new ground. And their insights, ideas and drive are shaping the world we live in. With each episode, you will be privy to a wealth of powerful ideas and strategies that you can use immediately to increase income, influence others more effectively, advance your career, enhance your personal relationships, improve your health, eliminate fears, and experience more joy and fulfillment in your life. In this episode, you will hear an exciting conversation between Tony and Deepak Chopra, as they discuss the principles of lifelong health, the spiritual forces that shape our lives, and the immense power of the mind-body connection. Renowned for blending Eastern philosophy with Western medicine, Dr. Chopra is the author of best-sellers such as Ageless Body, Tireless Mind; The Seven Spiritual Laws of Success; and Grow Younger, Live Longer. He is also a Fellow of the American College of Physicians, a member of the American Association of Clinical Endocrinologists, an adjunct professor of Executive Programs at the Kellogg School of Management at Northwestern University and an adjunct professor at the Columbia University Business School. TIME magazine has described him as “one of the top heroes and icons of the century.” And The Huffington Post global internet survey ranks him as the #17 influential thinker in the world and #1 in medicine. He has authored more than 80 books, which have been translated into over 43 languages, including numerous New York Times bestsellers. This episode of the Tony Robbins Podcast is brought to you by Tony Robbins Results Coaching. Are you ready to experience an extraordinary quality of life? Or maybe you're already doing well, but you know you can take your life to whole new level. To do that, you have to set yourself up to win. You need a process, a way to consistently grow and produce the results you need. And that's what a Tony Robbins results coach can do for you. Whatever area in your life you want to change -- your relationship, your health, your career, or your business -- coaching is one of the most valuable tools you can have. It's an investment in yourself, and it can yield some of the highest returns. Tony Robbins Results Coaches are hand-selected and trained by the master of coaching -- Tony Robbins himself -- to have the skills that will empower you with supreme focus, powerful insight and the accountability needed to achieve everything you've ever dreamed.
Dr. Jane Cases is a board certified endocrinologist and leader in regenerative medicine. Her work focuses on endocrinology, diabetes and metabolism as well as stem cell therapy, platelet-rich plasma (PRP) therapy, aesthetics and much more. Her passion for total wellness and weight management led her to start Wellness 360 Comprehensive Lifestyle Center in Marietta, Ohio, where she serves as Chief Medical Officer. The development of Healing Saint™ products came from her passion for regenerative medicine to help patients who want to fully address or prevent lifestyle diseases. After a horrific road bike accident, Dr. Jane was left with terrible scars on her face and arm. Unwilling to settle for the traditional approach to wound care which would have had less-than-desirable results, Dr. Jane was driven to learn even more about wound healing technology and to better understand its ability to enhance the body’s self-repair and self-renewal potentials. The result was the Healing Saint Luminosity Skin Serum, a proprietary formula to better heal damaged and aging skin. A leading researcher on cell medicine, Dr. Jane offers American Medical Association approved training courses for fellow physicians and has authored dozens of peer-reviewed articles and studies in numerous scientific and medical journals. She holds active professional memberships with the American Board of Internal Medicine, Endocrine Society USA, American Thyroid Association, American Association of Clinical Endocrinologists, European Association for the Study of Diabetes, American Academy of Anti-aging Medicine and the International Cell Medicine Society. In addition, she has served as an Assistant Professor at Ohio University’s School of Osteopathic Medicine. JJ Flizanes is an Empowerment Strategist. She is the Director of Invisible Fitness, an Amazon best-selling author of Fit 2 Love: How to Get Physically, Emotionally, and Spiritually Fit to Attract the Love of Your Life, and author of Knack Absolute Abs: Routines for a Fit and Firm Core. She was named Best Personal Trainer in Los Angeles for 2007 by Elite Traveler Magazine. JJ vividly reminds us that the word ‘fitness’ is not just about the state of one’s physical body, but also the factors which determine a person’s overall well being. And, for JJ, the key components in all these areas are ‘invisible’ — balanced support structures of nutrition, emotional centeredness and health. A favorite of journalists and the media for her depth of knowledge and vibrant personality, JJ, a contributing expert for Get Active Magazine, has also been featured in many national magazines, including Shape, Fitness, Muscle and Fitness HERS, Elegant Bride, and Women’s Health as well as appeared on NBC, CBS, Fox 11 and KTLA. She is also a video expert for About.com and regular contributor for The Daily Love. JJ launched her professional career in 1996 as the Foundations Director for the New York Sports Club, where she designed curriculum and in-house certification for new and previously uncertified fitness trainers. She has also been certified by the American Council on Exercise (ACE), International Sports Science Association (ISSA), and the Resistance Training Specialist Program (RTS). With a focus on biomechanics, JJ has lectured for The Learning Annexand as a featured speaker for New York Times Bestselling Author of The Millionaire Mind, T. Harv Ecker’s Peak Potentials seminars, as well as corporate clients, including Pacific Gas and Electric, Hanson Engineering, and Jostens, Inc. She is the Wellness Expert for KFC International, the Health and Fitness Expert for the National Association of Entrepreneur Moms, and a Fitness Expert for Nourishing Wellness Medical Center. She has been working in the health and wellness industry for 15 years, as a fitness trainer with a knack for helping her clients become more self-aware and self-empowered through her ability to quickly identify and pinpoint problem areas, and then create simple solutions involving exercise, nutrition and mindset changes. She is the Host of the new iTunes Podcast Show Fit 2 Love: Physical, Emotional and Spiritual Fitness for the Happy Life You Deserve which is six day a week video and audio show. What sets JJ apart from her Celebrity Fitness counterparts is the holistic approach to getting results. Over the last fourteen years she has studied, used and applied Positive Psychology, Neuro-Linguistic Programming (NLP), Eye Movement Desensitization and Reprocessing (EMDR), Emotional Freedom Technique (EFT), Law of Attraction, Quantum Physics, Non Violent Communication, Imago Therapy, and Hypnotherapy. JJ Flizanes has proven that she’s not only an expert in matters of the body and fitness—she’s an insightful and provocative author who delivers a timely message about matters of the heart.
When Dr. Jane Cases relocated to Marietta, OH in 2005, she started her practice in Endocrinology, Diabetes, and Metabolism and became part of the Faculty of Ohio University, College of Medicine where she continued basic science research in the field of Insulin Resistance, Obesity, and Diabetes. Her interest in this field had been tremendous since her time at Einstein College of Medicine in New York where she had been part of the research team on Diabetes, Obesity, Aging, and Longevity. After a year of basic science research and clinical practice, she decided to focus on her clinical practice and became the Medical Director of the Diabetes Center for the Marietta Health Systems. Her passion for total wellness and weight management served as the driving force when she started Wellness 360 Comprehensive Lifestyle Center. Now pursuing cutting-edge technology in the field of Regenerative Medicine, she yearns to provide total care to patients who want to fully address or prevent lifestyle diseases (e.g., Diabetes, some cancers, obesity, chronic joint pain and heart disease). She knows the potential use of cell medicine in clinical practice and has continuously sought out the optimum way to isolate adipose-derived stem cells and platelet-rich plasma (PRP) by collaborating with biotech companies and various clinicians. A leading researcher on cell medicine, Dr. Jane offers American Medical Association approved training courses for fellow physicians and has authored dozens of peer-reviewed articles and studies in numerous scientific and medical journals. She holds active professional memberships with the American Board of Internal Medicine, Endocrine Society USA, American Thyroid Association, American Association of Clinical Endocrinologists, European Association for the Study of Diabetes, American Academy of Anti-aging Medicine and the International Cell Medicine Society. In addition, she has served as an Assistant Professor at Ohio University’s School of Osteopathic Medicine. JJ Flizanes is an Empowerment Strategist. She is the Director of Invisible Fitness, an Amazon best-selling author of Fit 2 Love: How to Get Physically, Emotionally, and Spiritually Fit to Attract the Love of Your Life, and author of Knack Absolute Abs: Routines for a Fit and Firm Core. She was named Best Personal Trainer in Los Angeles for 2007 by Elite Traveler Magazine. JJ vividly reminds us that the word ‘fitness’ is not just about the state of one’s physical body, but also the factors which determine a person’s overall well being. And, for JJ, the key components in all these areas are ‘invisible’ — balanced support structures of nutrition, emotional centeredness and health. A favorite of journalists and the media for her depth of knowledge and vibrant personality, JJ, a contributing expert for Get Active Magazine, has also been featured in many national magazines, including Shape, Fitness, Muscle and Fitness HERS, Elegant Bride, and Women’s Health as well as appeared on NBC, CBS, Fox 11 and KTLA. She is also a video expert for About.com and regular contributor for The Daily Love. JJ launched her professional career in 1996 as the Foundations Director for the New York Sports Club, where she designed curriculum and in-house certification for new and previously uncertified fitness trainers. She has also been certified by the American Council on Exercise (ACE), International Sports Science Association (ISSA), and the Resistance Training Specialist Program (RTS). With a focus on biomechanics, JJ has lectured for The Learning Annexand as a featured speaker for New York Times Bestselling Author of The Millionaire Mind, T. Harv Ecker’s Peak Potentials seminars, as well as corporate clients, including Pacific Gas and Electric, Hanson Engineering, and Jostens, Inc. She is the Wellness Expert for KFC International, the Health and Fitness Expert for the National Association of Entrepreneur Moms, and a Fitness Expert for Nourishing Wellness Medical Center. She has been working in the health and wellness industry for 15 years, as a fitness trainer with a knack for helping her clients become more self-aware and self-empowered through her ability to quickly identify and pinpoint problem areas, and then create simple solutions involving exercise, nutrition and mindset changes. She is the Host of the new iTunes Podcast Show Fit 2 Love: Physical, Emotional and Spiritual Fitness for the Happy Life You Deserve which is six day a week video and audio show. What sets JJ apart from her Celebrity Fitness counterparts is the holistic approach to getting results. Over the last fourteen years she has studied, used and applied Positive Psychology, Neuro-Linguistic Programming (NLP), Eye Movement Desensitization and Reprocessing (EMDR), Emotional Freedom Technique (EFT), Law of Attraction, Quantum Physics, Non Violent Communication, Imago Therapy, and Hypnotherapy. JJ Flizanes has proven that she’s not only an expert in matters of the body and fitness—she’s an insightful and provocative author who delivers a timely message about matters of the heart.
This week on Mom Talk Radio, we are joined by Dr. Mark Harrell, President Elect of the American Association of Clinical Endocrinologists, shares tips for reducing your risk of thyroid cancer. Spotlight on Moms features Maria Casey of mariahcasey.typepad.com/leadermom. Drew Banks, head of marketing for Prezi, talks about developing children’s creativity. Jackie Walker, author of Expressionista, talks about how a tween, teen or woman can find out her internal fashion persona. Richard Greenberg, author of Raising Children that Other People Like to Be Around, talks about the S.M.A.R.T. parenting system.
Guest: Yehuda Handelsman, MD Host: Farhad Zangeneh, MD Dr Farhad Zangeneh is joined by Dr. Yehuda Handelsman, Medical Director at the Metabolic Institute of America; President of the American Association of Clinical Endocrinologists; and, Chair & Program Director, "Annual World Congress on Insulin Resistance, Diabetes & CVD". Dr. Handelsman will discuss the recent growing concerns between diabetes, anti-diabetes agents, and the increased prevalence of various cancers. Currently available data are limited, controversial, and confusing. The AACE and health care providers believe that this is a critically important area that needs further clarification.
Tune in for highlights from the American Association of Clinical Endocrinologists' 18th Annual Meeting and Clinical Congress, which took place May 13th through the 17th in Houston.
On this week's show, we welcome Fred G. Toffel, MD. FACE. Dr. Toffel, a board certified endocrinologist, is the Medical Director of the Diabetes Treatment Center at Desert Springs Hospital, and also runs a private Endocrinology practice in Las Vegas. Dr. Toffel is Vice President of the Nevada Chapter of the American Association of Clinical Endocrinologists.If you have any questions or comments for any of our team or would like to hear your voice on one of our upcoming shows, call our special voicemail line or email us. You might soon be a podcast star. Comment Line: (206) 888-0444 email: feedback @diabetespowershow.com
© 2020-2025 Ivy Podcast Discovery LLC
